Thursday, March 4, 2021

Trade-offs in Public Health Insurance Design | Health Care Economics, Insurance, Payment | JAMA | JAMA Network

Trade-offs in Public Health Insurance Design | Health Care Economics, Insurance, Payment | JAMA | JAMA Network Comment by Don McCanne This article was selected because it represents the views of a respected and influential academic, Katherine Baicker, PhD, Dean of the University of Chicago Harris School of Public Policy. She says that there are large hidden costs in the trade-offs that we would have to accept in adopting a single payer Medicare for All program. We should try to understand what these trade-offs would be and what costs they would entail. First she contends that covering everyone with the same plan could make them worse off because people have different needs and preferences. But that partially defeats the purpose of insurance which is to spread the risk amongst everyone (though we would add "equitably distributed"). We certainly cannot predict unknown risks in the future, and selectively covering pre-existing disorders also fails to spread the risk. Everyone should be covered for all reasonable services. She states that the sharp increase in the costs of having a uniform public insurance benefit is due to the dramatic advances in health care, but that is not a unique feature of having a universal program. Everyone should be able to benefit from these advances, and an equitably-funded, universal risk pool makes that possible. Besides much of the increase in costs is due to price increases, and they are better contained in a public system. She states that the substantial growth in income inequality might influence the willingness to devote resources to expensive care, suggesting that decisions would be based on the ability to pay. But a single payer system would obviate the need for such a two-tiered or multi-tiered system. She states that higher tax rates would be needed because of the increased economic cost of raising funds to cover a public insurance program, but she doesn't mention here the offset of a reduction in private spending. Besides, financing the system though progressive taxes is what makes the financing equitable. She stretches logic when she says that the wealthy might be worse off if the benefits are too limited, while lower-income people might be worse off if comprehensive benefits result in fewer resources that could be devoted elsewhere. But all reasonable health care services would be covered, and the wealthy would be free to purchase whatever services are not included in the comprehensive benefit package. She suggests an alternative of establishing a basic public health plan for all with additional social insurance programs for those with low incomes and privately purchased wraparound plans for the wealthier, but this abandons the concept of single payer Medicare for All while perpetuating many of the deficiencies of the current system. (In my early novice years in health policy, I wrote a proposal for a basic public health plan with options to purchase additional coverage. Fortunately, Claudia Fegan was able to set me straight, and I got to work studying health policy, which I have continued to this day.) She says that the hope of reducing costs while expanding coverage cuts across the political aisle, but there is a sharp divide in faith in whether the government or the private sector is best able to effectively provide that care. It is surprising to note the number of policy academics who are driven by faith in markets when the objective literature paints a clear advantage for government programs. Think of how many private insurance programs rely on public funds yet manage to divert significant amounts of these funds to their own industry. Sounds like greed-driven faith. Confirming her belief in private markets versus the government, she touts competition of health plans, when what we need instead is cooperation within the health care delivery system. Single payer Medicare for All would promote the latter. It is interesting that she closes by stating, "None of this is meant to say that the current system is serving the US population well now" and calls for "implementing a fiscally sustainable, high-value public insurance safety net." Well, single payer Medicare for All would do that for everyone in a comprehensive system that we could afford as individuals and as a nation.

Thursday, February 25, 2021

The Staggering Costs of Health Insurance “Sludge” | Stanford Graduate School of Business

The Staggering Costs of Health Insurance “Sludge” | Stanford Graduate School of Business: A new study finds that dealing with health insurance administrators costs the U.S. economy billions in wasted work time and lost productivity. Comment by Don McCanne So finally someone has discovered that private insurance companies not only waste a tremendous amount of health care funds on administrative excesses, but they also place a tremendous administrative burden on others - the health care delivery system, the business community and the employees insured by these firms. Professor Pfeffer says that he can't believe that no one looked at the employee burden before, but, of course, they have. More astonishing is the fact that Pfeffer says that the fault lies less with the insurance companies and more with the companies that purchase the private insurance plans and then fail to hold the insurers accountable. Accountable? Accountable for what? The insurance companies are private businesses rather than public service organizations. They strive for business success by erecting barriers to spending money on health care. They spend a large amount of funds on accomplishing this - not only on their own administrative services that are designed to cut back on health care spending, but also by creating administrative burdens for the health care delivery system, and businesses and their employees. That's just good business. If they want efficient public service organizations whose job it is to assist patients in getting the care they need, they should advocate for a single payer Medicare for All program and then dismiss the private insurers and their inefficiency at obtaining beneficial health services. But then isn't it characteristic of market-oriented business schools like Stanford to place the blame on the consumers? We should be assisting the consumers of health care, not blaming them.

For Real Healthcare Reform, Biden Should Break Up with Big Insurance – InsideSources

For Real Healthcare Reform, Biden Should Break Up with Big Insurance – InsideSources: The enthusiastically socialist Jacobin magazine recently took President Biden to task for a healthcare plan that superficially appeared “lifted” from

Wednesday, February 17, 2021

Medicare for All: A Citizen's Guide

Medicare for All: A Citizen's Guide Medicare for All A Citizen's Guide By Abdul El-Sayed and Micah Johnson Sample excerpt: When analyzing how health reform proposals do (or do not) address these problems, it is also helpful to keep in mind the "active ingredients" of Medicare for All described in Chapter 3. To review the six key elements of M4A: 1. Universal coverage. M4A guarantees health coverage to every American. 2. Comprehensive coverage. M4A guarantees that Americans' health coverage is comprehensive in terms of the range of covered benefits, the availability of a wide range of clinicians and hospitals, and minimal or no financial barriers to receiving care. 3. Pricing power. M4A can wield considerable negotiating leverage to rein in the cost of drugs, hospital stays, and physician services. 4. Administrative efficiency. M4A eliminates the high overhead costs of private insurance companies and reduces the administrative burden on providers and patients. 5. Progressive financing. M4A allows healthcare to be financed progressively, replacing the regressive financing of private insurance. 6. Public accountability. M4A would be accountable to the American public, rather than shareholders. Oxford University Press or === Comment by Don McCanne Abdul El-Sayed and Micah Johnson have produced an excellent primer on Medicare for All. Since further changes in our health care system are inevitable, it is a book that will be useful to everyone. I'll mention here how it will be useful particularly to the novice and also to the seasoned health care reform activist. First of all, it is very basic and highly readable, not getting lost in technical health policy jargon, yet it is still very clear and comprehensive enough to cover the subject well. For those who do not understand the basics of Medicare for All, and for those who have many questions and need to fill in the blanks, this book will do that. It first provides a diagnosis of health care problems in America and how we got here. It then discusses the fundamentals of Medicare for All policy and how such a program would be designed. It discusses the important point of how to pay for it, and then discusses the alternatives, explaining their deficiencies. The book closes with the politics of reform and how we must organize for it - a section that will be of more interest to the activist, though perhaps somewhat disappointing to some because it does not show us a way to get around the work that needs to be done. For the seasoned reform activist, not much new in policy is revealed, but, importantly, it does bring policy considerations up to date. It is also very accurate, which is important because even some of us who are very well informed may still be carrying ancient misconceptions about health policy, or be buried in ideology that will keep suppressed important variations in health policy. On the positive side, the simple but informative straightforward rhetoric gives us a common language for communicating the concepts which will help avoid diversions into divisive ideology instead of policy. This is not to say that ideology is not important since the book does address "We the People." The timeliness of this book is especially apropos. President Joseph Biden has promised us that he will advance reform by building on the Affordable Care Act and maybe by adding a "public option." Sadly, this reveals how uninformed our president is. Yes, he was involved in the Obama administration's reform efforts, but his understanding of policy, based on his public statements, seems to be limited to the Obama model. For instance, he has stated that we cannot afford a single payer Medicare for All model when the opposite is true. His reform will increase costs while failing to repair most of the deficiencies such as those implied in the excerpt above, repairs that automatically improve spending in our health care system. The president is very busy, and I doubt that we can get him to read the book, as readable as it is. If he did, he would recognize that he is headed down the wrong path. It would be especially helpful if his policy staff did read it, but they are all experts in policy and likely believe that they would not benefit from it, not realizing that the ACA approach is branded in their brains, displacing important policy considerations. That must be the case since they are not adequately addressing the profound waste due to our administrative inefficiency, which must be addressed if we are to have a health care financing system that is fully accountable to the public. Buy it. Read it. Share it. And then act on it.

Tuesday, February 16, 2021