CMS Smothers Us with Inconsequential Regulations for Medicare Advantage

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December 22, 2022 No Commentson CMS Smothers Us with Inconsequential Regulations for Medicare Advantage Summary: The Center for Medicare and Medicaid Services (CMS) just released 957 pages of proposed regulations for Medicare Advantage (MA). Despite the massive verbiage, and purported reflection of public comments, they fail to remedy the fundamental dynamics that make MA so lucrative for private insurers and so inadequate for sick enrollees. U.S. Health Officials Seek New Curbs on Private Medicare Advantage Plans The New York Times December 17, 2022 By Reed Abelson and Margot Sanger-Katz Federal health officials are proposing an extensive set of tougher rules governing private Medicare Advantage health plans, in response to wide-scale complaints that too many patients’ medical claims have been wrongly denied and that marketing of the plans is deceptive. Despite their popularity, the plans have been the subject of considerable scrutiny and criticism lately. A recent report by the inspector general of the U.S. Department of Health and Human Services found that several plans might be inappropriately denying care to patients. And nearly every large insurance company in the program, including UnitedHealth Group, Elevance Health, Kaiser Permanente and Cigna, has been sued by the Justice Department for fraudulently overcharging the government. The period leading up to this year’s enrollment deadline, Dec. 7, amplified widespread criticism about the deceptive tactics some brokers and insurers had used to entice people to switch plans. In November, Senate Democrats issued a scathing report detailing some of the worst practices, including ads that appeared to represent federal agencies and ubiquitous television commercials featuring celebrities. Federal Medicare officials had said they would review television advertising before it aired, and the new rule targets some of the practices identified in the Senate report that caused some consumers to confuse the companies with the government Medicare program. A proposed regulation would ban the plans from using the Medicare logo and require that the company behind the ad be identified. Federal Medicare officials had said they would review television advertising before it aired, and the new rule targets some of the practices identified in the Senate report that caused some consumers to confuse the companies with the government Medicare program. A proposed regulation would ban the plans from using the Medicare logo and require that the company behind the ad be identified. The new proposal would require plans to disclose the medical basis for denials and rely more heavily on specialists familiar with a patient’s care to be involved in the decision-making. Dr. Meena Seshamani, the director of the Center for Medicare and a deputy administrator at the Center for Medicare and Medicaid Services, said the changes had been influenced by thousands of public comments solicited by the agency and by lawmakers. “The proposals in this rule we feel would really meaningfully improve people in Medicare’s timely access to the care they need,” she said. Hospitals, which have been pushing for changes that would address their concerns that insurers were abusing prior authorization, applauded the proposals. The proposed regulations are not yet final. Health officials are soliciting comments from the public and may make changes. Comment by: Don McCanne The Feds are finally listening to the uproar against the privatized Medicare Advantage plans and all of their abuses. Or are they? Let’s see. CMS proposed a 957 page set of rules which you can read and respond to by February 13, 2023. Actually reviewing the first 72 pages should be adequate since it contains the Executive Summary. Therein you will find that our bureaucrats are attacking issues such as warning insurers that if they use the Medicare logo we will tell on them, though using the term “Medicare” is still acceptable. Addressing evidently more significant problems, as an example Medicare will mandate that prior authorization reveal clinical justifications and incorporate expert review. But this is a micro-fix; the real issue is that insurers don’t want patients who need expensive health care and will continue to make getting care difficult so that patients switch to other coverage. The lawsuits they face for denying coverage are a drop in the bucket compared to the billions they rake in by avoiding expensive care. Most private Medicare Advantage patients are relatively healthy and thus not dissuaded by limited provider panels or lack of access to centers of excellence that they don’t need right now, if they can have their teeth cleaned or join an exercise club. It really isn’t their concern that extra taxpayer dollars are diverted to enrich these private plans. Sorry, burying us in 957 pages of rules is not going to cut it. The privatization of Medicare, as a wealth-creating business model, has significantly damaged the program and these rules are only camouflage for perpetuating it. Our traditional Medicare program has some real problems that need to be addressed, and that is where the effort should have been directed. As a public program the traditional program is designed to serve all of us well, whereas the private Medicare Advantage model is designed primarily to serve business interests. Sadly, our government is going to use this proposed rule to try to convince us that they are addressing the Medicare privatization issue. They clearly are not. They have been listening to us but not acting on what we say. We need to turn the volume up even higher. Let’s throw out the privatizers and enact a single payer Medicare for All system. Then we can have Health Justice for All!

A Rural Hospital’s Excruciating Choice: $3.2 Million a Year or Inpatient Care?

"...the “prohibition” on inpatient services was set by Congress ..." Congress is being controlled by big-money donors and their hired lobbyists. Too many of the big city hospitals have been taken over by for-profit corporations. Seems they want to force us small-town folks to be transferred at our cost and our risk to fill their pockets. Other than that quote this article seems to miss that point. https://www.nytimes.com/2022/12/09/health/rural-hospital-closures.html

In Health Care pay for performance does not work..Profit is not the goal

Study Calls Medicare Pay-for-Performance Program Results Into Question — MIPS doesn't consistently correlate with process, outcome measure performance in primary care by Crystal Phend, Contributing Editor, MedPage Today December 6, 2022 https://www.medpagetoday.com/practicemanagement/reimbursement/102090

Bill Kaplan: South Dakota expands Medicaid

"What is Wisconsin waiting for? Wisconsin is losing out on $ billions of federal funding and coverage for an additional 90,000 Wisconsinites, mostly low-income working adults." Full Article “South Dakota is one of the most Republican states in the nation. … In the 2020 presidential election, President Donald Trump won in a 26-point romp” (Almanac of American Politics). However, on November 8, South Dakota voted for a constitutional amendment to expand Medicaid by a vote of 56% to 44%. It joins 38 other expansion states, including many GOP-led and most Midwest states except Kansas and Wisconsin. Although the Kansas GOP-led legislature did pass Medicaid expansion, it was vetoed by Republican Governor Sam Brownback. Wisconsin remains an outlier. The South Dakota ballot measure was strongly supported by the South Dakota Chamber of Commerce and Industry, the State Medical Association (SDSMA) and the South Dakota Association of Healthcare Organizations (SDAHO). The business group said: “The South Dakota Chamber of Commerce and Industry believes that expanding Medicaid will have a positive impact on helping people in low wage jobs secure healthcare services and remain in the workforce as healthier people.” Doctors said: “The SDSMA advocates not just for adequate funding for the Medicaid program, but for Medicaid eligibility expansion … .” And, hospitals (SDAHO) said: “Its passage will provide the opportunity for more South Dakotans to have access to affordable healthcare coverage.” South Dakota, like Wisconsin, is rural and agricultural. The state Farmers Union praised the vote: “Medicaid expansion will be a crucial opportunity for farmers and ranchers across South Dakota to accept affordable healthcare coverage for the first time. … This will allow farmers and their families to keep tradition alive and keep taking advantage of the opportunities living in rural communities provides.” “In addition to the 90% federal matching funds available under the ACA (Affordable Care Act) for the (Medicaid) expansion population, states can also receive a 5 percentage point increase in their regular federal matching rate for 2 years after expansion takes effect. The additional incentive applies whenever a state newly expands Medicaid and does not expire” (Kaiser Family Foundation). What is Wisconsin waiting for? Wisconsin is losing out on $ billions of federal funding and coverage for an additional 90,000 Wisconsinites, mostly low-income working adults. Medicaid eligibility expansion will be needed to cover thousands of other Wisconsinites who will lose their eligibility when the COVID public health emergency is ended. Moreover, Joan Alker, Georgetown University’s Center for Children and Families, said: “We have over 400 studies showing why Medicaid expansion is a good thing. It has not busted the budgets of the states that have done it, it’s supported their budgets, it’s reduced mortality, it’s improved health outcomes, it’s supported hospitals – the evidence is piling up. And, so saying ‘no’ is getting harder and harder.” Time for Wisconsin to move forward. State doctors and healthcare executives must provide persistent leadership. Finally, I implore retired GOP state Senators Luther Olsen and Dale Schultz, both supporters of Medicaid expansion, to form an advocacy expansion lobby with business, civic, healthcare, labor and political leaders – “Wisconsinites for Common Sense on Healthcare Coverage.” We can do this and join the now 39 expansion states.

US Hospital Money Machine

Summary: US hospitals use aggressive business models (mergers, high prices, & marketing of lucrative services) to drive up revenues. For-profit hospitals benefit investors, but even not-for-profits act similarly, with huge financial rewards for participants. Single payer’s hospital global budgeting would remove these perverse incentives. Hospital Billing Is a Crime Against American Patients The American Prospect November 22, 2022 By Robert Kuttner Most hospitals in the U.S. are either for-profits, or nominal nonprofits like large teaching hospitals that behave just like for-profits. Their goal is to maximize market share, particularly for the most lucrative specialized procedures. That means they spend a great deal of capital, not just on acquisitions but on construction of new facilities (that may be redundant in many cities) and on new costly equipment. U.S. hospitals have triple the capital costs of Europe’s hospitals. Meanwhile, every major European nation not only spends far less on health care but has much better outcomes in terms of every major health indicator. Medicare could save taxpayers a lot of money. Why are they so timid? Because hospitals in many areas are the largest and most politically powerful local employers, even more so when they are teaching hospitals connected to universities. One of the many regulatory failures of antitrust in the U.S. is the nearly complete failure to challenge hospital mergers and acquisitions, which have created monopoly power and degraded services in city after city. Even worse, many of these merger binges are by hospital systems that are nominal nonprofits. There is no direct price regulation in the U.S., so hospitals are free to charge what they think the market will bear. Hospitals also overuse specialists, who can bill at higher rates. Executive pay is also exorbitant. A variety of market-friendly techniques were devised to contain costs. Hospitals proved expert at gaming all of them. Until recently, advocates of single-payer health care have focused on comprehensive coverage but less so on the abuses of profit-maximizing medicine. If we went to Medicare for All but did not reform these billing practices and did not end the system of profit-maximizing medicine entirely, these excess costs would simply be piled onto taxpayers. Rep. Pramila Jayapal’s current Medicare for All bill does best at addressing these abuses, and Bernie Sanders’s latest version is more attuned to them than his earlier bills. Under Jayapal’s bill, co-sponsored by about half of the House Democratic caucus, the system would keep some elements of fee-for-service medicine and diagnosis-related coding, but hospitals would operate under “global” budgets. That is, they would receive an annual flat sum from the government that would be adjusted regularly to reflect caseloads. Medical education—one of the ways that teaching hospitals pad bills—would be its own separate budget item. Capital outlays and staffing ratios would be regulated. Incentive compensation aimed at gaming the system would be prohibited. There would be much greater emphasis on primary care. This legislation, which merely reflects common practices in most European nations, is at the outer fringe of what is even debated in the U.S. It is a reminder of how inefficient as well as unjust is market-led medicine, and how incremental reforms can never repair our broken health system. Comment by: Don McCanne Although we have the most expensive health care system in the world, it performs very poorly by international standards. We have far too many who are uninsured or underinsured and thus suffer financial hardship, and our system has too many features designed to direct health care dollars to the wealthy rather than to the patients where the need is so great. This article by Robert Kuttner demonstrates that another defect is in one of the most basic elements of our health care system: our hospitals! Hospitals have not escaped much of the fragmented and dysfunctional design defects that characterize our health care system. As a glaring example, our nominally nonprofit hospitals, which should be dedicated to providing health care to the most needy, frequently engage in activities that make the rich (e.g., prodigiously paid CEOs and procedural specialists) richer as unmet community care needs should make us cry out for universal insurance. Yet where are our reform activities directed? Our current government, which is supposedly more progressive than the alternative, has been busy converting our public Medicare program into private insurance plans, via heavily marketed but optional Medicare Advantage and now involuntary Direct Contracting through the REACH program. Meantime, ownership of the actual health delivery system is passing to private investors through private equity and other innovative business constructs designed to siphon off the massive pool of health care dollars that we have but are not using in the high performance system that our nation deserves. What is wrong with us? For decades we have known that a well-designed single payer system, using an improved version of Medicare, would serve all of us well. As we have stalled and deferred, allowing inadequate, dysfunctional, incremental measures to substitute for reform, we have allowed our health care system to feed the injustice of wealth inequities such that we now have a much greater legislative problem than merely establishing a universal public health insurance program. That makes it all the more urgent to act now. The shift of wealth to the top is a rapidly accelerating process. We are not talking about some vague population in the future. We are talking about our grandchildren and even our children. Look around at the medical needs that our aging friends face. How can we be so callous as to not ensure that those needs will be met for all of us in the future. Now is when we have to act! Dammit, now!

Red vs Blue - sent from Joel Clemmmer

https://hartmannreport.com/p/if-you-want-to-die-young-take-the?utm_source=post-email-title&publication_id=302288&post_id=85778050&isFreemail=true&utm_medium=email "Talk radio commentator and amateur researcher Thom Hartmann summarizes a political/geographic perspective on public health. The numbers are stark and tell a clear and compelling story. That said, i'm not with Hartmann on claiming that non-profit status makes such a big difference in health organization behavior. Minnesota's non-profits seemed to recklessly pursue revenue, as well. Sidebar: there is a story to tell about states like Montana, South Dakota and North Dakota where there are such stark differences among adjacent counties. I'm guessing the presence of reservations and/or oil boom territory." - Joel *** If You Want To Die Young - Take the Red Pill As giddy as Republicans are about “owning the libs,” the citizens they govern pay a tragic price for the sport Thom Hartmann Nov 21 Image by Septimiu Balica from Pixabay Share If dying young appeals to you, here’s a simple bit of advice: move to a state or county controlled by Republicans. At first glance, the images below appear to be political maps. And in the most real sense of the word they are: the county-by-county differences shown by the map from Jeremy Ney’s brilliant American Inequality Substack newsletter and the state-by-state screen shot from the CDC’s NCHS below it. Both reflect, in large part, decades of regional policy differences. Long-lived parts of America have generally embraced progressive policies dating back to FDR’s New Deal; the early-death parts of our country most often reflect conservative opposition to everything from the working-class wealth that unionization and higher minimum wages bring, to the availability of healthcare through Medicaid expansion. https://substackcdn.com/image/fetch/w_1456,c_limit,f_webp,q_auto:good,fl_progressive:steep/https%3A%2F%2Fbucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com%2Fpublic%2Fimages%2Feb553faf-565e-477b-948f-f746b7480c81_1240x1042.png Source: American Inequality by Jeremy Ney on Substack 2019 Life Expectancy by State — Source: National Center for Health Statistics of the Centers for Disease Control To zoom out ever farther, since many conservative policies affect the entire country, consider what happened to the health of our nation in the 1980s with the Reagan Revolution. It’s particularly visible when you compare the outcomes of our healthcare system with other developed countries. Our World In Data lays it out starkly, as you will see below. Prior to the neoliberal Reagan Revolution — following a bill Nixon signed in 1973 that opened the door to for-profit HMOs — most hospitals and health insurance companies were non-profits. The non-profit Blue Cross/Blue Shield controlled much, perhaps most, of the US health insurance market until that era. Reagan also, in 1983, ordered the DOJ, FTC, and SEC to essentially stop enforcing anti-trust laws dating back to the 1891 Sherman Act, resulting in the “Mergers & Acquisitions Mania” that characterized the 1980s and inspired the “greed is good” movie Wall Street starring Michael Douglas. Health insurance companies, hospitals, and pharmaceutical manufacturers all morphed from regional and competitive organizations into giant, monopolistic predators. Their profits exploded and our lifespans collapsed. Every year now, they spread hundreds of millions of dollars around Washington DC and state capitols to prevent regulation and maintain the status quo. We are, quite literally, the only country in the world with a corrupt Supreme Court that has legalized this kind of a vicious attack on its citizens by a bought-off political party and their morbidly rich donors. The Republicans on the Supreme Court call it “free speech” but every other nation in the world knows it’s simply naked, criminal, political bribery. Le vs health exp 2020 version Source: Our World in Data As you can see above, the average American spends more than twice as much on healthcare every year as do the citizens of any other developed country in the world. And, as the Reagan Revolution really bit hard in the 1980s and 1990s, our average lifespans collapsed while corporate healthcare profits exploded. And it’s not just death by lack of healthcare that skews these statistics: if you’re concerned about being murdered, it’s also a good idea to avoid states run by conservatives. As the centrist Third Way think tank noted last month: “In 2020, per capita murder rates were 40% higher in states won by Donald Trump than those won by Joe Biden. “8 of the 10 states with the highest murder rates in 2020 voted for the Republican presidential nominee in every election this century.” It’s true of Red cities as well. Again, from Third Way: “For example, Jacksonville, a city with a Republican mayor, had 128 more murders in 2020 than San Francisco, a city with a Democrat [sic] mayor, despite their comparable populations. “In fact, the homicide rate in Speaker Nancy Pelosi’s San Francisco was half that of House Republican Leader Kevin McCarthy’s Bakersfield, a city with a Republican mayor that overwhelmingly voted for Trump.” And don’t even think about having sex in Red states: they generally lead America in sexually transmitted diseases, presumably because most have outlawed teaching sex education in their public schools. The five states with the highest rates of Chlamydia infections are Alaska, Louisiana, Mississippi, South Carolina, and New Mexico. The highest rates of Gonorrhea are in Mississippi, Alaska, South Carolina, Alabama, and Louisiana. Speaking of schools, the states with the lowest educational attainment in the nation are entirely Red states. Ranked from terrible to absolutely worst, they are: Idaho, Indiana, Oklahoma, Alabama, Nevada, Louisiana, Kentucky, Arkansas, Mississippi, and West Virginia. As giddy as Republicans are about “owning the libs,” the citizens they govern pay a tragic price for the sport. They are literally dying as conservative politicians revel in their ability to cut taxes for the rich and suppress wages and healthcare for everybody else. Republicans are about to take over the House of Representatives and begin their “investigations” into, well, anything that will distract from these terrible statistics. In the meantime, Americans, particularly those in Red states and counties, will continue to die at rates considered obscene by the standards of every other developed nation in the world. Our next chance to put America back on track will be in two years, and we damn well better get ready.

Medicare, Medicare Advantage, Medical Assistance expansion, OR Single Payer

Article link: https://buffalonews.com/lifestyles/health-med-fit/a-traumatic-brain-injury-and-500k-in-medical-debt-it-feels-unbearable-sometimes/article_d87cf454-fcba-582e-8a13-79f8ccfafcbe.html   We need to keep sharing these stories/facts about the need to stop this in the USA and join all the modern countries that don’t allow this to happen. “Mais isn’t alone. One in every five people in Texas has medical debt that is in collections, one of the highest rates in the U.S.; medical debt has become a nationwide crisis, with 13% of U.S. adults impacted by past-due medical bills, according to data collected by the Urban Institute, a Washington, D.C., public policy think tank.” After I read that article I saw this column in our local small-town daily: "Healthful Hints: Medicare, Medicare Advantage plans: Basic differences" https://www.winonadailynews.com/news/local/column/healthful-hints-medicare-medicare-advantage-plans-basic-differences/article_4df87355-1852-50d8-95f9-339d36a0b161.html   Then I submitted this LTE to the paper: Health Care Access Thank you so much for the front page article Sunday (11/13/22) about medical debt. That is a problem for so many in this country. We need to learn from other developed countries about how to avoid this problem. We have been brainwashed to think that inability to pay for unexpected medical costs is somehow a personal weakness and a way of begging other citizens to pay our bills. Big-money corporations have been responsible for our lagging behind the rest of the modern, caring world. Most of that money is with for-profit insurance companies who are now taking over more and more of our actual medical providers. (BTW – insurance companies DO NOT provide care – they make money by not caring). Then on page 5 of the 11/13 edition, you had the Dr. Bures column. This time he talked about Medicare. He does not take sides but he does show the difference between Medicare and Medicare Advantage. I have been retired and covered by Medicare for many years. I am so grateful to the insurance agent who years ago recommended regular Medicare with a supplemental plan of my own instead of the Advantage plan offered by insurance companies. It provided me with freedom of choice and has worked well. Insurance companies give millions to members of congress and spend millions on advertising to keep making more and more money off of our need for medical care. I don’t want a for-profit company between me and my medical providers. We need to do what so many countries have done and make a simple single-payer medical care payment system part of how we treat our citizens. It should be treated like public schools, public roads, fire departments, police departments, etc. The government pays our private providers. Our access to health care without the risk of bankruptcy should NOT be in the hands of for-profit companies. Craig Brooks

A traumatic brain injury and $500k in medical debt: 'It feels unbearable sometimes'

Article about just how unbearable it is and that it should be for our country to allow this to happen to so many. Link to article "Mais isn’t alone. One in every five people in Texas has medical debt that is in collections, one of the highest rates in the U.S.; medical debt has become a nationwide crisis, with 13% of U.S. adults impacted by past-due medical bills, according to data collected by the Urban Institute, a Washington, D.C., public policy think tank."

Private Equity is Not Good for Your Health

Why Are Political Barriers to Health Reform So Great?

Why Are Political Barriers to Health Reform So Great?

Two Women Prioritize Helping the Public over Protecting the Rich – McCanne Health Justice Monitor

Two Women Prioritize Helping the Public over Protecting the Rich – McCanne Health Justice Monitor

What you need to know about Medicare Advantage Article from PNHP

From UpNorthNews First-of-Its-Kind Universal Health Care Referendum on the Ballot in Rural, Red Wisconsin County Voters in Dunn County, which includes the town of Menomonie in western Wisconsin, will have a chance to weigh in on a very important, albeit unusually progressive, question this November: Should the United States provide universal health care? Earlier this summer, the Dunn County board unanimously approved the advisory referendum. Like other referendum questions about abortion rights or marijuana legalization, it won’t change any laws. But advocates say it could eventually lead to change. Why You Should Care This is the first time a referendum like this is on the ballot in Wisconsin, and Dunn County, in many ways, is an unlikely place to have taken up the question. Fifty-six percent of voters in the rural, western Wisconsin county voted for Republican former President Donald Trump in 2020, and only 42 percent voted for Democrat Joe Biden. Democrats have made universal health care one of their policy priorities while Republicans in Wisconsin have resisted expanding Medicaid and other steps in that direction. What Next? Dunn County Board member John Calabrese, who was part of the effort to introduce the referendum, hopes this referendum will be part of a shift away from seeing expanded health care coverage as a left-vs.-right issue. "I think we can speak to this issue in a way that's not partisan," Calabrese said. Wisconsin polls show our state is split on healthcare. During the 2020 presidential primary, the Marquette University Law School poll found 41 percent of respondents favored Medicare for All, while 53 percent opposed it. A different 2020 poll from Change Research found 60 percent of Wisconsin respondents favored lowering health costs, while only 30 percent favored guaranteeing universal coverage. Our View Commentary by Founding Editor Pat Kreitlow Putting this resolution on the ballot was an idea approved unanimously by the Dunn County Board of Supervisors. Every member—conservative or progressive—sees what Republicans at higher levels refuse to acknowledge: America’s healthcare system—controlled in large part by for-profit insurance corporations—is unsustainable. The time for party politics is over, and leaders of all political stripes need to sit down and answer a question about “what would work better” rather than “how can I use this issue to win elections?” Wisconsin voters now have a chance to tell Congress they, too, should move forward with discussions of how a non-profit national health plan could work. People want solutions, not more partisan games. The Bottom Line Universal health care or not, the country's healthcare system needs to change. Dunn County Board member Monica Berrier put it best: "I don't know how anybody can look at this and think it’s a good situation, but it's the system that we're stuck with. We have a responsibility to demand better of the government that serves us." https://mailchi.mp/couriernewsroom/vote-this-week-the-nicest-player-in-the-nl-central-12644163?e=536c8c7421

New for Medicare

https://indivisible.actionkit.com/mailings/view/79847?t=8&akid=79847%2E513975%2Ef7Z75T

Racism in the Inflation Reduction Act: No Medicaid Expansion – McCanne Health Justice Monitor

Racism in the Inflation Reduction Act: No Medicaid Expansion – McCanne Health Justice Monitor

REACH Won’t Fix the Equity Harms of Value-Based Care – McCanne Health Justice Monitor

REACH Won’t Fix the Equity Harms of Value-Based Care – McCanne Health Justice Monitor

What’s Wrong With Health Insurance? Deductibles Are Ridiculous, for Starters. July 7, 2022 By Aaron E. Carroll, NYT

Dr. Carroll is the chief health officer of Indiana University and writes often on health policy. More than 100 million Americans have medical debt, according to a recent Kaiser Health News-NPR investigation. And about a quarter of American adults with this debt owe more than $5,000. This isn’t because they’re uninsured. More often, it’s because they’re underinsured. The Affordable Care Act was supposed to improve access to health insurance, and it did. It reduced the number of Americans who were uninsured through the Medicaid expansion and the creation of the health insurance marketplaces. Unfortunately, it has not done enough to protect people from rising out-of-pocket expenses in the form of deductibles, co-pays and co-insurance. Out-of-pocket expenses exist for a reason; people are less likely to spend their own money than an insurance company’s money, and these expenses are supposed to make patients stop and think before they get needless care. But this moral-hazard argument assumes that patients are rational consumers, and it assumes that cost-sharing in the form of deductibles and co-pays makes them better shoppers. Research shows this is not the case. Instead, extra costs result in patients not seeking any care, even if they need it. Cost-sharing isn’t set up in a thoughtful way such that it might steer people away from inefficient care toward efficient care. Deductibles are, frankly, ridiculous. The use of deductibles assumes that all medical spending is the same and that the system should disincentivize all of it, starting over each Jan. 1. There is no valid argument for why that should be. Flu season peaks in the winter. We were in an Omicron surge at the beginning of this year. Making that the time when people are most discouraged from getting care doesn’t make sense. Co-pays and co-insurance aren’t much better. They treat all patients the same, and they assume that all patients should be treated the same way. In a National Bureau of Economic Research working paper published last year, researchers looked at how increases in cost-sharing affected how older adults, who are more likely to need care, pay for and use drugs. Remember, people age 65 and older in the United States are insured with what most consider to be rather comprehensive coverage: Medicare. The researchers claimed, however, that a simple $10 increase in cost-sharing, which many would consider a small amount of money, led to about a 23 percent decrease in drug consumption. Worse, they said it led to an almost 33 percent increase in monthly mortality. In other words, making seniors pay $10 more per prescription led to people dying. These seniors weren’t taking optional, esoteric, exceptionally expensive medications. This finding was for drugs that treat cholesterol and high blood pressure. In fact, they were considered “high value” drugs because they were proven to save lives. Further, those at higher risk of a heart attack or stroke were more likely to cancel their prescriptions than people at lower risk. People are not smart shoppers or rational spenders when it comes to health care. When you make people pay more, they consume less care, even if it’s for lifesaving treatment. Moreover, a $10 increase in drug cost-sharing is small potatoes compared with what most people have to pay out of pocket for care each year. The average deductible on a silver-level plan on the A.C.A. exchanges rose to $4,500 in 2021. If people tried to buy plans with a lower premium, at a bronze level, the average deductible rose to more than $6,000. Granted, some cost-sharing reductions are available for those who make less than 250 percent of the federal poverty line, but even after accounting for those, the average deductible was more than $3,100 for silver plans. Those who receive insurance from their employers aren’t much better off than those who buy on the A.C.A. marketplaces. The average deductible for insurance offered by large companies in the United States was more than $1,200. At small companies, it was more than $2,000. Those are only the deductibles. After they are paid, people must still cover co-pays and co-insurance until they hit the out-of-pocket maximums. The good news is that the A.C.A. limits these in plans sold in the exchanges. The bad news is that they’re astronomical: $8,700 for an individual and $17,400 for a family. A large majority of Americans don’t have that kind of money sitting in accounts, certainly not after paying an average of about $5,000 in premiums each year for a benchmark individual silver plan. Half of U.S. adults don’t have even $500 to cover an unexpected bill. Anyone who requires significant health care will be out the entire deductible, meaning thousands of dollars, and if severely ill, is likely to hit the out-of-pocket maximum. Of course Americans are in medical debt. The Kaiser Family Foundation estimates the country’s collective medical debt is almost $200 billion. It’s worth noting that the cost of health care in the United States is so high that even expensive premiums are not enough to cover the full amount without significant out-of-pocket spending. That doesn’t mean no better options exist for cost-sharing. We could treat those with diagnosed chronic diseases differently, as many countries in Europe do. It makes sense to try to disincentivize healthy people from overtreatment, but lots of people, including me, need care that costs money every day. It makes no sense to try to persuade me to rethink that. U.S. leaders could also consider adapting a reference pricing system, where the health system determines what constitutes the lowest-cost, highest-quality care and makes that available without any out-of-pocket spending. Cost-sharing can then be applied to other options that might cost more or have less evidence behind them. The purpose of insurance is to protect people from financial ruin if they face unexpected medical expenses. Reducing the amount that they need to pay from six figures to five is necessary, but not sufficient. It’s not enough to give people insurance. That insurance must also be comprehensive.

US could have saved 338,000 lives from Covid with universal healthcare, study finds | US healthcare | The Guardian

US could have saved 338,000 lives from Covid with universal healthcare, study finds | US healthcare | The Guardian

Medical Debt in the US: Pervasive, Harmful, Unnecessary – McCanne Health Justice Monitor

Medical Debt in the US: Pervasive, Harmful, Unnecessary – McCanne Health Justice Monitor

Analysis of the 2022 Senate Medicare-for-All legislation

From PNHP: What’s in the Bill? Benefits: Covers all medically-necessary services including primary and preventive care, mental health care, reproductive care including abortion (with a ban on the Hyde Amendment), vision and dental care, prescription drugs, and home- and community-based long-term services and supports. Patient Choice: Provides full choice of any participating doctor or hospital. Providers may not dual-practice within and outside the Medicare system. Patient Costs: Provides first-dollar coverage without premiums, deductibles, or copays for medical services, and prohibits balance billing. Does require small copays for some brand-name prescription drugs. Eligibility: Covers everyone residing in the U.S. regardless of immigration status. Cost Controls: Prohibits duplicative coverage, negotiates drug prices with manufacturers, and funds hospitals through global operating budgets. Timeline: Provides for a four-year incremental transition to Medicare for All. What’s different in this year’s version? The 2022 bill includes some major improvements from the 2019 version, bringing it closer to the PNHP’s gold standard as established by the Physicians Proposal. Global budgeting of hospitals and other institutional providers: Global budgets would fund hospitals with annual lump sum payments which can be used for patient care — not for profits, advertising, or executive bonuses — with separate funding for capital projects. PNHP estimates that global budgets would save $220 billion per year; they would also prevent hospital closures by providing facilities in rural and other underserved communities with stable funding, which can be quickly supplemented during public health emergencies. Global budgets also promote health equity by funding services and capital projects based on community health needs (i.e., mental health, obstetrics, and HIV care), not what’s most profitable for hospitals (i.e., elective surgeries). Standardized fee-for-service payments to providers: Establishes a national fee-for-service schedule for individual and group providers, similar to language in the House bill (H.R. 1976). Expanded benefits: Provides transportation for seniors with functional limitations, and expands mental health care by covering licensed marriage and family therapist and licensed mental health counselor services. Office of Health Equity: Establishes an Office of Health Equity to monitor and eliminate health disparities, and promote primary care. How could the bill be improved? Cover all long-term care (LTC): While community-based LTC supports would be covered by Medicare for All, institutional LTC remains within Medicaid, preserving the state-based variations that contribute to inequities, injustice, and complexity. PNHP recommends moving all LTC services into Medicare for All. Shorten transition period: The four-year transition period gradually expands Medicare’s benefits and lowers the eligibility age, along with a “buy in” scheme that includes commercial Medicare Advantage plans. The transition period is needlessly complex, delays access to care for the most vulnerable patients, and could exacerbate inequalities. PNHP recommends a one-year transition. Eliminate prescription drug costs and strengthen price negotiations: While drug co-pays are lower than the 2019 bill, even modest cost-sharing is a proven barrier to care. PNHP recommends eliminating all patient cost-sharing. While the bill does authorize Medicare to negotiate drug prices, it lacks certain safeguards if negotiations fail, such as direct procurement of drugs. PNHP recommends competitive drug licensing, direct procurement of drugs, and other safeguards if price negotiations fail. Ban (and buyout) investor-owned health facilities: This bill does not explicitly ban for-profit health facilities and agencies, which provide lower-quality care at higher costs than nonprofits. PNHP recommends an orderly conversion of investor-owned, for-profit providers to not-for-profit status.

HJM: Repeat -- Medicare Advantage & Other Private Investment Hurt Medicare

http://healthjusticemonitor.org/2022/06/07/repeat-medicare-advantage-other-private-investment-hurt-medicare/ Summary: A September 2021 Health Affairs blog revealed how Medicare Advantage insurers use aggressive and fraudulent diagnostic coding practices to artificially boost revenues, with similar risks looming from Direct Contracting Entities. That blog was criticized as inaccurate by two corporate leaders in healthcare. The original blog authors responded this week, buttressing their case against Medicare Advantage and DCEs (now known as ACO Reach). The Emperor Still Has No Clothes: A Response To Halvorson And Crane Health Affairs Forefront June 6, 2022 By Richard Gilfillan and Donald M. Berwick Following our September 2021 Health Affairs Forefront articles on the “Medicare Advantage Money Machine,” the most common reaction of which we are aware has been that this was an “Emperor Has No Clothes” moment. Many knew the Medicare Advantage (MA) game, but few had called it what it was. Two responses to our articles … have been published in Forefront that find fault with our analyses. … For the most part, their arguments fail. We count more than a dozen assertions in these critiques, some matters of opinion and others matter of fact. These can be grouped into … six categories … [see HJM Comment] [Many] have documented that MA costs more than fee-for-service [largely due to the gaming of risk scores]. Every extra dollar paid to MA plans is, indeed, a transfer of taxpayers’ money to MA plans, which then benefit in terms of growth and higher profits. Those profits represent direct transfers of wealth from taxpayers to plans. The impact of MA on the delivery of care goes well beyond the Risk Score Game. Traditional Medicare presents a relatively straightforward, highly standardized approach to coverage and the financing of health care. MA creates a highly fragmented coverage and financing system that brings complexity and additional cost for all segments of the industry, particularly the providers. The result is an expensive MA administrative superstructure that we have layered on top of, and that now permeates and distorts, the actual delivery of care. Estimates of administrative costs and profits for all health system parties vary significantly but the broadest definitions are in the range of 25 percent. MA is a major driver of those costs. We must ask what we are getting for that if, after 35 years of privatized Medicare costing more than fee-for-service, we cannot demonstrate real clinical outcomes improvement. The answer is, “We are not getting much.” The opacity that comes from the privatization of public payment confounds objective, scientific analysis. Comment by: Jim Kahn Gilfillan and Berwick logically and effectively counter the two published criticisms of their September 2021 “Medicare Advantage Money Machine” blog (discussed in HJM). In so doing, they solidify an appropriately harsh assessment of Medicare Advantage and ACO Reach (rebranded DCEs). Below is a structured summary, incorporating quotations from the blog. Bottom line: Massive insurer profits achieved via widespread diagnostic upcoding deplete Medicare funds without evidence of added value for beneficiaries. 1) The Medicare Advantage Business Model Snapshot: Model = diagnostic upcoding to raise capitation rates. Coding efforts are not just to inform clinical practice, as the critic argues; they are to drive up payment rates. “MA risk scores have for decades risen continually … now almost 2 percent per year faster than those in traditional Medicare. That is not a mark of … increasing relative severity of actual illness in MA compared with the fee-for-service population; it is the Risk Coding Game …” The industry is so focused on this, it refers to a “risk score headwind” when COVID prevented home visits used to add more diagnoses. Overall, an estimated 14 percent risk score excess will result in overpayments to Medicare Advantage of $600 billion from 2023-2031. 2) The Profitability of MA Firms Snapshot: Huge profits and valuations. The critic proposes “Most businesses in most industries would see their stock prices dropping with only 4.5 percent profits [as seen with insurers].” Yet “[T]he increases in plans’ stock prices and valuations [are extraordinary].” Why? I argue in HJM that the nominal 4.5% for insurers obscures a real return rate of 30%, and thus explains why the investment is so attractive. “Profits are the product of profit margin multiplied by revenue. Risk Score Gaming positions plans to increase profits from both.“ And here’s the maximum profit strategy: if insurers buy up providers, as they are doing, the “Medical Loss Ratio” restriction on profits is easily evaded, dropping the real MLR from 85% to 70% and thus more than doubling actual profit margins. 3) The Effects of MA On Care and Underinsurance for Low-Income MA Beneficiaries Snapshot: Lower upfront costs, but poor financial protection when sick. “Plans use some of the subsidies [overpayments] from CMS to offer products with improved benefits and lower premiums for members. … Zero-premium products, with less-rich benefits and more out-of-pocket costs, are targeted at cost conscious buyers, particularly those with limited disposable income. Lower-income individuals have little choice but to trade a known zero premium cost for an unknown likelihood of greater out-of-pocket costs. But that tradeoff leaves many low-income beneficiaries underinsured and possibly experiencing significant negative impacts on their health.” The Kaiser Family Foundation found that “enrollees in Medicare Advantage do not generally receive greater protection against cost-related problems than beneficiaries in traditional Medicare with supplemental coverage, particularly for some enrollees, such as Black beneficiaries in relatively poor health...” 4) Financial Savings for MA Beneficiaries Snapshot: Impossible to tell, with distorted comparisons. The critics claim that “MA members actually spend much less money each year on care.” Gilfillan and Berwick explain why: a) MA plans are subsidized due to over-payment by Medicare, and they share the subsidies with members, and b) the plans use risk selection to enroll a healthier population than traditional Medicare. In other words, apparent savings are artifact, meaningless. 5) The Quality of Care In MA Snapshot: Mixed and ambiguous picture, with flawed data. The critics claim higher quality of care in MA. We just can’t know, say Gilfillan and Berwick. For example, “[R]ecent studies document that MA plans are actively ignoring system-improvement efforts as they use lower-quality skilled nursing facilities and home health providers more, and high-quality hospitals less, than traditional Medicare.” Claims that integrated care systems like Kaiser improve care (itself dubious, IMO) don’t carry over to the non-integrated Medicare Advantage norm. MA plans actually artificially boost quality scores – “manipulating contracts to ‘move about 550,000 enrollees from non-bonus contracts to bonus-level contracts, resulting in unwarranted bonus payments in the range of $200 million in 2019.’” “Understanding the effects of MA on quality is extremely difficult in part because MA operates in an information environment in which it is all but impossible to demonstrate better clinical outcomes for patients.” Data are missing, biased, or manipulated. [Stunning eg’s in the blog.] Gilfillan and Berwick’s positive view of ACOs diverges from my deep skepticism. But I agree with them, the greatest danger lies in the growth of investor-controlled entities. 6) The Direct Contracting Model/ACO Reach Model Snapshot: Investor control portends problems such as in Medicare Advantage. [W]e remain concerned that [ACO Reach] brings MA investor and insurer-controlled firms directly into the fee-for-service alternative payment model (APM) world. The 52 of 100 Reach ACOs that are investor-controlled operate in 49 states (including the District of Columbia and Puerto Rico) containing 99 percent of the 35 million fee-for-service beneficiaries. 7) Resolution via Single Payer Snapshot: They didn’t say this. They should have.

What is single payer?

What is Single Payer? Summary: Today we take a step back to review a fundamental issue – the definition of single payer. Also its typical features and options. Why? Because sometimes we get lost in technical details, and forget the big picture. And too often experts get confused, and thus confuse others. Comment by: Jim Kahn It drives me to distraction when health policy researchers, journalists, medical journals, and critics misrepresent single payer. This has come up several times in recent months. I guess it’s understandable, with all the misinformation that’s floating around. But I’m eager to settle on a single, correct definition. Here’s my attempt… DEFINITION: One entity (a public agency) pays for health care. This agency receives all funding and disburses all payments for standard comprehensive coverage. Private insurers are prohibited from this role. All patients and providers deal with just one payer for the standard coverage. This is especially important for providers, offering the simplicity of a single payment source. TYPICAL FEATURES: These elements are typical in single payer, if not in the definition, in order to achieve overall goals of universal, equitable, efficient, and affordable access to care. Everyone is covered. Universal, lifelong – meeting a fundamental human need, and part of single payer’s efficiency. Everyone has identical comprehensive coverage / benefits. This is hugely different from our current system, with myriad and varied restrictions on benefits according to health plan. Payment rates are the same for everyone. Again, this is vastly different from today, with up to 10-fold differences in payment levels for the same services, creating strong economic forces for unequal access. Cost-sharing is minimal. No deductibles, and co-pays either not used or small with low-income exemptions. This avoids financial barriers to care. Capital spending (investment) decisions are made by the payer, not by providers. This assures that capacity is increased where most needed. Negotiated drug & medical equipment prices. A single payer negotiates a single set of prices, directly with manufacturers. Currently prices vary widely across insurers and plans, and intermediary PBMs distort the market and extract profits. Long-term care. In most single payer plans, long-term care (both institutional and community-based) is included as an essential care need. A single electronic health record, focused on clinical care rather than billing. With much simpler billing, a universal EHR would reduce the burden on providers and facilitate exchange of medical information and enable effective public health tracking and intervention. DO WE HAVE SINGLE PAYER NOW? NOT MUCH Veterans Affairs (the VA) has a single payer (the federal government). With full-time staff, the VA resembles a national health service. Access to and quality of care is better than average. Some patients have private insurance as well, and recently more VA funds have been used for community providers, but still, a single payer. Medicare is not a single payer, even though it’s the predominant payer for seniors. This is a common misunderstanding. Medicare is not a single payer because from the perspective of providers, it’s just one of many payers, losing the efficiencies and equity enhancements of single payer. The large role of private insurers in Medicare Advantage further distances Medicare from single payer. CHOICES UNDER SINGLE PAYER: Provider payment mechanisms. Fee-for-service is the most common proposed approach for individual providers, but they can also be paid with salaries. Hospitals and other institutions may be paid via global budgets. Indeed, capitated provider groups (without intermediaries, and not-for-profit) may be possible, though controversial and require very strong rules to prevent undertreatment and gaming. Supplemental or complementary insurance. Many nations permit focused (small scope) additional insurance, e.g. to speed access to specialty care. These are fraught, potentially undermining standard coverage, but satisfying demand for service enhancements. In other countries, they take many forms and work acceptably (not materially reducing access for the broad population) … but can they in the US? Parallel single payer systems. A single payer approach may permit having a second system in tandem, such as the VA. Two independent systems, each meeting the definition of single payer from the perspective of participating providers and patients. Opting out. Providers can practice outside of the single payer system, accepting direct payments for services. But they are not permitted to both participate in single payer and accept payment for the same services. That is: either fully in or fully out. So, now that we’ve clarified, let’s get back to winning the long-running battle for an efficient and equitable system to pay for health care – single payer (you know what I mean!). From Health Justice Monitor

The American Way - Tarbell

The American Way - Tarbell: “It requires less effort and background investigation to buy an AR-15 assault rifle than it does to adopt a kitten from the local humane society.” This is

The Blind Spot in Medicare for All | The Nation

The Blind Spot in Medicare for All | The Nation The United States is the only high-income nation to insist that health should be determined by markets and profits rather than rights and dignity. The result is that the prohibitively high cost of American health care causes tens of thousands of preventable deaths every year. For the first time since the Covid-19 pandemic compounded this long-standing national disaster, Congress is considering the state of America’s health care system. The House recently held hearings on Medicare for All, and the Senate Committee on the Budget is convening parallel proceedings today. In this context, many members of Congress who benefit from the status quo are rehashing their opposition to Medicare for All, citing the importance of defending of “freedom” and “choice.” With thousands of people dying each week precisely because they have no choices in our current health care system, this rhetorical game should fool no one. Although universal health care appears unlikely to be enacted by this Congress and has never even appeared on President Biden’s agenda, the current hearings serve an important purpose. They remind the US public that our existing system of for-profit health care exclusion is a deliberate policy choice, not an inevitability. While Medicare for All would be an enormous step forward for the health of Americans and the health of US democracy, it’s essential to recognize that what determines our health care system is not simply who pays but also for what we pay. If we adopt a single-payer structure without remaking the bureaucracy by which the value of care is determined, we will perpetuate the perversity at the core of our system and its world-leading inefficiency. Despite efforts to implement alternative models over the last two decades, a fee-for-service framework remains embedded in American health care and endures as its dominant underlying driver. Fee for service compensates doctors, clinics, and hospitals based upon number and type of visits involved in a patient’s care, creating incentives for unnecessary procedures, excessive clinic appointments, and the mountains of paperwork that have become the bane of American doctors’ daily lives. This system, which places value on specialized services rather than on primary care, is also a crucial factor behind the worsening shortage of primary-care doctors. The persistence of fee for service is no accident. It’s the consequence of a long political campaign initiated by doctors that has since been taken over by industry executives and their lobbyists. Fee for service solidified its central role in American health care in 1965 when Congress passed legislation to create Medicare and Medicaid. For years, the American Medical Association (AMA), a physicians’ lobbying group organized to protect doctors’ economic interests, had been doing all it could to oppose public health-insurance programs like Medicare and Medicaid. They feared that government involvement in health care would lead to a decline in doctors’ earnings and professional status. The AMA campaigned to associate government-financed health care with Cold War fears of a communist takeover of medicine. American doctors had struggled for several decades to build respectable professional status and high incomes. Now, they were told that if “socialized medicine”—that is, health care that’s a public service—came to America, then they would earn no more than Soviet factory workers and would be overwhelmed by bureaucracy and documentation requirements. When the AMA realized in the 1960s that its efforts to keep government out of health care were failing, it shifted its strategy to protect the fee-for-service model upon which high physician compensation had been built. AMA leadership drew from Relative Value Studies, an experiment the AMA had pioneered in California that created a billing model for the burgeoning private insurance industry, and made a list that they hoped would allow them to control government involvement in health care. This list, the Current Procedural Terminology (CPT), was comprised of a series of billable procedure codes, stratified by compensation levels. The AMA persuaded doctors across the country that endorsing this list was vital for preserving their autonomy and income. With physician support, the AMA then convinced the government to adopt the CPT list as the foundation of its new billing system when it rolled out Medicare and Medicaid in 1966. This allowed doctors and hospitals to bill the government just as if it were another private insurance company. The CPT system thereby stymied any substantive changes to the private, fee-for-service model of American health care. More than half a century later, the CPT system, most recently revised as CPT 2022, remains in place. Fatefully, when the AMA licensed the CPT billing system to the government, it managed to include in the licensing contract a stipulation that prohibited the government from either seeking an alternative billing system or from creating its own. It required the government to mandate that health care organizations use this system to bill Medicare and Medicaid, and required the government to encourage all health care entities, regardless of relation to Medicare and Medicaid, to adopt this system as well. With a brilliant clerical strategy that was largely hidden from public view, the AMA took American health care hostage. Since 1966, it has been virtually impossible to function as an American health care provider without using CPT codes. As a result, the AMA reaps an undisclosed amount every year from CPT licensing contracts. In 2019, for example, this appears to have been in excess of $100 million. These dollars support the AMA’s lobbying efforts and its prioritization of doctors’ and administrators’ economic interests, often over the interests of patients, public health, and rational improvements to the US health care system. But direct revenue gleaned by the AMA from the CPT billing system pales in comparison to the influence it allows the organization to exercise over the US health care system. The AMA’s plan to preserve fee-for-service medicine was successful, but its consequences for patient experiences and physician workdays have been disastrous. This system has, in part because of government efforts to catch and prevent health care fraud by private actors, produced ever-expanding documentation requirements that now constitute the bulk of American doctors’ workloads. This is a major factor behind the alarming rates of physician burnout. As the US faces an already severe doctor shortage, one in five physicians now plans to leave their job Despite our desire as physicians to believe that our patients’ care is determined by the nuances of doctor-patient relationships and the wisdom of our clinical recommendations, the truth is that patient care is largely determined by billing structures. Medical care in America entails only an illusion of choice. Bureaucrats dictate the options in advance, guided not by the goal of the best possible patient care but by the aim of maximizing revenue. The “freedom” of America’s private health care system has come at the cost of real choices—both doctors’ and patients’. We will not produce genuine change in the American health care system nor can we effectively remedy its inequalities until we address its political-economic determinants. In this moment in which a pandemic has exposed and deepened the chronic crisis of access, quality, and equity in American health care, the medical community needs a new guiding ethic. We must reject the self-serving illusion that caregiving could ever be simply a matter of clinical duties and embrace the fact that care is always also a matter of political responsibility. Rather than continue to acquiesce to systems designed to generate wealth, advance careers, and protect doctors’ professional status, doctors have an ethical duty to organize in solidarity with our coworkers and patients. Collectively, we should demand that our lawmakers build the systems required to ensure highest-quality care for all, beginning with those communities whose needs the American health care industry has historically refused to meet. To achieve this, Congress must not only establish a single-payer system; it must also reexamine what we mean when we talk about the “value” of care and who it is that determines this. Health care should be, as it is in all peer nations, a fundamental right ensured by the state via public systems paid for with public dollars. Instead of equating value in health care with billing, price, and profit, we need to invest in public systems that render each of these market-oriented terms irrelevant. Only once we have done so will we be able to make a right to health care an actual reality rather than simply an empty rhetorical gesture.

Who’s in charge, them or us? – McCanne Health Justice Monitor

Who’s in charge, them or us? – McCanne Health Justice Monitor

Republicans Have Stopped Trying to Kill Obamacare. Here’s What They’re Planning Instead

Full Article: https://www.politico.com/news/magazine/2022/04/26/gop-obamacare-aca-health-care-00027585 Couple quotes: "The result would be a system with more options and fewer guarantees. Giving employees less money to cover slimmed-down health insurance will lead many workers to forego coverage entirely. Are conservative politicians prepared to look the other way when they develop serious diseases and have no way to pay for care?" "The two behemoths of federal health policy, Medicare for senior citizens and many disabled, and Medicaid for low-income households of every variety, are far less the reform target of Republicans and conservatives than they used to be. An essential reason for this is that both programs, with little controversy, have become increasingly privatized."

Stop the Privatization and Reverse It

Privatization of Medicare An experiment with Medicare called a “direct contracting model” (DCE) was begun during the Trump administration. It allowed for-profit giants to take over portions of Medicare. A complete privatization of Medicare could happen by 2030. The Biden Administration could stop this from progressing but hasn’t. About 250 health organizations complained to the federal agencies responsible for Medicare, demanding a halt to the operation of these “Direct Contracting Entities” (DCEs). The complaints caused the agencies to rename the privatization scheme from DCEs to “Accountable Care Organization (ACO) Reach.” The for-profit companies, dubbed DCEs or ACO Reach, get paid monthly by the Centers for Medicare and Medicaid Services (CMS) to cover a specified portion of a patient's medical care. This is a major shift away from traditional Medicare. Traditional Medicare pays health care providers directly. During this current experimental period, Medicare patients could be put into an ACO Reach without their knowledge or permission! ACO Reach is designed to drive up costs for patients and maximize corporate profits. President Biden needs to end this program now. ACO Reach corporations are allowed to keep the funding they don’t spend on patient care. That motivates these secret, for-profit middlemen to skimp on patient care. In February 2022, an expert testified before a U.S. Senate subcommittee that this privatization would bankrupt the hospitalization part of Medicare by 2026, and Medicare itself by 2030. This insidious attack on Medicare allows ACO Reach corporations to insert themselves between doctors and patients and use our Medicare dollars to pad their profits. Seniors value traditional Medicare because it is simple, efficient, and universal. Right now, these changes are happening at a small scale, but the privatization experiment is set to expand this year unless President Biden takes action to stop it. Contact the President, your Senators, and Congressional Rep; tell them to outlaw ACO Reach. Keep traditional Medicare strong and intact. No privatization! https://www.commondreams.org/news/2021/11/30/congress-asleep-switch-biden-continues- trump-era-ploy-privatize-medicare

New Member Orientation - YouTube - Healthcare-NOW!

New Member Orientation - YouTube: Learn more and sign up for a Volunteer Team here: https://www.healthcare-now.org/national-volunteer-teams/

The Potter Report 📝

The Potter Report 📝

The Potter Report: Biden Admin Gives Insurers Big Pay Raise - Tarbell

The Potter Report: Biden Admin Gives Insurers Big Pay Raise - Tarbell: In a move generally ignored by most media outlets, the Biden administration this week made the shareholders of a small number of for-profit health

Big Insurer Explosive Growth & Profits Since ACA Passage – McCanne Health Justice Monitor

Big Insurer Explosive Growth & Profits Since ACA Passage – McCanne Health Justice Monitor

Insurers’ new cash cow is the federal government’s Medicare program

https://mailchi.mp/e44e22b64e4f/the-potter-report-140-billion-10138442?fbclid=IwAR3fjykffXCohRdp4lwiAzz2HL474zrAYSfMdz8_Kw8qkmquJKFK9Vy0q2k

Health Care Reform Must Return Ownership to the Community – McCanne Health Justice Monitor

Health Care Reform Must Return Ownership to the Community – McCanne Health Justice Monitor

Katie Porter Touts Medicare For All: ‘I Support Patients Over Paperwork’ - YouTube

Katie Porter Touts Medicare For All: ‘I Support Patients Over Paperwork’ - YouTube: Rep. Katie Porter (D-CA) questioned witnesses during a House Oversight Committee hearing about Universal Health Coverage on Tuesday. Stay ConnectedForbes on ... https://youtu.be/6l4YZSRTNGw

Fee-for-Service vs. Capitation

http://healthjusticemonitor.org/2022/03/03/fee-for-service-vs-capitation/

A Useful List

 http://healthjusticemonitor.org/2022/02/19/single-payer-20-20-vision-advantages-obstacles/

Webinar Registration - Zoom

Webinar Registration - Zoom Meet the MN Health Plan Legislative Caucus! We will explain the MN Health Plan briefly and have a selection of the sponsoring legislators to discuss why they are involved and how you can help build the momentum to the passage of this plan for a universal single-payer healthcare system in Minnesota! Join us on Thursday, February 10th from 6:30-8:00pm for this open Q&A with the legislators of The Minnesota Health Plan Caucus! Leaders will answer YOUR questions about the companion Single Player bills in the MN House and MN Senate. Be sure to register in advance by clicking the Zoom registration link.