Friday, July 16, 2021

NNU Medicare for All Leadership School Interest Form | National Nurses United

NNU Medicare for All Leadership School Interest Form | National Nurses United: Do you want to be a better activist and volunteer leader in the fight to win Medicare for All, but feel like you could use more skills and training? Sign up to apply to the NNU Medicare for All Leadership School! We’ll be accepting between 20-30 activists across the country to be part of an in-depth, 2 month program to learn and practice all the skills and background needed to make an effective leader and organizer. You’ll get trainings, workshops, be part of group projects, and get to implement what you’ve learned in a hands-on way with the direct support of our staff. And, you’ll make lots of new friends who are just like you! The application for the fall cohort is now live! Complete this short interest form to receive the link to the application, which you may submit in written or video format. Applications for the fall are due at midnight on Friday, August 13th. People of color, women, and those with firsthand experience with our broken health care system are encouraged to apply. The next cohort will begin in mid September 2021, and will continue through October and November. The program requires a dedication of about 5 hours per week.

Trojan horses and fatal flaws

https://youtu.be/0mmgIWelFbU

Monday, July 12, 2021

Wednesday, April 7, 2021

The Big Tech of Health Care - The American Prospect

The Big Tech of Health Care - The American Prospect Comment by Don McCanne UnitedHealth/Optum is BIG - the largest health care entity in the U.S. - representing that medical-industrial complex that Arnold Relman warned us about so many years ago. Well, it's here. And it is structured to make money - a lot of it - and patients just happen to be an essential element in their equation, but patient care is an expense. So much of what they do is to create administrative functions that are designed to reduce spending on patients, and, further, to increase revenues by selling those administrative services. By gaining control of much of the industry - hospitals, doctors, pharmacies, insurance functions - they are in a position to dictate the business terms for health care. So what will happen should we ever be able to enact and implement a single payer Medicare for All program? The model calls for negotiating rates with physicians, global budgets for hospitals and bulk purchasing of pharmaceuticals. How do you do that with a mega-corporation like UnitedHealth/Optum? Do you really think that they will accept government negotiations for payment rates for health care entities such as doctors, hospitals and pharmacies while not being paid for their large infrastructure that has been designed to increase revenues? Change Healthcare is a data analytics firm that is used to leverage higher revenues (profits, executive salaries, stock dividends and buybacks); it is not for the purpose of providing quality and value in patient care. Again, the entire corporation is structured to make money with patient services being a necessary expense that is to be minimized as much as possible. Will Medicare for All legislation be written in a way that we can remove passive corporate investors and excess executive salaries from the equation, thus essentially destroying the for-profit corporate structure? Would our conservative courts even uphold such limitations? Health care should be guided by a patient service ethic rather than a business ethic. Can we rein in the medical-industrial complex, or is it too late? The transition to Medicare for all will certainly cross paths with this corporate monster, and something will have to give.

Tuesday, April 6, 2021

The Age of Care | The Nation

The Age of Care | The Nation "... only a radical reconfiguration of the way that health care and other services are delivered to the American people can enhance the dignity and well-being of workers in the caregiving economy. American hospitals and their satellite enterprises must be stripped of their profit-making, empire-building propensities. And for that to happen, we will need to embrace the inherent socialization that must govern health care in our time."

Saturday, April 3, 2021

In U.S., An Estimated 46 Million Cannot Afford Needed Care

In U.S., An Estimated 46 Million Cannot Afford Needed Care Comment by Don McCanne We are spending almost $4 trillion per year on health care, the highest per capita spending of all nations, and yet, because of our dysfunctional health care financing system, far too many U.S. residents are facing potential financial hardship due to these costs. Although the COVID-19 relief bill will provide partial temporary relief for a portion of those affected, it is quite clear that, with the amount we are already spending, the health care financing system still needs major structural reform if we expect to provide affordable access to health care for everyone. Perhaps the most significant finding in this survey is that the majority now supports government action to make health care more affordable. But only 19% of Republicans favor making Medicare available to everyone, and even less, only 15%, support expanding and strengthening the Affordable Care Act. And yet over 70% of Republicans favor setting caps on out-of-pocket costs for Medicare. So do they want the government involved or don't they? Since they have come up with no reasonable alternative (medical savings accounts won't do it), we should move ahead anyway. U.S.-style private insurance is too expensive and inefficient, and they don't really want that anyway based on their opposition to the Affordable Care Act. Although other models exist, the most affordable, comprehensive and effective model is single payer improved Medicare for All. The Republicans can either join us or watch, but their inaction can no longer be tolerated.

Wednesday, March 31, 2021

The Importance of the ‘VA Advantage’ - The American Prospect

The Importance of the ‘VA Advantage’ - The American Prospect Comment by Don McCanne Opponents of single payer Medicare for All tell us, "The government can't do anything right; just look at the VA system." Yes, just look at that system - better outcomes at a lower cost. Of course, providing VA care to everyone would be more like socialized medicine through a national health service, whereas single payer Medicare for All would be a social insurance program with a private health care delivery system. Also Medicare for All would be an improved version of Medicare over what we have right now. The point is that our government can do it better, in this case through Medicare rather than through the private insurance industry, so let's let them do it. After all, it is our government, so it should work for us, not the private insurers.

Thursday, March 25, 2021

Democrats Gave Americans a Big Boost Buying Health Insurance. It Didn’t Come Cheap. | Kaiser Health News

Democrats Gave Americans a Big Boost Buying Health Insurance. It Didn’t Come Cheap. | Kaiser Health News Comment by Don McCanne This article makes an important point. President Biden and his staff, along with Congress, chose the most expensive method of expanding health care - giving more taxpayer funds to the private insurers. There is a bit of sleight of hand here since it is us - the taxpayers - who are paying these higher prices for a health care financing system heavily dependent on private insurers. Why are costs higher when we use private insurers? The author indicates that private commercial insurers pay more for health care services than government programs, and, by and large, that is correct. But that is a relatively small portion of the higher spending by private insurance, and it does not take into consideration that public programs are more effective at setting appropriate prices - costs plus fair margins - not to mention that they use more efficient financing methods such as global budgeting of hospitals. But what has been ignored in this article is the major reason that private insurers are more expensive, and that is administrative costs. Those extra taxpayer funds going to private insurers include costs such as marketing of their plans, costs of contracting for restrictive provider networks, administering prior authorization requirements, complex systems of processing claims including denial of benefits, simple administrative costs of operating large corporate entities, and distributing generous profits to their executives and passive investors. Which of these administrative services do you want to continue to pay for through increased taxes? So these increased costs that the taxpayers are bearing are not just for more health care, but they are a gift to the most expensive and inefficient financing system on earth. Particularly galling is the fact that the administration is presenting this as if it were a gift from the government to the patients, but that government money is provided by us - the taxpayers. Much of it is hidden from view since a large portion of these taxes we pay are disassociated from health care spending. Keep in mind that funds moved into the health care financing system are not available for other important needs such as food, housing, transportation, education, environment, infrastructure, and so on. A single payer Medicare for All program would fill in our health care financing needs without wasting the hundreds of billions of dollars on these superfluous administrative costs of the private insurers, plus their profits. But they are now talking about making these wasteful expenditures permanent. Maybe they might even add a public option, which would be only one more player in our profoundly inefficient system. As the title of Noam Levey's article indicates, the big boost was in buying health insurance rather than simply health care, and it didn't come cheap. As Paul Starr states, we ended up adding on to an incredibly expensive system. We didn't have to do that. We can still redirect our course toward an efficient, equitable system for all. After all, it's our money, and yet progressive taxation makes health care affordable for all since it is simply based on the ability to pay. That is certainly more efficient than playing games with taxpayer subsidies for premiums and cost sharing for expensive, self-serving private insurers.

Saturday, March 20, 2021

Finishing the Job: Americans Want Action on the Cost of Health Care This Year, New Poll Shows - Families Usa

Finishing the Job: Americans Want Action on the Cost of Health Care This Year, New Poll Shows - Families Usa Comment by Don McCanne The history of Families USA and Physicians for a National Health Program dates back to the Clinton administration effort to expand health care to everyone. When Bill Clinton was offered the choice of a market of private health plans or a single payer national health program, he chose the former - the plan of Families USA. Anyone around then certainly remembers that failure. Later, "President Barack Obama credited Families USA with playing an instrumental role in promoting the enactment of the ACA and for the organization's work helping to implement and protect the historic health legislation." (Wikipedia) But after a decade of ACA, we still have serious deficiencies in our health care financing system: tens of millions uninsured, tens of millions underinsured with excessive out-of-pocket cost sharing, narrow provider networks that limit choices in health care, high prices, diversion of health care dollars to passive investors, inequity in access to health care, and profoundly excessive administrative services which have made us the most expensive system on earth, in spite of all its deficiencies. What do people want? The recent polling from Families USA and Hart Research Associates shows that people want affordable health care and affordable prescription drugs, and they want action now. Three-fourths of voters say that health reform should be a high priority this year: 91% of Democrats, 75% of independents, and 58% of Republicans. Support holds across racial, geographic, and gender differences. Over 80% of voters across various demographic groups and political preferences believe that the health care system today works more for the benefit of the insurance and drug industries than the average person. Voters are concerned that Congress will not go far enough to make changes to the heath care system, outweighing their concern that Congress might go too far. Families USA has had a quarter of a century to prove that the private insurance market should be the primary source of health care financing in the United States. Based on the wishes of American voters, that model has woefully failed. Even their own poll indicates that people want the system fixed now, and not by the private insurance industry. A quarter of a century ago, President Clinton said that the single payer model was the better plan but that he was going to go with Ron Pollack's Families USA private insurance market plan. That was clearly a mistake. President Obama's tweaks were somewhat beneficial but again fell far short because he left the private insurers in place in the financing infrastructure. President Biden and Congress now have the chance to rectify those errors by enacting and implementing a single payer system of Medicare for All. But we cannot allow the wishes of America to be hidden in a poll. We need to raise our voices in a deafening roar that will be heard throughout the nation, and especially in the White House.

Friday, March 12, 2021

Providers Blast Medicare Spending Cuts in COVID Relief Package

Providers Blast Medicare Spending Cuts in COVID Relief Package Comment by Don McCanne The American Rescue Plan Act of 2021 - a much needed $1.9 trillion economic stimulus bill - was signed into law by President Joe Biden this week. But as the celebration dies down, we should address what some may say are the "intended" consequences of this bill. It's a godsend to the private insurance industry, and, further, it doesn't just move the concept of a single payer Medicare for All program to the bottom of the policy heap, it actually dumps the heap into a shredder as the private insurance industry capitalizes on control of health care financing in America. For providers who are celebrating, they should remind themselves of the pending automatic spending cuts in Medicare. Nice penalty for a job well done. We really can fix this so everyone - the patients and their partners in the health care delivery system - can fare well. We merely need to enact and implement a single payer, improved Medicare for All program. Do you think we can get it done before the sunset of the two year provisions in the economic stimulus plan? It will be an uphill struggle when the Biden administration keeps dismissing us with the claim, "We've already fixed health care!" Yes, for the private insurers, but we can do much better by targeting the patients instead.

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 https://global.oup.com/academic/product/medicare-for-all-9780190056629 or https://medicareforallbook.com/ === 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

Saturday, February 6, 2021

Friday, January 29, 2021

Prescription Drug Prices in the United States Are 2.56 Times Those in Other Countries | RAND

Prescription Drug Prices in the United States Are 2.56 Times Those in Other Countries | RAND Comment by Don McCanne This current RAND study confirms that U.S. drug prices were 256 percent of drug prices in other countries, while brand name originator drugs were 344 percent of prices in other countries. Although these brand drugs represented 82 percent of U.S. prescription drug spending, they accounted for only 11 percent of U.S. prescription drug volume. High prices indeed. The one positive note is that 84 percent of U.S. prescription drug volume is for unbranded generics, but it represented only 12 percent of prescription drug spending at manufacturer prices. However the large volume of low cost generics does not make up for the exorbitant prices of the brand name originator drugs. We are continuing to spend way too much on brand name drugs. Think of all of the television ads that you see for these expensive drugs. Although the authors recommend further analyses of these relationships, it really is time to switch to government administered pricing which we could easily do by enacting and implementing a well designed, single payer, improved Medicare for All. Decades of relying on markets has just not been effective.

Tuesday, January 26, 2021

How to Win Medicare for All Under President Biden - In These Times

How to Win Medicare for All Under President Biden - In These Times "... we have an opportunity to organize like never before to finally achieve a universal, single-payer healthcare system. Let’s seize it."

We can easily afford to include everyone in Medicare for All - PNHP

We can easily afford to include everyone in Medicare for All - PNHP: Share on FacebookShare on Twitter By Adam Gaffney, David U. Himmelstein, Steffie Woolhandler, and James G. Kahn Health Affairs, January…read more Medicare for all would greatly reduce the administrative waste by eliminating the private insurers, saving hundreds of billions of dollars, plus prices would be set at a lower level - enough to cover costs plus fair profit margins.