Friday, July 21, 2023

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.”

Thursday, July 13, 2023

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

Joel Clemmer via 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 . 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

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[GrNoHealth] Private equity is having a moment Full Message with Links Joel Clemmer via 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 Highly recommended. peq6.png 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 peq1.png peq2.png peq3.png . . . 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 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

Tuesday, July 11, 2023

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.

Saturday, July 8, 2023

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: " 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