Democrats Shouldn’t Abandon Medicare for All Over a Misleading Survey

Appearing in COMMON DREAMS,  An article by Richard Eskow suggests that it may not have been possible for Kaiser Family Foundation (KFF),  given its internal culture, to conduct an unbiased survey. Eskow writes:

David Leonhardt of the New York Times has highlighted a survey from the Kaiser Family Foundation that, if true, would suggest that Medicare for All is not nearly as popular as initial polling would suggest. Based on this survey’s results, Leonhardt concludes that Democrats who support the idea are committing an “unforced error.”

Unfortunately, that survey is deeply misleading. While pollsters made it clear that they were merely presenting “some arguments some people have made for or against a national Medicare-for-all plan,” they only presented partial arguments in favor of Medicare for All while presenting deeply deceptive arguments against it. Their questions almost certainly skewed the results.

The poll finds that 56 percent of voters surveyed initially support “Medicare for All” and 42 percent oppose it, for a net favorability rating of +14 percent. When arguments in favor of Medicare for All are presented—it will guarantee coverage to all Americans and reduce out-of-pocket costs—net favorability rises to +45 percent. (KFF does not provide the raw numbers here.)

Support reportedly falls dramatically when people hear arguments against the program. The problem, however, is in the presentation.The pros, as presented, are understated. Medicare for All would not “reduce” out-of-pocket costs. It would eliminate them for all medical interventions, including hospitalization, surgery, pharmaceuticals, medical devices, and doctor visits.  The use of “reduce” suggests that any out-of-pocket savings would be marginal at best, which is not true.

The KFF survey told respondents that Medicare for All would “require most Americans to pay more in taxes.” It did tell them that health insurance premiums would be eliminated, but failed to explain that the vast majority of families would pay considerably less in taxes than they currently pay in premiums and out-of-pocket costs. Many working Americans with employer-based insurance are unaware of how much is deducted from their paychecks in premiums, which also dilutes the impact of this question.

The survey told respondents that Medicare for All would “eliminate private health insurance companies,” but it did not tell them why: these corporations add to the overall cost of health care without providing anything of value.

It gets worse. The pollsters then presented the statement that Medicare for All will “threaten the current Medicare program.” While this is a common Republican line of attack, it is an openly deceptive one. Medicare for All proposals would expand and improve coverage for seniors and the disabled under the current program, by expanding the scope of services rendered and eliminating out-of-pocket costs in most cases.

Surveyors also offered the argument that Medicare for All could “lead to delays in people getting some medical tests and treatments.” There is no evidence to support this assertion, and no reason to believe it’s true. The opposite should be the case, in fact. While increased demand could lead to limited delays, the elimination of insurance company bureaucracy, paperwork, network restrictions, and pre-certification procedures means that overall wait times should be reduced.

Despite the survey’s methodological flaws, Leonhardt uses it to conclude that Medicare for All is politically unfeasible. He suggests that Democrats embrace another plan instead: the Center for American Progress proposal (in Leonhardt’s words from an earlier column) “through which any American, regardless of age, could buy health insurance” from the government.

There are serious actuarial problems with this approach, however. As has been seen with Medicare Advantage, the private-insurance option for today’s Medicare, insurance companies are experts at “cherry-picking” healthy enrollees. (As some whistleblower cases demonstrate, they can also be expert at committing fraud.) This would create service problems for enrollees and financial problems for the government.

The immediate questions are these: Why was the KFF survey so flawed, and why has Leonhardt (and presumably others) been so quick to embrace it? Leonhardt describes KFF as “one of the country’s most respected health care pollsters,” and so it has been. But KFF, like other mainstream health institutions, is deeply embedded in the current health care system’s political culture. A centrist Democrat and two former Republican senators sit on its Board of Trustees, one of whom is former Senate majority leader and physician William Frist. Frist is the son of Thomas Frist, founder of Hospital Corporation of America. The Washington Post reported that his HCA holdings represented a “significant source of his wealth” (a reported $13 million in 1994).

Given its internal culture, it may not have been possible for KFF to present the arguments for and against Medicare for All in an unbiased manner.

It’s true that the GOP (and centrist Democrats) will likely present these misleading arguments in much the same way they do. But why should Democrats tailor their platform to voters’ reactions, when those reactions are based on a biased or one-sided set of arguments? An important proposal like Medicare for All should be subjected to public debate, so that the public gets a deeper understanding of its ramifications. That is, after all, why we have elections.

And why would Leonhardt or political scientist Brendan Nyhan (whom he quotes) embrace such a flawed survey instrument so quickly? It may be a simple case of confirmation bias, since the survey appears to support their ideas about Medicare for All. That doesn’t make its findings accurate or meaningful. The nation deserves a meaningful debate about Medicare for All.

This is Dio talking: We won't get that meaningful debate unless we flood our representatives' ears with our demands for A TRUE MEDICARE FOR ALL, WHICH SERVES ALL REGARDLESS OF WEALTH -- AND NOT SOME COCKAMAMIE BUY-IN PROGRAM WHICH REWARDS MAINLY THE INSURANCE COMPANIES.  For too long, our opinions have been warped by corporate propaganda which would have us fear everything but the status quo. If our representatives don't hear the roar of our demand, it will be too easy for them to pretend they're being prudent, while in reality they are simply buying in to the line that brings in the money.

Dio

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ELEVATOR LANGUAGE

From Don McCanne of the PNHP (Physicians for a National Health Plan) comes today's very timely CNN bulletin, followed by his comment:

CNN

January 30, 2013

Democrats distance themselves from Harris' call to eliminate private health plans

By Alex Rogers, Manu Raju and Elizabeth Landers

The emerging 2020 presidential campaign has deepened the Democratic party's divide over how the government should cover all Americans, further exposing the differences between those who want a total overhaul of the health care system and those who prefer a more incremental approach to fix it.

Sen. Kamala Harris of California renewed the party's debate over single-payer health care in a CNN town hall Monday, saying she's willing to end private insurance, which more than 170 million Americans use.

"It would take a mighty transition to move from where we are to that," said Sen. Dick Durbin, the chamber's No. 2 Democratic senator in leadership.

"What most of us said we would support is a Medicare type plan -- a not-for-profit public plan that is available for everyone," said Durbin of Illinois. "I think that's a good first step."

Sen. Tim Kaine, the 2016 Democratic vice presidential nominee, claimed that "about 80%" of those who get insurance through their employers like their private insurance plan.

"I'm not going to say you have to give it up," Kaine said. "I think the idea is to offer a nonprofit insurance plan as an option."

Of eliminating private health insurance, Sen. Dianne Feinstein, Harris' senior Democratic colleague from California, said, "Well I'm not there."

Sen. Gary Peters, Democrat of Michigan, said he believes lawmakers should expand the ability for people to buy into a version of Medicare, adding he's a co-sponsor to a bill by Kaine and Sen. Michael Bennet of Colorado that would do just that. Sen. Chris Murphy, Democrat of Connecticut, plugged another bill that would expand access to Medicare, calling it "a lot more politically palatable and ultimately more popular than statutory prohibition of private plans."

CNN on Kamala Harris and Fellow Democrats' Response

==

Comment by Don McCanne

Now that Medicare for All has become such a popular concept, many seem to believe that all we need to do is elect more Democratic senators and a Democratic president and we're in. But if you listen carefully, most Democratic politicians give lip service to Medicare for All, but when you pin them down on policy they actually support a Medicare buy-in - a public option - and most of them support the continuation of offering the private Medicare Advantage plans. They also support allowing employers to offer their own private health plans. We are not even close to enactment of a bona fide Single Payer Medicare for All program.

Everyone needs to get busy perfecting their elevator speeches so we can explain why we must not allow private insurance plans to be options in our health care financing. If we were to allow them under Medicare for All, the entire single payer financing infrastructure crumbles, perpetuating an inefficient, fragmented financing system that impairs health care access, and often results in personal financial hardship. In contrast, a Single Payer Medicare for All program would ensure access and affordability for everyone. The secret? Saving hundreds of billions of dollars by reducing the profound administrative excesses of our fragmented, dysfunctional financing system, along with exercising the monopsonistic purchasing power of our own single public payer. See if you can convert that into elevator language.

Here's my try at an "elevator language" pitch: "Private insurance exists to make money -- charging more and providing less, and often forcing you to see the doctors in their network. But if you want to see the doctor you want, and get the care you need -- even if you have no money to pay for it, then Single Payer is the way to go. And -- as a bonus -- you'll be helping  the government save billions in wasteful overhead. But if you believe that any Private Insurance is going to be 'non-profit,' then I've got a bridge to sell you."

And -- if the elevator is going up more than a few floors, you could add: "Sure, Single-Payer isn't free. You pay according to your means. If you have nothing, you pay nothing. If you're in the top-most two percent -- you'll pay more for healthcare than you do now. But most of us will pay a lot less -- and we'll all get a lot more."  

I'd love it to hear your elevator pitches. Do please leave them as comments, or, if you like,  email them to me at  indivisible12401@gmail.com.  I hope I'll get lots of them -- that should be fun!

Dio

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HAPPY ENDING!

I belong to a group that tries to promote the New York Health Act (NYHA) by what it calls "Direct Action" -- e.g. public demonstrations, etc. Recently, when discussing a possible demonstration against a pharmaceutical maker, the leader of the group said, "We want to be able to tell the people that with NYHA, drug costs would be contained." He looked in my direction and asked, "did I hear you volunteer to research what is contained in the Act in this regard?" Actually, he didn't hear me say it, but I got the message. "Sure Bob," I replied, I'll be glad to."  I figured that  the text of the Act -- A4738/S4540 -- is available on line, so I ought to be able scan the text for some reference to drug price limitation or containment.

But it turned out I couldn't. Except for language about helping with insurance premiums for the poor, there was nothing I could find. I was horrified: What sort of healthcare reform was this NYHA where I could find no mention of drug cost containment? Regretfully, at the next meeting I had to inform Bob that there as no mention of it that I could find.

Bob was very tactful: "Your findings," he said, "are not accurate. Look: in the Campaign's FAQ page it says that through bulk purchasing, New York Health will buy drugs and medical supplies at lower, negotiated prices. And Katie [Katie Robbins of the NYHA campaign and the New York Nurses Association] would never put in something like that unless it were absolutely true."

I was thrilled to hear it, but uneasy that I couldn't find it anywhere in print. So after the meeting, I sent off a slew of emails, and, to make a long story short, finally received an answer from a very distinguished dude, one Len Rodberg, who wrote:

Drug purchasing and prices are handled in the NYHealth Act in Sect. 5105, Part 4(c) which refers to Article 2-A of the NYC Public Health Law. (That’s the way legislation works, unfortunately!) That law set up the Preferred Drug Program under which the State has been purchasing drugs for the Medicaid program getting large (33%) discounts. It is described very clearly in the attached policy brief which Gottfried wrote several years ago. I think it will answer any questions. 

In other words, the NYHA text refers to another law, already passed -- the Preferred Drug Program -- through which New York State is currently able to purchase at a steep discount drugs for a small subset of its Medicaid program -- the fee-for-service plans -- covering a relatively few 4 million people. It used to be employed for the entire medicaid population until Cuomo got passed a provision eliminating patients in managed care plans from the program, leaving only patients in the fee-for-service plans -- a juicy gift to Big Pharma. What the NYHA would do is "piggyback" onto the PDP plan, increasing the "covered lives" from 4 million to some 20 million, thus dramatically increasing the state's bargaining power. With this increased bargaining power, it would not surprise me that the state would enjoy discounts far exceeding 33% -- which would be, in Shakespeare's words, "a consummation devoutly to be wished."

All we need is the political will to make this happy ending real.

Dio

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Good Heavens, Cuomo -- How Could You?!

Part 2

In my last post, I showed that -- with respect to healthcare -- Governor Cuomo has demonstrated himself apparently indifferent to the suffering of very many New Yorkers. I based my information on an email I got from Bob Lederer MPH, who is Executive Director of the Physicians for a National Health Program - New York Metro Chapter.  In the body of his email he included a link to a statement by the advocacy group Health Care For All New York -- a statement that I quoted in its entirety. This statement got me so exercised, that I dashed off my angry reaction to the failures it criticized, which was the post I published.

Only when I cooled down a little did I realize that I neglected to bring out what was the most damning indictment of all -- the attachment Bob included in his email. This attachment he described as "a compilation of research that the PNHP [Physicians for a National Health Plan] team has done."

At the very bottom of this compilation, you may read the following:

"Realities of Single Payer"

"REALITIES OF SINGLE PAYER PRAISES GOVERNOR CUOMO’S UNIVERSAL HEALTH CARE COVERAGE PROPOSAL

The Realities of Single Payer coalition applauds the Governor’s efforts to achieve universal access to health care for all New Yorkers. Our broad-based coalition of employers, health care providers, labor unions, health plans and brokers fully support his approach of building on the success of the Affordable Care Act, which has reduced the number of uninsured in New York to historically low levels and reduced the cost of individual coverage by 50 percent.
Convening a Commission for Universal Access to Health Care to identify policy options to improve access to care and strengthen New York’s commercial insurance market is a pragmatic and progressive approach to attaining universal coverage. We look forward to contributing to the policy objectives of the Commission.”

For those who don't know, the "Realities of Single Payer" is a coalition of insurance companies who are dead set against any form of insurance that is not commercial, profit-driven insurance. Check out the link above for a sample of the lies and distortions they put out for any one who will listen. And what do you think motivates them? It's money of course, a great deal of which they stand to lose if there is only one insurer in New York State instead of many insurers, each with its CEO making many millions of dollars, and each with its bureaucracy of gate keepers dedicated to increasing profits and dividends by limiting healthcare or denying it altogether. This coalition of business-as-usual types came out with their statement at a time so closely following the issuance of Cuomo's that one might suspect (if one was a cynical type) that each was in collusion with the other!

Obamacare represented a great step forward, but it has many flaws that need remedying, of which not a few are based on the fact that it was built upon the profit-driven corporations that agreed to them -- which was why they agreed to them in the first place! It was a handout to the insurance industry!  

I hold as axiomatic the view that when it comes to keeping people healthy, or healing them when they're sick, PROFITS ARE POISON!  From my point of view, enriching the greedy beast is not the way to go. As I see it, Cuomo's approach to curing what ails our healthcare system is more of the same.

Dio

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Good Heavens, Cuomo -- How Could You?!

A week ago, the advocacy group HCFANY (Health Care For All New York) published a blog post which I quote in its entirety:

The proposed executive budget is shockingly silent on health coverage:

-Health insurance for immigrants left behind by the ACA:  $0

-State premium assistance for people who can’t afford coverage:  $0

-Funding to stabilize the high costs of NY’s individual market: $0.

Instead, the people get a “commission” of so-called experts. What can a commission tell us about health coverage that we don’t already know?  Here’s what we already know:  coverage reduces mortality; coverage reduces morbidity; coverage brings people out of poverty; coverage provides economic security to people.

Coverage matters. There are plenty of giveaways in this budget for the health care industry. But no investment to provide the health coverage that would make such a difference to so many New Yorkers. State leaders in California, Colorado, New Mexico, and Washington have taken big steps on coverage.  But not here in New York, where over a million people are uninsured and millions more are struggling to afford their insurance.

New York’s advocates, including HCFANY, have developed agendas over the years that would move New York towards universal coverage. Our most progressive advocates have proposed a bold single-payer plan.  New York could take several smaller steps that would immediately ease the financial burden of accessing health care in New York: (1) state premium subsidies for people who buy their own plans and have trouble affording them; or (2) a public option for people who want a cheaper alternative to private plans.

The most heartbreaking oversight in the budget is that it does nothing to help the 400,000 New Yorkers who are uninsured because of their immigration status. Again, there are simple steps that New York could take to help. Governor Cuomo could have proposed an expansion of Child Health Plus to young adult immigrants, as Governor Newsom did. He could have been bolder and expanded the Essential Plan to all low-income adults, regardless of status. If health care is a human right, why are there so many New Yorkers whose birthplace leaves them without health coverage?

State premium assistance, a public option, immigrant coverage: all would have been progressive achievements to crow about – something that would let HCFANY agree wholeheartedly with Governor Cuomo that New York is the “most progressive big state in the nation.”

After this shocking report, there was an invitation to comment. So I posted: "This does seem to tell us where Gov. Cuomo stands on all these matters -- apparently centered smack-dab in the desires of the Health Care Industry, and discernibly not at all on the needs of his constituents, who have been pleading for help.  I wonder why does Cuomo's position seem so counter to the desires of the people?" 

Well, for me, the answer seems straight forward: Cuomo, who is sitting on an enormous war chest of dollars, remembers where a lot of that money must have come from -- corporate interests, of which a sizable portion probably came from the Healthcare Industry.  Note well: I am not accusing, I am guessing -- but it's a pretty good guess, wouldn't you think?  With notable exceptions, most of our Federal government has been for sale; why shouldn't our state -- which has been less than conspicuous for honesty and integrity -- be likewise offered to the highest bidder?

However that may be, it's obvious that Cuomo is trying a tactic designed not only to delay our progress but also to vitiate the considerable momentum our movement has developed. Just as runaway trucks can be slowed by artificial hills of gravel and sand, nothing will grind  us to a halt better than empty words -- a lot of them.

All these empty words can be countered by a few pungent ones, such as, GOVERNOR: CUT THE B.S. AND DEAL WITH THE PROBLEM! The problem, should he need reminding, is that people are dying, their families going bankrupt because of an out-of-control, extortionate, profit-driven healthcare system. And what he suggests is another commission?  

And it's not only Cuomo. Many of our nominally Democratic Assembly people,  who reliably voted for NYHA because they knew the Republican Senate would just as reliably bat it down -- these nominal Democrats, I say, will remember the source of the money that got them elected  -- UNLESS WE SPEAK UP!

And the general public, most of whom, I fear, have never even heard of the NYHA -- even fine Doctors and Nurses -- will be ignorant of what Cuomo is doing to us UNLESS WE SPEAK UP! 

I feel that this last is most important. One commentator  -- seeing what he perceived to be a waffling even on the part of so-called progressive Democrats -- asked "what shall we do -- take to the streets?" He was being serious. We have in our Healthcare Industrial Complex a huge vested interest, which will expend all its resources -- and they are very many -- to keep single payer from becoming law. By insisting that in this particular instance -- healthcare -- the profit motive be set aside, we are getting uncomfortably close to the beating heart of the corporate monster that owns this country.

Dio

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JUST WHEN YOU THOUGHT THINGS COULD GET NO WORSE

On January 17, the Health and Human Services Department announced proposed rule changes for ACA -- otherwise known as Obamacare.  Hundreds of pages long, and written in the most obtuse language possible, these proposed rule changes were impossible for your humble observer to figure out. But since this was coming from the Trump administration, I presumed that the proposed changes boded no good to the every day citizen.

Four days later, an article by Robert Pear confirmed my fears. I reprint it below:

The New York Times

January 21, 2019

Trump Proposals Could Increase Health Costs for Consumers

By Robert Pear

Consumers who use expensive brand-name prescription drugs when cheaper alternatives are available could face higher costs under a new policy being proposed by the Trump administration.

The proposal, to be published this week in the Federal Register, would apply to health insurance plans sold under the Affordable Care Act.

The administration is proposing several other changes that could increase costs for consumers.

Under the proposal, fewer people would qualify for federal subsidies, and those who qualify could be required to spend a larger share of their income on insurance premiums.

The Trump administration estimated that the changes would save the government $900 million annually in subsidies in 2020 and 2021 and $1 billion a year in 2022 and 2023. In addition, it predicted that 100,000 fewer people would have coverage through the insurance exchanges created under the Affordable Care Act.

The administration said that some of the 100,000 people might buy short-term insurance policies, which do not have to cover pre-existing conditions or provide all the benefits required by the health law. But, it said, most are “likely to become uninsured.”

Either way, the administration said, “these individuals will be bearing a larger share of the costs of their own health care consumption.”

Senator Ron Wyden of Oregon, the senior Democrat on the Finance Committee, described the new proposed rule as “Trump’s latest attempt to sabotage health care.”

Commenting on these proposals,  Don McCanne writes: "There would certainly be rule-making under Single Payer Medicare for All, but the rules would be designed to benefit patients rather than designed to satisfy the whims of the right-wing, anti-government ideologues who are also rewarding their friends in the health care corporate world with our tax funds."

The opponents of Single-Payer would like to frighten us with all sorts of tales of the terrible; whereas this blog is trying to show that not only is the current system unsustainable, it is daily deteriorating.  As we detail the greedy excesses of the for-profit model of healthcare, making it look worse and worse (it's not hard to do this), our hope is that Single-Payer will look better and better, to encourage you to think: WE CAN'T GO ON LIKE THIS! Because the Trumpians haven't yet plumbed the depths of their depravity.  Bless their hearts, they'll keep trying. 

Dio

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BUSINESS AS USUAL

A friend of mine posted something on Facebook that caught my eye. It was a video clip showing two commentators discussing the case of a woman who had had a stroke. The hospital brought her to the only hospital within reach that could deal with her problem. Trouble was, the hospital turned her away because they were overloaded,  they said, and "diverted" her ambulance to another hospital, who, though nearby, didn't have the equipment to deal with her particular problem. Result: she became comatose and is now in a vegetative state. 

At the end of the clip, my friend -- who is employed by a group of hospitals -- commented that nowadays many people who ought to see the doctor because of the way they feel, are afraid to see him/her because they cannot afford to. They wait until they feel so bad they are sure they'll be admitted to the ER, sometimes filling it full to overflowing. My friend did not comment that the woman was black, a fact that possibly could have played a role in the hospital's diverting her ambulance. 

However that may have been, a life that might have been saved was destroyed. It was, in our broken medical system, BUSINESS AS USUAL.

What can we do about this? Get behind Single-Payer -- the only system that will guarantee healthcare for everybody -- not just the well-off.

Dio

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NOT THE WAY TO CONTROL COSTS

In my post of 12/21/2018 (Why Is American Healthcare Se Expensive -- Part Two), I cited my heroes Woolhandler and Himmelstein, who said, "Medicare's (and other payers') Pay for Performance initiatives impose substantial costs on providers, with no evidence that they've improved patients' outcomes in any setting." [Emphasis added.]

This would seem to conflict with the assertions of those touting what they claim is the success of Medicare’s Hospital Readmissions Reduction Program (HRRP) in lowering risk-adjusted readmission rates for targeted conditions at general acute care hospitals.

But now (in January, 2019) comes a Paper in Health Affairs titled Decreases In Readmissions Credited To Medicare’s Program To Reduce Hospital Readmissions Have Been Overstated. The  Paper's abstract presents a statistical analysis far beyond my sphere of competence. But Don McCanne of the PNHP (Physicians for a National Health Program) comments:  "This study shows that, at a minimum, the benefits of penalizing hospitals for readmitting patients have been tremendously overstated."  Moreover, he points out the additional concern that

patients are often held on observation status rather than being readmitted, sometimes to avoid the readmission penalties. This can significantly increase out-of-pocket costs for the patient since they are billed as outpatients (Part B), with greater cost-sharing, rather than as inpatients (Part A). More importantly, there is also the risk that the patient may receive less care as an outpatient when the patient's condition warrants full inpatient services. Thus the readmission reduction program may be causing significant patient harm, both physically and fiscally.

In conclusion, he states :

The government bureaucrats and the policy community are fixated on these various programs that they just thought up out of the blue that supposedly would control spending, even though their track record overall is dismal. Yet they keep avoiding a proven solution that would reduce our uniquely outrageous administrative waste that costs hundreds of billions of dollars. That solution is a single payer national health program, an improved Medicare that would cover everyone. We should at least enact that and then we could examine other innovations as long as they are designed to truly benefit patients.

Of course he is right:  Single-Payer would save administrative costs more reliably than any of  our government's fiscal schemes, which have proved so far to be, in  McCanne's words, "a dismal failure."  But whether Single-Payer in New York State (NYHA) would control non- administrative costs -- such as hospitals gaming the system in order to make profits, and whether payments to hospitals would reflect current market realities (e.g. regional differences in payscales, etc.) and different standards of excellence (e.g. Memorial Sloan Kettering vs a provincial outfit like Poughkeepsie's Vassar Hospital) has not yet, to my knowledge, been figured out.

The last time I checked, the House of Representatives proposal for Single-Payer adopted Woolhandler and Himmelstein's suggestion that medical facilities such as hospitals should NOT be privately owned and should be compensated NOT by procedure, but should be publicly owned and compensated globally for operating expenses, with capital expenses (MRI machines, etc) awarded by government grants, not by any profits or surpluses, which they would not be supposed to make.  Sanders' Senate Bill keeps the current setup, where hospitals are expected to make profits and are tacitly encouraged to game the system in order to do so. But the House proposal, as I understand it, is currently being rewritten, with results yet to be announced. And how the NYHA would treat these matters is yet to be determined.

With all these uncertainties, why go to single-payer, or for that matter any new system?  The answer is simple: Our current system is fiscally unsustainable and morally bankrupt. Single-Payer seems the best avenue forward. Inaction is not an option. Hence this blog.

Dio

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GoFundMe CEO: 'Gigantic Gaps' in Health System Showing Up In Crowdfunding

I received this info from PNHP's Don McCanne. It's from an interview from Kaiser Health New's Rachel Bluth, and it was published today (1/16/2019). She was speaking to GoFundMe CEO Rob Solomon, who is, according to Time Magazine, one of the 50 most influential people in health care. Ms. Bluth wanted to know what it says about our system "when so many people rely on the kindness of strangers to get treatment."

"Kaiser Health News
January 16, 2019
GoFundMe CEO: ‘Gigantic Gaps’ In Health System Showing Up In Crowdfunding
By Rachel Bluth

Scrolling through the GoFundMe website reveals seemingly an endless number of people who need help or community support. A common theme: the cost of health care.

Of the $5 billion the company says it has raised (in eight years), about a third has been for medical expenses from more than 250,000 medical campaigns conducted annually.

The prominence of the medical category is the symptom of a broken system, according to CEO Rob Solomon. He said he never realized how hard it was for some people to pay their bills: “I needed to understand the gigantic gaps in the system.”

Solomon talked to Kaiser Health News’ Rachel Bluth about his company’s role in financing health care and what it says about the system when so many people rely on the kindness of strangers to get treatment.

Q: KHN and other news outlets have reported that hospitals often advise patients to crowdfund their transplants. It’s become almost institutionalized to use GoFundMe. How do you feel about that?

It saddens me that this is a reality. Every single day on GoFundMe we see the huge challenges people face. Their stories are heartbreaking.

Some progress has been made here and there with the Affordable Care Act, and it’s under fire, but there’s ever-widening gaps in coverage for treatment, for prescriptions, for everything related to health care costs. Even patients who have insurance and supposedly decent insurance [come up short].

I would love nothing more than for “medical” to not be a category on GoFundMe. The reality is, though, that access to health care is connected to the ability to pay for it. If you can’t do that, people die. People suffer. We feel good that our platform is there when people need it.

Q: What have you learned that you didn’t know before?

I guess what I realized [when I came] to this job is that I had no notion of how severe the problem is. You read about the debate about single-payer health care and all the issues, the partisan politics. What I really learned is the health care system in the United States is really broken. Way too many people fall through the cracks.

The government is supposed to be there and sometimes they are. The health care companies are supposed to be there and sometimes they are. But for literally millions of people they’re not. The only thing you can really do is rely on the kindness of friends and family and community. That’s where GoFundMe comes in.

Q: But what does this say about the system?

The system is terrible. It needs to be rethought and retooled. Politicians are failing us. Health care companies are failing us. Those are realities. I don’t want to mince words here. We are facing a huge potential tragedy. We provide relief for a lot of people. But there are people who are not getting relief from us or from the institutions that are supposed to be there. We shouldn’t be the solution to a complex set of systemic problems. They should be solved by the government working properly, and by health care companies working with their constituents. We firmly believe that access to comprehensive health care is a right and things have to be fixed at the local, state and federal levels of government to make this a reality."


https://khn.org/news/gofundme-ceo-gigantic-gaps-in-health-system-showing-up-in-crowdfunding/

There it is -- laid out in simple terms.  It's worth repeating: "The reality is ... that access to health care is connected to the ability to pay for it. If you can’t do that, people die." 

The question is, what are we going to do about it?  If we take this seriously -- and how is it possible NOT to -- we must spread the word, and we must put our bodies in the space.  In New York State, we have a campaign to pass the New York Health Act -- which is Single-Payer for anyone living in New York State. 

Anybody in doubt about how he or she can help can email me at indivisible12401@gmail.com. 

I'll have a few suggestions to get you started.

Dio

If you'd like to comment (and I hope you will) simply click on the number of comments area and enter your comments in the "comment rectangle" that appears.  Thanks!

THIS IS NOT FOR THE FAINT OF HEART

Read It If You Dare

A few days ago,  Bruce Woych, a good friend of mine and frequent supplier of comments to this blog, alerted me to a famous special edition of Time magazine, published in March 2013. It contained a ground-shaking article by Steven Brill. More than 24,000 words long, it reports in scarifying detail why and how medical bills get so astronomically high. I found it difficult to read -- not because it's poorly written -- on the contrary, unlike the jargon contained in hospital bills, Brill's writing couldn't be more painfully clear and easy to follow. But for me, to learn how you and I are being ripped off, taken for chumps, nay, victimized, reduced to grovelling beggars by a coterie of !@#%*! -- I have no words that can be printed here. When I was reading it, I found myself getting more and more angry, clenching my fists and gritting my teeth, and muttering "Oh my God ... oh my God!" Truly, if you have high blood pressure, you may want to skip Brill's article.  But his summation, though chilling, can and should be read by everyone:

When you follow the money, you see the choices we've made, knowingly or unknowingly.

Over the past few decades, we've enriched the labs, drug companies, medical device makers, hospital administrators and purveyors of CT scans, MRIs, canes and wheelchairs. Meanwhile, we've squeezed the doctors who don't own their own clinics, don't work as drug or device consultants or don't otherwise game a system that is so gameable. And of course, we've squeezed everyone outside the system who gets stuck with the bills.

We've created a secure, prosperous island in an economy that is suffering under the weight of the riches those on the island extract.

And we've allowed those on the island and their lobbyists and allies to control the debate, diverting us from what Gerard Anderson, a health care economist at the Johns Hopkins Bloomberg School of Public Health, says is the obvious and only issue:

"All the prices are too damn high."

A few highlights should be noted:

• Every hospital has what is termed a Chargemaster, an internal price list for every service performed and every item supplied. But  "there seems to be no process, no rationale, behind the core document that is the basis for hundreds of billions of dollars in health care bills." What  results is a price ten or more times higher than the actual cost of the item. And these prices rise, automatically every year.
• But the Chargemaster prices, hospital officials insist, are just starting points for negotiations. And indeed, folks who are not on medicare and who are not on medicaid and who have decent insurance will have their insurance negotiate some of those prices down a bit. But those with no insurance or poor insurance are forced to pay the full chargemaster prices. Thus the economically vulnerable are penalized for their poverty.
• Hospitals routinely do double -- sometimes triple -- dipping, Brill quotes a Billing Advocate:, "First they charge more than $2,000 a day for the ICU, because it's an ICU and it has all this special equipment and personnel ...  "then they charge $1,000 for some kit used in the ICU to give someone a transfusion or oxygen ... And then they charge $50 or $100 for each tool or bandage or whatever that there is in the kit. That's triple billing."
• Brill writes: "According to the Center for Responsive Politics, the pharmaceutical and health-care-product industries, combined with organizations representing doctors, hospitals, nursing homes, health services and HMOs, have spent $5.36 billion since 1998 on lobbying in Washington. That dwarfs the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by oil and gas interests over the same period. That's right: the health-care-industrial complex spends more than three times what the military-industrial complex spends in Washington."

If you have the stomach for more, I salute you, and ask you to check out this link:

Bitter Pill: Why Medical Bills are Killing Us.

Now you know. But it'snot enough simply to know:  For your knowledge to do any good YOU MUST SPREAD THE WORD!  As I never tire of saying,  when I meet somebody new, there's a more than 50% chance they'll not have heard of the New York Health Act (NYHA). Next time I meet them, there's a zero percent chance they won't know.  But I'm only one person.  Please help!  If you would like to know how you can spread the word, or have an idea about it, please email me at  indivisible12401@gmail.com and let me know.  Thanks!

Dio

PS: If you would like to leave a comment (and I hope  you will), simply click on the number of comments area, and share your thoughts in the "comment box" that appears.  Thanks!

A $20,243 BIKE CRASH

Zuckerberg Hospital finds a novel way to shock us

In a recent article published by VOX, Nina Dang, 24, broke  her arm in a bicycle crash on April 3, 2018. A bystander called an ambulance, and Nina was taken to the emergency room at Zuckerberg San Francisco General Hospital (ZSFG -- so renamed because of a $75 million dollar gift from the founder of FaceBook), where doctors x-rayed her her arm and took a CT scan of her brain and spine.  When she left, she had her arm in a splint; she had been given pain medication and a recommendation to follow up with an orthopedist.

A few months later, she got the bill: $24,074.50. Of that, her insurer -- Premera Blue Cross, would cover only $3830.79 -- which it thought was fair for the services provided. The balance  due -- $20,243.71 -- the hospital threatened to send to collections in mid-December.

Why? The reason is that ZSFG was not in Ms. Dang's network. Though regrettable, that's not surprising; it can happen. What's surprising is that ZSFG couldn't be in her network, because it is not in any network whatever.  Virtually all other hospitals contrive to arrive at contracts with at least a few private insurers, but not ZSFG.  Although they are the trauma center for the whole city, they recognize only the public insurers -- e.g. Medicare and Medicaid. For those on private insurance -- any private insurance -- the sky is the limit. Their idea is that if you're not old or poor -- you'll be able to pay.

The obvious trouble with that is that there are people in the middle, such as Ms. Dang, for whom such charges are catastrophic. And when an ambulance is speeding off with you,  no matter what your financial resources, you can be less than able to tell the paramedics where to take you. And even if you can direct them, the chances are that you won't know what hospital is the most appropriate  for you. (My wife, in an ambulance, was indeed asked where she wanted to go, and made a choice which afterwards she regretted). 

Once in the hospital, you could, as one person did, recite to everyone who came close to you the formula: "Are you in my network? If not, I DECLINE TREATMENT." One woman in Vox's study did just that, so nobody touched her. But she was billed more than $5000 anyway!

The hospitals are playing a game with us, a game they are bound to win because they have stacked the deck against us. For example, there is what they term a "facility fee" charged for simply walking (or being carried) through the door. Only they won't tell us ahead of time what that fee is, and it differs for every hospital.  

Thus the hospitals, like much of the rest of the medical establishment, take advantage of our suffering to make profits we would most certainly try to avoid if we were in possession of our full abilities.

If this truly is the American Way, then I'm not proud to be an American. But I think this is not the American Way, which has far more reserves of kindness than do the corporations who have us in thrall, and the government they have bought to act in their behalf.

Dio

If you'd like to leave a comment (and I hope you will) then simply click on the number of comments area, and share your thoughts in the "comment box" that appears. Thanks!

That’s The Way Things Are

There was a death in my family, so I was out of town.  attending to the funeral and related matters – hence the hiatus in my postings. I just got home.  This post, however, is not related to the death of my loved one, who was cared for with great care and tenderness by the Lutheran Home nearby. All of us in the family are grateful to them.

No, this post about a couple of men I met when I was there – a hospitalist in a New York Hospital, and his son. I asked the hospitalist his thoughts on paying doctors by salary, and he replied that he certainly was on salary; given the circumstances, he felt that arrangement was fair. Many of the doctors who worked at his hospital were likewise salaried, but some of the ones who weren’t tended to rack up tests and procedures if they thought the insurance would pay for them.

“Really!” I exclaimed, feigning surprise.

“Oh yes,” said his son, who was a Junior in college. “When I was given a physical prior to my freshman year, I was given a cardiological sonogram.”

“I’m sorry to hear of it,” I said. “What was the matter with you?”

“Nothing, really. They just gave me that test because they knew my insurance would pay for it. Next year, I had a different insurance company, so they didn’t order that test.”

He spoke in a matter-of-fact way, as did his father, as if to say, that is the way things are. They seemed to accept it.

BUT WE DON’T HAVE TO!

I have to run off now; my wife and I have more business to attend to – all related to the family death.  So it may be a day or two before I can get back to my normal rhythm.  But before my wife and I rush off, I thought I’d send you this reminder:

The Way Things Are mixes profits and patient care – a deadly mix.  WE MUST NOT STAND FOR IT!

Dio

 PS: If you’d like to leave a comment – and I encourage you to do so – simply click on the number of comments  area and share your thoughts in the “comments box” that appears. Thanks!

MODIFIED RAPTURE!

In Gilbert & Sullivan’s MIKADO, the male romantic lead, Nanki-Poo, is appalled to learn that the girl he loves, Yum-Yum, is to marry someone else.  But when she tells Nanki-Poo than she doesn’t love her fiancé,  her lover exclaims, “modified rapture!”

Just so, when I heard yesterday that Nancy Pelosi supports holding hearings on "Medicare for all," I had an all-too-brief surge of elation.  According to THE HILL, “Pelosi had said last year only that Medicare for all would ‘have to be evaluated’ and is ‘on the table,’” but now...was Pelosi actually saying that the status of Single-Payer had risen from the theoretical to the possible, which the political art might somehow make real? This was worth celebrating, EXCEPT:

•      Doug Henwood of JACOBIN magazine says that “we have this coalition now developing in Congress of Democrats opposed to any idea of single-payer,  so not obvious at this point.”
•          We have Democrats in the House who – like Joe Kennedy III – talk a good game about healthcare being a right and not a privilege – but, at the end of the day betray why they may be less than enthusiastic about it.  Kennedy, for example, says he’s concerned that – among other things – it could negatively affect investor - owned hospitals, which include Catholic hospitals in Massachusetts.  He doesn’t mention that he has taken $348,000 in campaign donations from Big Pharma, and that he owns stock in a pharmaceutical company one of whose medications – which fights Hepatitis C – costs $1000 per pill.
•         Among the ones who say they actually are for some form of “universal healthcare,” there is little agreement as to what form it should take. (See my earlier post “Various Flavors of Healthcare Reform.”)

Meanwhile everyone seems to agree that Single-Payer would save this country money. Even Koch’s Mercatus institute, in an attempt to slam the concept, estimated that in ten years it would cost this country $32 trillion -- which happens to be $2 trillion LESS than what it would cost us if we kept spending at the rate we’re spending now!  And the latest confirmation of the Single-Payer idea – from the Political Economy Research Institute (PERI) -- estimates that, when stabilized, a single-payer plan would save this country 15%-16% of GDP. 

PERI’s report -- Economic Analysis of Medicare for All – was subjected to Peer Reviews, all of which were uniformly positive:

                      Peer Review of PERI Economic Analysis of Medicare for All                    

In their review, my heroes, Woolhandler and Himmelstein, together with the redoubtable Adam Gaffney, pointed out that, based on their own researches,  PERI’s estimates of savings were less than they probably would be, while their estimates of expenses were greater than they probably would be.  In contrast to these conservative estimates,  according to Woolhandler et al,  was the optimism of Peri’s estimate of the time it would take to achieve much savings, if for no other reason than the challenge of reducing to a single computer architecture the daunting welter and variety of systems now being used.

But from my point of view, a very cogent observation was also made by Alison Galvani, who pointed out that while Medicare was pretty good at controlling prices, it wasn’t very good at controlling overuse of high-tech procedures (see my post: Why is American Healthcare So Expensive?).  She pointed out that the same McAllen doctors who, with their Medicare Patients, went through the roof in prescribing procedures that were unlikely to help, were much more conservative when it came to the Blue Cross/Blue Shield patients. He cited an article by Luisa Franzini in Health Affairs, which touted Blue Cross/Blue Shield’s supervisory measures  -- prior approval for elective procedures, and case managers for any case likely to cost $50,000 or more, and so on.  She also mentioned what I felt was one of the most important factors: "Private insurers have the advantage of a “threat point” at which they can ultimately refuse to contract for services to specific physicians or hospitals—something that Medicare cannot do."

I wondered what indeed could rein-in the entrepreneurial ambitions of Doctors.  In outfits like the Mayo Clinic or the Cleveland Clinic, Doctors are on salaries, so that nothing distracts them from focusing on the patient, who comes first.  It turns out that this way, outcomes are better while expenses are less.  Does this mean that Single-payer is going to require all Doctors to be on salaries? I wouldn’t hold your breath waiting.

But there is one economy that Galvani doesn’t mention:  As Woolhandler, Himmelstein, and Gaffney point out, that PERI analysis uses the House version’s approach to Hospitals, Clinics, Dialysis Centers:  the gradual take-over of all such privately owned facilities so that ultimately they are publicly owned,  (no stockholders) and directed NOT to make a profit.  The profit incentive being removed, these facilities are no longer incentivized to game the system and are supported globally, the way we support firehouses.  It’s a great idea, though Joe Kennedy III isn’t likely to be pleased with it.

The action in congress is thus likely to be fascinating and extremely consequential.  But that doesn’t mean we should ease up on our own efforts. Don McCanne,  a physician who writes a blog for the Physicians for a National Health Program (PNHP), writes the following:

“The hearings will be part of the process, but it is important that we continue with our other advocacy activities as well. Special targets should include politicians who do not yet seem to understand why single payer is an imperative, and politicians who profess to be advocates but who could be swayed to support detrimental reform policies in a perversion of the process of political compromise. We need to continue to work with politicians who are already fully on board, but we should also continue our efforts to educate those who say they are opposed, if,  for no other reason, they might accept defeat more readily were they to understand the clear social benefit of Medicare for All.  Also we cannot let up in the least in our efforts to educate the public at large. Grassroots efforts will continue to be an essential component of the reform effort.”  (Emphasis added)

This paragraph contains marching orders for all of us.  As the discussions intensify, both in Albany and D.C., our efforts must likewise grow stronger and more passionate.   On the day when Single-Payer passes in New York State, we all will experience not modified, but complete rapture!

A TASTE OF WHAT WE COULD HAVE HERE IN THE U.S.

Yesterday in the New York Times, Erica Rex wrote an opinion piece entitled, What a French Doctor’s Office Taught Me About Health Care. The Times' illustration is deliciously apt, showing a first aid box divided in half: 

In the right hand part we see what you need for first aid in France -- band-aids, antiseptic, etc.  On the left half we see what you need for first aid in America: MONEY.  

Indeed it was money that caused her to move to Europe, not because she'd rather live there -- she would have much preferred to stay home in the U.S. -- but because, as she puts it, "I couldn’t afford to be a cancer patient in America." In France, as it turns out, not only does the government pay for most of her treatment by the top orthopedic surgeon she's seeing, it pays for the cab ride she had to take to get there (it was only a few days after surgery).  Notice I said the government pays for "most of her treatment." Her specialist -- like many in France -- charges more than is paid for by "la Sécu" (The French Social Security System -- which also pays for healthcare). But Ms. Rex, as a tax-paying resident, does what most of the French do and pays for supplementary insurance which covers the gap.

It's a highly significant point. Most of the European Single-Payer systems I've looked at have a two-tiered system: The lower tier covers everyone and pays almost, but not quite everything. But if you can afford it, you take out supplementary insurance which covers the gap. My personal belief is that we are going to end up with something like that, here. Only a few days ago I had a conversation with a member of  a very strong New York State Union. She pointed out that currently her Union has been able to provide her with a super-deluxe medical coverage which she suspects will exceed what will be offered by NYHA.  She herself says that she would be willing to give up some of those deluxe extras "for the common good," though she's doubts whether many of her union colleagues would go along. As it stands now they are very uneasy about Single-Payer. But I personally believe that some sort of two-tiered approach might solve the problem, and might be what we will eventually see here.

But back to the Orthopedist's office. The financial aspects of her care are not on the top of Ms. Rex's mind. It's the feeling of relaxation, the freedom to chat with others about one's condition candidly. She writes, 

"To my friends in the United States, this casual attitude seems foolish, even risky. But in France, medical privacy is irrelevant. No one will lose her job because of a lengthy convalescence. There is no possibility that pre-existing conditions will make insurance unaffordable. Unemployed people still receive treatment. Huge medical bills do not reduce ordinary citizens to a state of existential terror. The absence of unease over health care alters the texture of French experience. We get cozy in waiting rooms."

Indeed, the atmosphere of the waiting room might be described as "homey" in a declassé sort of way, with six-month-old copies of Le Monde  and Paris Match on the table, and a framed print of a Monet painting on the wall. No nurse helps our author's specialist in the examining room; he changes the examining table paper himself.

The whole thing reminds me of a short movie my wife and I were shown more than fifty years ago. We were taking classes in the Lamaze method of child bearing, which enables a woman to give birth without anesthesia -- much better for the baby. The film we were shown was made in France. The delivery room was very homey, with a table bearing a vase full of flowers.  The young woman used the Lamaze technique to give birth and did so with aplomb. After the umbilical cord was cut, the young mother,  holding the baby, got off the table and walked out of the room. The obstetrician, smiling, cried "VOILÁ!"

Now I haven't done justice to Ms. Rex's wonderful piece; there's a lot more homey detail than I've shown here. so I encourage you to read it for yourself, and get the full picture:

What a French Doctor's Office Taught Me About Health Care

After you've read it, you will smile and join me in crying "VOILÁ!"

Dio

PS: I encourage you to comment if you'd like. Just click on the number of comments area and share your thoughts in the comment box that appears.