JustCare

Tag: Medicare for all

  • What’s the value of private health insurers?

    What’s the value of private health insurers?

    Many Americans believe that private health insurance has value. And, many wealthy countries with universal health care rely on private health insurers. What is their value?

    With private health insurers, the question is who’s in control of coverage and costs. So long as private health insurers are in control of coverage and costs, their incentive is to maximize profits through delays and denials of care. But, private health insurers can add value when they act as third-party administrators.

    Most people don’t appreciate that even traditional Medicare relies on private health insurers to administer claims. Health insurers serve as claims processors, following the rules set by the government as to what care to pay for, when to pay for it and how much to pay. Many other wealthy countries also rely on private insurers in this capacity.

    When the government offering coverage contracts out claims processing to private health insurers, the government bears the risk, as it does in traditional Medicare. The government is responsible for covering the cost of all the claims, not the insurers. So, insurers have no incentive to stint on coverage. They don’t profit from denying care.

    In a piece for CounterPunch, John Geyman makes the case that we need to get rid of the US health insurance system that allows profit-driven insurers to benefit from denying care. It has made health care unaffordable for almost everyone in the US, employers and taxpayers included.

    We need a non-profit public financing system that covers everyone, as Geyman says. People cannot count on employers for their coverage, as we have seen during the novel coronavirus pandemic. Workers are not guaranteed their jobs.

    Private health insurance also limits people’s choice of doctors and choice of treatments. Insurers denied nearly one in five in-network claims in 2018. And, private insurance leaves tens of millions of people underinsured, with high out-of-pocket costs.

    Furthermore, for reasons that are unclear, the Congressional Budget Office reports that the private health insurance industry receives federal subsidies averaging $685 billion a year. The trajectory we are on is unsustainable.

    Ending the ability of private health insurers to restrict access to physicians and treatments would expand people’s choices. Ending insurers’ ability to squeeze substantial profits out of the system would lower health care costs. And, simplifying the system through a single government insurer that negotiates provider rates for everyone would bring down both health care prices and administrative costs. At the same time, we would do away with prior authorization requirements and other hurdles that keep people from getting needed care.

    With Medicare for All, private health insurers could have a role processing claims. And, health care would be far more affordable. All but five percent of Americans would spend less on health care than they do today.

    Here’s more from Just Care:

  • Why did Amazon’s health care venture fail?

    Why did Amazon’s health care venture fail?

    You likely recall that a few years ago, Amazon, Berkshire Hathaway and JP Morgan Chase decided that they would come together to address the health care needs of their employees collectively. They put Atul Gawande at the helm and paid him the big bucks to fail. Yes, Haven, the name of this health care venture, could not accomplish what it set out to do–take on the health insurers to lower costs and improve quality of care for 150,000 workers.

    Here’s a question for those people who believe that employers have the power to use their leverage to hold insurers accountable and deliver people the health care they need: Do you think Gawande/Amazon et al. messed up or have you come to recognize that the system must change in order to deliver better health outcomes at lower cost?

    Here are the biggest lessons learned, according to Gawande:

    • The Haven concept had a fatal flaw: Insurance tied to people’s work makes no sense. People are changing their work all the time, so employers have no interest in making long-term investments in their health. Employers want to limit their health care spending as much as possible to the short-term.
    • Government needs to step in and put an end to employer-provided healthcare if we want to ensure people’s long-term health.
    • People want insurance with low or no out-of-pocket costs. They want low-cost mental health care, primary care and prescription drugs. Gawande does not say this, but Haven designed its coverage without these costs, presumably in response to what employees were asking for.
    • Medicare for All, one public insurer investing in people’s care over the short and long-term, is the only cost-effective way to ensure critical investments in people’s long-term health. Gawande fails to say this. But, if he doesn’t believe it, how does he imagine getting insurers to meet people’s long-term health needs? How does Gawande imagine our health care system, as is, can protect rural hospitals, vulnerable communities, and other precious health-care resources when the marketplace cannot?

    Here’s more from Just Care:

  • Government agency finds Medicare for all saves money

    Government agency finds Medicare for all saves money

    Matt Bruenig writes for Jacobin about the latest Congressional Budget Office (CBO) estimate of the cost of Medicare for All. The CBO finds that, with Medicare for all, everyone in the country would be guaranteed health insurance at little or no cost and overall health care spending would fall. Medicare for all saves money!

    In arriving at its estimated cost, the CBO looked at the number of additional people who would need to be insured, administrative savings from having one system for enrolling everyone and paying providers, along with savings from negotiated rates to providers and pharmaceutical companies. The CBO considered four different options for designing Medicare for all and found savings from all of them ranging from $42 billion to $743 billion in one year. The only design that cost more paid doctors, hospitals and drug companies higher rates and included coverage for long-term services and supports–home care and nursing home care. That design was projected to cost $290 billion a year more.

    The design closest to the Medicare for all legislation in the House and Senate–which pays lower rates to providers–is projected to save $650 billion in one year. Even with coverage for long-term services and supports, it saves about $300 billion annually.The CBO finds tremendous administrative savings from moving to Medicare for all.

    The CBO determines that administrative costs would be lower than traditional Medicare’s, which are 2 percent, because the federal government would not have to spend money establishing whether people were eligible for coverage. It would also save money on the cost of collecting premiums, which it would not need to do. Consequently, administrative costs would fall to 1.5-1.8 percent, which literally translates to hundreds of billions of dollars in savings.

    In sum, the CBO concludes what myriad other single payer/Medicare for All studies conclude. If the US moved to Medicare for all, everyone would be insured and it would cost less than we spend today on healthcare. The issue is not the cost but the political challenges.

    Here’s more from Just Care:

  • Biden has power to authorize free Medicare for everyone

    Biden has power to authorize free Medicare for everyone

    President-elect Biden could guarantee everyone in the US affordable healthcare if he wanted to. David Dayen writes for The American Prospect that, because of the pandemic, a Biden administration–without Congress–has the power to ensure everyone in the country free health care coverage through Medicare. Will Biden have the courage to act and save millions of lives in the process?

    Dayen reports that the Social Security Administration and the Department of Health and Human Services have the authority to give people Medicare for free during the pandemic. A provision in the Affordable Care Act allows this coverage for all people who are subject to an “environmental exposure.” Consequently, the COVID-19 pandemic could make everyone in the country eligible for Medicare, if the incoming administration chose to exercise its authority to do so. 

    Congress might not be planning to enact Medicare for All any time soon. But, in a real way, Section 1881A of the Social Security Act specifically confers the authority on the administration to put in place Medicare for all who want it. Today, more than 2,500 people of Libby, Montana have free Medicare. These people have Medicare because they were exposed to an environmental hazard that could lead to medical issues. So, the federal government is covering their medical costs.

    It’s hard to imagine that President-elect Joe Biden will use this power even in a limited way to provide Medicare to millions of Americans with COVID-19 or who have tested positive for COVID and who otherwise might not be able to afford needed care during this pandemic. But, the ACA provides his administration the authority to establish “optional pilot programs” throughout the country, because of President Trump’s public health emergency declaration. Individuals can then choose to apply for Medicare benefits. They will meet the criteria so long as they are in the middle of a “public health hazard to which an emergency declaration applies . . .” There is nothing to stop HHS from establishing such a pilot program.

    Indeed, HHS could establish the program for everyone in the country, as everyone is at risk of COVID. Cost of testing and treatment should not impede people’s access to care and would promote the public health. And, Biden has said that he supports free coronavirus treatment and a free vaccine.

    What’s more radical: Giving everyone free Medicare or letting tens of thousands of Americans die because the federal government did not do so?

    Here’s more from Just Care:

  • Biden picks California AG Xavier Becerra to head HHS

    Biden picks California AG Xavier Becerra to head HHS

    There is some good news for people with Medicare and Americans writ large! President-elect Joe Biden has named California Attorney General, Xavier Becerra, to head the US Department of Health and Human Services. Becerra is a vocal advocate of Medicare for All and a politically savvy former member of Congress.

    Joe Biden could not have picked a better candidate than Xavier Becerra to serve as Secretary of the US Department of Health and Human Services. Becerra is not a physician, but he has tremendous expertise in health care policy and the politics of health care. Before becoming Attorney General for California, Becerra served for 24 years in the US House of Representatives. And, as California Attorney General, he has led the charge to defend the legality of the Affordable Care Act.

    In the role of HHS Secretary, Becerra would help set the direction of our nation’s health care policy. Of course, Becerra would have to answer to the President. And, any major reforms would need to come from Congress.

    Becerra could and should put an end to many of the Trump administration’s health care policies, including a move afoot to privatize traditional Medicare. He could also implement rules that brought down prescription drug prices, at least for people in Medicare and Medicaid.

    David Sirota reports in the Daily Poster that Becerra supported government action to end patents on some high-priced drugs through the exercise of “march-in rights.” Under the law, when the federal government has invested in research and development for medicines that are not reasonably priced, it can march in, pay the manufacturer a royalty, and issue licenses to other manufacturers to produce the drugs at a lower cost.

    As California’s attorney general, Becerra advocated for the Trump administration to exercise march-in rights to bring down the cost of remdesivir for the treatment of COVID. The federal government paid for much of its research and development.

    President Obama refused to exercise march-in rights. And, it is not at all clear that President-elect Biden will be willing to exercise them either. But, with millions of Americans unable to pay for their medicines and drug prices through the roof, pressure is mounting on the government to step in.

    Becerra also has supported importation of prescription drugs from abroad. While that would be a band-aid measure, it is an important one that would help reset the price of prescription drugs in this country on a par with other countries. As Secretary of HHS, Becerra could make it a lot easier for states and other agencies to import drugs from abroad.

    Here’s more from Just Care:

  • Health care reform in 2021: What you need to know

    Health care reform in 2021: What you need to know

    Mark Dudcik, National Coordinator of the Labor Campaign for Single Payer, offers ten important facts that will affect health care reform in 2021 and over the long-term. They help to highlight the challenges and opportunities for health care justice with President-elect Joseph Biden at the helm. Here’s what you need to know:

    1. 72% of voters support Medicare for All. Fox News exit polls reveal that 72% of the voters were in favor of a “government run healthcare plan”  
    2. All House candidates who cosponsored the Medicare for All Act were reelected. These advocates for Medicare for All even won in swing states. 
    3. The COVID-19 pandemic has caused 14 million people to lose employer-sponsored health coverage. The 14 million Americans include workers who lost their jobs and their families. Since 2017, when President Trump took office, and pre-novel coronavirus pandemic, an additional 2.3 million people lost their health insurance.
    4. Unions are beginning to see the risk of tying health care to jobs. They are struggling to guarantee health care to their members who have lost their jobs since the pandemic or who are likely to lose them if the economy sinks. With state and local governments in economic distress, union members are likely to face health care benefit cuts. 
    5. President-elect Joe Biden is seeing an outpouring of support from the for-profit health care sector, including the health insurance industry and the pharmaceutical industry.  
    6. President-elect Biden has said that he does not support Medicare for All.  Indeed, he said that he would veto it, if passed. 
    7. President-elect Biden proposes a “public option.” It doesn’t look like people will be able to opt for public health insurance, a “public option” in the next year or two. But, even if Congress were to enact legislation allowing people to buy a version of traditional Medicare with an out-of-pocket cap–the only public option that would give people access to the doctors they want to see at a lower cost than they currently pay–it would not address out-of-control health care costs or eliminate the $600 billion in administrative waste in our health care system.
    8. President-elect Biden proposes lowering the age of Medicare eligibility age to 60. Helping 20 million older people get good coverage is beneficial. But, if Congress were to enact this legislation, which is unlikely in the next two years, it would also need to offer a subsidy to people 60-64, or most people would not be able to afford to enroll inMedicare. Congress would also need to improve traditional Medicare, adding an out-of-pocket cap and drug benefits or it would not be a viable option. People under 65 do not have the right to buy Medicare supplemental insurance, which they would otherwise need to fill gaps in traditional Medicare.  
    9. The Supreme Court could undo some or all of the ACA. Most people do not believe that the Supreme Court will completely undo the ACA, but it still might undo some of it. Democrats in Congress might not have the power to strengthen the ACA.  
    10. Without Congressional action, our people and our economy are likely to suffer tremendously. Congress should pass the Health Care Emergency Guarantee Act, which would help Americans get needed care and stimulate the economy. So, long as Mitch McConnell is Senate Majority Leader, it is unlikely to happen.

    Given the state of our Congress and President-elect Biden’s policy agenda, it’s hard to see a clear path forward to a better health care system in the near future. But, those of us who believe health care is a human right need to continue to make our voices heard and to pressure our political leaders to do right by Americans and guarantee everyone access to affordable care.  

    Here’s more from Just Care:

  • Fox News: 72% voters want “government-run healthcare”

    Fox News: 72% voters want “government-run healthcare”

    Vice-President Biden’s victory in the presidential election is cause for huge relief and celebration, though the number of people who voted for Trump should give us pause. What it means and how best to move our nation forward will be a subject of research and conversation for some time. What’s no surprise is that many people who voted for Trump support government-run health care, just as they overwhelmingly support Medicare and Social Security.

    A new Fox News poll finds that 72 percent of voters favor “changing to a government-run health care plan.” Of course, they do. They need health care, and they increasingly cannot afford it, even with private insurance.

    Unfortunately, many Democrats in Congress who ran for the first time for Senate and House seats, refused to take a bold stand on health care affordability, let alone Medicare for all. They lost. What’s noteworthy is that Democratic candidates in swing states who supported Medicare for all won. And, all 109 Democratic House candidates who co-sponsored Medicare for all were elected or re-elected.

    Even still, centrist Democrats refuse to admit that their failure to support Medicare for All is what cost them seats in the House and Senate. Majority Whip James Clyburn wrongly conflated Medicare for all–private health care paid for directly through the government–with socialized medicine–public health care provided by the government. And, he advised candidates to stay away from supporting Medicare for all.

    Clyburn receives a lot of support from the health care industry. Like his fellow Democrats in Congress who depend on the health care industry for support, he won’t concede that the cost of care with private health insurance is forcing tens of millions of Americans to forego needed care.

    Centrist Democrats appear to believe that the Affordable Care Act is a solution to the crisis in our health care system. But, only 20 million Americans benefit from coverage through state health care exchanges. And, though they get coverage, the deductibles and copays too often force them to go without care.

    Fox News reports that nearly two in three voters in Georgia want the choice of public health insurance. Both Raphael Warnock and Jon Ossoff, two Democratic Senate candidates who face runoff elections in Georgia in January, support the public health insurance option for anyone who wants it. And, that’s what Americans support.

    But, if the centrist Democrats have their way, they will try to limit access to the public option to people with low-incomes only. That might please their corporate backers from the health care industry, but it would not address the need to decouple health care from employment and give every American access to public health insurance.

    Almost every working American risks losing a job and, with it, health insurance. Every working American deserves the protection of reliable government-administered public health insurance if they want it. If modeled on traditional Medicare, as the Biden-Sanders Unity Task Force proposes, with an out-of-pocket cap, the public option would ensure people have good health insurance. If public health insurance covered care from virtually every doctor and hospital in the country, as traditional Medicare does, and benefited from Medicare’s negotiated provider rates, Americans would have access to lower-cost health insurance and health care from the doctors and hospitals they want to use.

    Democrats in Congress should recognize that progressive activists organized voters in key communities and helped Biden win the presidential election. And, no one should disregard the fact that House candidates who backed Medicare for all, won reelection, even in swing states.

    Here’s more from Just Care:

  • If we reduce administrative costs, we lower health care costs

    If we reduce administrative costs, we lower health care costs

    In the Health Affairs Blog, Harvard economics professor, David M. Cutler, explains why health care administrative costs are extremely high and the need to lower them. Drs. Steffie Woolhandler and David Himmelstein have found that a move to a single-payer, Medicare for all, health care system would both guarantee everyone coverage and cut $600 billion in administrative waste, lowering health care spending substantially. Cutler recognizes these features of Medicare for All, but is not willing to advocate for it. You have to wonder who’s lining his pockets.

    Cutler sees the myriad benefits of lowering administrative health care costs. He appreciates that they consume as much as 25 percent of our health care spending. And, he knows reducing administrative costs would generate significant savings.

    Cutler also understands that some significant part of administrative spending goes to undermining people’s ability to get care. Administrative costs kick in every time you need a pre-authorization or a referral; every time you call your health plan to figure out who is in its network; every time your doctor needs to get on the phone for an approval; every time you have to fight a denial of care.

    Indeed, more than one in five health care workers, 22 percent, are engaged in administrative jobs. For each doctor and dentist, there are just under four administrative employees. In addition, doctors and nurses undertake considerable administrative work.

    The majority of administrative expense is in billing and insurance-related services. Before you can see a doctor, the doctor’s office needs to check your insurance coverage. It has to determine the amount you owe out of pocket. It needs to put codes on the care you receive. And, the insurer must pay the claim.

    Cutler acknowledges that a Medicare for all system would save a lot of these costs. In part, Medicare for all minimizes the paperwork. He makes the case for reducing administrative costs, but he then dismisses moving to Medicare for all, claiming that its tradeoffs “may not be appealing.”

    As Don McCanne, MD, writes in response, Medicare for all has many appealing qualities, not simply reduction of administrative waste. It offers guaranteed universal coverage, affordable and easy access to care, transparency, the ability to make health care system improvements, promotion of the public health and lower health care spending. What is it about our multi-payer for-profit system that Cutler does not want to lose?

    Here’s more from Just Care:

  • Majority of Americans support a public health insurance option

    Majority of Americans support a public health insurance option

    Vice-President Biden is proposing that the government offer people a public health insurance option, if he is elected President. A new Data for Progress poll finds that a large majority of voters support the government offering a public health insurance option. That said, there’s not yet a clear definition of how a public option would work.

    The concept of a public option was first raised in the last wave of health reform. It was based on the notion that private health insurers were not meeting people’s needs, either in terms of access to care or affordability; they offered restricted provider networks and charged high premiums and out-of-pocket costs. What’s worse, many seem to indiscriminately deny care because they profit when they deny care. But, no one knows when they enroll in a plan, the extent to which that health plan inappropriately denies people care.

    Congress ultimately enacted the Affordable Care Act, which offers government-administered private health insurance. It opted not to offer people the choice of public health insurance, provided directly through the government, like traditional Medicare.

    Unlike private health insurance, which generally is accountable to shareholders, public health insurance, like traditional Medicare, is accountable to the public. It relies on the government’s leverage to control costs and to ensure people access to providers across the nation. It does not profit from denying care, and is designed to “spread risk,” so that people with costly conditions are not burdened with high health care costs.

    As the Biden-Sanders Unity Task Force spells out. Americans who opted for public health insurance would pay the government for their coverage. And, the Data for Progress poll indicates Americans are fine with that. Nearly half of voters, a plurality, say they would be willing to pay the government directly for public health insurance (49 percent).

    Members of Congress are still considering how to design a public option and whether it should be available to everyone. Americans want public health insurance to be available as a choice to everyone (45 percent). It should be. Private insurers, no matter how many there are in a given market, do not engage in meaningful competition–competition that drives value by lowering health care costs and improving quality.

    Americans also support automatic enrollment in public health insurance for people who do not have other coverage. The novel coronavirus pandemic has revealed the fragility of our employer-based health care system. You lose your job and, often, your health insurance as well. People who leave their jobs continue to need protection from health care costs and do not want to worry about having health care coverage.

    What’s most interesting is that two-thirds of Americans say they would get their health insurance through a government-run plan. Fewer than one in five voters say they would not get insurance through the government. Americans increasingly realize that they need an alternative to private health insurance, which is often unreliable and unaffordable.

    Lest there remain any confusion about the definition of a public option–the choice of public health insurance–it is not the same as the choice of private health insurance through the government. Americans already have government-administered private health plan options in the state health exchanges. These health plans do not have the power to rein in costs; they do not offer a broad provider network; and, they answer to their shareholders first and foremost.

    The question becomes whether Democrats in Congress, much less Republicans, are prepared to acknowledge that if they enact a public option it should piggyback off of traditional Medicare with an out-of-pocket cap and prescription drug coverage woven into the benefit. That would put it on a level playing field with private health plans. Only this improved traditional Medicare offers people the guarantees of easy access to care from the doctors they want to see at a price they can afford.

    Here’s more from Just Care:

  • The Medicare Advantage scam and beyond

    The Medicare Advantage scam and beyond

    Kay Tillow writes for Daily Kos about the “Medicare Advantage scam” and beyond. She explains that these for-profit health plans that deliver Medicare benefits are using stars like Joe Namath to mislead people into signing up for coverage that very well might not meet their needs if they get sick or need a lot of costly care. Medicare Advantage plans, in fact, could keep them from accessing critical care.

    What Namath does not tell you is that if you choose the wrong Medicare Advantage plan, you might face inappropriate denials of care, along with other administrative and financial barriers to care. Indeed, new research finds that the wrong choice of Medicare Advantage plan might literally kill you. That’s what Yale economics professor Jason Abaluck found when analyzing data about these corporate health plans. But, the plans won’t let you have access to their mortality data, and Congress is not requiring them to give you access.

    Instead, the Centers for Medicare and Medicaid Services (“CMS”) is allowing Medicare Advantage plans to send you to “the Medicare Coverage Helpline.” And, while you might think that it is a government, independent agency, it is in fact a corporate marketing agency, designed to seduce you into giving up your public health insurance under traditional Medicare and to sign up for a private insurance Medicare Advantage plan.

    No question that you take a big gamble when you sign up with a Medicare Advantage plan. If you’re lucky and are healthy, you can save money because you won’t need to buy supplemental coverage, as most people need to do in traditional Medicare. But, if you get sick, you might find that you can’t see the doctors you want to see, your plan refuses to pre-authorize procedures your doctors say you need and, if you get care, the copays and deductibles add up to thousands of dollars.

    Medicare Advantage plans generally offer some benefits that traditional Medicare does not offer, which is an attraction. But, you are trading away your ability to see the doctors and use the hospitals you want to use anywhere in the country without worry that your care will be covered. Moreover, Medicare Advantage plans can and do sometimes take a narrow view of what’s covered, refusing to pay for services that traditional Medicare pays for. And, the data show that they tend to offer lower quality care.

    If you need nursing home care or home care, you are likely to find that the network providers are of poor quality. Medicare Advantage plans maximize profits by paying as little as possible for the care they provide you. So, that can often mean they contract with poor quality providers.

    Namath makes it sound as if he is working for Medicare. That he is helping you. He does not explain that he is trying to get you to disenroll from traditional Medicare, the public health insurance plan. What’s worse, he does not explain that if you leave traditional Medicare and enroll in a Medicare Advantage plan, you very well might not be able to switch back to traditional Medicare. Unless you live in Connecticut, New York, Massachusetts or Maine, if you are in poor health and need costly care, insurers that sell supplemental coverage do not have to sell it to you.

    And, if that’s not bad enough, you do not have anywhere near the information you need to make an informed choice about a Medicare Advantage plan. What’s the mortality rate? How frequently does it deny claims inappropriately? Has CMS found that it jeopardizes the health and well-being of its members? You can’t find this information. Medicare’s star-rating system is a farce and you should not rely on it.

    Members of Congress on both sides of the aisle have been taken in by these for-profit companies. Maybe it’s because these lawmakers are heavily lobbied. Maybe it’s because of the campaign contributions they receive. Maybe it’s because they just have not had to focus on the horror stories. Senator Brown and five other Senators have hit a wall trying to understand why CMS is not holding Medicare Advantage plans accountable for their bad acts.

    If you have a Medicare Advantage horror story to share, contact your Senators. Let them know. They need to understand why they need to preserve traditional Medicare. If traditional Medicare goes, everyone with Medicare likely will end up in a Medicare Advantage plan that is not likely to meet their needs.

    P.S. The  Medicare Coverage Helpline is owned by TogetherHealth PAP, LLC, which in turn is owned by Health Insurance Innovations. Health Insurance Innovations is enmeshed in two class-action lawsuits. It allegedly bilked Americans of millions of dollars. The FTC ended up shutting them down last fall.

    Our elected representatives can continue to put their heads in the sand and ignore the predatory and unscrupulous behavior of corporate health insurers and their marketing agents. They can dismiss the reality that millions of Americans are being ripped off and tens of millions more are going without needed care. Or, they can close down the Medicare Advantage plans and guarantee us the health care we need through improved Medicare for all.

    Here’s more from Just Care: