medicare for all – R&R – Reachout and Rebuild

Changing her mind on Medicare for All

David Posnett — Wed, 22 Jul 2020 17:42:42 +0000

https://thehill.com/opinion/healthcare/507348-how-i-changed-my-mind-on-medicare-for-all

Dr. Li Tso, opinion contributor July 14, 2020

I know most of the arguments against “Medicare for All.” I’ve been making them for most of my professional life as a physician:

1) We don’t need it; our current mix bag of public and private insurance coverage is adequate

2) Disrupting the private insurance industry would result in too many job losses

3) The government cannot be trusted to run a program of this size

4) We don’t have buy-in from a majority of constituents

5) We simply can’t afford it.

I’ve said all of these for 30 years. I now know that I am wrong.

Health care policy can be simplified to answering the basic question of who gets covered and at what cost. Universal coverage was once championed only by the most progressive. Then came COVID-19.

COVID has taught us that every member of our society needs adequate health care. This is not just a progressive talking point, it is the reality of infectious disease: those without proper care run the risk of acquiring and transmitting the disease to the rest of us.

The most marginalized segments of our population such as the homeless, undocumented workers, and the incarcerated still have contact with clerks in coffee shops, police officers, and staff in our emergency rooms. This was made evident when a homeless patient came to my practice’s office for wound care seven times over a two weeks period at the beginning of the pandemic before strict safety protocols were instituted. This patient subsequently tested positive for COVID-19. Fortunately, none of the staff in my practice contracted COVID from this patient. This scenario is just a microcosm of what can go wrong if we do not care for everyone.

Universal coverage is no longer charity or a luxury, it’s now medically necessary as protection for us all.

COVID has also taught us that tying insurance to employers no longer makes sense. It’s a historical accident that we even have this system: The Stabilization Act of 1942 was passed to limit war-time inflation and limited employers’ ability to raise wages, but there was an exemption for “insurance and pension benefits” which could grow “in a reasonable amount” during the freeze.

Suddenly, employers were in the health insurance business as health benefits could be considered compensation but did not count as taxable income.

When Congress rewrote the tax code in 1954, it preserved the tax subsidies for third-party insurance, and by 1964, almost 80 percent of the population had some form of employer-sponsored health insurance.

This system sort of worked until the cost of health coverage became too expensive and companies, especially small companies, reduced or eliminated coverage. Today, Kaiser Permanente estimates that only about 49 percent of Americans get their coverage this way.

COVID made it clear what a weak link this is as sudden massive unemployment can quickly result in public health catastrophe. More than 30 million people lost their jobs — and for many, their health insurance–in just a few months of lockdown. Many of these people run the risk of being suddenly uninsured.

Yes, Medicare for All will cost a lot, and it will cause huge disruptions. But disruption is part of free enterprise and innovation. Why should health care companies be exempt? It makes little sense and is almost un-American. Think electricity replacing whale oil, combustible engine replacing horse and buggy, the invention of the computer, the internet, smartphones, fax machines. Each innovation caused massive job restructuring but they also made our lives better and easier. By some estimates, Amazon has resulted in the elimination of 1.5 million retail jobs. Are health insurance jobs more vital than retail jobs? In the case of Medicare for All, displaced private insurance workers are the very ones the government would need to hire and help implement the new program.

For many years I didn’t trust the government to run a system as large as Medicare for All — not when the DMV can barely handle your license renewal. Consider our newest department, the Department of Homeland Security, which was created in 2002. DHS now has over 240,000 employees and a budget of nearly $50 billion. Bureaucracy exists within any large organization. We now readily accepted this new department after the terrorist attacks of 9/11. Aside from the extremists, no one is calling for the dismantling of major departments due to bureaucracy.

Medicare for All will certainly be expensive. Projections range from 13-47 trillion dollars over 10 years.

Critics claim that this enormous amount would bankrupt our treasury and unfairly pass down this debt to our children and grandchildren. However, other than for a short duration in the 1990s, the U.S. government has run a budget deficit every year since 1970. Our national debt is now over 25 trillion dollars and will surely grow in the future. Economists continue to debate about the meaning and consequence of this large debt.

The United States government has spent more than six trillion dollars to help support the economy during the pandemic with widespread support from both politicians and the public and very muted dissent from the traditional deficit hawks. That’s because it’s clear to politicians that the stimulus is preventing a broader crisis. Deficit spending is considered not only reasonable but a wise use of resources when it provides benefit to a large segment of our population.

The sizable cost of 1 to 4 trillion per year for universal health coverage is justifiable and may even appear to be a bargain considering the amount we have already spent on COVID, and the amount people will continue to spend on the most expensive health care system in the world. We currently are already spending nearly $4 trillion per year on U.S. healthcare. Despite this enormous amount, we still have gaps in coverage and we rank poorly as measured by healthcare access and quality index compared with other developed countries.

COVID has made clear that we need to reframe the way we think about universal health coverage. It would be naïve to think that COVID will be our last novel pathogen or last economic shock. The disruption and cost of permanent universal coverage is indeed high but the cost of not pursuing this policy will likely be much higher.

Li Tso, M.D. is a primary care physician at Mass General Hospital, assistant professor of medicine at Harvard Medical School.

Medicare-for-all-who-want-it

David Posnett — Mon, 11 Nov 2019 17:12:19 +0000

Adapted from John Hooker in response to Wendell Potter’s statement:

“There’s now a chorus of voices, led by Senators Sanders and Warren, that are saying, ‘enough’. An entire generation has grown up hearing the stale health insurance industry talking points (that I helped craft decades ago). And they aren’t fooled! Politicians who keep defending the insurance industry will go down with them when the health care system finally collapses.”

I will repeat myself until I’m unable to write any more. THIS IS NOT THE RIGHT STRATEGY FOR SUCCESS. Wendell Potter is right factually but is playing the role of an activist (and selling books).

If you want to change something, choose Medicare for all who want it (MFAWWI) – also known as the public option. This will do the work without being bombarded with slogans like “socialism” etc. Remember, not so long ago, even some Democrats did not support Obamacare in 2010. They were too afraid of the public reaction when Republicans began bombarding the country with their fraudulent slogans.

We have reached, a “McCarthyism” situation in this country where the number of people becoming irrational is increasing. This is very dangerous. If we do not reform, we will screw up this country for good.

Introducing the government option or MFAWWI will do the dirty work of putting the insurance companies gradually out of work. It will bring the price of pharmaceuticals down because the increasing size of MFAWWI will put pressure on pharmaceutical pricing. It will force re-structuring through market forces and do this at a more manageable pace for society so that it can adapt to this huge change.

There is too much now to disentangle in one fell swoop — particularly while half of the opposing stakeholders will be bombarding a well-meaning single-payer system.

Time to be realistic. The only way to get the whole country to move in a direction of this magnitude (re-structuring one-sixth of the economy) is to have a huge majority convinced that that is what we have to do — like a war effort! We aren’t there yet.

Same for climate change!! Which is even bigger an issue.

Wendell Potter on ‘Medicare For All’

David Posnett — Fri, 12 Apr 2019 21:50:39 +0000

Medicare For All: A Conversation with Wendell Potter

by Francesca Rheannon

The campaign against Medicare For All is being fueled by health insurance cash to politicians.

The health insurance industry is mounting a full court press against Medicare For All. Former health insurance industry executive and whistleblower Wendell Potter says one big way they’re doing that is by making sure their talking points are repeated by politicians who have taken big donations from them.

Potter had an inside seat to the process when he was a health insurance executive for Cigna. He blew the whistle on the industry with his books, Deadly Spin and Nation On the Take. He went on to found the website Tarbell.org, which does investigative journalism on the healthcare industry.

I spoke with Wendell Potter for my radio show Writer’s Voice about the health industry’s talking points against Medicare For All and how he counters them. What follows is part of that interview, lightly edited for reading. I started out by asking Potter who were the different players in the health care industry that are involved in the campaign against Medicare For All.

Wendell Potter: There’s this front group that was formed last year by health insurance companies, pharmaceutical companies, and big hospital chains through their trade associations, the American Hospital Association and the Federation of American Hospitals, which is the for-profit hospital organization and they’re pooling their money–-all these parts of healthcare–-to finance collectively this campaign against Medicare for All.

Francesca Rheannon: Why are the hospitals against Medicare For All?

WP: The hospitals are against it because they’ve got a good thing going. One of the things I often tell people is that it’s not really accurate to think that health insurance companies are really all that much in the game to control healthcare costs. They’re not. They can’t, for one reason or another, nor do they have an interest in doing it, because the more healthcare costs go up, the more money they are able to demand from us in terms of premiums.

Hospitals are in on the game, in that, because health insurance companies cannot really control health care costs, the hospitals can pretty much have their way with them. So they like the system as it is. They get more money from private insurers than they do from the current Medicare program or from the Medicaid program, and it’s because of the weakness and the smallness of individual private insurance companies.

FR: So, what are the industry talking points that politicians, including some Democrats, are using?

WP: Some of the talking points are that this country can’t afford Medicare For All, that it would cost too much money and that so many Americans get their coverage through their workplace.

Those are talking points directly from the insurance industry and this partnership that I mentioned, to scare people, to make them think that this is really not something that we should strive for, that we shouldn’t even give it any consideration.

It is true, most Americans who are not enrolled in Medicare or Medicaid or some other public program do get their coverage through private insurers. That’s the way it’s been for in this country for many, many decades. But it doesn’t mean it always has to be that way. And the reality also is that many people who are enrolled—in fact probably a majority—of people enrolled in private insurance plans through their workplace, are finding that their coverage is increasingly less valuable, even though they’re paying more for it every single year.

So, I know that in reality a lot of people are very dissatisfied with what they’re getting for the high premiums they are paying and they’re having to pay more and more out of their own pockets these days for coverage, even if they have insurance. But that’s one of those talking points. It is to try to make policymakers and the public believe that for some reason our employer based system is sacred, that we can’t touch it.

FR: Yes. I remember the last time I got health insurance through an employer, they instituted a new program called Value Plus and I used to joke that it was more like Value Minus, because I was paying a lot more for a lot less.

WP: Right. In fact, my last CEO in the health insurance business, at Cigna, was asked by someone what kept him up at night and he said it is the worry that employers and individuals will wake up and question the value proposition of health insurers and I think employers and individuals are waking up to question-–and rightfully so: what value do the private insurers actually bring to this country? One of the things I used to have to do for a living was was to try to make people believe that we had a reason to exist, but increasingly employers in particular are questioning the reason why we have this middleman in the equation in the first place.

FR: Let’s go to some of the other talking points. Cheryl Bustos, the new head of the DCCC, has said that a $33 trillion price tag for Medicare For All is just too much.

WP: Well, that actually is only part of the number that this think tank–-actually a conservative think tank–-came up with. So she’s quoting that. But even that think tank said that is at least $2 trillion less over ten years than what it would be if we continue with the current system. So in other words, even that—yes, that’s a big number—but it’s over ten years, first of all. And what she did not say was that that would represent less money than the country would spend on healthcare if we go to Medicare For All than if we don’t.

The reality is that this year, we’ll spend three and a half trillion dollars on healthcare as a country. So if you multiply that by ten, you’ve already gotten over $30 trillion. And that is just based on the assumption that there will be no medical inflation, which of course you have to factor in. So if we stick with what we’ve got, we will be spending a lot more than $33 trillion over the course of the next ten years.

FR: Now, the third talking point is “think of all the jobs that are going to be lost for people who are processing all those claims—or denying all those claims.

WP: Right. And I think it’s a talking point to obscure the reality that the work that they do makes it, in many cases, impossible for the rest of us, the many millions of us, to get the care that we need. A lot of these folks, as you pointed out, are employed to try to avoid their companies paying claims. Because we have a multi-payer system, which is unique in the world, insurance companies not only have armies of employees who are in the business of determining whether or not someone should get coverage for whatever it is a doctor recommends, but you also, on the provider side, have to have armies of people who do nothing more than deal with insurance company bureaucrats day in and day out. So you’ve got these tens, if not hundreds of thousands of people who are employed in our healthcare system who do not do anything to make us better or to help us with our health. In fact, in many cases it keeps us from getting the care that we need.

Insurance companies have employed literally tens of thousands of nurses who are not providing care, but they are working for these big insurance companies, in many cases standing in the way of the care that we need, And medical doctors as well. So in my view, those folks have been trained as caregivers; they should be back at the bedside or providing care in offices, rather than making it more difficult for us to get care.

The other thing is that most of these big insurance companies have diversified over the years. They have other lines of business that are really quite profitable and are growing. So it’s a fallacy to say that they would go out of business if we move tomorrow to a Medicare For All plan. Some people would need to be retrained and some, like doctors and nurses, could go straight away to work at a better place, in my opinion.

FR: Some of the 2020 Democratic candidates are saying that instead of Medicare For All, which is too hard to get, we should just go for universal coverage and that we can do it with the kinds of plans that, let’s say, Switzerland has or Germany or Holland, where there are private nonprofit insurance companies that the government pays and bargains with.” So what is the best way to do health care for all?

WP: I’ve heard that too. Obviously my response is, why in the world would you not want to do the best job? Why would you want to emulate another country that, yes, they have achieved universal coverage, but they’re kind of runners up with us in terms of how much they spend on healthcare. We spend almost $10,000 per person per year on health care, which is twice the average of other developed countries and we have worse outcomes than most of those countries, so we have very little to show for all that we’re spending. But Switzerland comes in second in terms of the amount of money that the country spends on healthcare. Germany’s not too far behind.

The thing that is distinctive about those countries is that the insurance companies or sickness funds, as they may be called, are heavily price regulated. They’re all nonprofit entities. And we moved far away from that kind of structure many decades ago. So insurance companies would be just as resistant to a proposal that would force them into nonprofit status as they are to Medicare for All.

Why do we want to do a half measure? Why do we want to postpone what is inevitable, which is moving to a single payer healthcare system? And it is the one system of those that are proposed that not only would get us to universal coverage but would save us the most money.

In fact, when the Affordable Care Act was being debated, policy makers knew that we needed to try to do something about healthcare costs, while also trying to achieve the goal of universal coverage. They decided during the Obama administration to go first for universal coverage and deal with healthcare costs later. We see now where we wound up. We wound up with a bill that does a great deal of good in terms of bringing a lot of us into coverage, but there’s still about 30 million of us who are uninsured.

And the other problem is that a fast growing percentage of us are under-insured, because of the way that law is structured, and the insurance industry has been going in the direction of moving every last one of us into high deductible plans. And increasingly, those of us who are low and moderate income have trouble meeting our deductible. So we go without care. That’s the definition of underinsurance. So why don’t we just do something that really gets us to where we need to be rather than just continuing to tinker with the system that has failed us for many years?

FR: And the other thing that I’ve heard coming out with some of the candidates are proposals to decrease the Medicare eligibility age to 55 or 50. In other words, an incremental approach. The other one is make it possible for businesses and people to buy into Medicare. What are your thoughts on those proposals?

WP: Well, you know, it would be better than not doing anything, I guess. But again, why do you want to settle for something that is not as good as you can try to get?

FR: Well, the reason is politics.

WP: The reason is politics. But as I said, you can expect as much resistance to that as you would to going boldly. In fact, an American historian was interviewed on TV not too long ago saying, if you look at American history or history broadly, you’ll see that sometimes it’s easier to achieve sweeping change by bold views than by incremental change. Incremental change can be incredibly tough to pull off. Sometimes bold measures are more successful.

But back to that specific proposal, instead of simplifying the system, it just adds greater complexity. And you would keep the insurance industry in place maybe indefinitely. It is our multi payer system and the complexity of our system that is at the heart of our problem with costs being out of control.

It also does nothing to curb the practice of the health insurance industry to limit the choice of doctors and hospitals we have in these so called limited or narrow networks that are in vogue among the companies. Almost all of them have limitations to the doctors and hospitals you can see. And they’re forcing you to pay more and more for prescription medications by putting more and more drugs in tiers that require that you pay more out of your own pocket. Why do we want to keep a system in place that makes us pay more for care out of our own pockets, even if we have insurance, and to pay more and more every year in premiums? That doesn’t make sense to me. And I can’t imagine why policy makers would propose that we keep a system like that in place just because it might be easier politically.

FR: This is affecting cancer drugs too, isn’t it?

WP: Yes. In fact, I draw your attention to a piece that is on Tarbell now written by a leading oncologist from MD Anderson in Houston about the cost of oncology drugs. And it’s just extraordinary what has happened to the price of pharmaceuticals broadly, but in particular for cancer drugs. And insurance companies are just largely on the sidelines because they are not large enough. None of them, even the biggest, have enough clout to really do anything to control drug prices. All they are able to do is require that we take one drug as opposed to another that our doctor might have recommended, or again, shift those medications into tiers that make us pay more. So they’re not controlling costs, they’re shifting more of the cost to us. And in many cases, as this doctor who wrote that piece pointed out to me, he has seen patients die for economic reasons. They just simply can’t figure out the resources to get the medications or the treatments that they need.

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Francesca Rheannon, Journalist

Writer’s Voice with Francesca Rheannon, Producer and Host

Twitter Accounts: @WritersVoice

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Our Healthcare System will Change (Like it or Not)

David Posnett — Mon, 05 Nov 2018 01:44:40 +0000

Submitted by John Hooker

In reply to a recent laudable post “Drug Prices: How Pharma Games the System,” I have this to add.

To gather momentum to change our system we should be relentless in emphasizing the cost that affects patients directly.

There is one major fallacy of our healthcare system. We chose to link healthcare insurance to employment in the years following World War II. In contrast, at that same time, Europeans chose to provide health care as a right for all (Universal Healthcare). Their countries chose different systems (some public and some private), but the underlying intent was always to insure everyone in the country, because that is how a successful insurance system works.

Healthcare obtained through your employer was our original sin. It never insured more than 70% of the population, and it actually took over our rights to choose and in stead put our employers in charge.

As per “Drug Prices: How Pharma Games the System,” Medicare is not allowed to negotiate prices. Pharmaceutical prices are still unregulated. Worse, Medicare is hamstrung by administrative rules that tend to increase fraud or waste. As we all know, that led to claims that anything government puts “its hands on” cannot work.

But the reality is that Medicare was engineered to be inefficient and to maximize profits for our private health care industry.

However, recent talk about healthcare is raising factual awareness and creating a platform for campaigns. Excessive patenting to extend branded product life, as described in “Drug Prices: How Pharma Games the System,” is only one aspect of the problem.

Most important is to remind ourselves that American pharmaceutical companies are free to charge whatever they want, whether the product is on or off-patent! Even if the drug is 30+ years old! That is outrageous.

Another point related to messaging: We should stop reminding the younger generations that health care costs are rising and implying they are being made to pay the bill for the costly care of older Americans via higher healthcare premiums. What no one seems to get, is that this is how insurance works! If you are a very careful car driver and never have an accident you are still paying insurance and this “covers” the expenses of the insurance company when others submit claims. In contrast to auto-insurance where higher premiums due to accident prone driving make some sense, health issues are often unrelated to negligent behavior. Even if you think that those who smoke, drink, or have unprotected sex with multiple partners, should be made to pay higher healthcare premiums, consider this. In our immediate future, say in 10-20 years, everyone will get a full sequence of their genetic profile. This means that you, your doctors and perhaps even your health insurance, will know the details of which diseases you are prone to get in the future.

Will you get a heart attack with 10% chance or with a 90% chance? Will you get hypertension? Will you have a stroke? Will you have diabetes? Will you get any number of different cancers? Thanks to Angelina Jolie and other celebrities, everyone already knows about BRCA gene mutations and the high risk for breast cancer and ovarian cancer that they impart. Within a few decades there will be thousands of such cancer genes. You can bet that private for-profit health insurance companies would love to get your genetic profile and charge you insurance rates accordingly.

The ONLY way to “overcome the inequity of nature” is to adopt the widest healthcare insurance pool possible, distribute the risk, and lower premiums for everyone.

It is time to debunk healthcare insurance through employment. It increases the lack of transparency. It decreases control for the individual. It is unmanageable in its current form and it is getting worse.

Experts predict that the expanded use of genomics will eventually afford predictability of disease for the entire population. This is the “holy grail” for healthcare providers. It is also the right time to dramatically change our healthcare insurance system.

If not politics, science may compel us to accept Medicare for all.

Let’s simplify and make good.

John Hooker is an International Medical Communications Consultant with 36 years of experience working with Big Pharma.