JustCare

Tag: Single-payer

  • Can we fix our broken health care system without reining in costs?

    Can we fix our broken health care system without reining in costs?

    Aaron Carroll writes for the New York Times about how to fix our broken health care system.

    Notwithstanding all the ways the Covid-19 pandemic exposed fissures in our health care system, bringing with it more than one million deaths, Congress is doing precious little to address uninsurance and underinsurance and their consequences for our health and well-being.  Carroll studied health systems in five other wealthy countries to appreciate differences between them and the US. Carroll suggests that universal health care is the solution to our broken system, whatever it looks like; he doesn’t see health care costs in the US as a stumbling block.

    We spend more per person on health care than any other country, and health outcomes are generally significantly worse than in every other wealthy country, including life expectancy. So, what does the United Kingdom, France, Australia and New Zealand do differently? They all guarantee health care coverage to their citizens.

    Carroll posits that in every other significant way these other wealthy countries are different from one another. But, these countries not only share guaranteed universal coverage. They all have a sets price for most health care goods and services. It’s that combination, along with significant restrictions on insurance company profits, that make health care affordable for their citizens.

    Australia, New Zealand and Canada all offer government-provided coverage,  sometimes called single-payer.  Australia and New Zealand’s single-payer systems allow people to buy private insurance to improve their access to care. Canada does not allow that.  Australia’s system requires people to contribute significantly to the cost of their care.

    Carroll says France’s system is not quite single-payer because people get their coverage through different systems. But, it is primarily with government funding, either through their jobs or some other means, and with significant government rules and regulations. France requires people to pay upfront for their outpatient care and then reimburses them for the cost.

    Britain likely offers the most robust coverage of all these countries. Most services come with no out-of-pocket costs. Britain’s system is different from single payer because it is not insurance-based. Rather, the government employs physicians and owns hospitals and covers people’s care directly.  The British system is socialized medicine. While people can have private insurance for enhanced benefits, almost no one does.

    Singapore offers everyone only catastrophic coverage for high-cost services. People can buy private insurance to supplement the public coverage, but few do.

    Carroll acknowledges that public hospital systems in all these countries make a huge difference in improving access to care, eliminating competition for profits. It seems hard to imagine how the US moves to that system to reduce costs and improve access, given the very limited number of public hospitals here. Is there any way to open up the Veterans Administration hospitals to all Americans? And, even if there were, would that give people living in remote areas adequate access to care?

    Carroll points up that housing, food and education also contribute significantly to better health. Other countries invest in these “social determinants of health.” The US does not, but we could.

    Carroll suggests that if we allocated some of our health care budget to the social determinants of health, we would likely see far better health outcomes. But, we are currently on the reverse trajectory, cutting this discretionary spending, such as food stamps. With all the money we invest in health care, Carroll has hope of realigning these investments. He thinks it’s simply a matter of political will.

    Here’s more from Just Care:

  • How does Taiwan’s health care system work?

    How does Taiwan’s health care system work?

    In Taiwan, whether you suffer from diabetes, alcoholism or heart disease, you can always get the health care you need. Health care is a right. And, under Taiwan’s single payer, universal health care system, health care is affordable, with few if any costs to patients. Dylan Scott reports for Vox on Medicare for All–single-payer by another name–in Taiwan.

    Taiwan’s single-payer system is relatively new. Less than 30 years ago, Taiwan’s health care system looked a lot more like the US system, fragmented and inequitable. In the 1980s, about four in ten Taiwanese had no health insurance.

    Today, about ten percent of Americans lack health insurance. Yet, tens of millions of Americans lack adequate coverage, meaning they are underinsured, unable to pay for needed care even with coverage.

    When asked how to reform Taiwan’s health care system back in the 1980’s, Princeton economist Uwe Reinhardt’s answer was Medicare for all, a single unified national system that would be equitable and cost-effective. Notably, many Taiwanese opposed the idea and did not think it could work. There were protests, and more than half of the Taiwanese said they did not want a single-payer system. But, it was enacted.

    Then, single-payer  took root. Taiwan’s single-payer system covers all medically reasonable and necessary care, including prescription drugs and Chinese medicine (but not long-term care), and it’s simple and easy to use. Relying on a sophisticated database to process claims, the government spends only one percent of its health care budget on administration. The government negotiates rates with providers and further contains costs through global budgets.

    In stark contrast, corporate health insurers in the US spend 12 percent of their revenue on administration. And, administrative costs account for 25 percent of hospitals’ budgets. The US also does not negotiate provider rates for all Americans or rely on global budgets to contain costs.

    In Taiwan, the government can monitor the health care system for inappropriate care and drive system improvements. Patients’ medical records are all on one system. Taiwan uses a national electronic health records database. In the US, there are scores of different electronic health records systems and a lot of them are proprietary and not open to public access. It’s generally very difficult to know what’s working and not working in our health care system.

    Single-payer has worked quite well in Taiwan for the last 25 years. More than eight in ten Taiwanese currently support its single-payer system. Their health insurance premium payments take the form of  payroll contributions (5.17 percent of income) from them and their employers, just as ours do with Medicare and Social Security.

    Progressive income taxes and additional taxes on lottery tickets and tobacco also help fund the Taiwanese health care system. And, the Taiwanese government imposes a copay of about $12 whenever people use the medical system, unless they are low-income. Taiwanese with greater incomes can buy private insurance to pay for services their public system does not pay for.

    The Taiwanese find  their system easy to use. On average, they have more than 12 medical visits a year and wait times are relatively short. But, there are not enough doctors.

    Taiwan’s health care system has its challenges for patients, doctors and residents alike. People see costs rising, albeit at a far slower rate than in the US. Some patients don’t have access to the newest medical services. And, some doctors feel overworked.

    With health care costs growing, Taiwan is concerned about how to keep its system sustainable. Still, the country only spends six percent of GDP on health care, as compared to 17.7 percent in the US. And, the Taiwanese system works much better than in the US, where it’s far more common for people to go without care and die prematurely. In Taiwan, everyone is covered, health care outcomes are far better, with longer life expectancies and better health care quality, and costs are lower than in the US.

    Before the US can move forward with a system like Taiwan’s, policymakers need to agree that health care is a social good, like Social Security, public education and public safety. Taiwan reached that consensus in the 1990s. We’ve made some headway with passage of the Affordable Care Act, but we still have a ways to go.

    Here’s more from Just Care:

  • Strong majority of public continues to support Medicare for all

    Strong majority of public continues to support Medicare for all

    A new Kaiser poll finds that public opinion on health care reform changes depending upon how it is described. Nearly two thirds of the public supports “Medicare for all,” a form of universal health care. Far fewer support other terms, even though they describe Medicare for all.

    Different descriptions for health care reform could have the same or different meanings. “Medicare for all” describes US Senate and House bills which improve Medicare benefits to include hearing, vision, and dental care and long-term services and supports. It also gives people the freedom to use the doctors they want to see anywhere in the US. And, it eliminates premiums, deductibles and coinsurance and ends Medicare Advantage plans, expanding traditional Medicare to everyone.

    The Kaiser poll shows that 63 percent of the public support Medicare for all. The Kaiser poll further shows that over the last two years, Democratic support for Medicare for all has strengthened. Fifty-eight percent of Democrats have a very positive reaction to it as compared to 49 percent two years ago.

    The term “universal health coverage” has as much public support as Medicare for all. This makes sense given that we cannot have Medicare for all unless we have universal health coverage. However, when people speak about universal health coverage, it does not necessarily mean Medicare for all. They could mean expanding commercial insurance to everyone or creating a health care system for everyone that includes both Medicare and commercial insurance. It doesn’t tell you enough about the health care system and whether it will bring down costs and guarantee people access to the care they want and need.

    The terms “single-payer health insurance system” and “socialized medicine” have the least support, 49 percent and 46 percent, respectively. Curiously, support for single payer health insurance should be as high as for Medicare for all, which is single payer health insurance.

    Socialized medicine is a form of universal health coverage, but it is very different from single payer health insurance and Medicare for all. In a socialized medicine system, like the Veterans Administration, the government owns the hospitals and employs the medical providers as well as pays for the care.

    If you support Medicare for all, please sign this petition.

    Here’s more from Just Care:

  • Why mixing Medicare with commercial insurance is not the health reform we need

    Why mixing Medicare with commercial insurance is not the health reform we need

    At a gathering last weekend in Burlington, Vermont, convened by the Sanders Institute, with support from National Nurses United, I spoke about the perils of giving people the choice between Medicare and commercial insurance. We need improved Medicare for all, one single federally administered health plan that meets everyone’s needs.

    To maximize profits, commercial health insurers, including Medicare Advantage plans have to steer clear of delivering good affordable care to people who most need care, people with complex or disabling conditions. They don’t compete to deliver better care at lower cost for people with costly needs and never will. It’s not in their financial interest.

    Think about it. When was the last time you heard Aetna, or UnitedHealth boast about its great cancer or stroke care or say “Join us if you have heart disease?”

    Commercial health insurers too often design their networks so that they don’t include the top cancer center or other centers of excellence in a community. They want to keep people with cancer and other costly conditions from signing up with them. Have you ever heard of a health plan that says if you need costly care, you can use top doctors and hospitals with low costs? That’s the one we all want. That’s Medicare for all. You can’t get that from a commercial health plan.

    Here’s why. If a group of people got together to offer the best commercial health insurance, with a robust network of the best hospitals and doctors, they would be out of business before they opened their doors. Everyone needing costly care would join. They couldn’t spread costs across healthy and sick. And, they couldn’t afford to deliver needed care. And, that, in a nutshell is why commercial health insurers will never meet our needs.

    There is no way to create a level playing field between commercial insurers and Medicare. Commercial health insurers will always game the system if there is a public option and people have the choice of traditional Medicare. Only if there is a single payer, as with improved Medicare for all, can you pool and broadly distribute costs, rein in spending, and guarantee everyone good coverage.

    Commercial health insurers force people to gamble with their health and their savings. If you’ve ever wondered why you have little or no clue what you’ll pay for your care with your health insurance, it’s not your fault. They do not tell you.

    Commercial health plans are designed specifically to not meet everyone’s needs. Their narrow networks, arbitrary delays and denials of care and high out-of-pocket costs penalize people who need costly care and keep people from getting needed care.

    We need to end systemic bureaucratic waste and profiteering in our health care system. Commercial insurers drive up administrative costs and pocket profits for their shareholders rather than investing in their members’ needs, let alone the public health. They don’t look out for the long-term collective health of Americans.

    We need a transparent single-payer health care system so we understand what’s working and what’s not working and the government can drive systemic improvements. Commercial insurers hide their data, claiming it’s proprietary. Their financial incentives are not aligned with the public good.

    If you support Medicare for All, please sign this petition to Congress.

    Here’s more from Just Care:

  • Do we really need commercial health insurance?

    Do we really need commercial health insurance?

    For anyone who questions the value of commercial health insurance and wants to understand how to fix our health care system, Fix It: Healthcare at the Tipping Point is a must-see 58-minute film. It illustrates how commercial health insurers drive up costs and add little benefit. And, it shows us why an expanded Medicare system, which they call “single-payer,” is the smartest way to reduce costs and deliver value in our health care system.

    The film focuses on how exorbitant health care costs put many businesses in the U.S. at risk and keep companies from opening factories here. And, it shows how the typical worker earning $18 or $19 an hour is wiped out if someone in his or her family gets sick. Even with insurance, people go broke paying the deductibles and other cost sharing, and businesses can go under when a few workers have costly conditions that drive up premiums substantially. “A few sick employees can take down a company.”

    A wide range of health policy experts explain the waste that health insurers contribute to the system–effectively eating up a third of health care spending on sales, marketing, administration, profits–without adding real benefit and forcing hospitals and doctors to go through hoops to deliver needed care.

    Choosing their health plan is not the “consumer choice” people want. Even top policy experts can’t understand their complex health insurance policies. People want choice of doctors and hospitals, not choice of insurance plans. Today, insurers ration care based on people’s ability to pay and keep people from seeing the doctors and hospitals of their choice. There’s no accountability.

    We need one health plan–like Medicare–that covers everyone, and is transparent and accountable. Medicare for all brings costs under control, serves businesses and supports a free market.

    Please sign this petition telling Congress to keep its hands off Medicare.

    Here’s more from Just Care:

  • Vermont prepares for all-payer health system

    Vermont prepares for all-payer health system

    Democratic Governor of Vermont, Peter Shumlin, and Republican Governor-elect of Vermont, Phil Scott, both support all-payer rate setting in Vermont. And, unless the Trump administration undoes approvals from the Centers for Medicare and Medicaid Services, CMS, Vermont will be the first state to implement an all-payer health system in decades. With an all-payer system, every insurer pays the same rate for a particular service or bundle of services.

    Back in the early 1980s, 12 states had some form of all-payer system. But, New Hampshire is the only one of those states remaining with an all-payer system, and it’s only for hospital services.

    Like a single-payer system, an all-payer system ensures that providers in a given community all receive the same rate for the same doctor and hospital services but allows for multiple payers or health insurers. These insurers generally band together to negotiate the fixed rate they all pay. Under a single-payer model, like traditional Medicare, the government is the sole insurer and sets the rate. These egalitarian approaches to paying for health care, all-payer and single-payer–are supported by a substantial majority of the population.

    According to health economist, Uwe Reinhardt, we need an all-payer system to “get a handle on health care costs,” and rein in health care spending. Hospitals would lose their monopoly leverage to drive prices up.

    Governor Shumlin supports an all-payer system that allows Vermont to move away from a fee-for-service system that pays for each service delivered. Vermont’s all-payer system, as envisioned, would pay based on health outcomes and promote preventive services. That said, the jury’s still out on whether value-based insurance design, sometimes called a pay-for-performance model, will improve health outcomes for people or simply steer them to low-cost providers who may or may not deliver good care.

    Vermont’s all-payer system will pay doctors a monthly rate to care for people with particular conditions and additional money when their patients’ health outcomes are good.

    Here’s more from Just Care:

  • Most Americans favor Medicare for all

    Most Americans favor Medicare for all

    Most Americans favor Bernie Sanders’ “Medicare for all” proposal, according to a new Gallup poll. Indeed, nearly six in ten Americans support a single-payer health care system for all Americans. And, they support replacing the ACA with this federally funded system.

    Poll results reveal that 58 percent of Americans would like to see a single-payer health care system replace the ACA as compared to 37 percent who oppose this; 5 percent did not have an opinion. Notably, 73 percent of Democrats and those who lean Democrat support this proposal and 41 percent of Republicans and those who lean Republican support it. About half of Americans are OK with the ACA as it is.

    Hillary Clinton’s proposal to keep the ACA in place received lukewarm support, with 48 percent of Americans supporting it and 49 percent opposing it; 2 percent did not have an opinion. Of those Americans who support keeping the ACA in place, 72 percent also support replacing it with Medicare for all.

    When asked to choose between keeping the ACA in place and replacing it with a Medicare-for-all system, the 35 percent of Americans surveyed who had supported both policies chose Medicare-for-all by a two-to-one ratio–64 percent to 32 percent.

    Just over half of people surveyed, 51 percent, said that they supported Donald Trump’s proposal to repeal the ACA. Forty-five percent opposed ACA repeal and 3 percent had no opinion. That said, 27 percent of Americans who favor repealing the ACA would like to replace it with Medicare for all.

    Here’s more from Just Care:

  • If commercial insurers paid hospitals Medicare rates, spending would drop 31 percent

    If commercial insurers paid hospitals Medicare rates, spending would drop 31 percent

    There continues to be irrational variation in hospital prices in the United States, both within a given area and across markets. Hospital market-power forces commercial insurers to pay excessive rates. In most markets, commercial insurers do not have the leverage to rein in hospital prices, but Medicare does. If commercial insurers paid hospitals Medicare rates, health care spending would drop 31 percent, and premiums and out-of-pocket costs would also come down considerably.

    Shockingly, we have very little hospital-specific price data and very little data on health care spending by people with commercial insurance, let alone quality information. Hospitals and insurers are allowed to claim their data is proprietary. Without data, there is no effective competition.

    Prices should be transparent. Moreover, there’s a strong case for an all-payer system. An all-payer system would help rationalize the prices.

    A paper by Zach Cooper, Stuart Craig, Martin Gaynor and John van Reenen, which analyzes health insurance claims data from three commercial insurers for 27.6 percent of people with employer coverage, between 2007 and 2011, reveals that prices are all over the map.

    Overall, hospitals with monopoly power command prices that are 15.3 percent higher than hospitals in competitive markets.  So, a knee replacement in South Dakota costs more than a knee replacement in Manhattan. An MRI of the lower limb, a standard procedure, can cost 12 times more in one area than another area.  Within a market, prices for a given procedure at one hospital can be four times more than at another hospital.

    This makes no sense. It also rewards inefficient hospitals. And, it drives up our overall health care costs and individual insurance premiums considerably. It’s time Congress stepped in to rationalize hospital prices and rein in spending on medical care since insurers are unable to do so.

    A recent report from the Center for Improving Value in Health Care looks deeper into these findings and shows both tremendous variation in commercial insurance prices in different areas of Colorado as well as just how much more commercial insurers pay for hip and knee replacements in Colorado than Medicare. In the northeast of Colorado, the price of hip and knee replacements is $55,000 more (232 percent higher) than Medicare. In Denver, the price is $17,000 more. It’s not surprising that a single-payer health care proposal is on the Colorado ballot this year.

    Here’s more information from Just Care on health care costs:

  • Medicare for all, the Sanders proposal

    Medicare for all, the Sanders proposal

    Bernie Sanders is calling for Medicare for all.  He says, “If the goal of health-care reform is to provide comprehensive, universal health care in a cost-effective way, the only honest approach is a single-payer approach.” And, if every other industrialized nation can insure their people, the United States can as well.

    A single-payer approach can drive health care system improvements, streamline administrative costs and rein in the cost of medical and hospital care as well as prescription drugs and medical devices. It can also ensure that everyone automatically has health insurance and that no one falls through the cracks.  Furthermore, as Theodore Marmor and I wrote in Health Affairs, “Medicare is designed to absorb risk, serving individuals who have or may have costly and complex medical needs as well as the relatively healthy, whereas commercial insurance is required to protect its business interests by avoiding those most likely to use medical care.”

    Sanders also wants to eliminate out-of-pocket costs that are preventing people from accessing needed care today or driving them into medical debt. Even with Obamacare, there are 29 million uninsured Americans and millions more who are underinsured.

    Professor Kenneth Thorpe questions the projected costs of Sanders’ proposal. But, Drs. David Himmelstein and Steffie Woolhandler, two leading proponents of a single-payer system, critique Thorpe’s assumptions.

    Do you agree that it’s time we had Medicare for all in this country? What if it means increasing taxes?