tag:blogger.com,1999:blog-42217996184515415682024-03-17T21:01:13.914-06:00Great Northern States Health Care Initiative<br>
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The Great Northern States Health Care Initiative is a group of people from Minnesota and Wisconsin who have come together for the purpose of advocacy for a better health care system in our respective states and the nation. Our main objective is education of ourselves and others in our communities on the imperatives of a single payer health care system.
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641-715-3900, Ext. 25790#Unknownnoreply@blogger.comBlogger2658125tag:blogger.com,1999:blog-4221799618451541568.post-41091555929546216772024-02-12T12:10:00.001-06:002024-02-12T12:10:02.247-06:00Reclaim Medicare<a href="https://act.newmode.net/action/be-hero-fund/reclaim-medicare-corporate-greed?source=email&link_id=1&can_id=a7a333514a8432762bdf6938f0e2d1b3&email_referrer=email_2203294&email_subject=the-gop-_health-care-profiteers" target="_blank">Article on threats</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4221799618451541568.post-63253604382874682982024-01-21T09:34:00.002-06:002024-01-21T09:50:10.910-06:00Need to change how U.S. handles drug pricingA complicated system of intermediaries and a lack of legal constraints have contributed to high drug prices in the United States.Credit...Paola Chapdelaine for The New York Times
<a href="https://www.nytimes.com/2024/01/17/health/us-drug-prices.html?unlocked_articIfle_code=1.PU0.tmj7.hEWr5miPfJVA&smid=url-share" target="_blank">NYT article</a>
<a href="https://drive.google.com/file/d/1FjljlkrZpphtx3TvFlaQuyV1NeQvGFQJ/view?usp=sharing" target="_blank">copy access if NYT can't be accessed</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4221799618451541568.post-49414062261558790742023-12-15T07:44:00.006-06:002023-12-15T07:47:15.317-06:00Medicare Advantage wastes our money and gives away millions to corporationsMedicare 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 href="https://www.msn.com/en-us/money/insurance/medicare-advantage-routinely-denies-reimbursements-for-necessary-care-hospital-execs-say/vi-AA1lwlxw?ocid=msedgntp&pc=LCTS&cvid=29b03fb1c019483d9c9989a686acb7c9&ei=24" target="_blank">A video from MSN that tells the story.</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4221799618451541568.post-64731850149204372422023-12-09T08:12:00.003-06:002023-12-09T08:12:31.647-06:00British National Health Service Crippled by Privatization & Austerity Funding<a href="https://healthjusticemonitor.org/2023/12/08/british-national-health-service-crippled-by-privatization-austerity-funding/" target="_blank">Link to article</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4221799618451541568.post-91366528532542528012023-11-29T07:54:00.001-06:002023-11-29T07:54:35.479-06:00Trump vows again to try to ‘terminate’ Affordable Care ActTrump 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, <a href="https://www.kff.org/interactive/kff-health-tracking-poll-the-publics-views-on-the-aca/?utm_source=Sailthru&utm_medium=email&utm_campaign=UNN%2011.29.23&utm_term=UpNorthNews#?response=Favorable--Unfavorable&rMin=1514247453658.5366" target="_blank">given the strong and growing public support for affordable health care</a>. “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.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4221799618451541568.post-27082560216585460832023-11-16T11:26:00.001-06:002023-11-16T11:26:18.692-06:00Excessive Corporate Control in MedicineSummary: 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.
<a href="http://healthjusticemonitor.org/2023/11/15/excessive-corporate-control-in-medicine/" target="_blank">The Corporate Practice of Medicine</a>
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.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4221799618451541568.post-89605260559460802732023-10-04T06:43:00.002-06:002023-10-04T06:43:51.686-06:00Lancet Panel on Investor-Owned Health Care<a href="http://healthjusticemonitor.org/2023/10/03/lancet-panel-on-investor-owned-health-care/" target="_blank">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.</a>
Public policy and health in the USA: should investors own healthcare?
<a href="https://www.thelancet.com/webinars" target="_blank">https://www.thelancet.com/webinars</a> (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.
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4221799618451541568.post-37148938113641844072023-09-22T07:38:00.003-06:002023-09-22T07:38:58.567-06:00"Cha-Ching!" Lina Khan Attacks Private Equity in Health CareFTC 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 -- <a href="https://www.thebignewsletter.com/p/cha-ching-lina-khan-attacks-private?utm_source=post-email-title&publication_id=11524&post_id=137241134&utm_campaign=email-post-title&isFreemail=true&r=fqox&utm_medium=email" target="_blank"> article link</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4221799618451541568.post-64753419714021981022023-09-20T16:08:00.004-06:002023-09-20T16:08:46.313-06:00Understanding & Fighting Investor Ownership of Health Care
<a href="http://healthjusticemonitor.org/2023/09/20/understanding-fighting-investor-ownership-of-health-care/" target="_blank">http://healthjusticemonitor.org/2023/09/20/understanding-fighting-investor-ownership-of-health-care/</a>
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,
DonUnknownnoreply@blogger.com0tag:blogger.com,1999:blog-4221799618451541568.post-48161265020245369552023-09-14T08:20:00.001-06:002023-09-14T08:20:31.261-06:00US Health Care Is Pretty Good … If You Own an Insurance Company<a href="http://healthjusticemonitor.org/2023/09/14/us-health-care-is-pretty-good-if-you-own-an-insurance-company/" target="_blank">article link</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4221799618451541568.post-70853277450095482942023-08-13T10:09:00.001-06:002023-08-13T10:10:00.452-06:00Basic library of universal health careBasic 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. <a href="https://docs.google.com/document/d/1DPTujgZSNvj6cUO65dsMCi0ULQUZCzXMqCqsRugw_WA/edit?usp=drive_link" target="_blank">Link to copy with the links to articles</a>
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.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4221799618451541568.post-41770270732578720022023-07-21T07:45:00.001-06:002023-07-21T07:45:08.588-06:00Health Care Financing Issues<a href="http://healthjusticemonitor.org/2023/07/20/ny-times-tantalizingly-close-on-health-care-financing-issues/" target="_blank">NY Times Tantalizingly Close On Health Care Financing Issues</a>
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By Admin2
Post date
July 20, 2023
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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.”Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4221799618451541568.post-79307720129748720322023-07-13T07:30:00.000-06:002023-07-13T07:30:00.237-06:00Rose Roach talks about nurses, unions, single-payer. July 11, 2023 at OPS Office HoursJoel 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
<a href="https://youtu.be/FCE_MHDp-Fk" target="_blank">Rose gave an excellent presentation last night at the Tuesday, July 11, 2023, OPS Office Hours</a>.
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 StatesUnknownnoreply@blogger.com0tag:blogger.com,1999:blog-4221799618451541568.post-66004078603462888212023-07-13T07:09:00.001-06:002023-07-13T07:09:15.850-06:00Thanks for this email message[GrNoHealth] Private equity is having a moment
<a href="https://drive.google.com/file/d/1EtjAAa7gh-ncAaxnTuOiwZm1_yYBpald/view?usp=sharing" target="_blank">Full Message with Links</a>
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.
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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
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. . .
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.
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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.
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Here is a snippet from the Times' review, which included another book, as well:
. . .
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. . .
Consider all this as summertime beach reading for nerds. Enjoy!
Joel ClemmerUnknownnoreply@blogger.com0tag:blogger.com,1999:blog-4221799618451541568.post-46588514876662007252023-07-11T07:14:00.001-06:002023-07-11T07:14:15.109-06:00Federal Actions Leave in Place a Flawed Health Insurance SystemSummary: 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! <a href="http://healthjusticemonitor.org/2023/07/10/federal-actions-leave-in-place-a-flawed-health-insurance-system/" target="_blank">Article</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4221799618451541568.post-75361019182757302842023-07-11T07:07:00.001-06:002023-07-11T07:07:08.211-06:00HealthCare Now - Learn with us this summer!We are building a movement to win!
That’s why we’ve <a href="https://www.healthcare-now.org/civicrm-base-page/mailing/view/?reset=1&id=3202" target="_blank">expanded our training series</a> 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.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4221799618451541568.post-3544453878074549162023-07-08T06:32:00.002-06:002023-07-08T06:35:30.509-06:00CA 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:
<a href="https://calmatters.org/health/2023/07/single-payer-health-care/" target="_blank">https://calmatters.org/health/2023/07/single-payer-health-care/</a>
" 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. "
CraigUnknownnoreply@blogger.com0tag:blogger.com,1999:blog-4221799618451541568.post-39725547038945531002023-06-27T06:54:00.000-06:002023-06-27T06:54:01.385-06:00PNHP will dig deep on Medicare privatizationArticle: "<a href="https://bit.ly/3plUf5B">our vision of improved Medicare for All is under dire threat from profit-hungry corporations and the policymakers</a> "Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4221799618451541568.post-4243409805605583872023-05-18T16:16:00.002-06:002023-05-18T16:16:40.246-06:00It’s time to guarantee healthcare to all Americans as a human right<a href="https://www.theguardian.com/commentisfree/2023/may/18/healthcare-us-human-right-medicare-for-all-bernie-sanders" target="_blank">It’s time to guarantee healthcare to all Americans as a human right</a>
Bernie Sanders
It is time to end the international embarrassment of the US being the only major country that does not guarantee healthcareUnknownnoreply@blogger.com0tag:blogger.com,1999:blog-4221799618451541568.post-67013826594938605092023-05-09T15:36:00.001-06:002023-05-09T15:36:24.459-06:00This is Go Time<div class="separator" style="clear: both;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVAEPueE3aPl4p2PHrlvR-Lde1dHcfNCBKbav71m1TwDofY5bhHcTdNMqKmQEOw-bL_T6ntveQUPlVegRg_YW4nY5TsRL-BEPmJCXCYBtgy4IB7YGbgB3AnBILQ0ZLauRwZsUhsZgvWMjCztgNZtI7asAeER5qkb4BrNX-3S5_LqgXJjT4C_ZtJBxj6w/s1200/med4all.png" style="display: block; padding: 1em 0; text-align: center; "><img alt="" border="0" width="400" data-original-height="224" data-original-width="1200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVAEPueE3aPl4p2PHrlvR-Lde1dHcfNCBKbav71m1TwDofY5bhHcTdNMqKmQEOw-bL_T6ntveQUPlVegRg_YW4nY5TsRL-BEPmJCXCYBtgy4IB7YGbgB3AnBILQ0ZLauRwZsUhsZgvWMjCztgNZtI7asAeER5qkb4BrNX-3S5_LqgXJjT4C_ZtJBxj6w/s400/med4all.png"/></a></div>
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?
<a href="https://bit.ly/3ppmtvN" target="_blank">https://bit.ly/3ppmtvN</a>
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!Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4221799618451541568.post-53790862527632489152023-04-14T07:42:00.006-06:002023-04-14T07:48:54.061-06:00Researchers find flaws in WI Medicaid restrictions bill, and in the ideas behind itThey 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."
<a href="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" target="_blank">Article # 1</a>
<a href="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" target="_blank">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</a>
<a href="https://wisconsinexaminer.com/2023/04/13/lawmakers-debate-bills-that-would-create-new-barriers-to-benefits/?eType=EmailBlastContent&eId=f7aa741b-e239-4770-a208-ed7889724a78%20https://docs.legis.wisconsin.gov/2023/related/proposals/ab148" target="_blank">Aricle #2</a>
<a href="https://wisconsinexaminer.com/2023/04/13/lawmakers-debate-bills-that-would-create-new-barriers-to-benefits/?eType=EmailBlastContent&eId=f7aa741b-e239-4770-a208-ed7889724a78%20https://docs.legis.wisconsin.gov/2023/related/proposals/ab148" target="_blank">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</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4221799618451541568.post-43467869441886469422023-04-06T07:01:00.001-06:002023-04-06T07:01:28.598-06:00Managing Medicaid changes so people don’t lose health insurance"<a href="https://wisconsinexaminer.com/2023/04/06/managing-medicaid-changes-so-people-dont-lose-health-insurance/?eType=EmailBlastContent&eId=0595264b-d1cc-403a-a35e-9642fe2da23a" target="_blank">Official outlines steps federal government is taking — and states could take — as continuous coverage requirement ends</a>"
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4221799618451541568.post-85726014057621279592023-04-02T12:38:00.001-06:002023-04-02T12:38:08.630-06:00U.S. judge rules insurers don’t have to cover many free preventive health services<a href="https://wisconsinexaminer.com/2023/03/30/u-s-judge-rules-insurers-dont-have-to-cover-many-free-preventive-health-services/" target="_blank">Article in 3/30/23 WI Examiner</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4221799618451541568.post-81650822611729747592023-03-29T08:14:00.003-06:002023-03-29T08:17:51.091-06:00LTE on health care access - Mark Martin: More health coverage options needed<a href="https://www.winonadailynews.com/opinion/letters/mark-martin-more-health-coverage-options-needed/article_fbc55d6d-e5fc-5849-9e4f-9e51f9f165f9.html" target="_blank">More health coverage options needed</a>
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."
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4221799618451541568.post-54827082013013958862023-03-28T11:22:00.003-06:002023-03-28T11:24:56.875-06:00The quiet privatization of government health insurance programsArticle: <a href="https://www.axios.com/2023/03/28/medicare-medicaid-privatization-health-insurance" target="_blank">https://www.axios.com/2023/03/28/medicare-medicaid-privatization-health-insurance</a>
<div class="separator" style="clear: both;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjQ4LAsfgDHWYLso1DwhSmce8azq6Dk8YfHgUPAWoRbCUCsliBGN9MypdbFqGLuluSO_ivE_eDdg71Y9B8oUyscnH5SvR_LRYeQQgVdGSxgw-gYCJ3stnq7Wfv7N7X_ZzX8v4FP26wQ8aKscfaMpjTkoYGUXwvpBs7C1cIGfuimilWv5hrk6y0HJmajg/s779/Capture.JPG" style="display: block; padding: 1em 0; text-align: center; "><img alt="" border="0" width="400" data-original-height="420" data-original-width="779" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjQ4LAsfgDHWYLso1DwhSmce8azq6Dk8YfHgUPAWoRbCUCsliBGN9MypdbFqGLuluSO_ivE_eDdg71Y9B8oUyscnH5SvR_LRYeQQgVdGSxgw-gYCJ3stnq7Wfv7N7X_ZzX8v4FP26wQ8aKscfaMpjTkoYGUXwvpBs7C1cIGfuimilWv5hrk6y0HJmajg/s400/Capture.JPG"/></a></div>
"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."
Unknownnoreply@blogger.com0