Each week I’ve been adding a brief tidbits section to the THCB Reader, our weekly newsletter that summarizes the best of THCB that week (Sign up here!). Then I had the brainwave to add them to the blog. They’re short and usually not too sweet! (And yes, this week’s is a tad late!) –Matthew Holt
In this week’s health care tidbits, you may be wondering what happened to health policy under Joe Biden. He said no to Medicare for All because instead he was going to create a public option and lower the Medicare age to 60. Yet both those two policies seem to have vanished into the night. Presumably that’s because they think they’re a hard political sell and maybe that’s right. But why? This past week a massive study of American consumers shows that Medicare recipients are much happier with their experience than people with employer-based coverage. And employer based coverage is no better than Medicaid! To wit, the study showed:
Compared with those covered by Medicare, individuals with employer-sponsored insurance were less likely to report having a personal physician and were more likely to report instability in insurance coverage, difficulty seeing a physician because of costs, not taking medication because of costs, and having medical debt. Compared with those covered by Medicare, individuals with employer-sponsored insurance were less satisfied with their care.
Compared with individuals covered by Medicaid, those with employer-sponsored insurance were more likely to report having medical debt and were less likely to report difficulty seeing a physician because of costs and not taking medications because of costs. No difference in satisfaction with care was found between individuals with employer-sponsored private health insurance and those with Medicaid coverage.
I guess the new AHIP slogan is, “we’re just as good as Medicaid!” But you have to wonder, why are the rest of us being forced to consume an inferior product?
By MIKE MAGEE
In the fog of the Covid pandemic, many are wondering what ever happened to prior vocal support for universal coverage and Medicare-for-All. Expect those issues to regain prominence in the coming months. A bit of recent history helps explain why.
The January 6th insurrection, followed by the past weeks two mass shootings, have served to remind our citizens that we must address a range of issues while continuing to confront the pandemic threat.
Modern civilized societies rely on a double-armed approach to maintain order, peace and security. The first arm is laws. But laws are of little value without even and unbiased enforcement.
The second guardrail of civility is culture. MIT professor Edgar Schein described it this way: “Culture has three layers: the artifacts of a culture — our symbols and signs; its espoused values — the things we say we believe; and, most important, its underlying assumptions — the way things really are.”
In the Senate chamber this week, and in Republican controlled state houses across the nation, Americans witnessed a colossal collision of reality and ideals in the form of new Jim Crow laws to suppress minority voting rights, and refusal to address gun violence. In the wake of a constant stream of racial animus and mass shootings, this lethal epidemic demands a response as well.
Were these the only flashing alerts signaling danger ahead, that would be enough to cause sleepless nights. But unenforced or unevenly enforced laws, and value dissonance in America, do not occur in isolation, but are supported by an even more erosive underpinning – greed-induced economic inequality.
By MIKE MAGEE
Cautionary tales are timeless. Take for example Aesop’s Fables, from 620 BC, which included the advisory, “Be careful what you wish for lest it come true.”
Trump and the Republicans who oppose the ACA take heed. You may be inadvertently taking the entire collusive Medical-Industrial Complex down a rabbit hole.
In the opening salvo to the Amy Coney Barrett hearings, House Speaker Nancy Pelosi seemed to be anxious for the fight. Her view of Trump’s strategy? “The president is rushing to make some kind of a decision because … Nov. 10 is when the arguments begin on the Affordable Care Act…He doesn’t want to crush the virus. He wants to crush the Affordable Care Act.”
With no health plan replacement on the shelf, death star Republicans have been struggling to bury this ever more popular piece of legislation for ten years.
In the process, they’ve alienated not only those who believe health care is a right rather than a privilege, and those who support protections for pre-existing conditions, but also those against deceptive skimpy health insurance, those who believe transgender Americans deserve care guarantees, those who demand access to affordable drugs, those who have their under age 26 adult children covered on their family plan, those opposed to cuts in coverage of contraceptives, and those in favor of federal funding of Planned Parenthood clinics.
As Kaiser Health News Washington correspondent, Julie Rovner, recently wrote, “With the death of Ruth Bader Ginsburg, the ACA’s future is in doubt.” In a case now known as California v. Texas, set for presentation to the Supreme Court in just a few weeks, 21 attorneys general (AGs) led by California are seeking clarity on a challenge by Texas led Republican AGs to declare the ACA unconstitutional based on a weak technicality.
By KEN TERRY
(This is the third in a series of excerpts from Terry’s new book, Physician-Led Healthcare Reform: a New Approach to Medicare for All, published by the American Association for Physician Leadership.)
The American Medical Association (AMA) last year announced that, for the first time, more physicians were employed than were independent. While many of these doctors were employed by private practices, the AMA said, about 35% of them worked directly for a hospital or for a hospital-owned practice.25
This estimate was lower than that of other surveys. According to research conducted by the Physicians Advocacy Institute (PAI) and Avalere Health, a consulting firm, 44% of physicians were employed by hospitals in January 2018, compared to 25% in July 2012. More than half of U.S. physicians now work for or contract with fewer than 700 healthcare systems across the country, according to a new study in Health Affairs.
Many of the physicians employed by hospitals and health systems formerly were in private practice. They sold their practices to hospitals because of increasing overhead, dwindling reimbursement, and the rising administrative burdens of ownership, according to Jackson Healthcare, a physician recruiting firm.
The many negative factors affecting primary care also have impelled a growing number of primary care physicians to seek employment in recent years. In 2018, 47% of general internists, 57% of family physicians and 56% of pediatricians were employed. There is evidence that this trend may be exacerbating the primary care shortage because employed doctors see fewer patients per day, on average, than do those in private practice.
By KEN TERRY
(This is the first in a series of excerpts from Terry’s new book, Physician-Led Healthcare Reform: a New Approach to Medicare for All, published by the American Association for Physician Leadership.)
Even before COVID-19, healthcare reform seemed to be stuck between a rock and a hard place, but there is a rational way forward. This approach, which I call “physician-led healthcare reform,” would engage doctors in building a healthcare system that was safe, effective, patient-centered, timely, efficient, and equitable, to use the Institute of Medicine’s set of foundational goals in its landmark book, Crossing the Quality Chasm: a New Health System for the 21st Century.Primary care physicians, rather than hospitals, would be in charge of the system, and they’d work closely with specialists and other healthcare professionals to produce the best patient outcomes at the lowest cost.
It would take a decade or more to restructure the healthcare system so that this goal could be achieved. Similarly, the transition to a single-payer insurance system needs to be accomplished gradually—although the pandemic might accelerate that timetable. Most people are not yet ready to abandon employer-sponsored insurance, and there’s still a lot of distrust of the government. Providers are more likely to accept changes in how they’re paid over time than all of a sudden. Additional benefits can also be brought online slowly. Ideally, we could transform healthcare financing over a 10-year period while rebuilding the care delivery system at the same time.
That is why implementing Medicare for America—a reform plan devised by the Center for American Progress and embodied in a current House bill–makes more sense than going directly to Medicare for All: it changes the system incrementally while achieving universal coverage fairly quickly. Medicare for America would do this by enrolling the uninsured, people who purchase individual insurance, and those now in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). People would also be enrolled automatically at birth. Companies could enroll their employees in Medicare for America, and employees could opt out of employer-sponsored plans and enroll in the public plan.
By MATTHEW HOLT
Since Saturday’s Nevada primaries, confusion seems to be reigning about how Bernie Sanders seems to be winning. Time (and not a lot more of it) will tell who actually ends up as the Democratic nominee. But the progressive side (Bernie + Warren) is doing much better than the moderate side (Biden/Butt-edge-edge/Klobuchar) expected, while we wait to see how the Republican side of the Democratic primary (Bloomberg) does in an actual vote. The key here is the main policy differential between the two sides, Medicare For All.
Don’t get too hung up in the details of the individual plans, especially as revealing said details may have hurt Elizabeth Warren. But do remember that there is one big difference between Sanders/Warren and the moderates. It comes down to whether everyone is in the same state-run single payer system (a modified and expanded version of Medicare) or whether the private employer system is left as it is, with expanded access to something that looks like Medicare (the public option) for everyone else. Note that no Democrat wants to stand pat on Obamacare “as is”. Everyone is way to the left of what Obama ran on in 2008 (or at least what he settled for in early 2009).
Why has this changed? Well there’s been a decade of horror stories. I’m not talking about the BS anti-Obamacare stories from people forced to give up their junk insurance, I’m talking about people with insurance being bankrupted or put through horrendous experiences, like this mother who was put through the ringer by various insurers when her 1 year old son was killed and husband injured in a road accident. Or this health tech CEO, who was an MD & JD and had to put $62,000 on his American Express card to get surgery.
About 3 years ago as the dust was clearing from the Obamacare implementation, the impact of this started showing up in the polls.Continue reading…
By KIM BELLARD
We’ve been spending a
lot of time these past few years debating healthcare reform. First the
Affordable Care Act was debated, passed, implemented, and almost continuously
litigated since. Lately the concept of Medicare For All, or variations on
it, has been the hot policy debate. Other smaller but still important
issues like high prescription drug prices or surprise billing have also
received significant attention.
As worthy as these all
are, a new study suggests that focusing on them may be missing the
point. If we’re not addressing wealth disparities, we’re unlikely to
address health disparities.
It has been well
documented that there are considerable health disparities in the U.S.,
attributable to socioeconomic status, race/ethnicity, gender, even geography, among other
factors. Few would deny that they exist. Many policy experts and
politicians seem to believe that if we could simply increase health insurance
coverage, we could go a long way to addressing these disparities, since coverage
should reduce financial burdens that may be serving as barriers to care that
may be contributing to them.
Universal coverage may
well be a good goal for many reasons, but we should temper our expectations
about what it might achieve in terms of leveling the health playing field.
By MIKE MAGEE, MD
Adam Gaffney’s recent Boston Review article, “What the Health Care Debate Still Gets Wrong”, a landmark piece that deserves careful reading by all, reaches near perfection in diagnosing our health system malady.
Dr. Gaffney is president of Physicians for a National Health Program, and a co-chair of the Working Group on Single-Payer Program Design, which developed the “Physicians’ Proposal for Single-Payer Health Care Reform.”
A seasoned health policy expert, his article cross-references the opinions and work of a range of health commentators including Atul Gawande, Steven Brill, Sarah Kliff, Elizabeth Rosenthal, Zack Cooper, and Canadian health economist Robert Evans. But his major companion is Princeton health economist, Uwe Reinhardt, whose posthumous book, Priced Out: The Economic and Ethical Costs of American Health Care, was recently published by Princeton University Press.
Gaffney’s affection for Reinhardt is evident as he recounts his desperate upbringing in post-war Germany, challenged by poor living conditions, but made whole by access to health care. Quoting a 1992 JAMA interview, Reinhardt states, “When we needed medical care, we got it at the local hospital, no questions asked. When you were sick, society was there for you.”
That acknowledgment is not only personal but historically significant, as I outline in my recent book, Code Blue: Inside the Medical Industrial Complex. The services Reinhardt received were part of a new national health care system funded fully by American taxpayers as part of the Marshall Plan. At the very same time, American citizens were denied a national health plan of their own as Truman was effectively branded a supporter of “socialized medicine” by the AMA and a cabal of corporate partners.
By ROBERT M. HERZOG
The Cure for healthcare isn’t Medicare for All, it’s establishing organizations with complete responsibility for the total care, costs, quality and outcomes for a person.
Discussions of Medicare for All substitute structure for substance. They engender a debate about the trappings of care delivery, administration, and cost, but don’t address the fundamental issue, which is how to provide genuinely better care for people of all ages and economic circumstances.
The premise of Medicare for All is that a single payer will provide better and more cost effective care. But what is really needed is single entity accountability. Whether there are one or many, whether they are public or private, is not as important as that one organization and its people become responsible for the total health and care of an individual and the costs associated with that care. With incentives for doing it well, and penalties for doing it poorly. And an ease of transition for people to move from an entity that doesn’t serve them well to one that does, to maintain the benefits of competition and varied approaches based on differing conditions.
Focusing on Medicare for All promulgate a systemic flaw baked into our health insurance and provider systems. High costs and lower quality can’t just be fixed by a single payer negotiating lower drug prices, nor would providing fewer services mean better care at lower costs. The core problem is exemplified by the invidious arbitrary split in public health insurance between Medicaid and Medicare, with each providing different services spread out among many providers, none of whom have sole responsibility for the complete health of the person.
BetterCare for All need not be a win-lose proposition, of Medicare for All or nothing. The feasibility near term of a one payer system is low, whereas the feasibility of building on existing systems and frameworks to create single system accountability is much higher.
By BOB HERTZ
It is not wise for Democrats to spend all their energy
debating Single Payer health care solutions.
None of their single player
plans has much chance to pass in 2020, especially under the limited
reconciliation process. In the words of Ezra Klein, “If Democrats don’t have a
plan for the filibuster, they don’t really have a plan for ambitious health
Yet while we debate Single Payer – or, even if it somehow
passed, wait for it to be installed — millions of persons are still hurting
under our current system.
We can help these people now!
Here are six practical programs to create a better ACA.
Taken all together they should not cost more than $50
billion a year. This is a tiny fraction of the new taxes that would be needed
for full single payer. This is at least negotiable, especially if Democrats can
take the White House and the Senate.