Category Archives: British Health Care

More Patients Insured in U.S. and More Can't Afford Doctors but May-be Americans Don’t Really Want Medicare for All — They Want Japa-nese Health Care and the American College of Physicians

As the Democrat presidential candidates argue about Medicare for All as well as alternate programs I still wonder if Americans really know what they want for a health care plan at all. Rapport of Reuters Health noted that A growing number of Americans find it too expensive to see doctors even though more people have health insurance, a U.S. study suggests. But just wait Bernie Sanders is going to give us all free health care, free education, free everything, which the big businesses will pay for. Really?

Over the past two decades, the proportion of adults without insurance dropped to 14.8% from 16.9%, the study found. But during this same period, the proportion of adults unable to afford doctor visits climbed from 11.4% to 15.7%.

Out-of-pocket costs made doctors too expensive for the uninsured, but costs also kept people with coverage from seeing physicians even when they had chronic medical conditions requiring regular checkups.

“The quality of private health insurance is getting worse, and the cost of healthcare is rising significantly,” said lead study author Dr. Laura Hawks of the Cambridge Health Alliance and Harvard Medical School in Boston.

“We know that private health insurance plans increasing rely on high premiums, high-deductible health plans . . . high copays and other forms of cost-sharing,” Hawks said by email. “All these create financial barriers.”

For the study, researchers examined survey data collected from 1998 to 2017 by the Centers for Disease Control and Prevention. They wanted to see how access to care changed after the Affordable Care Act (ACA) was implemented 2014.

The proportion of adults 18 to 64 years old who couldn’t afford to see a doctor climbed slowly from 1998 to 2009, then rose more rapidly for several years before improving with the passage of the ACA, researchers report in JAMA Internal Medicine. But even after the ACA took effect, the proportion of adults able to afford checkups never returned to 1998 levels.

Affordability worsened across all racial and ethnic groups, and nearly all income groups, the study found.

Among the uninsured, the proportion of adults unable to afford physician visits climbed from 32.9% to 39.6% during the two-decade study period.

For people with health benefits, the proportion unable to pay for doctor visits rose from 7.1% to 11.5%.

The inability to see a doctor because of costs rose for people with many common chronic health problems including heart disease, high cholesterol and alcohol use disorders.

The study didn’t look at how shifts in the affordability of physician checkups might directly affect health outcomes.

One limitation of the analysis is that researchers lacked data on the affordability of prescription medications, which can also impact health as well as how often people need to see doctors.

“We knew that uninsured adults are much more likely than insured adults to avoid seeing a doctor due to cost, and uninsured adults with chronic conditions such as diabetes or heart disease are much less likely to get regular check-ups,” said Dr. John Ayanian, director of the Institute for Healthcare Policy and Innovation at the University of Michigan in Ann Arbor, who wrote an editorial accompanying the study.

Still, the results underscore that the ACA hasn’t insured everyone who needs coverage or made care affordable for all Americans, Ayanian said by email.

This means patients who struggle to pay for checkups need to ask for help.

“For people with chronic conditions such as diabetes, high blood pressure, or heart disease who have difficulty affording their ongoing care, I recommend they speak to their doctor and pharmacist about ways to save costs, including reduced fees for office visits or switching to less expensive generic medications,” Ayanian said. “Community health centers or hospital clinics may also have special programs to provide care for free or reduced fees for lower-income patients who are uninsured or who have high levels of medical debt.”

Japan provides a model for Americans who want a system that covers everyone with no mandate and no new middle-class taxes

Jon Wallker noted that Bernie Sanders has made a habit of pointing out how much less other countries pay for health care. Throughout the Democratic debates, the Vermont senator repeatedly claimed that the United States is “spending twice as much per capita on health care as any other nation.”

Sanders of course doesn’t mention that his plan wouldn’t come anywhere close to cutting our health care spending in half — doing so would require bringing salaries for doctors and hospital workers down to international norms. His omission is no surprise: Too often, American politicians rely on superficial comparisons with other nations to promote their health care agendas. Moderate Democrats often claim Obamacare should resemble the Swiss health care system, though in reality Obamacare lacked all the regulations that make that system function. Conservatives frequently try to scare people by pointing to highly selective stories of wait times in Canada or Britain, while ignoring the infinite wait time caused by not being able to afford care here.

If we look honestly at all the health care systems in the world to find the one which most closely aligns with voters’ desires, we would probably end up with the Japanese model. It is not the system anyone would design from scratch. It is a relatively complex system that evolved over decades to fit the needs, changing dynamics, and political trade-offs of the country. But for that very reason, it might most closely satisfy Americans’ seemingly endlessly contradicting opinions on reform.

Japan has more than 3,000 insurance plans, yet the benefit is not nearly the costly mess it is in the United States.

The Japanese health care system is based on employer- or union-provided insurance, just like the American one. People not covered by employer insurance are covered by government plans. Seniors basically have their own special coverage. The poor and disabled have special subsidies. Cumulatively, Japan has over 3,000 insurance plans, yet the benefit is not nearly the costly mess it is in the United States.

The thousands of plans in the U.S. individually negotiate with thousands of providers for millions of different prices. This drives up prices and creates massive administrative waste. In Japan, everything is highly standardized by the federal government. All plans need to cover the same set of benefits, reimburse providers the same amounts, use the same forms, and so on. Japanese employers can provide extra benefits on top of the standard baseline and what you pay depends partly on your employer’s risk pool, like in the U.S., but overall the difference between the plans is minor. As a result, Japan’s administrative spending is below that of many single-payer countries like Canada.

In practice, the Japanese system doesn’t seem much different than single-payer systems: In Japan, large companies set money aside in special accounts, and the government then tells them how to pay hospitals. In single-payer systems, large companies have to give money to a special government account, which then gives it to hospitals. However, the difference has real political implications.

Rhetorically, American politics is weirdly obsessed with people “losing their employer health insurance,” but we rarely ever talk about how insurance changes almost every year, usually for the worse: higher deductibles, new narrower networks, more co-pays, and so on. Only 44% of Americans say they would prefer a system mostly run by the government and 68% have a favorable view of employer coverage. Yet, at the same time, insurance regulations the government puts on employer coverage are very popular.

This employer coverage also solves the funding problem which plagues reform efforts. Americans don’t seem to understand or simply don’t care just how much they indirectly pay for employer insurance. The type of broad new taxes needed to pay for Medicare for All tend to be very unpopular. Even with very favorable wording, polling by YouGov found just 32% supported paying for Medicare for All with a tax on income over $29,000. (Proponents of M4A claim the net savings from no premiums or coinsurance would outweigh the cost of new taxes.) Even in deep blue Vermont, once local Democrats saw the size of the taxes needed to replace employer premiums — an 11.5% payroll tax and a new income tax of up to 9.5% — they declared their single-payer plan politically infeasible.

The same poll found a per-employee fee proposed by Sen. Elizabeth Warren to get around this anti-tax problem polls better, with 50% yes and 31% no. Yet what is consistently even more popular is just mandating all employers provide quality insurance, like Japan does. That polls at 69% support.

The Japanese model also provides a solution for Americans’ seemingly conflicting desires for a system that features no new middle-class taxes, no individual mandate, and yet covers everyone. In Japan, people without employer insurance need to buy coverage from their local government. Premiums are subsidized for those with lower incomes. If you don’t pay for insurance, though, there is no direct penalty, except when you do reenter the system you can be made to pay back premiums. Basically, if there is some small group of recalcitrants who want to try to avoid health insurance altogether, just let them and charge them when they do seek treatment.

There are two main ways Japan controls cost. The first is standardized cost-sharing. There are no deductibles, but people have a 30% coinsurance up to a monthly limit. There is no gatekeeping or preauthorization, but if you go to a specialist without a referral, you need to pay extra. Cost-sharing is one mechanism Americans have already come to accept for decades.

The other main tool is the that government aggressively sets low uniform prices with doctors, hospitals, and drug makers. This is why it works. This is also the part of the Japanese system which would generate the greatest industry opposition in the United States — as would Medicare for All for the same reasons. And even a decent Medicare buy-in would likely end up a de facto benchmark rate for providers.

All adopting a Japanese type of system would require is for the U.S. to take what it is currently doing and heavily standardize it. The biggest change would be scrapping the individual non-employer-based market to put everyone on a government plan, but the individual market is the least popular part of our system anyway. The majority of people with employer insurance would still have their same “private coverage,” with the same branding, but now cheaper and better. It would be the least disruptive system to copy, and it even has a precedent here. Hawaii has mandated every employer provide standardized, affordable, high-quality insurance since 1974, thanks to a special waiver from federal laws that prevent other states from copying Hawaii’s model.

The price of the lack of disruption, though, is not addressing many of the financing fairness issues we rarely talk about. Companies with younger workers would still pay less than companies with older workers. People living in high-cost localities would still pay higher premiums than people in low-cost areas. The overall funding would remain roughly as regressive as it currently is.

Polling shows even Democratic voters rank lowering drug prices, lowering what people pay, and ending surprise billing as bigger priorities than Medicare for All. And it is not clear people who claim they favor Medicare for All actually want the level of change it would cause. Polling shows 68% of Democrats incorrectly believe that under Medicare for All people would be allowed to keep their employer coverage, and 61% of Democrats believe the employers/individuals would continue to pay premiums, according to a poll this year by the Kaiser Family Foundation.

Meanwhile, moderate Democrats like Joe Biden are offering voters more layers of complexity instead of simple solutions. Instead of just directly mandating all employer coverage be as good and affordable as his proposed public option, Biden simply allows every worker to run the complicated cost calculations themselves to decide if their employer plan is a worse deal for them than the public option. While Japan automatically ensures your coverage is good, Biden makes that task a yearly burden for employees — which is deeply problematic since only 4% of Americans understand basic insurance terms.

It is possible adopting a Japanese-style health care system might even be the fastest way to Medicare for All. South Korea created universal health care via a system very similar to Japan in 1989 and then in 2000 decided to move to a true single-payer system. Of course “have the federal government set prices, heavily regulate employer insurance so it acts basically like Medicare, and making buying subsidized Medicare quasi-optional for everyone else,” isn’t the catchiest slogan. So, it is unlikely voters will ever hear about a path that could give them what they seem to want championed.

ACP Backs Single-Payer Healthcare

Alicia Ault noted that The American College of Physicians (ACP) is backing both a single-payer system and a public option that retains private insurance as the best ways to ensure that all Americans have healthcare.

The ACP’s endorsement comes as part of a broad proposal to overhaul the US healthcare system, published today in the Annals of Internal Medicine.

Rather than continue to react to others’ proposals, the ACP decided, “we are going to stick our necks out and put forward what we think is a better way,” Bob Doherty, ACP senior vice president for governmental affairs and public policy, told Medscape Medical News. 

It is a break from previous ACP policy — which never explicitly backed single payer — and with other physician organizations, including the American Medical Association and the American Academy of Family Physicians, both of which have declined to back a single-payer healthcare system.

The ACP’s board of regents endorsed the overhaul proposal in November, and Doherty said he was confident that it had the backing of the majority of the organization’s 159,000 internists and medical students.

Physicians for a National Health Program (PNHP) applauded the ACP’s policy shift.

“For a century, most US medical organizations opposed national health insurance,” PNHP cofounders Steffie Woolhandler, MD, and David Himmelstein, MD, write in an Annals editorial. “The endorsement by the American College of Physicians (ACP) of single-payer reform marks a sea change from this unfortunate tradition,” they say.

No Political Endorsement

The ACP timed its announcement to come just before the first major presidential primary contests in Iowa (February 3) and New Hampshire (February 11), but the organization is not backing any candidate’s healthcare proposal.

“We know that election years, particularly presidential election years, create an opportunity to engage in discussion about the future of public policy,” Doherty said, adding that healthcare, and in particular affordability, rank among voters’ top concerns.

After examining health systems in a dozen countries and reviewing policies that have been proposed for the United States, the ACP decided that both single payer and a public option would increase universal coverage, one of the ACP’s long-stated policy goals.

“For us to say single payer is the only way to achieve universal coverage is just not consistent with the evidence,” Doherty said. The coverage goal can also be achieved with a public option, “provided that you had enough marketplace regulation of private insurance that would be competing with the public program,” and if there was automatic enrollment for people who did not have private insurance, Doherty said.

Negotiate Payment Rates

Unlike Democratic presidential candidate Elizabeth Warren’s plan to pay for her Medicare for All plan by pegging physician and hospital pay to Medicare rates, the ACP said that would not work.  

“There would have to be a process to negotiate for established rates that would be sufficient to ensure that physicians would participate in the program,” Doherty said.

As part of its multipronged overhaul, the ACP is also proposing an elimination of copays and deductibles for high-value services such as primary care, and also for patients with chronic diseases.

A renewed emphasis on primary care would create savings, the ACP posited in its call to action and the four papers outlining its positions on how to overhaul the health system.

“We believe that American health care costs too much; leaves too many behind without affordable coverage; creates incentives that are misaligned with patients’ interests; undervalues primary care and under invests in public health; spending too much on administration at the expense of patient care; and fosters barriers to care for and discrimination against vulnerable individuals,” said ACP President Robert M. McLean, MD, MACP, in a statement.

I believe that the ACP has some interesting reasonable solutions as well as my opinion that President Obama and his experts came up with a great plan except for financial sustainability. As a country we have to realize that any sustainable program will be costly and the cost will be shared by all. Do we all really want Bernie or Elizabeth to be our presidents to drive our country to the edge and convert to socialism? Wake up America!

A British doctor was treated in an American emergency room and said it revealed how broken US healthcare really is, The Republicans on Healthcare and Obamacare Again!!

  1. “You should never, ever have to say, ‘I can’t afford this medical treatment I need,'” he said. Really??
  2. He experienced American healthcare firsthand when he went to the emergency room in the US with a bloody finger.
  3. Adam Kay says he never paid a single medical bill in his life — until, while vacationing in the US, he got a piece of glass lodged in his finger.

His finger sprang open, spurting bright red blood in every direction.

“It was really embarrassing. It was like a little fire hose,” the former obstetrician told Insider. “It looked like there’d been some sort of massacre, and the blood was coming, and I couldn’t stop it bleeding.”

That was the day that Kay got a glimpse of just how different the US healthcare system is from the system in his home in the UK, where medical care is taxpayer-funded.

Kay swiftly headed off to the nearest emergency room, travel-insurance card in hand, for care.

“They took my card details and my insurance details,” he recalled. “That was the most important thing. And that was quite weird, because that just doesn’t happen back home.”

Kay, a former National Health Service worker who chronicled his time as a doctor in a bestselling book, “This Is Going to Hurt,” said he took great pride in being a doctor in the NHS — what he called the “closest thing” Brits have to “a national religion.”

One of the biggest differences between the UK and US health systems, he’s noticed, is the pay-as-you-go, employer-bankrolled nature of many American health plans. He said the for-profit US health system undermined the idea that healthcare is a basic human right.

“The NHS was founded on the principle that it’s free at the point of delivery and you’re treated according to clinical need, not ability to pay — whether you live in Windsor Castle or on a bench outside Windsor Station,” Kay wrote in his book. “Other systems around the world might be more efficient, but I’d drag myself out of a coma to argue that none of them is fairer.”

Kay acknowledged that it’s not a perfect system. In recent years, it’s been tough for the NHS to find enough doctors and nurses to go around. With Brexit on the horizon, many doctors are worried that the shortages will only get worse.

Meanwhile, the UK’s Conservative Party, famous for slashing the NHS’s budget in recent years, won an overwhelming majority of parliamentary seats in the country’s general election on Thursday. British Prime Minister Boris Johnson, the Conservative leader, has promised to reverse course and make the national healthcare system the first priority. Even so, he’s proposing to spend less than his left-wing rivals.

Despite issues of cash and people power, the NHS still tends to outperform private care systems in the US. For example, the NHS said that in November, more than 80% of patients who were rushed to the ER were admitted, transferred, or discharged within four hours. In California, the average ER patient can expect to wait more than 5 1/2 before admission. Life expectancy is also shorter in the US by more than two years.

“I feel like America’s been gaslit about what the NHS is,” Kay said. “I speak to hugely intelligent people over here who’ve just been slightly brainwashed into the idea that healthcare is rationed.”

Instead, he said, it’s the US system that has “got this wrong.”

“You’ve got yourself worked up into this lunatic situation where everything’s itemized and everything’s become hyperinflated, because it’s become a marketplace,” Kay said. “I don’t think that should ever play a part in medicine. They’re two separate things. Do what’s best, clinically.”

That was not how Kay’s trip to the ER went.

Money should not dictate best practices in medicine, Kay said- hmmm, and that’s why the most complex, complicated cases in other countries come to the U.S. for treatment!!

After the bleeding stopped, Kay was shocked when his doctor said he’d have to decide what to do based on how much he wanted to spend.

“They said, ‘Normally, because it was a glass injury, we would want to X-ray it, just to make sure that nothing’s got into the joint, but that will be an extra $1,500.’ I’m suddenly thinking, do I really [want this X-ray]? I imagine I’ll get this back from my travel insurance, but if I don’t, that’s a lot of money on my holiday … And then I suddenly thought, no! If I was the doctor back home, I wouldn’t suggest it as an option. I would say, ‘This is best practice.'”

The cost of US healthcare has consistently been at the top of the list of issues Americans are most worried about. Healthcare bills are the most common reason Americans file for bankruptcy protection. In the UK, while people are still concerned about the direction of their national healthcare system, they’re more likely to say their top life worry is a looming Brexit deal, or crime, or maybe the environment.

“You should never have to sell your house ’cause you got ill,” Kay said. “You should never, ever have to say, ‘I can’t afford this medical treatment I need.’ I’ve just grown up in an environment where it’s effectively a human right. You get the healthcare you need.”

Interesting, then who pays the bill and if the government is paying all the bills and if there is no fear of bills and who will pay them the patient can ask for anything to treat them without care as to expense and can go from doc to doc without care as to cost. Not a happy scenario.

A growing number of Republicans say they’re satisfied with US healthcare costs — even as insurance prices have surged 20% in the past year

Joseph Zeballos-Roig noted that a growing number Republicans are satisfied with the cost of healthcare in the United States, according to a new Gallup poll released Wednesday.

The increase comes as another major index from the Labor Department showed average insurance prices spiking 20% over the last year.

The poll noted overall satisfaction with US healthcare costs is the highest since 2009 as just over one in four Americans are content with the healthcare pricing environment — though much of that boost was driven by the uptick in Republican approval.

It suggests that heightened partisanship is swaying Republicans on healthcare just as it has been on the economy, another issue where they are much likelier than Democrats to view the situation more favorably, An growing number of Republicans are satisfied with the cost of healthcare in the United States, according to a new Gallup poll released Wednesday. The increase comes as another major index from the Labor Department showed average insurance prices spiking 20% over the last year.

The poll noted overall satisfaction with US healthcare costs is the highest since 2009 as just over one in four Americans are content with the healthcare pricing environment — though much of that boost was driven by the uptick in Republican approval.

The Labor Department’s consumer price index, which tracks the average change over time in prices paid for goods and services, said the cost of overall medical care rose 5.1% since Nov. 2018. That measure also incorporates doctors’ visits and hospital services.

The cost of health insurance had the biggest jump over the past year at 20.2%, representing one part of the broader healthcare industry. Other elements such as the price of doctors’ visits and hospital services saw more modest increases at 1.4% and 3.3%, respectively.

It suggests that heightened partisanship is swaying Republicans on healthcare just as it has been on the economy, another issue where they are much likelier than Democrats to view the situation more favorably, the Pew Research Center said.

By comparison, only 9% of Democrats were satisfied with healthcare costs in the US, according to the Gallup poll.

Still, another recently-released Gallup poll showed both Democrats and Republicans broadly satisfied with what they pay for their own healthcare, though there was a notable dip in Democratic satisfaction and an increase among Republicans. 

The cost of healthcare, though, continues to rise in the United States.

That’s led to Democratic primary candidates to propose a variety of methods to reform American healthcare. They range from incrementally shoring up the Affordable Care Act and introducing an optional government insurance plan to enrolling every American into a government-run insurance system.

Trump has repeatedly promised to introduce another plan to replace Obamacare, but he hasn’t done so yet.

House Republicans rolled out their own alternative in October, but it looks a lot like the unpopular “skinny repeal” version that was narrowly defeated by a single Senate vote in 2017. That one has almost no chance of becoming law before the 2020 election as it would have to pass the Democratic-led lower chamber.

Striking down Obamacare would open a path to better, more affordable health care

Realize that I really believe that Obamacare was and still is a well thought out health care system, but my concern is the lack of long term financing of the program, especially in comparison to the new program touted by the Democratic liberals running for president.  Now, Thomas Price and Alfredo Ortiz and Opinion contributor noted that The 5th Circuit Court of Appeals in Texas is expected to rule soon on the constitutionality of Obamacare. While its decision will have significant implications for American health care policy, it won’t affect people’s health coverage for at least a couple of years as the appeals process plays out. In the meantime, a ruling striking down Obamacare would give the country the opportunity and the impetus to unite behind a health care reform plan that actually lowers costs, increases choices and improves the doctor-patient relationship.

In 2012, the U.S. Supreme Court ruled that Obamacare was constitutional under the government’s power to tax. However, President Donald Trump’s tax cuts eliminated the tax, more commonly known as the penalty, for not purchasing health insurance. In February 2018, 20 states led by Texas filed suit against the federal government, arguing that Obamacare was no longer constitutional because the tax upon which the law had been based no longer existed. Without this tax, the plaintiffs argued, the law’s individual mandate is nothing more than the unlawful federal compulsion to purchase health insurance.

Last December, a federal judge in Texas agreed with this reasoning and declared Obamacare unconstitutional. But he also issued a stay on his judgment, allowing the law — the Affordable Care Act — to remain while the case is being appealed in order to save Americans potentially needless uncertainty. The case, Texas vs. Azar, was then appealed to the 5th Circuit.

Disgraceful fearmongering

Politicians and commentators claim that this case threatens to eliminate health care coverage for Americans covered by Obamacare. California Attorney General Xavier Becerra, who is leading the appeal, called the lower court ruling “an assault on 133 million Americans with preexisting conditions, on the 20 million Americans who rely on the ACA for health care.” House Democratic Caucus Chairman Hakeem Jeffries claims that the Trump Justice Department is trying to “destroy health care for tens of millions of Americans.”

Sabrina Corlette, co-director of the health care industry-funded Center on Health Insurance Reforms at Georgetown University, warns that if Obamacare is deemed unconstitutional, “the chaos that would ensue is almost impossible to wrap your brain around. The marketplaces would just simply disappear and millions of people would become uninsured overnight, probably leaving hospitals and doctors with millions and millions of dollars in unpaid medical bills. Medicaid expansion would disappear overnight.”

This is fearmongering of disgraceful proportions. In reality, Democrats would appeal a plaintiff’s victory to the Supreme Court. In the meantime, the trial court stay would remain in effect. The earliest the high court would be able to hear the case would be next fall at the start of its next session, barring an expedited Supreme Court timeline. Based on the usual timeline between hearings and rulings, this means the soonest it would issue a final decision would be the spring of 2021. Obamacare health coverage already purchased and planned upon for 2021 would likely continue.

Listen to your doctor: Medicare for All government chokehold would be even worse than private insurance

In the meantime, policymakers and reformers can develop a health care alternative that fixes the many flaws in Obamacare while keeping its protections for those with preexisting conditions. Obamacare has done nothing to control spiraling medical costs and diminishing health care choices for many ordinary Americans. Despite their different reform visions, Republicans and many Democrats are united in their agreement that the country must move on from Obamacare. 

‘Medicare for All’ would be worse

Yet the solution proposed by these Democrats — “Medicare for All” — would exacerbate our current cost and choice problems even further. The Mercatus Center of George Mason University estimates that Medicare for All would cost $32 trillion over 10 years. That means one year would amount to more than two-thirds of the entire 2020 federal budget.

The only way government-run health care could attempt to control costs is by rationing care — meaning fewer options, longer wait times and less innovation.

‘Medicare for All’ is unpopular: Democrats could lose to Trump if they abandon Obamacare and private health insurance

A better alternative is the Job Creators Network Foundation’s “Healthcare for You”  framework, which prioritizes reform from the bottom up rather than the top down. In practice, this means deregulating insurance markets and allowing state officials to set insurance parameters while maintaining protections for those with preexisting conditions. Instead of the one-size-fits-all health care plans that proliferate today, this reform would unleash a flood of new insurance options — from Cadillac to catastrophic — that patients could tailor to their unique needs.

By also prioritizing direct medical care, transparent prices and expanded tax-free health management accounts (also called health savings accounts), a true health care market would emerge, allowing patients to shop for coverage while prices fell.

A Texas vs. Azar ruling that deems Obamacare unconstitutional will help spur such long-overdue patient-centric health care reforms. It will not immediately remove lifelines for patients, as critics claim. 

Sunday Deadline Looms For Affordable Care Act Open Enrollment

Brakkton Booker alerted us all that for millions of Americans, time is running out to sign up for health insurance through the Affordable Care Act’s online marketplace healthcare.gov.

For those who will not receive health coverage beginning Jan. 1, 2020 through an employer or other programs like Medicaid, Medicare or the Children’s Health Insurance Program — commonly referred to as CHIP — the deadline to purchase health insurance is Sunday, Dec. 15.

Health and Human Services Secretary Alex Azar tweeted a reminder: “If you decide that purchasing coverage through healthcare.gov is the right decision for you, make sure you select coverage by this Sunday.”

December 15 is the deadline to shop for 2020 plans.

Costs are down and choices are up for 2020 plans. If you decide that purchasing coverage through 

 is the right decision for you, make sure you select coverage by this Sunday.

Sign-ups for 2020 coverage in the first six weeks of open enrollment for the ACA, also referred to as Obamacare, are down slightly, trailing last year’s totals by 6%. However, this decline is happening at a slower rate when compared to 2019 coverage sign-ups in the first six weeks. That decline dipped 12%, according to Modern Healthcare.

The publication also notes that the latest numbers “don’t include the millions of people who will be automatically enrolled in coverage at the conclusion of open enrollment.”

NPR’s Health Policy reporter Selena Simmons-Duffin told NPR’s Up First podcast on Saturday that enrollment has been down every year since 2016.

“Last year more than 11 million people enrolled and we’re on track to be slightly behind that this year,” Simmons-Duffin said.

Many experts blame the drop in sign-ups on the Trump administration making sharp reductions in outreach efforts to connect would-be insurance purchasers to available plans.

“One of the actions that President Trump’s administration took to change the [Affordable Care Act] law is to radically cut back the funding to do outreach and to do advertising to let people know that this exists,” Simmons-Duffin said.

Kaiser Health News points out there is typically “a flurry in the last few days before the Dec. 15 deadline” when last-minute participants decide to sign-up.

Some states have seen double-digit declines. In Arizona, for example, enrollments are down 17% from this time a year ago, according to the Arizona Republic. The paper cites “apprehension among some Latino families over enrolling in anything government-related” as one possible cause for the drop off.

Meanwhile, Delaware Public Media reports a 1.7% decline from last year. It adds: “Lagging enrollment comes despite premiums in Delaware dropping for the first time since the ACA became law seven years ago.”

Health officials in California announced Thursday more than 130,000 people signed up for new coverage plans this year — an increase of 16% compared to the open enrollment period last year.

For those who miss the open enrollment sign-up period, not all is lost. The health care law does allow, in specific cases, a special enrollment period where people can sign-up after the open enrollment period ends.

The government lists circumstances including losing health insurance, getting married, moving, having a baby or adopting a child as “life events” that would make applicants eligible.

And the confusion continues with no real solution in the horizon! Let’s get to the discussion that I had promised, what a single-payer system is really all about!

The Democrats’ single-payer trap and Why Not Obamacare?? Let’s Start the Discussion of Medicare!!

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Richard North Patterson’s latest article started off with the statement- back in 2017-Behold the Republican Party, Democrats — and be warned.

The GOP’s ongoing train wreck — the defeat of its malign health care “reform,” the fratricidal troglodyte Roy Moore, and Donald Trump’s serial idiocies — has heartened Democrats. But before commencing a happy dance, they should contemplate the mirror.

They will see the absence of a compelling message. The party desperately needs a broad and unifying economic agenda — which includes but transcends health care — to create more opportunity for more Americans.

Instead, emulating right-wing Republicans, too many on the left are demanding yet another litmus test of doctrinal purity: single-payer health care. Candidates who waver, they threaten, will face primary challenges.

As regarding politics and policy, this is gratuitously dictatorial — and dangerously dumb.

The principle at stake is universal health care. Single-payer is but one way of getting there — as shown by the disparate approaches of countries that embrace health care as a right.

Within the Democratic Party, the discussion of these choices has barely begun. Senator Bernie Sanders advocates “Medicare for all,” expanding the current program for seniors. This would come at considerable cost — Sanders includes a 7.5 percent payroll tax among his list of funding options; others foresee an overall federal tax increase of 25 percent. But the dramatically increased taxes and the spending required, proponents insist, would be offset by savings in premiums and out-of-pocket costs.

Skeptics worry. Some estimate that Sanders’s proposal would cost $1.4 trillion a year — a 35 percent increase in a 2018 budget that calls for $4 trillion overall. It is not hard to imagine this program gobbling up other programs important to Democrats, including infrastructure, environmental protection, affordable college, and retraining for those dislocated by economic change.

For these reasons, most countries aspiring to universal care have multi-payer systems, which incorporate some role for private insurance, including France, Germany, Switzerland, and the Netherlands. The government covers most, but not all, of health care expenditures. Even Medicare, the basis for Sanderscare, allows seniors to purchase supplemental insurance — a necessity for many.

In short, single-payer sounds simpler than it is. Yet to propitiate the Democratic left, 16 senators have signed on to Sanders’s proposal, including potential 2020 hopefuls Elizabeth Warren, Cory Booker, Kamala Harris, and Kirsten Gillibrand. Less enthused are Democratic senators facing competitive reelection battles in 2018: Only one, Tammy Baldwin of Wisconsin, has followed suit.

This is the harrowing landscape the “single-payer or death” Democrats would replicate. Like “repeal and replace,” sweeping but unexamined ideas are often fated to collapse. Sanderscare may never be more popular than now — and even now its broader appeal is dubious.

Democrats must remember how hard it was to pass Obamacare. In the real world, Medicare for all will not become law anytime soon. In the meanwhile, the way to appeal to moderates and disaffected Democrats is not by promising to raise their taxes, but by fixing Obamacare’s flaws.

To enact a broad progressive agenda, the party must speak to voters nationwide, drawing on both liberals and moderates. Thus candidates in Massachusetts or Montana must address the preferences of their community. Otherwise, Democrats will achieve nothing for those who need them most.

Primary fights to the death over single payer will accomplish nothing good — including for those who want to pass single-payer. Parties do not expand through purges.

Democrats should be clear. It is intolerable that our fellow citizens should die or suffer needlessly, or be decimated by financial and medical calamity. A compassionate and inclusive society must provide quality health care for all.

The question is how best to do this. The party should stimulate that debate — not end it.

Generous Joe: More “Free” Healthcare For Illegals Needed

Now, R. Cort Kirkwood notes that Presidential candidate Joe Biden wants American taxpayers to pay for illegal alien healthcare. Indeed, he doesn’t just want us to pay for their healthcare, he says we are obliged to pay for their healthcare.

That’s likely because Biden thinks illegals are American citizens and doesn’t much care how many are here as long as they vote the right way.

What Biden didn’t explain when he said we must pay for illegal-alien healthcare is how much such beneficence would cost.

Answer: A lot.

The Question, The Answer

Biden’s demand that we pay for illegal-alien healthcare answered a question earlier this week from a reporter who wanted to know whether the “undocumented” deserve a free ride.

The question was this: “Do you think that undocumented immigrants who are in this country and are law-abiding should be entitled to federal benefits like Medicare, Medicaid for example?”

Answered Biden, “Look, I think that anyone who is in a situation where they are in need of health care, regardless of whether they are documented or undocumented, we have an obligation to see that they are cared for. That’s why I think we need more clinics in this country.”

Biden forgot to put “free” before clinics, but anyway, the candidate then suggested that Americans who disagree likely have a nasty hang-up about the border-jumping illegals who lie with the facility of Pinocchio when they apply for “asylum.”

“A significant portion of undocumented folks in this country are there because they overstayed their visas,” he continued. “It’s not a lot of people breaking down gates coming across the border,” he falsely averred.

Then came the inevitable. “We” need to watch what we say about all those “undocumented folks.”

“The biggest thing we’ve got to do is tone down the rhetoric,” he continued, because that “creates fear and concern” and ends in describing “undocumented folks” in “graphic, unflattering terms.”

Biden thinks those “undocumented folks” are citizens, as Breitbart noted in its report on his generosity with other people’s money.

In 2014, Biden told the worthies of the Hispanic Chamber of Commerce that entering the country illegally isn’t a problem, and Teddy Roosevelt would agree.

“The 11 million people living in the shadows, I believe they’re already American citizens,” Biden said. “Teddy Roosevelt said it better, he said Americanism is not a question of birthplace or creed or a line of dissent. It’s a question of principles, idealism, and character.”

Illegals “are just waiting, waiting for a chance to be able to contribute fully. And by that standard, 11 million undocumented aliens are already American.”

Roosevelt also said that “the one absolutely certain way of bringing this nation to ruin, of preventing all possibility of its continuing to be a nation at all, would be to permit it to become a tangle of squabbling nationalities,” but that inconvenient truth aside, Biden likely doesn’t grasp just what his munificence — again, with our money — will cost.

The Cost of Illegal-Alien Healthcare

I mentioned the cost of healthcare for the illegal-alien population and  Biden is right that visa overstays are a big problem: 701,900 in 2018, the government reported. But at least those who overstay actually entered the country legally; border jumpers don’t.

But that’s beside the point.

The real problem is the cost of the healthcare, which Forbes magazine estimated to be $18.5 billion, $11.2 billion of it federal tax dollars.

In 2017, the Federation for American Immigration Reform reported a figure of $29.3 billion; $17.1 in federal tax dollars, and $12.2 billion in state tax dollars. More than $15 billion on that total was uncompensated medical care. The rest fell under Medicaid births, Medicaid fraud, Medicaid for illegal-alien children, and improper Medicaid payouts.

The bills for the more than half-million illegals who have crossed the border since the beginning of fiscal 2019 in October are already rolling in.

Speaking at a news conference in March, Brian Hastings, operations chief for Customs and Border Protection (CBP), said about 55 illegals per day need medical care, and that 31,000 illegals will need medical care this year, up from 12,000 last year. Since December 22, he said, sick illegals have forced agents to spend 57,000 hours at hospitals or medical facilities. Cost: $2.2 million in salaries. Between 25 percent and 40 percent of the border agency’s manpower goes to the care and maintenance of illegals, he said.

CBP spent $98 million on illegal-alien healthcare between 2014 and 2018.

Hastings spoke before more than 200,000 illegals crossed the border in March and April.

NYC Promises ‘Guaranteed’ Healthcare for All Residents

Program to bring insurance to 600,000 people, including some who are undocumented

As the Mayor of New York City considers whether he wants to run for President and join the huge group of 21 candidates Joyce Frieden noted that the city of New York is launching a program to guarantee that every resident has health insurance, as well as timely access to physicians and health services, Mayor Bill de Blasio announced Tuesday.

“No one should have to live in fear; no one should have to go without the healthcare they need,” de Blasio said at a press conference at Lincoln Hospital in the Bronx. “In this city, we’re going to make that a reality. From this moment on in New York City, everyone is guaranteed the right to healthcare — everyone. We are saying the word ‘guarantee’ because we can make it happen.”

The program, which will cost $100 million annually, involves several parts. First, officials will work to increase enrollment in MetroPlus, which is New York’s public health insurance option. According to a press release from the mayor’s office, “MetroPlus provides free or affordable health insurance that connects insurance-eligible New Yorkers to a network of providers that includes NYC Health + Hospitals’ 11 hospitals and 70 clinics. MetroPlus serves as an affordable, quality option for people on Medicaid, Medicare, and those purchasing insurance on the exchange.”

The mayor’s office also said the new effort “will improve the quality of the MetroPlus customer experience through improved access to clinical care, mental health services, and wellness rewards for healthy behavior.”

For the estimated 600,000 city residents who don’t currently have health insurance — because they can’t afford what is on the Affordable Care Act health insurance exchange; because they’re young and healthy and choose not to pay for insurance, or because they are undocumented — the city will provide a plan that will connect them to reliable care at a sliding-scale fee. “NYC Care will provide a primary care doctor and will provide access to specialty care, prescription drugs, mental health services, hospitalization, and more,” the press release noted.

NYC Care will launch in summer 2019 and will roll out gradually in different parts of the city, starting in the Bronx, according to the release. It will be fully available to all New Yorkers across the city’s five boroughs in 2021.

Notably, the press release lacked many details on how the city will fund the plan and how much enrollees would have to pay. It also remained unclear how the city will persuade the “young invincibles” — those who can afford insurance but believe they don’t need it — to join up. Nor was arithmetic presented to document how much the city would save on city-paid emergency and hospital care by making preventive care more accessible. At the press conference, officials mostly deflected questions seeking details, focusing instead on the plan’s goals and anticipated benefits.

“Every New Yorker will have a card with [the name of] a… primary care doctor they can turn to that’s their doctor, with specialty services that make a difference, whether it’s ob/gyn care, mental health care, pediatric care — you name it, the things that people need will be available to them,” said de Blasio. “This is going to be a difference-maker in their lives. Get the healthcare you need when you need it.” And because more people will get preventive care, the city might actually save money, he added. “You won’t end up in a hospital bed if you actually get the care you need when the disease starts.”

People respond differently when they know something is guaranteed, he continued. “We know that if people don’t know they have a right to something, they’re going to think it’s not for them,” de Blasio said. “You know how many people every day know they’re sick [but can’t afford care] so they just go off to work and they get sicker?… They end up in the [emergency department] and it could have been prevented easily if they knew where to turn.”

As to why undocumented residents were included in the program, “I’m here to tell you everyone needs coverage, everyone needs a place to turn,” said de Blasio. “Some folks are our neighbors who happen to be undocumented. What do they all have in common? They need healthcare.”

Just having the insurance isn’t enough, said Herminia Palacio, MD, MPH, deputy mayor for health and human services. “It’s knowing where you can go for care and feeling welcome when you go for care… It’s being treated in a language you can understand by people who actually care about your health and well-being.”

De Blasio’s wife, Chirlane McCray, who started a mental health program, ThriveNYC, for city residents, praised NYC Care for increasing access to mental health services. “For 600,000 New Yorkers without any kind of insurance, mental healthcare remains out of reach [but this changes that],” she said. “When New Yorkers enroll in NYC Care they’ll be set up with a primary care doctor who can refer them [to mental health and substance abuse services], and psychiatric therapy sessions are also included.”

“The umbrella concept is crucial here,” said de Blasio. “If John or Jane Doe is sick, now they know exactly where to go. They have a name, an address… We want it to be seamless; if you have questions, here’s where to call.”

Help will be available at all hours, said Palacio. “Let’s say they’re having an after-hours issue and need understanding about where to get a prescription filled. They can call this number and get real-time help about what pharmacy would be open,” or find out which urgent care center can see them for a sore throat.

Mitchell Katz, MD, president, and CEO of NYC Health and Hospitals, the city’s public healthcare network, noted that prescription drugs are one thing most people are worried about being able to afford, but “under this program, pharmaceutical costs are covered.”

Katz noted that NYC Care is a more encompassing program than the one developed in San Francisco, where he used to work. For example, “here, psychotherapy is a covered benefit; that’s not true in San Francisco… and the current program [there] has an enrollment of about 20,000 people; that’s a New York City block. In terms of scale, this is just a much broader scale.”

In addition, the San Francisco program required employers to pay for some of it, while New York City found a way around that, de Blasio pointed out. The mayor promised that no tax increases are needed to fund the program; the $100 million will come from the city’s existing budget, currently about $90 billion.

Now on to Medicare for All as we look at the history of Medicare. I am so interested in the concept of Medicare for All as I look at my bill from my ophthalmologist, which did not cover any of my emergency visits for a partial loss of my right eye. Also, my follow-up appointment was only partially covered; they only covered $5 of my visit. Wonderful Medicare, right?

The invoice was followed this weekend with an Email from Medicare wishing me a Happy Birthday and notifying me of the preventive services followed with a table outlining the eligibility dates. And the dates are not what my physicians are recommending, so you see there are limitations regarding coverage and if and when we as patients can have the services.

Medicare as a program has gone through years of discussion, just like the Europeans, Germany to start, organized healthcare started with labor. In the book American Health Care edited by Roger D. Feldman, the German policy started with factory and mine workers and when Otto von Bismark in 1883, the then Chancellor of newly united Germany successfully gained passage of a compulsory health insurance bill covering all the factory and mine workers. A number of other series of reform measures were crafted including accident insurance, disability insurance, etc. The original act was later modified to include other workers including workers engaged in transportation, and commerce and was later extended to almost all employees. So, why did it take so long for we Americans form healthcare policies for our workers?

Just like in Germany and then Britain, the discussion of healthcare reform began with labor and, of course, was battered about in the political arena. In 1911, after the passage of the National Health Act in Britain, Louis Brandeis, who was later to be appointed to the Supreme Court, urged the National Conference on Charities and Corrections to support a national program of mandatory medical insurance. The system of compulsory health insurance soon became the subject of American politics starting with Theodore Roosevelt, head of the Progressive or Bull Moose. H delivered his tedious speech, “Confession of Faith”, calling for a national compulsory healthcare system for industrial workers.  The group that influenced Roosevelt was a group of progressive economists from the University of Wisconsin, who were protégés of the labor economist John R. Commons, a professor at the university.

Commons an advocate of the welfare state, in 1906, together with other Progressive social scientists at Wisconsin, founded the American Association for Labor Legislation (AALL) to labor for reform on both the federal and state level. Roosevelt and other members of the Progressive Party pushed for compulsory health insurance, which they were convinced would be endorsed by working-class Americans after the passage of the British national program.

The AALL organization expanded membership and was responsible for protective labor legislation and social issues. One of the early presidents of the organization was William Willoughby, who had authored a comprehensive report on European government health insurance scheme in 1898.

The AALL next turned its attention to the question of a mandatory health insurance bill and sought the support of the American Medical Association. The AMA  was thought to support this mandatory health insurance bill if it could be shown that the introduction of a mandatory health insurance program would in fact profit physicians. This is where things go complicated and which eventually doomed the support of the AMA and all physicians as a universal health insurance plan failed in Congress. Why? Because the model bill developed by the AALL had one serious flaw. It did not clearly stipulate whether physicians enrolled in the plan would be paid in the basis of capitation fee or fee-for-service, nor did it ensure that practitioners be represented on administrative boards.

I discuss more on the influence of the AALL in health care reform and what happened through the next number of Presidents until Kennedy.

More to come! Happy Mother’s Day to all the great Mothers out there and your wonderful influence on all your families with their guidance and love.

Obamacare, Trump and a lawsuit: How industry is reacting, Mental Health and Back to Court!

Picture1.Trump and obamacare the wasps nestSorry for the delay with this week’s post but with all my travels through Europe the Internet connection was not secure enough to send this edition. So, here it is with a bit more regarding Obamacare and President Trump. However, it was interesting again to hear from some of my travel associates how they were satisfied with their type of socialized medicine, but that there were many shortcomings including long wait to see their doctors and with the care that they received. One additional point was made that the dental care had become unreliable since the dentists finally decided not to participate in the national dental plan in England due to the poor payment schedule and the government regulations. My wife and I were warned to be careful as a nation for what we really want the government to control. Also, the Brits told us that there wasn’t enough money to cover the needs of health care for all in their country.

Susannah Luthi’s piece on Obamacare and Trump deserves mention as we go on to discuss alternatives. The Trump administration’s decision to support eliminating the entire Affordable Care Act has riled lawmakers and industry alike as they navigate the line between politics and the potential practical impact of the lawsuit.

The Justice Department’s politically volatile move last week to agree with a Texas judge’s ruling against the law sparked a political firestorm not likely to end soon in the ramp-up to 2020 elections. It has already inspired calls for a GOP replacement plan.

But as the case wends its way through the 5th U.S. Circuit Court of Appeals, and potentially the U.S. Supreme Court after that, healthcare business goes on as usual across the country and likely will continue to do so as legal experts are skeptical the lawsuit will succeed.

“From my perspective, anything that would happen to the law is at best a year away,” said Dave Schreiner, CEO of Katherine Shaw Bethea Hospital, an 80-bed rural facility in Dixon, Ill. He is also the chair of the American Hospital Association’s Section for Small or Rural Hospitals. “It’s hard from a strategy perspective to react to anything like that.”

Last week, just after the Justice Department made its statement, Schreiner held a three-year strategic planning retreat with his board of directors.

“The ACA was not part of that discussion,” he said.

Instead, the organization’s discussion delved into the Trump administration’s regulations that touch industry’s day-to-day operations — such as last year’s regulation to cut Medicare Part B reimbursement to 340B hospitals and setting some Medicare site-neutral payment rates.

“Those have the opportunity to impact us very urgently and negatively,” Schreiner told Modern Healthcare, noting the 340B drug discount program in particular.

But in Washington, the industry trade groups on the front-lines of policy battles say there is plenty of reason to worry or at least keep their guard up.

“The important thing for the industry is to keep in mind the old saw about, ‘Don’t listen to what they say, watch what they do,'” said Chip Kahn, president, and CEO of the Federation of American Hospitals. “And that being the case, this position is a reminder that the administration ultimately supports policies that are likely to mean less coverage rather than more. And we need to prepare ourselves for that to continue.”

Ceci Connolly, president, and CEO of the Alliance of Community Health Plans which represents not-for-profit insurers, is also taking the administration’s position extremely seriously. On Monday her group filed an amicus brief in the lawsuit on Monday, supporting the ACA and the Democratic state attorneys general who will defend it.

America’s Health Insurance Plans (AHIP), the American Medical Association and the American Hospital Association also filed amicus briefs on Monday.

“If you look at small nonprofits, we don’t have a lot of extra dollars to spend on filing court briefs, so I think this indicates how seriously we are taking this threat — that we have taken this step to articulate, we hope very clearly, to the court that this would be incredibly detrimental on so many levels,” Connolly said.

She called the president’s move a “complete game-changer, with no replacement plan.”

Axios over the weekend reported that President Donald Trump doesn’t expect the lawsuit to succeed and made the move out of political considerations. Joseph Antos of the American Enterprise Institute characterized the lawsuit move as a “particularly awkward play” aimed at Trump’s political base and the administration’s approach as a “short track to nowhere.”

Last week, Trump over Twitter and in Congress declared the Republican party the “party of healthcare,” and promised a new and better plan, although Republicans failed to pass a replacement in 2017 when they controlled both chambers of Congress.

The gap between political rhetoric around the lawsuit and what’s likely to happen next makes for a confusing landscape for GOP lawmakers to navigate.

Sen. Susan Collins (R-Maine), a moderate, urged Attorney General William Barr in a letter Monday to reject the administration’s stance on the Obamacare lawsuit.

“This surprising decision goes well beyond the position taken by the department last June, and puts at risk not only critical consumer provisions such as those protecting individuals suffering from pre-existing conditions but also other important provisions of that law,” Collins wrote to Barr.

Sen. Roy Blunt (R-Mo.), a member of Republican leadership in the Senate, last week emphasized that the lawsuit’s fate depends on the 5th Circuit rather than the president.

“From my point of view, I don’t want to presuppose what the courts are going to do,” he said. “Certainly, the Court of Appeals has the entire record that is not dependent on the government’s arguing its past position.”

On the regulatory side, the administration is pushing for industry-specific policies on healthcare, including site-neutral payment policies and 340B cuts, as well as policies hospitals favor like rolling back Medicare red tape.

Not all of the rules are partisan: the site-neutral payments, in particular, have bipartisan support from policy analysts.

On the insurance front, the White House has homed in on expanding association health plans and short-term, limited duration plans.

But industry representatives in Washington, who watch those regulations for their impact on profits, characterize the president’s stance on the lawsuit as part of the regulatory picture.

“When you couple (the lawsuit) with other efforts on association health plans and short-term plans, you begin to have a higher degree of concern,” Connolly said.

Kahn also argued that the administration’s regulations are in line with its strategy on the lawsuit.

“I think when you look at the different issues (around the regulations), I don’t think my concern about this lawsuit necessarily overshadows my concern about any of those other matters,” he said. “There’s a strategic reason why the president chose to take this position on the lawsuit, and it reflects a policy that HHS carries out every day, in its attitude toward coverage provisions of the ACA.”

Attacking the ACA Is an Attack on Mental Health: The Sequel

The threat is even more real

This article is adapted from a blog post on Sept. 20, 2018, when the author anticipated the consequences of a possible federal court ruling declaring the unconstitutionality of the Affordable Care Act.

Micheal Friedman had reported that the Affordable Care Act(a.k.a. Obamacare) was ruled unconstitutional by a federal court in Texas in December. That ruling has been appealed, and now the Justice Department has asked that the ruling is upheld. If that happens, millions of people will lose health coverage, including coverage for mental health and substance abuse treatment.

Amazing! At a time when everyone agrees that access to treatment is critical to fighting the opioid epidemic and that mental health services fall woefully short of meeting America’s need; a court ruling could deprive tens of millions of people of coverage for mental health and substance abuse services.

The Affordable Care Act increased access for these services for those tens of millions by increasing coverage generally, by mandating that the health coverage purchased through the federal and state health exchanges include coverage for mental health and substance abuse treatment, and by requiring coverage of pre-existing conditions — including mental disorders. It also required parity — i.e., that payment for behavioral health services be on a par with physical health services, making such services more affordable.

Before the Affordable Care Act, many health insurance plans for small groups or individuals and occasionally for large groups did not cover the behavioral cost at all or only at a great additional cost. The amount of coverage was also usually very limited. Typically, there were caps on numbers of covered outpatient visits and of inpatient days per year. Co-pays were typically 50% rather than 20%. Annual and lifetime caps were common, which might not be a problem for occasional acute disorders but left people with chronic conditions without coverage very quickly.

Mental and substance use disorders were also among the pre-existing conditions for which coverage could be and often was denied.

Federal legislation prior to the Affordable Care Act addressed some of the problems related to lack of parity, but not all. And parity was only required if a health plan included behavioral health coverage, not if the health plan covered only physical health conditions — a widely used option open to the purchasers of health plans.

And, prior to the ACA, no one — not large employers or small employers or individuals — was legally obliged to buy health insurance at all.

The ACA addressed all of these problems. Employers — except very small employers — were required to provide coverage for their employees (some with subsidies). Medicaid eligibility was extended to more working poor people. Individuals who did not have coverage through work, Medicare, Medicaid, the State Child Health Insurance Program, or the VA were required to purchase coverage (some with subsidies). And the small group and individual plans purchased through the federal or state health exchanges were required to include coverage for mental health and substance abuse disorders.

The original expectation was that changes under the ACA would provide behavioral health coverage for as many as 62 million people. The decision of several states not to extend Medicaid to larger populations and a subsequent decision not to penalize people who did not purchase insurance resulted in some shortfall. Nevertheless, there are still tens of millions of people with behavioral health coverage today who did not have it prior to the ACA.

Of course, not all will lose coverage if the ACA falls. Some employers who previously did not provide behavioral health coverage may decide to do so. Some individuals could continue to buy plans with such coverage — if such plans are affordable.

But that is unlikely. If people who do not believe they need coverage for mental health or substance abuse services opts for cheaper plans without behavioral health coverage — or no plans — the cost of plans with such coverage will rise because the people who buy them are likely to use them. The insurance industry refers to this as “adverse selection.”

If our nation really wants to have a health insurance system that will help to address the opioid epidemic and the vast underserviced of people with mental disorders, it must make sure that behavioral health coverage is affordable. It must also require coverage of people with pre-existing conditions. And it must enforce parity requirements.

To do this, the Affordable Care Act must stay in place unless or until a viable alternative is created. Swatting it down suddenly by court decree will have devastating consequences for millions.

 

Trump’s battle with ‘Obamacare’ moves back to the courts

Ricardo Alonso-Zaldivar noted that after losing in Congress, President Donald Trump is counting on the courts to kill off “Obamacare” as I started off this post. But some cases are going against him, and time is not on his side as he tries to score a big win for his re-election campaign.

Two federal judges in Washington, D.C., this past week blocked parts of Trump’s health care agenda: work requirements for some low-income people on Medicaid, and new small business health plans that don’t have to provide full benefits required by the Affordable Care Act.

But in the biggest case, a federal judge in Texas ruled last December that the ACA is unconstitutional and should be struck down in its entirety. That ruling is now on appeal. At the urging of the White House, the Justice Department said this past week it will support the Texas judge’s position and argue that all of “Obamacare” must go.

A problem for Trump is that the litigation could take months to resolve — or longer — and there’s no guarantee he’ll get the outcomes he wants before the 2020 election.

“Was this a good week for the Trump administration? No,” said economist Gail Wilensky, who headed up Medicare under former Republican President George H.W. Bush. “But this is the beginning of a series of judicial challenges.”

It’s early innings in the court cases, and “the clock is going to run out,” said Timothy Jost, a retired law professor who has followed the Obama health law since its inception.

“By the time these cases get through the courts there simply isn’t going to be time for the administration to straighten out any messes that get created, much less get a comprehensive plan through Congress,” added Jost, who supports the ACA.

In the Texas case, Trump could lose by winning.

If former President Barack Obama’s health law is struck down entirely, Congress would face an impossible task: pass a comprehensive health overhaul to replace it that both Speaker Nancy Pelosi and Trump can agree to. The failed attempt to repeal “Obamacare” in 2017 proved to be toxic for congressional Republicans in last year’s midterm elections and they are in no mood to repeat it.

“The ACA now is nine years old and it would be incredibly disruptive to uproot the whole thing,” said Thomas Barker, an attorney with the law firm Foley Hoag, who served as a top lawyer at the federal Health and Human Services department under former Republican President George W. Bush. “It seems to me that you can resolve this issue more narrowly than by striking down the ACA.”

Trump seems unfazed by the potential risks.

“Right now, it’s losing in court,” he asserted Friday, referring to the Texas case against “Obamacare.”

The case “probably ends up in the Supreme Court,” Trump continued. “But we’re doing something that is going to be much less expensive than Obamacare for the people … and we’re going to have (protections for) pre-existing conditions and will have a much lower deductible. So, and I’ve been saying that, the Republicans are going to end up being the party of health care.”

There’s no sign that his administration has a comprehensive health care plan, and there doesn’t seem to be a consensus among Republicans in Congress.

A common thread in the various health care cases is that they involve lower-court rulings for now, and there’s no telling how they may ultimately be decided. Here’s a status check on major lawsuits:

— “Obamacare” Repeal

U.S. District Court Judge Reed O’Connor in Fort Worth, Texas, ruled that when Congress repealed the ACA’s fines for being uninsured, it knocked the constitutional foundation out from under the entire law. His ruling is being appealed by attorneys general from Democratic-led states to the 5th U.S. Circuit Court of Appeals in New Orleans.

The challenge to the ACA was filed by officials from Texas and other GOP-led states. It’s now fully supported by the Trump administration, which earlier had argued that only the law’s protections for people with pre-existing conditions and its limits on how much insurers could charge older, sicker customers were constitutionally tainted. All sides expect the case to go to the Supreme Court, which has twice before upheld the ACA.

— Medicaid Work Requirements

U.S. District Court Judge James E. Boasberg in Washington, D.C., last week blocked Medicaid work requirements in Kentucky and Arkansas approved by the Trump administration. The judge questioned whether the requirements were compatible with Medicaid’s central purpose of providing “medical assistance” to low-income people. He found that administration officials failed to account for coverage losses and other potential harm, and sent the Health and Human Services Department back to the drawing board.

The Trump administration says it will continue to approve state requests for work requirements, but has not indicated if it will appeal.

— Small Business Health Plans

U.S. District Court Judge John D. Bates last week struck down the administration’s health plans for small business and sole proprietors, which allowed less generous benefits than required by the ACA. Bates found that administration regulations creating the plans were “clearly an end-run” around the Obama health law and also ran afoul of other federal laws governing employee benefits.

The administration said it disagrees but hasn’t formally announced an appeal.

Also facing challenges in courts around the country are an administration regulation that bars federally funded family planning clinics from referring women for abortions and a rule that allows employers with religious and moral objections to opt out of offering free birth control to women workers as a preventive care service.

I thought that I laid out fixes for the Affordable Care Act in my last three posts so now let us look at “alternative solutions”.

Survey Shows that Worries about Healthcare​ Will Follow Voters into the Voting Booth, Waiting for Healthcare in Canada and Some Progress Finally!!

41715310_1709429559186696_758100051737182208_nIf anyone doubts the significance of our discussion regarding how important health care discussion is in the voters’ minds. Look at this survey! Oh, those greedy angry politicians and the mid-term elections!! The question is what are our politicians interested in?

I had an interesting conversation with a strategist for the Democratic party and she agreed with me that even if the Republicans in the House and the Senate came up with a solution to health care and or immigration that fulfilled their wants and needs, they wouldn’t approve or vote in favor of any bills until after the mid-term election to which they expected to declare their majority position.

Jenny Dean reviewed a survey, which showed that of the 37 percent of voters nationwide who planned to vote for President Donald Trump in the 2020 election, more than a third of Republicans and 37 percent of Independents said in a survey conducted by the Texas Medical Center that they would change their mind if his policies led to an increase in the uninsured. When the majority of voters across the country head to the voting booth in November and again in 2020, the politics of health care will not be far from their thoughts.

That’s the finding of the fourth annual Texas Medical Center’s national consumer survey, released Wednesday, which gauges attitudes on health issues, ranging from support of President Donald Trump’s policies to whether foods laden with fat and sugar should cost more.

“The Nation’s Pulse,” the survey questioned 5,038 people across 50 states, including 1,018 people in Texas. Respondents were both Democrats and Republicans but also included those who identified as Independent. Nearly two-thirds, or 61 percent, said they would be likely to only vote for candidates who promise to make fixing health care a priority. Additionally, the majority of voters said it was important that candidates share their views on such hot-button issues as the expansion of Medicaid. Those views held both in states that expanded Medicaid under the Affordable Care Act and in the 17 states, including Texas that did not.

Survey responses at a glance

Likelihood to only vote for a candidate who wants health care fixed:

Democrats: 68 percent

Republicans: 60 percent

Independent: 53 percent

Plan to vote for Donald Trump in 2020:

U.S (all parties).: 37 percent

Texas (all parties): 38 percent

2020 Trump voters who would change their mind if the uninsured rate rises:

Republicans: 35 percent

Independents: 37 percent

Democrats: 60 percent

Texans who support Medicaid expansion:

60 percent

Texans who support Medicare for all:

55 percent

Support lowering legal blood alcohol limit while driving to 0.0 percent:

U.S.: 46 percent

Texas: 48 percent

Think foods that lead to obesity should cost more:

U.S. 51 percent

Texas: 56 percent

Source: Texas Medical Center Health Policy Institute

Across all political parties, 60 percent of Texans favored a Medicaid expansion, according to the survey. This comes despite years of steadfast opposition from state leaders. It also closely mirrors a similar survey in June by Houston-based Episcopal Health Foundation and the Kaiser Family Foundation that found 64 percent of Texans wanted a Medicaid expansion.

But perhaps most striking was that “Medicare for All” health coverage — once politically unthinkable in Texas —found surprising favorability with 55 percent in the state saying they would support it. That compares with 59 percent nationwide, the survey found.

“With health care so expensive and increasingly unaffordable, the respondents told us that it is important to try to fix it,” said Dr. Arthur “Tim” Garson, director of the Texas Medical Center Health Policy Institute, which led the study.

While the bitter health care debate of a year ago has slipped mostly out of the headlines, it apparently has not slipped from people’s minds, political operatives from both parties said Tuesday.

Neither Glenn Smith, an Austin-based progressive consultant nor Jamie Bennett, vice president at Potomac Strategy Group, a right-leaning political consulting firm, were especially surprised when told of the survey results.

“I think (health care) is the most critical domestic issue that we face today,” said Smith, adding that worries about affordability and access are “ever-present” in people’s lives.

“Health care is a very important issue for our elected leaders to solve,” agreed Bennett in an email, “It makes up the majority of the federal budget and affects every American at some point in their lifetime. I think health care will continue to be a central issue in the mid-terms and 2020 presidential election — especially given the inaction from the federal level.”

Looking ahead to 2020, the survey zeroed in on Trump supporters. Of the 37 percent of voters nationwide who planned to vote for the president, more than a third of Republicans and 37 percent of Independents said they would change their mind if his policies led to an increase in the uninsured.

Such potential defection did not surprise Smith. “That is one of the things that could knock significant numbers from his base,” he said. Garson cautioned, though, the presidential race is still two years away. “You don’t know until Election Day what people will do,” he said,

There were differences, however, in how party affiliation affected priorities. While reducing costs was considered the highest priority across the board, Democrats listed universal coverage as next, while Republicans and Independents said affordability was the second highest priority.

In other issues, the survey found nearly half of Americans, including those in Texas, supported lowering the legal blood alcohol limit while driving to 0.0. It is currently .08 in Texas. Also, an overwhelming majority in all states wanted the age of buying tobacco products raised to 21, and more than half said that foods that lead to obesity should cost more.

The policymakers and politicians continue to point to the Canadian health care system as one that we should use as the model for our system here in the U.S.A. ’Canadians are one in a million — while waiting for medical treatment

Sally Pipes points out that Canada’s single-payer healthcare system forced over 1 million patients to wait for necessary medical treatments last year. That’s an all-time record.

Those long wait times were more than just a nuisance; they cost patients $1.9 billion in lost wages, according to a new report by the Fraser Institute, a Vancouver-based think-tank.

Lengthy treatment delays are the norm in Canada and other single-payer nations, which ration care to keep costs down. Yet more and more Democratic leaders are pushing for a single-payer system — and more and more voters are clamoring for one.

Indeed, three in four Americans now support a national health plan — and a new NBC/Wall Street Journal poll finds that health care is the most important issue for voters in the coming election.

The leading proponent of transitioning the United States to a single-payer system is Sen. Bernie Sanders, Vermont’s firebrand independent. If Sanders and his allies succeed, Americans will face the same delays and low-quality care as their neighbors to the north.

By his own admission, Sen. Sanders’ “Medicare for All” bill is modeled on Canada’s healthcare system. On a fact-finding trip to Canada last fall, Sanders praised the country for “guaranteeing health care to all people,” noting that “there is so much to be learned” from the Canadian system.

The only thing Canadian patients are “guaranteed” is a spot on a waitlist. As the Fraser report notes, in 2017, more than 173,000 patients waited for an ophthalmology procedure. Another 91,000 lined up for some form of general surgery, while more than 40,000 waited for a urology procedure.

All told, nearly 3 percent of Canada’s population was waiting for some kind of medical care at the end of last year.

Those delays were excruciatingly long. After receiving a referral from a general practitioner, the typical patient waited more than 21 weeks to receive treatment from a specialist. That was the longest average waiting period on record — and more than double the median wait in 1993.

Rural patients faced even longer delays. For instance, the average Canadian in need of orthopedic surgery waited almost 24 weeks for treatment — but the typical patient in rural Nova Scotia waited nearly 39 weeks for the same procedure.

One Ontario woman, Judy Congdon, learned that she needed a hip replacement in 2016, according to the Toronto Sun. Doctors initially scheduled the procedure for September 2017 — almost a year later. The surgery never happened on schedule. The hospital ran over budget, forcing physicians to postpone the operation for another year.

In the United States, suffering for a year or more before receiving a joint replacement is unheard of. In Canada, it’s normal.

Canadians lose a lot of money waiting for their “free” socialized medicine. On average, patients forfeit over $1,800 in lost wages. And that’s only counting the working hours they miss due to pain and immobility.

The Fraser Institute researchers also calculated the value of all the waking hours that patients lost because they couldn’t fully function. The toll was staggering — almost $5,600 per patient, totaling $5.8 billion nationally. And those calculations ignore the value of uncompensated care provided by family members, who often take time off work or quit their jobs to help ill loved ones.

Canada isn’t an anomaly. Every nation that offers government-funded, universal coverage features long wait times. When the government makes health care “free,” consumers’ demand for medical services surges. Patients have no incentive to limit their doctor visits or choose more cost-efficient providers.

To prevent expenses from ballooning, the government sets strict budget caps that only enable hospitals to hire a limited number of staff and purchase a meager amount of equipment. Demand inevitably outstrips supply. Shortages result.

Just look at the United Kingdom’s government enterprise, the National Health Service, which turns 70 this July. Today, British hospitals are so overcrowded that doctors regularly treat patients in hallways. The agency recently canceled tens of thousands of surgeries, including urgent cancer procedures, because of severe resource shortages. And this winter, nearly 17,000 patients waited in the backs of their ambulances — many for an hour or more — before hospital staff could clear space for them in the emergency room.

Most Americans would look at these conditions in horror. Yet Sen. Sanders and his fellow travelers continue to treat the healthcare systems in Canada and the UK as paragons to which America should aspire.

Sen. Sanders’s “Medicare for All” proposal would effectively ban private insurance and force all Americans into a single, government-funded healthcare plan. According to Sen. Sanders, this new insurance scheme would cover everything from regular check-ups to prescription drugs and specialty care, no referral needed — all at no charge to patients.

Americans shouldn’t fall for these rosy promises. As Canadians know all too well, when the government foots the bill for health care, patients are the ones who pay the biggest price.

Sanders was asked to respond to comments Schultz made about the plan in another interview.

Schultz recently announced that he would be leaving Starbucks and said he was considering “public service.” He said on CNBC he was concerned about the way “so many voices within the Democratic Party are going so far to the left.”

Sen. Bernie Sanders said Medicare-for-all is a “cost-effective” program.

“And I ask myself, how are we going to pay for all these things? In terms of things like single-payer or people espousing the fact that the government is going to give everyone a job, I don’t think that’s realistic,” he said.

CNN’s Chris Cuomo asked Sanders about the possibility of Schultz running as “the Left’s Trump” who may go up against the current president in 2020.

Sanders said he didn’t know Schultz but his comment was “dead wrong.”

“You have a guy who thinks that the United States apparently should remain the only major country on earth not to guarantee health care to all people,” Sanders said. “The truth of the matter is that I think study after study has indicated that Medicare for All is a much more cost-effective approach toward health care than our current, dysfunctional health care system, which is far and away the most expensive system per capita than any system on Earth.”

But there was progress made as evidenced in that the Senate finally Passes Historic Health Spending Bill and the Package includes funding for cancer, opioids, and maternal mortality

Shannon Firth a Washington Correspondent, for the MedPage, wrote that a spending bill that boosts funding for medical research while also taking aim at the opioid epidemic and maternal mortality passed the Senate on Thursday in a vote of 85-7.

The $857-billion “minibus” package bundled funding for Department of Health and Human Services (HHS) as well as for the Defense, Labor, and Education departments.

Senators Mike Lee (R-Utah), Jeff Flake (R-Ariz.), Rand Paul (R-Ky.), Bernie Sanders (I-Vt.), Pat Toomey (R-Pa.), Mike Crapo (R-Idaho) and James Risch (R-Idaho) voted against the bill.

Attention now turns to the House of Representatives, which has not yet acted on a bill to fund HHS. Congress faces a Sept. 30 deadline to enact a funding package to avoid a shutdown of the affected departments.

What’s in It?

The legislation provides $2 billion in additional funding for the National Institutes of Health (NIH), including $425 million for Alzheimer’s research and $190 million for cancer research. It also maintains current levels of CDC spending for cancer screening and early detection programs, as well as for the agency’s Office of Smoking and Health.

Also woven into the package: $3.7 billion for behavioral and mental health programs targeting opioid addiction — an increase of $145 million over the FY2018 budget — including $1.5 billion in State Opioid Response Grants from the Substance Abuse and Mental Health Services Administration; $200 million to increase prevention and treatment services in Community Health Centers; and $120 million to address the epidemic’s impact in rural areas through support for rural health centers. The bill also dedicates $50 million to programs aimed at tackling maternal mortality.

Sen. Patty Murray (D-Wash.) lauded the investment in ending maternal mortality in a press statement.

“It is completely inexcusable that mothers are more likely to die in childbirth in our country than any other country in the developed world, and long past time we treated this issue like the crisis it is,” she said.

New Push for Research

Sen. Roy Blunt (R-Mo.), speaking on the Senate floor Thursday, blasted the short shrift given to NIH from 2003 to 2015.

Should this bill become law, the agency will see a nearly 30% increase in its reserves — from $30 billion to $39 billion, he added.

Already, heightened funding since 2015 has driven efforts to develop new vaccines, rebuild a human heart using a patient’s own cells, and identify new nonaddictive painkillers — “the holy grail of dealing with the opioid crisis” — said Sen. Lamar Alexander (R-Tenn.), chairman of the Health Education Labor and Pensions Committee, during a committee hearing on Thursday.

In addition, NIH Director Francis Collins, MD, Ph.D., said at the hearing that the new monies will let the agency award 1,100 new grants to first-time investigators through the Next Generation Researchers Initiative — the largest number to date.

On the Senate floor, Sen. Ed Markey (D-Mass.) stressed the importance of NIH funding to curb the costs of health care, especially of Alzheimer’s disease.

“If we do not find the cure for Alzheimer’s by the time we reach the year 2050, the budget at Medicare and Medicaid for taking care of Alzheimer’s patients will be equal to the defense budget of our country,” he said.

“Obviously, that is non-sustainable,” Markey noted.

U.S. taxpayers currently spend $277 billion on patients with Alzheimer’s disease. By 2050, that figure is projected to grow to $1.1 trillion, Blunt noted.

Also Wrapped In… 

The minibus package also included the following:

  • $1 million for HHS to develop regulations stipulating that drug companies include the price of the drug in any direct-to-consumer advertisements — an idea supported by HHS Secretary Alex Azar
  • Full funding for the Childhood Cancer STAR Act which involves collecting medical specimens and other data from children with the hardest to treat cancers, and supports research on the challenges pediatric cancer survivors encounter within “minority or medically underserved populations”
  • The requirement that the HHS Secretary provide an update on rulemaking related to information-blocking, as mandated in the 21st Century Cures Act
  • Funds “Trevor’s Law,” which seeks to enhance collaboration among federal, state, and local agencies and the public in investigating possible cancer clusters
  • Mandates that CDC report on the Coal Workers Health Surveillance Program, which targets black lung disease among coal miners

An amendment from Paul aimed at defunding Planned Parenthood failed in a vote of 45-48.

Docs, Wonks Weigh In

Stakeholders in medicine applauded the Senate’s work.

“[T]his bill will enable the nation’s medical schools and teaching hospitals, which perform over half of NIH-funded extramural research, to continue to expand our knowledge, discover new cures and treatments, and deliver on the promise of hope for patients nationwide,” said Darrell Kirch, MD, president and CEO of the Association of American Medical Colleges, in a press statement.

These new NIH monies will also help support “well-paying jobs across the country, strengthen the economy … and make America more competitive in science and technology,” Kirch said; he urged the House to pass a similar measure as quickly as possible.

The American Heart Association also applauded the Senate’s bipartisan achievement.

“Sustained funding for the NIH is critical to ensuring the nation’s standing as a global leader in research. Even more importantly, it opens an abundance of possibilities in pioneering research that could help us conquer cardiovascular disease, the no. 1 killer in America and around the world,” said Ivor Benjamin, MD, president of the AHA.

Members of the right-leaning Heritage Foundation, however, were disappointed.

“The bill fails to make any program reforms or policy recommendations to address Obamacare. Congress still needs to provide relief to the millions suffering under Obamacare’s reduced choices and higher costs,” said a Heritage report issued Wednesday.

The departments to be funded by the minibus package account for more than 60% of discretionary federal spending for 2019, so there was some positive movement on the health care system despite our political dysfunction. Where do we go next?

 

A Journalist’s Family escaped Socialism and now the Democrats think that they should move the party in its direction; So Let’s Look Closer at the British Experience.

 

 

40790419_1699020056894313_3889611529598795776_nAfter reviewing last week’s craziness I am convinced that our politicians along with the media are truly dysfunctional and really lack civility. Look at the demonstrators who were interviewed during the next potential Supreme Court Judge’s “interrogation”. Most didn’t even know what they were demonstrating against or even what their signs meant. What a crazy world we live in!!

As the “New Democrats” declare their need to change us all and make our system based on socialism I found this interesting article.

Giancarlo Sopo wrote an Opinion contributor who stated that Cuba’s socialist revolution was supposed to work for workers — like his grandparents who lived in Miami during Fulgencio Batista’s dictatorship this interesting article. In January 1959, just two weeks after Fidel Castro seized power, they returned to the island to care for his grandmother’s ailing mother. For the next 20 years, they remained prisoners in their own country. Democratic socialism is a lot like the system his family fled, except its proponents promise to be nicer when seizing your business.

As Cuba’s political and economic situation worsened, his grandfather told a friend he wanted to return to the United States. Someone overheard the conversation and reported him to the authorities. For this, the Castro regime threw him in jail. He was later stripped of his job and salary as an accountant and assigned to feed zoo animals. In addition to the emotional distress it caused, this made my family’s financial circumstances even more precarious.

To understand his grandparents’ desperation to flee socialism, imagine leaving everything behind and starting anew at almost 60 years old.

He, the writer was born in Miami a little after his family was able to return to America — when President Jimmy Carter allowed travel restrictions to lapse. Growing up, a framed photo of his parents with President Ronald Reagan was a mainstay in the living room of his modest duplex. Yet, during the first election, he was able to vote, he served as a precinct captain for Democratic presidential candidate John Kerry. Four years later, he knocked on doors in New Hampshire for then-Sen. Barack Obama. In 2016, his wife and he drove 14 hours to volunteer for Hillary Clinton and this June, they marched in support of immigrant families.

The popularity of ‘democratic socialism’

Despite his working-class immigrant roots, he is concerned by the popularity of socialism within my party. On the night of Alexandria Ocasio-Cortez’s victory in New York, he thought that she used the term as a misnomer. He then began studying the views of the Democratic Socialists of America (DSA), remember that we discussed the various forms of socialism and the system here would be democratic socialism and now the rapidly growing national organization she belongs to and was disturbed by what he learned.

Like those of yesteryear, today’s socialists believe the government should nationalize major industries, propose eliminating private ownership of companies, and reject profits. In other words, democratic socialism is a lot like the system my family fled, except its proponents promise to be nicer when seizing your business.

When he confronted some progressive friends about this, they initially dismissed his concerns. After sharing some articles with them, the conversation shifted to “they just want us to be more like the Nordic countries” and “they’re not like real socialists!” Both are reductionist, self-delusions to avoid confronting difficult truths.

The latter is a particularly absurd fallacy because it requires one to believe that adults who willfully join socialist organizations, sound like socialists and call themselves socialists are not what they claim to be.

Claims of “Nordic socialism” are also largely exaggerated. As Jostein Skaar, of Oslo Economics, told him, “I would stress that the Norwegian economic system is capitalistic, heavily influenced by the U.S. and U.K.”

This is probably why DSA argues that the Nordic model is not good enough.

The ideological counterparts of America’s democratic socialists are likelier to be found to our south than in northern Europe. For instance, Cuba — where the state controls three-fourths of the economy, limits private-sector activity, and employs the majority of workers — is clearly more representative of DSA’s economic vision than Denmark, where 89 percent of the wealth is privately owned and seven out of 10 Danes work in the private sector.

Moreover, as an investigation by Transparency International revealed, the Venezuelan government owns at least 511 companies — resulting in a state-owned enterprise’s per-capita ratio that is more than three times greater than all of Scandinavia’s combined.

As someone who spent years defending Democrats from “socialista” charges, he understood why people roll their eyes when Cuba and Venezuela are mentioned alongside democratic socialism, but to reject the comparison simply because we don’t like those countries’ outcomes misses the point of why they turned out the way they did. He is under no illusion that increased access to health care and education will turn us into the Venezuelan capital Caracas, but it’s foolish to believe that democratic socialists — who promise to end capitalism — would be satisfied with Medicare for all if given the reins of power.

This must never happen. The descendants of Karl Marx and Friedrich Engels should have no place in the party of Harry Truman and John F. Kennedy. Given its horrific record of human suffering, it would be a moral disgrace for Democrats to embrace socialism just to win elections, as some suggest. Those who use the blitheful ignorance of many for the political gain of a few deserve to lose. Indeed, if socialism represents the future of the Democratic Party, that’s a dystopia, no American should want to be a part of.

Britain’s Health Care System Demonstrates Perils of Socialized Medicine

Dr. Kevin Pham and Robert Moffit reviewed the British experience with socialized medicine and why those who want to convert our system to socialized medicine had better do some serious research first. Younger doctors who are flirting with the support of government-run health care should consider some hard facts—including the unfortunate results such control would likely have for patients and doctors themselves. They should also look at the recent raw experience of Britain with a government-controlled health care system.

But first, let’s look at the most serious plan for government-run health care: Sen. Bernie Sanders’ Medicare for All Act of 2017, which has the support of one-third of Senate Democrats.

Recently, Sanders, I-Vt., claimed that his bill would save more than $2 trillion over a 10-year period. According to the Associated Press, however, the senator “mischaracterized” the analysis upon which that estimate was based, a major study of the cost of the Sanders bill by Charles Blahous, a former Medicare trustee, now at the Mercatus Center.

As the Associated Press’ fact check notes, the $2.1 trillion “savings” estimate rests on the implausible assumption—studiously ignored by Sanders and others—that hospitals and staffing levels would remain the same—despite an estimated 40 percent reduction in compensation for medical services.

Such a massive pay cut would guarantee, says Blahous, that doctors and hospitals would get paid for services “substantially below” their costs of providing the services. Thus, he warns, “ … whether providers could sustain such losses and remain in operation, and how those who continue operations would adapt to such dramatic payment reductions, are critically important questions.”

Yes, they are. Blahous’ findings are particularly relevant for young men and women entering medical school. As Kaiser Health News recently reported, a growing contingent of young physicians and medical students favor expanding the power of government officials to control medicine, and thus their professional lives.

After all, most students become doctors more out of a desire to care for patients than to make a lot of money. Sanders’ proposed pay cut, however, would likely price many doctors out of independent practice, as well as decimate larger medical systems—neither of which would benefit patients.

Medicare would ostensibly be the model for Sanders’ national health insurance program. Beyond lower payment levels, Medicare is governed by tens of thousands of pages of rules, regulations, and guidelines.

The transactional or administrative costs that doctors and other medical professionals already incurred in compliance with these reams of red tape are real, though they do not show up on Medicare or Medicaid budget documents. That is one reason why Medicare’s official administrative costs are deceptively low; the government shifts a large share of administrative costs for medical professionals.

By 2030, America faces a physician shortage ranging from roughly 43,000 to 121,000, depending upon the assumptions. The crush of nonclinical administrative duties is today a leading cause of American physician burnout and accelerated retirements.

Ultimately, the Sanders bill, by reducing physician compensation while enlarging the power of Washington’s health care bureaucracy, would only make matters worse.

Young doctors—and anyone else considering government-run health care—should look at the performance of the British National Health Service.

In a candid Oct. 12, 1975 interview with the London Sunday Times, then-Labor Minister David Owen, conceded:

“The health service was launched on a fallacy. First, we were going to finance everything, cure the nation and then spending would drop. That fallacy has been exposed. Then there was a period when everybody thought the public could have whatever they needed on the health service- it was just a question of governmental will. Now we recognize that no country, even if they are prepared to pay the taxes, can supply everything.”

Today, the British National Health Service is plagued with long wait times, delayed procedures, and an overstressed medical workforce.

A cursory survey of recent British news sources reveals a worrying trend in the delayed delivery and deteriorating quality of National Health Service health care. While British tabloids can be sensational, with bleeding ledes on hospital problems, sober British analysts are concerned.

Last winter, a particularly virulent strain of influenza hit Britain. British hospital wards are often overcrowded, but the crush of flu patients exacerbated the system’s persistent and underlying problems—inadequate staffing and insufficient resources. The British Medical Association’s quarterly survey of physicians found that 82 percent of respondents felt their workplaces were understaffed.

One doctor described the situation this way to the British Medical Association: “I came on to shift yesterday afternoon and there were patients literally everywhere. The corridor into the hospital was so busy we couldn’t have got a cardiac arrest patient through it into the resuscitation room.” He added, “To say the staff was at the end of their tethers would be a complete understatement.”

National Health Service morale has been suffering, and British Medical Association surveys show that complaints about resources, understaffing, and perpetual physician vacancies have been constant.

Aggravated by the flu season, and budget constraints, the National Health Service canceled some 50,000 “non-urgent” surgeries. The problem is that the urgency for a particular patient’s surgery is, or should be a doctor’s clinical judgment. For example, surgery for a person to repair an abdominal aortic aneurysm (AAA), for instance, may be delayed. But delaying an AAA repair is risking a rupture, and patients with a ruptured AAA have a 90 percent mortality rate.

By March 2018, British emergency departments reached new lows, leaving 15.4 percent of patients waiting over four hours before being seen. This was far short of the goal of less than 5 percent of patients forced to wait over four hours.

When considering only major emergency departments, classified as Type 1 in the National Health Service, the rate increased to 23.6 percent of patients waiting longer than four hours to be seen. The British Medical Journal reports that this is the worst performance since 2004 when these metrics were first tracked.

Outside of emergency departments, the number of British patients waiting 18 weeks or more for treatment increased by 35 percent, which was an increase of 128,575 patients from about 362,000 patients in 2017, to over 490,000 patients in 2018.

Additionally, by March 2018, 2,755 patients had waited over a year to be treated, compared to 1,528 patients in 2017. In England, the National Health Service also broke records by canceling over 25,000 surgeries at the last minute in the first quarter of 2018—this was the highest number of last-minute cancellations in 24 years. Remarkably, this was after the British authorities initiated a series of reforms that started in 2016.

The British, of course, are responsible for their system and its results. They will, or will not, undertake reforms to reduce long queues, delayed care, and the consequent harm to British patients.

It is naïve, however, to believe that Americans can avoid similar consequences—annual budget dramas, long waiting times, and scandalous care denials—by giving members of Congress and officials of the federal bureaucracy control over American health care.

And if you want to see how crazy “our” politicians are, one only has to look at New York State and the governor’s race. We have discussed weeks ago the estimation of how much Medicare for All will cost.

Cynthia Nixon on getting single-payer health care in New York: ‘Pass it and then figure out how to fund it’

Kaitlyn Schallhorn wrote about Ms. Cynthia Nixon’s pursuit in her quest to become New York’s next governor.  Cynthia Nixon has advocated for a single-payer health care system in the state – something studies have shown would be a costly endeavor.

The proposed New York Health Act(NYHA), which would establish universal health care for everyone in the state, including undocumented immigrants, would require the state’s tax revenue to increase by about 156 percent by 2022, according to a study by the RAND Corp. But it also found state spending on total health care under NYHA would be slightly lower – about 3 percent – by 2031 than under the current system.

Nixon recently told the New York Daily News editorial board she did not yet have a plan to pay for single-payer.

“Pass it and then figure out how to fund it,” Nixon said. What an ignoramus and I’m not sure who or what she is as she tells the media not to call her a lesbian, but instead label her a queer!!

Gov. Andrew Cuomo, who Nixon is challenging in the Democratic primary next week, has said it should be up to the federal government to pass a universal health care system. During a debate between the two candidates last month, Cuomo said the NYHA was good “in theory,” but would cost more than New York’s annual budget to implement it “in the long-term,” according to the Albany Times Union.

‘SEX AND THE CITY’ STAR CYNTHIA NIXON COULD BE NEW YORK’S NEXT GOVERNOR: A LOOK AT HER POLITICAL ACTIVISM

Nixon, on the other hand, has said a single-payer system will save the state and New Yorkers money overall.

There is widespread disagreement over how much it would cost to implement a single-payer health care system. Supporters of the single-payer system say it would cut excessive administrative costs compared to those incurred by private insurers. But critics, including most Republicans, warn the savings would be less dramatic than expected – and the system would cost too much.

Joe White, president of the Council for Affordable Health Coverage, has estimated that with single-payer “costs and taxes will rise, or patient access will be severely diminished – turning America’s medical system into a third-world product.”

The Medicare-for-all bill proposed earlier this year by Sen. Bernie Sanders, I-Vt., was estimated to cost$32.6 trillion over 10 years by a Mercatus Center at George Mason University study and it is estimated that a single-payer health care system in New York will cost $155 billion dollars over 10 years or less.

ANDREW CUOMO, CYNTHIA NIXON ACCUSE EACH OTHER OF LYING, CORRUPTION IN HEATED PRIMARY DEBATE

The term “single-payer health care” denotes only one entity bears the financial responsibility of health care – the government. Under this system, the government would be solely responsible for covering health care costs.

“The basic idea of single-payer is to cover everybody with a single government program, and that program would basically cover all the doctors and hospitals,” Dr. Adam Gaffney, an instructor of medicine at Harvard Medical School, told Fox News.

As the Times Union reported, the NYHA has continuously been introduced by Democrats in the state Assembly every year since 1992 but has been unsuccessful in the Senate.

I believe that the dysfunction in our Congress will continue and may get worse as the Mid-Term elections get closer and they will get nothing done. What happens after the elections will be determined depending on whether the Democrats grab the majority in one or both the House and the Senate.

On forward to look closer at Medicare for All and other ideas for a single-payer health care system as we get closer to what a real future health care system will or could look like in the U.S.A.