Wednesday, March 31, 2021
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.
Posted by Craig at 7:07 AM
Tuesday, March 30, 2021
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.
Posted by Craig at 11:41 AM
Monday, March 22, 2021
Sunday, March 21, 2021
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.
Posted by Craig at 7:43 AM
Friday, March 12, 2021
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.
Posted by Craig at 3:31 PM
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.
Posted by Craig at 1:06 PM