Medicare Advantage wastes our money and gives away millions to corporations

Medicare Advantage routinely denies reimbursements for necessary care, hospital execs say 31 million people are on Medicare Advantage plans, a private alternative to traditional Medicare. The plans are often cheaper and promise better benefits. However, the CEOs of rural hospital systems in six states told NBC News that Medicare Advantage routinely denies reimbursements for necessary care. NBC News’ Sam Brock reports. A video from MSN that tells the story.

British National Health Service Crippled by Privatization & Austerity Funding

Link to article

Trump vows again to try to ‘terminate’ Affordable Care Act

Trump vows again to try to ‘terminate’ Affordable Care Act News and commentary from Founding Editor Pat Kreitlow - Up North News Even as former President Donald Trump promised to try again to “terminate” the Affordable Care Act (ACA), Wisconsin progressives doubled down on their own promise to expand healthcare coverage and make it more affordable for working families. Trump put a post on his Truth Social account last Sunday that criticized Republicans who refused to “terminate” the ACA—adding “we should never give up.” Democrats immediately amplified the post, given the strong and growing public support for affordable health care. “Christmas has come early” for Democrats and President Joe Biden, reported Axios. Robert Kraig, executive director for Citizen Action Wisconsin, told UpNorthNews Radio the better path would be for Wisconsin Republicans to take advantage of an ACA provision that would expand and strengthen Medicaid—better known in Wisconsin under the name BadgerCare. For more than a decade, Republicans in the Legislature have blocked BadgerCare expansion, leaving Wisconsin as one of only 10 states in the country missing out on the extra federal funding that would cover more families. Democratic legislators recently introduced a bill that would also add a public option to BadgerCare, allowing families and small businesses to buy into Medicaid coverage and use ACA subsidies to help make premiums even more affordable.

Excessive Corporate Control in Medicine

Summary: A valuable report lays out the harm due to a corporate takeover of medicine –deleteriously affecting the experience of both providers and patients. The American Medical Association is failing to fight this trend. Regulatory action and physician activism are needed. The Corporate Practice of Medicine TAKE MEDICINE BACK October 2023 By Mitchell Li, Sailesh Konda, Robert McNamara [HJM bolding] Conclusion: The corporate practice of medicine doctrine was integral in providing an ethical basis for the practice of medicine. Today, the American Medical Association (AMA) explicitly tolerates the corporate practice of medicine, and state prohibitions on CPOM are broadly unenforced. The vast majority of physicians are now employees of increasingly consolidated corporations, while moral injury and burnout among physicians are at unsustainable levels. Rapid horizontal and vertical consolidation of non-physician healthcare corporations that employ physicians not only increases monopoly power over consumers, which in return increases costs, but also increases monopsony power over physician labor. This has resulted in anti-competitive labor practices that lead to intimidation of, and retaliation against physicians who advocate for patients. This places the public at risk through greater corporate influence over the practice of medicine. Corporations are increasingly replacing physicians with lesser-trained non-physician practitioners in order to maximize profits, while increasing costs to patients and taxpayers and eliminating remaining safeguards of physician expertise from the unfettered corporate practice of medicine. A new era of robust antitrust enforcement in healthcare is needed. Past FTC actions against the AMA restricting the ability to impose ethical restrictions on its members should be re-examined in the context of unintended consequences of enabling corporatization and consolidation. A national prohibition on the corporate practice of medicine is necessary to accompany the strengthening, and enforcement of existing state-based prohibitions. Physician organizations must collectively reject non-physician corporate ownership of medical practices. Reclaiming the profession from corporate interests will take time, and greater protections for employed physicians are needed now in order to protect patients. In the face of legislative inaction at the state and federal level, employed physicians should use the tools available to labor and organize through unionization. Comment by: Don McCanne This very impressive 63-page report on the corporate practice of medicine explains very well how the monopoly (one seller) power over health care consumers has increased costs, and the monopsony (one buyer) power over physicians has led to intimidation of and retaliation against physicians who advocate for their patients, resulting in moral injury and burnout. And this is just the beginning of the harm being done. Coincidentally, Sen. Bernie Sanders is currently holding hearings with the message that we need to expand union organizing in this country to rein in corporate greed if we are going to save the middle class and the workers in this country (https://www.theguardian.com/us-news/2023/nov/14/bernie-sanders-unions-middle-class-labor-movement). This report on the corporate practice of medicine closes its Conclusion with the following two sentences: “Reclaiming the profession from corporate interests will take time, and greater protections for employed physicians are needed now in order to protect patients. In the face of legislative inaction at the state and federal level, employed physicians should use the tools available to labor and organize through unionization.” Remarkably, the American Medical Association, at its interim meeting of its Congress of Delegates this week, actually brought this report up for consideration. However, the membership is down to 10% of US physicians, and they are predominantly politically conservative in my opinion (I’m a Life Member), so their Council on Legislation recommended that it not be adopted. But at least some more concerned members did have it pulled out of the “not for consideration” list of resolutions. There is some moral spark within the AMA such as those who attempted to have the AMA withdraw their long-standing opposition to single payer. Even though that effort failed this time, maybe the good guys and gals will eventually prevail. Anyway, for those of us who care about our patients, we need to end the private corporate control of health care, and we need to take the immediate action of using the tools available to labor and organize through unionization.

Lancet Panel on Investor-Owned Health Care

Summary: The recent Lancet webinar on private for-profit ownership of US health care assembled leading experts on this crucial issue. We must – and can – reverse this commoditization of health care. Public policy and health in the USA: should investors own healthcare? https://www.thelancet.com/webinars (scroll down to “On-demand webinars”) The Lancet Webinars Sep, 2023 Claudia Fegan: The question of “Should investors own healthcare,” I believe is the most important policy question facing healthcare in the United States today. We spend over 4 trillion dollars a year, 18 percent of our gross domestic product is spent on healthcare in the U.S. each year. That is more than twice as much as most other developed countries. Yet we rank miserably in the outcome measures such as life expectancy, preventable hospitalizations, maternal mortality, and suicide. We need to ask what role in the U.S. the current investor-driven system plays in causing and exacerbating the racial disparities in healthcare. Donald Berwick: In the past few years I’ve tried to understand how such a noble system can be so underperforming in its potential at the cost of the well being and spirit of the work force and the patients it serves, I have come to use the word GREED, and I’ve been challenged for that because most of the people that work everyday in all of the sectors of healthcare feel quite good about what they’re doing, they’re trying to help patients. But when we look at the underlying dynamics, I believe the commoditization, commercialization, the role of changing ownership to private hands, and the proletarianization of the healthcare workforce lie at the core of at least some of the reasons why this system is so deeply underperforming. You cannot find a sector in healthcare in which greed is not just manifest, but I would claim even dominant. Greed right now effectively concentrates wealth in the United States; wealth concentrates political power and influence through the role of lobbying and political contribution, and that political contribution stops efforts to reign in or place constraint on greed. Rosemary Batt: Private equity turns healthcare from a social good into a financial asset. It extracts wealth through financial strategies and not primarily by providing better care. There may be some improvements in care, but the fundamental focus is on financial gain. (She explains the mechanisms that private equity uses for wealth extraction.) Steffie Woolhandler: What we’ve seen is what I’ll call financialization of the entire healthcare system: money has become the mission. Traditionally providers invested money in buildings and equipment in order to produce medical care. That was our service mission or social mission. Now, financial entities are investing in medical care to produce money through profit, and money is their mission, and that, fundamentally, is what is wrong with the U.S. healthcare system today. This is happening despite the fact that the majority of the American people do not want this. Polls continue to show that the majority of the American people want a nonprofit, single payer, Medicare for All system for the United States. But Medicare for All is not enough. We need to address ownership, and we need to take back hospitals, community resources, the doctors’ practices, we need to take them back from investors and return control to community providers and patients (see HJM post on The Nation “Medicare For All Is Not Enough”). Q & A: Don McCanne: Is there any prospect that the United States could have a progressive legislature and administration that would support a healthcare financing system exclusively devoted to the service of universal patient care rather than being devoted to private wealth? Steffie Woolhandler: Absolutely. There’s that possibility. Other nations have succeeded in establishing non profit, publicly owned, sometimes publicly regulated and publicly administered systems. If they can do it, we can do it. It’s just going to take a lot of organizing and a lot of educating the public about the possibility. Donald Berwick: I’ll add that we are the outlier. Every other country finds a way to guarantee care to everyone – every other developed country – at a cost of about half of ours. So no-one can say, “it can’t be done.” It’s a matter of will, and I fear nowadays it’s a matter of political will. Comment by: Don McCanne This excellent one hour webinar by The Lancet explains why single payer alone is not enough. Not only do we have to establish an equitable, affordable financing system that makes healthcare accessible for all (single payer), we are going to have to address the issue of ownership of the healthcare delivery system such that our healthcare dollars that derive from us, the people, end up serving the public, social mission of providing healthcare for all instead of the private mission of enhancing personal megawealth for the few. The notice of this Lancet webinar should be distributed to all who care, and to those who don’t now seem to care but may have within them the capacity to care when the facts are understood. Whether nominally public or private, it’s our money; let’s spend it on us.

"Cha-Ching!" Lina Khan Attacks Private Equity in Health Care

FTC Chair Lina Khan is getting more aggressive, targeting individual Amazon executives, and seeking to stop a brazen scheme to monopolize health care in Texas. Private equity is big mad. MATT STOLLER SEP 22, 2023 -- article link

Understanding & Fighting Investor Ownership of Health Care

http://healthjusticemonitor.org/2023/09/20/understanding-fighting-investor-ownership-of-health-care/ Summary: Private for-profit ownership of health care is undermining the health care mission, diverting care resources to shareholder bank accounts. Single payer financing is not enough … we need to resist the corporate takeover. Two important webinars are coming up NEXT WEEK. Listen in, and get involved. Medicare for All Is Not Enough The Nation March 31, 2022 By David U. Himmelstein, Steffie Woolhandler, Adam Gaffney, Don McCanne, John Geyman covered in HJM here Dr. Glaucomflecken videos (2 min each) 30 Days of US Healthcare: United Healthcare For All September 20, 2023 30 Days of US Healthcare: Private Equity Visits Rural Medicine September 19, 2023 30 Days of US Healthcare: Physician Owned Hospitals September 9, 2023 Comment by: Don McCanne Single payer financing meets the goal of insuring everyone, funded equitably through progressive taxation. However, it is incapable of controlling the dictates of private ownership with a primary mission of increasing private wealth as opposed to providing the public service of health care for all. Private equity is acquiring not only facilities but also the health care professional groups staffing these facilities. Our article in The Nation summarizes these terrible trends, and Dr. Glaucomflecken distills the problems with his astringent humor. The public service model of single payer cannot work in a system designed to pump up the coffers of billionaires. Two zoom webinars NEXT WEEK address the hazards of private ownership in health care: 1) The Lancet Webinars: Public policy and health in the USA miniseries: should investors own healthcare? Tuesday September 26, 2023 2 pm EDT / 11 am PDT Register here Four US experts will examine the implications of growing investor ownership of physicians' practices, hospitals, and other health services in the US, and their consolidation into giant corporate enterprises that dominate insurance and care delivery in many regions of the US. Panelists are luminaries Don Berwick, Rosemary Batt, Steffie Woolhandler, and Claudia Fegan. 2) Health Affairs: Briefing: How the Ownership and Structure of Health Care Entities Affect Clinicians & Patients Wednesday September 27, 2023 2 pm EDT / 11 am PDT Register here WATCH THE ZOOM MEETINGS AND THEN WORK TOGETHER TO FIGHT THIS PROCESS. WE HAVE TO DO IT. SINGLE PAYER WILL GO NOWHERE IF WE DO NOT ADDRESS THE OWNERSHIP HARM CAUSED BY THE BILLIONAIRES. WE HAVE TO REBUILD THE SYSTEM! In solidarity and with love, Don

US Health Care Is Pretty Good … If You Own an Insurance Company

article link

Basic library of universal health care

Basic library of universal health care What is “Single Payer” and What is it Not? By KIP SULLIVAN and JOEL CLEMMER. As the single-payer solution has become more popular, the phrase “single-payer” has been misinterpreted by both proponents and opponents of universal coverage. It is extremely important that the public understand what the phrase means. Link to copy with the links to articles Healing Health Care: The Case For A Comprehensive Universal Health System By JOHN MARTY. Roseville, MN, Birch Grove Publishing, 2016. The lead author of The Minnesota Health Plan and well-known state Senator brings it home with a specific proposal for our state. The fundamental arguments for universal care are here, as are extensive footnotes to peer-reviewed science. A free download is available. The Healing of America: A Global Quest For Better, Cheaper, And Fairer Health Care By T. R. REID. New York, Penquin, 2009. A very accessible 30,000 foot view of national health care systems. This comparative approach puts our non-system into perspective. Available through libraries and stores. FIX IT – Healthcare At The Tipping Point Unfinished Business Foundation This docuseries addresses many issues within our healthcare system in the United States. It is eye-opening and very informative. CLICK HERE to visit their website. Rethinking Consumerism in Healthcare Benefit Design CONSUMERS UNION, Research Brief No. 11, April 2016 Isn’t it all about high deductibles driving health care “consumers” with “skin in the game” to shop wisely in the health marketplace? Doesn’t “market magic” ensue? The organization behind Consumers Reports says – usually not. . . Continue reading It’s The Prices, Stupid: Why The United States Is So Different From Other Countries By GERARD F. ANDERSON, UWE E. REINHARDT, PETER S. HUSSEY and VARDUI PETROSYAN Health Affairs, 22, no.3 (2003): 89-105 Everyone now admits that health care costs are high in the U.S. But that is because greedy American doctors looking for extra fees and overly demanding patients utilize too much medicine, right? The facts say otherwise. . . Continue reading Medicare at 50: Why Medicare-for-all Did Not Take Place By THEODORE R. MARMOR and KIP SULLIVAN Yale Journal of Health Policy, Law, and Ethics, Volume 15, Issue 1, Article 9, 2015 Universal health care has been a popular goal in the U.S. and the Medicare system would appear to offer a way forward. Why did it never happen? The rise of managed care and the myth of competitive markets in health coverage offer and explanation and say a lot about where we are now. . . . Continue reading or download from Yale’s digital commons site.

Health Care Financing Issues

NY Times Tantalizingly Close On Health Care Financing Issues Post author By Admin2 Post date July 20, 2023 No Commentson NY Times Tantalizingly Close On Health Care Financing Issues Summary: This week, a profile of challenges facing the UK NHS and an op-ed proposing universal coverage in the US got so many issues right. But they critically missed on pivotal pillars of successful health care financing: adequate funding and comprehensiveness of coverage. A National Treasure, Tarnished: Can Britain Fix Its Health Service? New York Times July 16, 2023 By Mark Landler As it turns 75 this month, the N.H.S., a proud symbol of Britain’s welfare state, is in the deepest crisis of its history: flooded by aging, enfeebled patients; starved of investment in equipment and facilities; and understaffed by doctors and nurses, many of whom are so burned out that they are either joining strikes or leaving for jobs abroad. … Health care spending rose by an average of less than 2 percent a year from 2010 to 2019, compared with 5.1 percent from 1998 to 2008. Britain spent less a year per person on health care than the wealthiest European Union countries during the decade of austerity, and now has fewer doctors and hospital beds per capita than its European neighbors. Its capital investment lagged the bloc’s average by $41 billion, according to the Health Foundation, which tracks the industry. We’re Already Paying for Universal Health Care. Why Don’t We Have It? New York Times July 18, 2023 By Liran Einav and Amy Finkelstein There is no shortage of proposals for health insurance reform, and they all miss the point. They invariably focus on the nearly 30 million Americans who lack insurance at any given time. But the coverage for the many more Americans who are fortunate enough to have insurance is deeply flawed. Health insurance is supposed to provide financial protection against the medical costs of poor health. Yet many insured people still face the risk of enormous medical bills for their “covered” care. A team of researchers estimated that as of mid-2020, collections agencies held $140 billion in unpaid medical bills, reflecting care delivered before the Covid-19 pandemic. To put that number in perspective, that’s more than the amount held by collection agencies for all other consumer debt from nonmedical sources combined. As economists who study health insurance, what we found really shocking was our calculation that three-fifths of that debt was incurred by households with health insurance. What’s more, in any given month, about 11 percent of Americans younger than 65 are uninsured. But more than twice that number — one in four — will be uninsured for at least some time over a two-year period. Many more face the constant danger of losing their coverage. Perversely, health insurance — the very purpose of which is to provide a measure of stability in an uncertain world — is itself highly uncertain. And while the Affordable Care Act substantially reduced the share of Americans who are uninsured at a given time, we found that it did little to reduce the risk of insurance loss among the currently insured. It’s tempting to think that incremental reforms could address these problems. For example, extend coverage to those who lack formal insurance. Make sure all insurance plans meet some minimum standards. Change the laws so that people don’t face the risk of losing their health insurance coverage when they get sick, when they get well (yes, that can happen) or when they change jobs, give birth or move. But those incremental reforms won’t work. Over a half-century of such well-intentioned, piecemeal policies has made clear that continuing this approach represents the triumph of hope over experience, to borrow a description of second marriages commonly attributed to Oscar Wilde. … Coverage needs to be free at the point of care — no co-pays or deductibles — because leaving patients on the hook for large medical costs is contrary to the purpose of insurance. A natural rejoinder is to go for small co-pays — a $5 co-pay for prescription drugs or $20 for a doctor visit — so that patients make more judicious choices about when to see a health care professional. Economists have preached the virtues of this approach for generations. But it turns out there’s an important practical wrinkle with asking patients to pay even a very small amount for some of their universally covered care: There will always be people who can’t manage even modest co-pays. … Finally, coverage must be basic because we are bound by the social contract to provide essential medical care, not a high-end experience. Those who can afford and want to can purchase supplemental coverage in a well-functioning market. Keeping universal coverage basic will keep the cost to the taxpayer down as well. It’s true that as a share of its economy, the United States spends about twice as much on health care as other high-income countries. But in most other wealthy countries, this care is primarily financed by taxes, whereas only about half of U.S. health care spending is financed by taxes. For those of you following the math, half of twice as much is … well, the same amount of taxpayer-financed spending on health care as a share of the economy. In other words, U.S. taxes are already paying for the cost of universal basic coverage. Americans are just not getting it. They could be. We … were struck — and humbled — to realize that at a high level, the key elements of our proposal are ones that every high-income country (and all but a few Canadian provinces) has embraced: guaranteed basic coverage and the option for people to purchase upgrades. Comment by: Jim Kahn & Don McCanne The profile of UK NHS challenges is vivid and compelling in portraying the financial and associated operational and clinical problems plaguing that system. And, buried deep into the article, they do mention, in passing, the reason: “Health care spending rose by an average of less than 2 percent a year from 2010 to 2019, compared with 5.1 percent from 1998 to 2008.” Let’s be appropriately blunt about this: The Conservative Party (the Tories) are intentionally bleeding the system, since 2010 putting the NHS on austerity footing. See HJM discussion here. Privatization is driving up family financial burdens and increasing mortality. Thus, the crisis is intentional, policy- and politics-driven. The good news is that there is a good chance that the Tories will pay a steep political price for this evisceration of the popular NHS. Turning to the US: Wow, Einav and Finkelstein got so much right. The health insurance system is fundamentally broken, unfixable. We need free, universal coverage. Just what we in the single payer movement have been saying for decades. Just what all other wealthy nations do. But wait, “basic”? What does that mean? The article doesn’t elaborate (their book, to be released later this month, lays out some principles if not a definitive definition …). We don’t like the sound of it. If “basic” means “access to under-funded and over-stretched providers,” that’s a recipe for a two-tiered system with divergent political interests, like we have for schools. If basic means excluding a subset of medical services, what would we comfortably omit? Not a good solution. On the other hand, if “basic” means “everything necessary for quality medical care, and no fluff” that could be fine. As long as “medical care” includes inpatient, outpatient, drugs, mental health, dental, vision, medical equipment … everything medically indicated. That’s what other countries do: supplemental insurance is typically just a few percent of total health spending, for example providing access to private hospitals or specialists in a system with excellent public care. Long-term care should be in the “basic” category too. We think it will be impossible to define “basic” narrowly in a way that is medically sound and doesn’t lead to operational and political fractures. The good news is, we don’t need to be stingy. Analyses of single payer demonstrate that we can provide standardized, comprehensive coverage and still save money for the system and for households. Our colleague Ed Weisbart put it very well: “Two-tiered systems become as underfunded as the UK’s National Health Service, and outcomes degrade. We’re either all in this together, as a society that looks out for each other, or it’s Game of Thrones for us all.”

Rose Roach talks about nurses, unions, single-payer. July 11, 2023 at OPS Office Hours

Joel Clemmer via googlegroups.com Jul 12, 2023, 7:32 PM (12 hours ago) to GreatNorthernHealth Minnesota had a great legislative system and that goes for healthcare reform, too. Rose Roach is former head of MN Nurses Union and current head of Healthcare for Minnesota NOW and she is the perfect person to summarize. She just did so in a presentation to One Payer States. See the announcement below. Typical for Rose, it is high-energy and very pertinent. I especially liked her spontaneous editorial on MN Attorney General Ellison. The direct URL is https://www.youtube.com/watch?v=FCE_MHDp-Fk . Joel Clemmer Rose gave an excellent presentation last night at the Tuesday, July 11, 2023, OPS Office Hours. Topic: Unions, Nurses, State-based Universal Healthcare Click HERE view her slides and text. Click HERE to view. the video Speaker: Rose Roach, Volunteer director of Unions for Single Payer Rose discussed foundational legislation passed in the recent Minnesota state session that will play a role in Minnesota's overall strategy to make single-payer possible. She addressed specific lessons learned related to the nurses but applicable to all of us effectively fighting the medical-industrial complex. She also described Health Care for All MN multi-year statewide campaign to pass the state single-payer bill, the MN Health Plan. Please donate to One Payer States. Your contributions keep these crucial conversations coming to help you educate, agitate, and activate. Mike Huntington 541-829-1182 Secretary, One Payer States

Thanks for this email message

[GrNoHealth] Private equity is having a moment Full Message with Links Joel Clemmer via googlegroups.com Jul 12, 2023, 4:24 PM (15 hours ago) to GreatNorthernHealth This long-ish and optional post has to do with the invasion of healthcare by private equity firms. It recommends three sources of information and perspective: a podcast by Dr. Abdul El-Sayed, an article in the New York Times' Upshot series, and a book by an author with Saint Paul roots. The podcast is an episode of El-Sayed's America Dissected series, among those mounted by Jon Favreau's Crooked Media. Favreau was Barack Obama's Wunderkind head speechwriter. (Check out the excellent Pod Save America when you visit Crooked). Abdul El-Sayed has one of those biographies that makes me think I've wasted my life: Dr. Abdul El-Sayed is a physician, epidemiologist, educator, and public communicator. He is a commentator at CNN and a Contributing Editor at the New Republic, and his newsletter, The Incision, cuts into the trends shaping our moment. His three books include Healing Politics: A Doctor’s Journey into the Heart of Our Political Epidemic (Abrams Press, 2020), which diagnoses our country’s epidemic of insecurity and the empathy politics we will need to treat it; and Medicare for All: A Citizen’s Guide(Oxford University Press, 2021), co-authored with Dr. Micah Johnson, which offers a no nonsense guide to the policy. He is the host of “America Dissected,” a podcast by Crooked Media, which goes beyond the headlines to explore what really matters for our health. He is a Towsley Foundation Policymaker in Residence at the University of Michigan Gerald R. Ford School of Public Policy, and a Senior Fellow at the FXB Center for Health & Human Rights at the Harvard T.H. Chan School of Public Health, teaching at the intersection of public health, public policy, and politics. In addition, he is a Scholar-in-Residence at Wayne State University and American University. Note that he more than gets it about single-payer. El-Sayed discusses the effects of private equity on healthcare with Eileen O'Grady of the Private Equity Stakeholder Project at https://crooked.com/podcast-series/america-dissected/. Highly recommended. peq6.png https://crooked.com/podcast-series/america-dissected/ The second source only just appeared. The Upshot feature of the Times published a frank, evidence-based assessment of private equity in healthcare. The "upshot" of this review is not good. See https://www.nytimes.com/2023/07/10/upshot/private-equity-doctors-offices.html peq1.png peq2.png peq3.png . . . https://www.nytimes.com/2023/07/10/upshot/private-equity-doctors-offices.html And this is the study to which this article refers (which I have not read yet). My impression is that it could be a supplemental chapter for Paul Starr's The Social Transformation of American Medicine. peq8.png See https://www.antitrustinstitute.org/wp-content/uploads/2023/07/AAI-UCB-EG_Private-Equity-I-Physician-Practice-Report_FINAL.pdf Finally, we have Brendon Ballou, who was born in Saint Paul and whose mother some of us know. Both have since moved on, Brendon to Stanford Law. After that, he was Special Counsel for Private Equity in the Justice Department's Antitrust Division.He is ideally suited to write this book, which just appeared to rave reviews. It deals with private equity across all sectors, not just the medical-industrial complex. peq4.png Here is a snippet from the Times' review, which included another book, as well: . . . peq5.png . . . Consider all this as summertime beach reading for nerds. Enjoy! Joel Clemmer

Federal Actions Leave in Place a Flawed Health Insurance System

Summary: The White House announced several actions to improve health care financial protections for consumers. Left in place is a fragmented and dysfunctional health insurance system which imposes massive burdens on consumers. Time for single payer! Article

HealthCare Now - Learn with us this summer!

We are building a movement to win! That’s why we’ve expanded our training series to include two new online workshops on the critical organizing skills we all need to cultivate to achieve that goal: “Planning a Campaign” goes more in-depth into the nuts and bolts of how to put your strategy into action. “Campaign Culture and Structure” deals with the challenges of working together and digs into the hard work of developing an organizing culture where everyone feels respected.

CA Proposals Analysis from Kip Sullivan

Kip 5:05 AM (2 hours ago) to GreatNorthernHealth Thanks for posting this article, Craig. The split within the CA single-payer movement is serious. The damage done to relations between the parties could be long lasting, and the bill that split the movement -- SB 770 -- will (if it passes) inflict some harm on the CA Nurses Association's single-payer bill. With a little luck, the harm will consist only of a delay of one biennium (2023-2024) while the legislature discusses SB 770, enacts it, and awaits a report due June 1, 2024 before taking further action on CNA's single-payer bill. But it's possible SB 770 will inflict harm far greater than a mere delay. SB 770 could give Gov Newsom and legislators who oppose CNA's single-payer bill an excuse to oppose single-payer legislation indefinitely and to support multiple-payer legislation and/or incremental reforms that further entrench and further complicate the existing system (such as the retrograde Health Care Affordability Board which held its first meeting last March). I'll write a brief summary of SB 770 here and offer more details if readers on this list are interested. As you read my description of SB 770, ask yourself, Do you think it would be a good idea for single-payer groups in MN to introduce SB 770 in the next session of the MN legislature? To hear SB 770 proponents in CA tell it, the answer is yes, SB 770 "complements" CNA's single-payer bill and would definitely "complement" the MN Health Plan, the name of the single-payer bill we support here in MN. We will know in less than a year whether the claims made for SB 770 (some of which are extravagant) were true. Although SB 770 is a short bill (it's six pages long), it is difficult to explain it. It's difficult to explain because it is so abstract and opaque (the cryptic phrase "unified financing" is the leading example of opaque language), and because it requires the Secretary of CA's Health and Human Services Department (HHS) to accomplish something he probably can't accomplish until the CA legislature enacts CNA's single-payer bill. SB 770 is opaque SB 770 does two things: (1) It authorizes the CA HHS Secretary, Dr. Mark Ghaly, to "pursue waiver discussions with the federal government with the objective of a unified health care financing system...." and (2) it creates a "work group" the purpose of which is to "undertake a program of stakeholder engagement at sites across the state to address issues including, but not limited to, the specifics of the transition to a unified health care financing system...." SB770 | California 2023-2024 | Health care: unified health care financing. | TrackBill In just these two sentences (which are the most important because they contain the instructions to the executive branch) we encounter "waiver discussion," "unified financing," and "program of stakeholder engagement," and yet nowhere in the bill are these terms defined. The term "unified financing" is the most worrisome. It was concocted by a commission created by the CA legislature in 2019 called the Healthy CA for All Commission. For reasons the commission didn't explain, it adopted the squishy label "unified financing" to refer to both multiple-payer and single-payer systems. Can any of you give me a good reason why Health Care for All MN and MN PNHP should introduce a bill in the MN legislature that adopts the commission's squishy label? "Unified financing" appears 10 times in SB 770, "single payer" only once. Why? Dr. Ghaly probably cannot do what SB 770 asks him to do Federal law requires states that seek to enact single-payer legislation to apply to the federal government (the Centers for Medicare and Medicaid Services) for waivers from provisions in the Affordable Care Act (for example, the provision requiring Minnesota to run an "exchange" where people can buy health insurance from insurance companies), and before doing so, to enact the single-payer law for which they seek a waiver. CA, obviously, has not enacted a single-payer bill yet. When SB 770 proponents are asked why they are proposing that Dr. Ghaly talk to CMS about a waiver before CA enacts a single-payer bill, they reply that states can extract useful information from CMS even before states enact single-payer bills. This is such a novel proposition, and the laws governing waivers for state universal-coverage laws are so complex, that I'm reluctant to say it's completely bogus. CMS states on its website that states are welcome to approach CMS with "draft legislation" to discuss what to put in their waiver application. But SB 770 proponents can't even point to "draft legislation." I have asked several SB 770 proponents if they can name one question Dr. Ghaly could ask CMS during "waiver negotiations" that CMS can answer, in the absence of an enacted law or draft legislation, that isn't already available in federal law and regulations? I get no answers. SB 770 proponents have stated, for example, that Ghaly should be able to get CMS to tell him how much Medicare and Medicaid funds CA will get over an unspecified length of time for the never-defined "unified financing" system. Isn't it likely CMS will ask Ghaly to see a "draft" bill? Seems to me the answer is yes. If that happens, what will Ghaly do? Write up both a single-payer and a multiple-payer bill? Just a multiple-payer bill? It seems likely to me that Ghalys final report to the CA legislature 11 months from now will say something like, "CMS couldn't give us a firm estimate of the Medicare and Medicaid funds CA will get until we pass a single-payer bill. My best guess is x dollars." We shall see. SB 770 is rapidly approaching enactment. Ghaly will have to begin "negotiations" with CMS about one or more "unified financing" waivers soon, and complete his work by May 2024 in order to file a report with the CA legislature by June 1, 2024. We will know soon whether other states can accelerate the progress of single-payer legislation with a bill like SB 770, or whether bills like SB 770 merely pave the way for delay or worse. Kip Sullivan On 2023-07-06 10:15, Craig Brooks wrote: https://calmatters.org/health/2023/07/single-payer-health-care/ " Another main concern for the nurses union is the language used in the commission's report and Wiener's bill. "Unified financing does not equal single payer," Comsti said. She argued that if "unified financing" includes programs that leave room for health insurers or any middlemen to profit, then that essentially goes against the single-payer system they're seeking. " Craig

PNHP will dig deep on Medicare privatization

Article: "our vision of improved Medicare for All is under dire threat from profit-hungry corporations and the policymakers "

It’s time to guarantee healthcare to all Americans as a human right

It’s time to guarantee healthcare to all Americans as a human right Bernie Sanders It is time to end the international embarrassment of the US being the only major country that does not guarantee healthcare

This is Go Time

This is go time- Medicare for All will be reintroduced in both the House and Senate in 8 days, which means now is a crucial time to contact your members of Congress to make sure they sign on as an original cosponsor of the bill. To catch you up: In each new session of Congress, the Medicare for All Act must be reintroduced, and all members of Congress must sign on (or back on) as cosponsors of the bill. Can you take three minutes to call your members of Congress today to ask them to sign on as a Medicare for All cosponsor? https://bit.ly/3ppmtvN You can find the number and a sample script below: → HOUSE: (202) 858-1717 ← → SENATE: (202) 519-0494 ← You will hear a short message; then we’ll connect you directly with your House rep and senators. Hi, my name is ______, and I'm calling from ________. I'm calling to urge [NAME] to cosponsor the Medicare for All Act when it is reintroduced in Congress on May 17. Health care is a human right that must be guaranteed for all – and Medicare for All is the only policy solution that will achieve guaranteed health care for all people. Will they commit to being an original cosponsor on the bill? Thank you. TELL US HOW IT WENT » These calls are tremendously important, William. Together we can make sure that Medicare for All gets as much, or even more, support than it did last time it was introduced in Congress. But it will take all of us making calls, writing letters, meeting with representatives, and more. Your reps need to hear from you, and all their constituents. We need you to call right now and to share this call to action with your friends and networks in your district. Please make a call today to help us secure as many cosponsors on the new Medicare for All bill as possible. Thank you for taking the time. Jasmine Ruddy Organizer Nurses’ Campaign to Win Medicare for All P.S. We put together a toolkit that has everything you need to help amplify our call for Congress to pass Medicare for All. Check it out here!

Researchers find flaws in WI Medicaid restrictions bill, and in the ideas behind it

They damn well better include a big increase in $ for staff to do all this crap. I agree that redetermination of eligibility, no more frequently than annually, might be a good idea -- BUT. They are including doing this twice a year and adding all kinds of paperwork/steps for the recipient AND for the public servants -- with no $ for the staff time. This just would add more barriers to folks getting medical care and WI already is one of the only states to NOT take advantage of expanded MA eligibility. "DHS must determine an individual's eligibility every six months under the bill. DHS is also prohibited from using prepopulated forms or otherwise supplying information, except for name and address, to a recipient under the BadgerCare Plus program that has been supplied to DHS. Additionally, any recipient under the BadgerCare Plus program that fails to timely report to DHS or its designee any change that may affect eligibility is ineligible for benefits for six months from the date DHS discovers the failure to report the change. Under current law, knowingly concealing or failing to disclose any event that an individual knows affects the initial or continued right to a Medical Assistance benefit is subject to a forfeiture of not less than $100 nor more than $15,000 for each concealment or failure."   Article # 1 https://wisconsinexaminer.com/2023/04/14/researchers-find-flaws-in-medicaid-restrictions-bill-and-in-the-ideas-behind-it/?eType=EmailBlastContent&eId=f7aa741b-e239-4770-a208-ed7889724a78 Aricle #2 https://wisconsinexaminer.com/2023/04/13/lawmakers-debate-bills-that-would-create-new-barriers-to-benefits/?eType=EmailBlastContent&eId=f7aa741b-e239-4770-a208-ed7889724a78 https://docs.legis.wisconsin.gov/2023/related/proposals/ab148

Managing Medicaid changes so people don’t lose health insurance

"Official outlines steps federal government is taking — and states could take — as continuous coverage requirement ends"

U.S. judge rules insurers don’t have to cover many free preventive health services

Article in 3/30/23 WI Examiner

LTE on health care access - Mark Martin: More health coverage options needed

More health coverage options needed 3/29/23 "Minnesota Care is a state-supported income-limited health insurance program that is set up to act as a bridge between medical assistance and private health insurance. Isn’t it time that all Minnesotans have all options available to them in choosing health insurance? Most of our health insurance is covered by employers (think private insurance companies) or government-backed programs (think medical assistance, Medicare, and MinnesotaCare). I reside in Wabasha County and have maintained a private medical practice in Winona since 1999. Almost daily I see patients that struggle to pay for co-pays, deductibles, premiums, and just basic care. Patients that have employer-based insurance complain that it is becoming more expensive with increases almost yearly in premiums, deductibles, and co-pays – with a corresponding decrease in covered services. I see many patients whose spouse works a job just for health insurance, which is especially hard on farmers and other self-employed people. There are also people who only work at a certain level because if they make over a set income limit, they will lose their MinnesotaCare insurance and they will be financially unable to afford health care, even with subsidies."

The quiet privatization of government health insurance programs

Article: https://www.axios.com/2023/03/28/medicare-medicaid-privatization-health-insurance

"The biggest public health insurance programs have become increasingly privatized over the last decade, even while politicians sparred over whether government-run health care should be expanded to cover more Americans. Why it matters: Although privately run Medicare and Medicaid plans are still highly regulated and funded by the government, the commercialization has complicated efforts to rein in medical spending and unleashed fierce partisan fights like the ongoing one over Medicare Advantage. Driving the news: The insurers that administer Medicare benefits and their allies are running an enormous lobbying blitz against proposed regulations by the Biden administration that they say will cut their government funding and, in turn, harm enrollees. Supporters of the cuts say that the proposal corrects overpayment, which plans obtain by manipulating the billing system. The potency of the lobbying is a sign of just how ingrained Medicare Advantage has become among seniors over the years — and how important it is to some insurers' business mix. The big picture: Medicare for All rose to prominence during Democrats' 2016 presidential primary, championed by Sen. Bernie Sanders. Four years later, it returned as a key litmus test for Democratic presidential hopefuls. More moderate candidates, including President Biden, instead embraced a public option, which would extend eligibility for government-run insurance to more Americans. But as Democrats aired out whether or not to abolish private insurance, existing public programs became increasingly commercialized. Meanwhile, attempts to expand Medicare eligibility or benefits as part of Democrats' domestic policy agenda during Biden's first two years in office fizzled largely over the cost. By the numbers: Medicare Advantage enrollment has grown from 22% of eligible Medicare beneficiaries in 2008 to 48% of beneficiaries in 2022, per KFF. This year's enrollment numbers, when they're released, will likely reveal that the majority of seniors are now enrolled in a Medicare Advantage plan. Private plans are even more ubiquitous in state Medicaid programs. In 2020, 72% of Medicaid beneficiaries were enrolled in a Medicaid managed care plan, also per KFF. In fiscal year 2021, more than half of state and federal Medicaid spending went to managed care organizations. Although Medicaid managed care organizations can be private for-profit, private non-profit or government plans, as of 2020 half of the market was covered by plans owned by one of five companies: Centene, Molina, Elevance, UnitedHealth Group and CVS. Between the lines: Administering entitlement benefits is an increasingly lucerative line of work for insurers. Another KFF analysis found that in 2021, plans had gross margins of $1,730 per enrollee — more than double those of other markets. The second highest were in Medicaid managed care, which had gross margins of $768 per enrollee — higher than both the group and individual market. The analysis cautions that gross margins aren't equivalent to profitability but are indicative of trends. A clear one presented in the analysis is that the employer-sponsored and individual markets were significantly less profitable in 2021 than they were in 2018, while managed care plans did better."

WI Spring Election will impact health issues

Up North News Article on WI Abortion issue that will be impacted by the Spring Election "OB/GYN: Wisconsin's Current Abortion Ban Isn't Just Dangerous, It's Deadly Right now, Wisconsin is facing a health crisis on multiple fronts. Students who want to become OB-GYNs are forced to leave the state to finish their training because they're unable to learn basic, standard care for cases of ectopic pregnancy or miscarriage under current Wisconsin law. Dr. Kristin Lyerly knows just how difficult this will be for her industry and the future of women's health. Today, she's answering a few of our questions. UpNorthNews: How has your job changed since Wisconsin's 1849 abortion ban went back into effect? Dr. Kristin Lyerly: There is a lot more fear and uncertainty related to women's health care now for both patients and providers. Women have become more afraid to ask questions about their reproductive health, and doctors are often unsure whether they can offer basic services like contraception and management of miscarriages, which are technically spontaneous abortions. What hasn't changed? Our desire to ensure that our patients have access to quality, affordable, comprehensive, compassionate health care. It's just so much harder to deliver that in the post-Dobbs era. What do you believe is the biggest lie anti-choice activists are currently spreading about abortion? Their goal is to tie issues like abortion to a political side in order to win votes, so they use hyperbolic language that plays on people's emotions. The one that infuriates me the most is the "abortion up until the time of birth" trope that conservative radio hosts love because it sounds so terrible. It is terrible because abortions that happen after viability, when a baby has a reasonable chance of survival outside of the mother, are only offered when either the baby or the mother have a profound medical problem that threatens the health, well-being, and future reproductive potential of the mother. These are heartbreaking situations where families are already suffering in tragic ways that most of us will never understand. Politicians and activists who retraumatize these people for their own gain should be ashamed. What is one thing most people don't know about abortion, but you wish they did? Abortion is health care and it's common—one in four women in the US will have an abortion in her lifetime. How does this tie into next week's election? We all want the freedom to make our own decisions about our own bodies within the context of our own lives, whether we're talking about a new cancer diagnosis or a complicated pregnancy. The conservative [state Supreme Court] candidates have shown us that they don't trust women to make these decisions."

In WI-Advocates mark Affordable Care Act anniversary with success stories, warnings Evers renews Medicaid expansion push; White House adds up the cost of cutbacks

Article

Is Wisconsin the only Midwest state to not accept the federal Medicaid expansion?

Fact Brief : Is Wisconsin the only Midwest state to not accept the federal Medicaid expansion? | Gigafact NO Both Wisconsin and Kansas have not adopted the federal Medicaid expansion, which expanded Medicaid coverage to those with incomes up to 138% of the federal poverty level. Despite not adopting the expansion, Wisconsin allows all uninsured adults who fall below the federal poverty line to be eligible for Medicaid, according to the Kaiser Family Foundation. In his previous budgets and a special session, Democratic Gov. Tony Evers has proposed funding an expansion of Medicaid, but it has failed to make it into the final budget under the Republican-controlled Legislature. In his 2023-25 budget, Evers has again proposed accepting the expansion. The Evers administration estimates the move would save the state $850 million in its first year and add 897,000 low-income people to its Medicaid program, including 30,000 people who currently do not have insurance.

post to Great Northern States Health Care Initiative - question about racism

As a new blog participant, I am curious if the issue of American racism, specifically white supremacy, has been discussed here as the fundamental barrier preventing the U.S. from terminating its present health care chaos and switching over to the sanity of a health care system which is funded through a one-payer administrator?

 

Diane J. Peterson

St. Paul, Minnesota

oak7@centurylink.net

Virus-free.www.avg.com

End Government Discrimination Against Medical Assistance Patients Pass the Freedom to Choose Bill

End Government Discrimination Against Medical Assistance Patients

Pass the Freedom to Choose Bill

Mission of the Freedom to Choose bill:

Restore equal access to all Medical Assistance patients to choose their own doctors

and other health care providers.

SF404 Author: Dr. Alice Mann

Co-Authors: Jim Abeler, DC; John Marty, Dr. Matt Klein, Liz Boldon

HF816 Author: Kim Hicks

Co-Authors: Tina Liebling, Peter Fischer, Brion Curran, Athena Hollins,

Hodan Hassan, Amanda Hemmingsen-Jaeger, Samantha Vang

 Eliminates discrimination, enforced by state government, among Medical Assistance patients.

Currently, a minority of them are granted the Freedom to Choose their preferred doctors and

other health care providers, but the state withholds this right to choose from the majority of

Medical Assistance patients.

 Reduces racial disparities, allowing Medical Assistance patients the Freedom to Choose

culturally appropriate health care providers.

 Provides good transparency and accountability on the tax funds paying for patients who

exercise the Freedom to Choose their preferred health care providers. There is no payment

transparency, and only the most minimum accountability, on tax funds devoted to the

majority of patients who lack the Freedom to Choose due to receiving care through managed

care organizations.

 The 2022 fiscal note on this bill demonstrated that it would save the state millions of dollars.

Such savings present funding opportunities for other needs in your district.

ENDORSED BY: Health Care For All Minnesota (HCAMN)

Our Revolution Twin Cities

Minnesota Nurses Association

ACTION: Support this bill: 1. Become a co-author

2. Speak up in favor of the bill in committees and in floor sessions.

3. Vote for the bill in committee hearings and in floor sessions.

Health Policy Advocates initiated this bill. We are a multi-partisan citizen

group in Minnesota for improved health care access and ending

discrimination against Medical Assistance patients.  

Contact Diane Peterson, 651 487 8007, oak7@centurylink.net; or Sharon

Schmidt, 952 996 9070, sschmidt776@usfamily.net

WI cutting Medicaid

With continuous coverage ‘unwinding’, a big transition looms for Medicaid patients Advocates warn that children could lose coverage needlessly if states aren’t careful, , Rural hospitals gird for unwinding of pandemic Medicaid coverage

Pervasive Greed Destroying US Health Care

Summary: Esteemed medical care quality leader Donald Berwick condemns the pervasive and crippling role of financial gain-seeking in US health care. As he said recently, single payer is the solution. Salve Lucrum: The Existential Threat of greed in US Health Care Link to Article

Galluping In the Wrong Direction: Higher Cost Barriers & Lower Quality

Health Justice Monitor - January 21, 2023 No Commentson Galluping In the Wrong Direction: Higher Cost Barriers & Lower Quality Summary: National polls show that the US is losing ground on two major indicators of health system performance: access to care and perceived quality. Who thought it could get worse? Gallup shows we’re galloping to disaster. Record High in U.S. Put Off Medical Care Due to Cost in 2022 Gallup January 17, 2023 By Megan Brenan The percentage of Americans reporting they or a family member postponed medical treatment in 2022 due to cost rose 12 points in one year, to 38%, the highest in Gallup’s 22-year trend. Americans were more than twice as likely to report the delayed treatment in their family was for a serious rather than a nonserious condition in 2022. In all, 27% said the treatment was for a “very” or “somewhat” serious condition or illness, while 11% said it was “not very” or “not at all” serious. [This] 16-point gap in the perceived seriousness of forgone treatment in 2022 is the second largest on record … Americans Sour on U.S. Healthcare Quality Gallup January 19, 2023 By Lydia Saad For the first time in Gallup’s two-decade trend, less than half of Americans are complimentary about the quality of U.S. healthcare, with 48% rating it “excellent” or “good.” The slight majority now rate healthcare quality as subpar, including 31% saying it is “only fair” and 21% — a new high — calling it “poor.” Americans’ evaluations of the quality of healthcare they personally receive are also at a low ebb — albeit higher than their U.S. rating — with 72% giving it excellent or good marks. This low reading has been two years in the making, with the metric falling six points to 76% in 2021 and another four points in the past year. Comment by: Jim Kahn This pair of national Gallup polls demonstrates our health care is headed in the wrong direction. The care is less affordable and lower quality. Why less affordable? In brief, under-insurance. As the Kaiser Family Foundation showed in its 2022 annual survey of job-based insurance, deductibles continue increasing (Fig. 7.18), even as employee premium contributions rise or stay flat (Fig. 6.23). Drug prices are extraordinarily high due to the industry’s relentless pursuit of profit, and cost controls in the Inflation Reduction Act are anemic. A commentary from last week noted that drug cost-sharing under the now ubiquitous pharmacy benefit managers (PBMs) can be devastating for patients who depend on expensive brand-name medicines with no generic options. Two main causes: First, a shift from fixed co-payments to percentage-of-cost coinsurance, which is based on inflated list prices. Second, exclusion of manufacturer patient assistance from deductible credit. The difference for patients can be tens of thousands of dollars a year (see sample calculations here). Wendell Potter wrote recently on the painful results for patients. Financial barriers have clinical consequences. Research by Gaffney et al in late 2022 found rationing of insulin by 17% of patients or 1.3 million US adults. Research by Chandra et al in 2021 found that a 34% ($10) rise in out-of-pocket cost for seniors reduces drug use by 23% and increases mortality by one-third, specifically for statins and antihypertensives. Why lower quality? It’s multi-factorial. Clearly COVID has burdened health care capacity, leading to worker stress, burnout, and staffing shortages. But I believe patient frustration also carries over from the financial challenges. When people have to pay more – which they can barely afford – they demand and expect more. When the system is failing in multiple ways, it feels like it’s completely falling apart. Which it is. Saddle up for single payer.

The Problems with Job-Based Insurance

http://healthjusticemonitor.org/2023/01/05/the-problems-with-job-based-insurance/ January 5, 2023 No Commentson The Problems with Job-Based Insurance Summary: The Chamber of Commerce uses the results of its online poll to claim overwhelming worker support for job-based health benefits. However, the methods and reporting are biased. Survey findings by the Commonwealth Fund tell a far more worrisome story. New Poll of American Workers Reveals Tremendous Value Placed on Workplace Health Benefits U.S. Chamber of Commerce December 15, 2022 Health insurance is the most important benefit an employer can offer workers and their families, according to a new survey on how American workers view employer-sponsored health coverage. Workers report that they overwhelmingly prefer to receive health insurance directly from an employer rather than through other means. The poll found that as high as 96% of Americans believe it is important that a job offer health insurance. Ninety-three percent of respondents said they were satisfied with their insurance. Employer-sponsored health insurance remains far more popular than insurance plans available on the individual market: 89% of Americans expressed a preference for obtaining their health coverage through an employer than through other means. 81% of respondents reported that they would rather receive their insurance from an employer than a government-provided health plan. “I expected there to be a high level of satisfaction with employer health benefits, but I was stunned by the level of intensity,” said Matt George of Seven Letter Insight, who ran the survey. “It is not an exaggeration to say Americans love, trust, and rely on their workplace health care coverage.” The survey was commissioned by the Protecting American’s Coverage Together (PACT) campaign, a coalition including the U.S Chamber of Commerce, Business Roundtable, Vermeer Corporation, The National Association of Manufacturers and Council for Affordable Health Coverage. PACT represents leading employer voices focused on strengthening the ESI system and protecting the coverage and benefits that American families depend on for their health. The State of U.S.Health Insurance in 2022 The Commonwealth Fund September 29, 2022 By Sara R. Collins, Lauren A. Haynes, Relebohile Masitha Forty-three percent of working-age adults were inadequately insured in 2022. These individuals were uninsured (9%), had a gap in coverage over the past year (11%), or were insured all year but were underinsured, meaning that their coverage didn’t provide them with affordable access to health care (23%). Twenty-nine percent of people with employer coverage and 44 percent of those with coverage purchased through the individual market and marketplaces were underinsured. Among the world’s high-income countries, the U.S. stands alone for the complexity of its health insurance system. Americans are eligible for different types of coverage depending on whether their employer offers it, what their income level is and what their age and health care needs are. There is no national enrollment mechanism for people who don’t have employer coverage; they must know which program they are eligible for and then sign up for coverage. Consequently, people can experience insurance gaps at different points in their lives, like when they lose a job. The average insurance deductible for employer health plans with single coverage is more then $1,000 ($1,434 for all covered workers in 2021), and out-of-pocket maximums average $4,272 for single coverage in employer plans. Half of survey respondents said they would not have the money to cover an unexpected $1,000 medical bill within 30 days. Comment by: Don McCanne & Jim Kahn With our inordinately high costs of health care and persistent gaps and inequities in access, many hope that 2023 is going to be the year that we finally start to enact and implement health care justice for all. Remarkably, however, there is still resistance to the tested and proven concept that will get us there: single payer Medicare for All. Some argue that Medicare has too many defects, but we know what they are and can revise the program to meet widely accepted standards of care. Other nations have shown that to achieve the goals of equity, accessibility, and affordability for all, the government must have a central role. To those who advocate for reliance on a private sector strategy, we point to its clear failings. Our health system failings reflect the shift of health care funds from patient care to wealthy investors, such as through public fund privatization (eg Medicare Advantage and Medicaid managed care) and the massive acquisition of providers by private equity. That’s why we must pay for health care through public insurance on the model of traditional Medicare. Employers and insurer organizations tout the benefits of employer-sponsored health insurance. Admittedly, these plans provide a welcome financial backstop for expensive medical problems, such as a heart attack or a fracture requiring surgery. Unsurprisingly, workers value getting health benefits with a significant employer contribution. Yet most job-based plans have large deductibles (thousands of dollars) and provider networks are limited. This mixed picture is evident in the Commonwealth poll and reports by the Kaiser Family Foundation and others. The Chamber of Commerce poll and report grossly exaggerate the level of support for job-based coverage. It’s biased, in four ways (please excuse geek detour): 1) Biased sample of respondents: it’s an online survey, with no sampling frame or response rate specified. This is a red flag for self-selection: the individuals who see and participate in the poll have a special perspective. The report doesn’t indicate the recruitment message, but if it was something like “What do you like about your health insurance?” or “Do you appreciate your health benefits?”, who do you think would click over to the survey? 2) Biased presentation: Statistics are presented in a way that favors the pro-benefits view. E.g., 52% do NOT strongly agree that insurance is affordable, and a similar % do NOT say that it’s high quality. More than 70% do NOT say it’s comprehensive or convenient. 3) Unfair comparison with public insurance like single payer. Respondents are asked if they prefer private work-based coverage or “government insurance”. No hint at what that means – is it Medicaid? The responses would be quite different if phrased fairly, e.g., “an improved Medicare for All, with coverage for all medical needs; no premiums, deductibles, or copays; and increased taxes only if you earn >$250,000”. 4) Omission. They don’t ask if workers are pleased that employer contributions to health benefits come out of wage or salary levels. (They do, to a very large degree.) Polling as advocacy isn’t real information. Ok geek mode off. Single payer would enable access to the entire health care system whenever needed. In contrast, employer insurance depends, first of all, on employment status and employer benefit plans. Second, details of the insurance contract matter: there may not be freedom to choose health care providers, hospitals, pharmacies, or even what care is covered. Workers may fall prey to job lock, required to stay in a job because insurance may not be available if they quit. Voluntary and highly varied job-based insurance guarantees that coverage is inequitable and unreliable, in contrast to the equity and universality of single payer. It is understandable how, through the years, individuals have liked employer sponsored plans, since they have been among the better options to provider, under the right circumstances, heath care for workers and for their families. (Less true these days due to the skyrocketing deductibles, and obscuring the lower wage effect.) Also, taking solace in decent job-based insurance undermines a principle that most of us care about: solidarity. Most of us really would like to see health care for everyone. Not long ago, we experimented on a large scale with trying to fix the private insurance approach. The Affordable Care Act aimed to preserve, improve, and expand employer sponsored insurance as a pillar of our health care coverage, filling in the voids with a regulated market for private insurance and more Medicaid. The ACA seemed to enhance solidarity while preserving employment sponsored plans. The problem, as reviewed well recently, is that this experiment in health policy was a dismal failure in providing decent coverage for everyone, and thus a failure in the solidarity we seek. Tens of millions remain uninsured, and under-insurance exploded with the rapid growth of high deductible plans. If solidarity is building, it’s of the wrong variety: shared pain. Other nations provide us with ample highly successful examples of single payer. They are effective in providing affordable care for everyone and thus also fulfill the goal of solidarity. We really can have high performance universal health care, and save money in the process. A single payer system would guarantee better health care choices than in employer sponsored plans, for workers and for everyone. We have the opportunity to reject the current, fragmented, dysfunctional employer-sponsored system and adopt policies of social solidarity that would bring affordable, comprehensive high quality health care to everyone. Look around you. This really seems to be the year to fix the health care financing system in the United States. We can use our ingenuity to create a uniquely American system of social and economic justice. Let’s do it. In solidarity, single payer for all!