Category Archives: Hospitals

Physicians Get Weed Killer; Administrators Get Miracle-Gro And neither is helping, Obamacare Funding Suggestions, Andrew Lang, Year in Review and Google Searches

Last week Suneel Dhand reported that compared to a couple of years ago, very little has changed in the hospital medical community. 

In fact, I’m sure the divergence of the curves has only grown bigger, as more and more administrators are added to the ranks of healthcare. Look at what happened in Chicago where one of the fairly large hospitals fired 15 of their physicians and replaced them with 15 nurse practitioners last year, and in Texas 27 pediatricians at a chain of clinics in the Dallas area lost their jobs and were replaced by nurse practitioners. 

Quite often in life, the answers to some of the biggest questions we have, are staring us right in the face and incredibly simple. Healthcare can never be fixed unless we radically simplify everything and strip away the unnecessary complexities in our fragmented system. The divergence of the above lines, however, actually represents so much more than just an obnoxious visual. It actually symbolizes what happens when any organization, system, or even country, becomes top-heavy and loses sight of what is happening at the front lines. And in the end, it eventually collapses under its own weight.

When this happens in America, we cannot predict, but consider this: The amount we spend on healthcare would be the 4th largest economy in the world if it stood alone (at $3.5 trillion, only China and Japan have a higher total GDP). With an aging population, increasing chronic comorbidities, and expensive new treatments, if costs are not reined in, healthcare expenditure could account for a third of the entire GDP in about 25 years. A figure that will quite simply destroy the American economy.

It would be one thing if all the administration and bureaucracy was actually resulting in an improved and more efficient healthcare system. But look around you folks. Acute physician shortages now plague every state. Millions of people find it impossible to find a primary care doctor. Certain specialties are now booking out appointments months in advance. ERs and hospitals are overflowing. And in the end, patients are still facing soaring out of pocket expenses.

The last 20 years have witnessed the consolidation and corporatization of the entire U.S. healthcare system. Sold initially as a way to reign in costs, I am yet to see any evidence that it’s done anything other than dramatically increase costs (please feel free to forward me any financial analysis if I’m wrong). And why should that be a surprise to anyone?

I’ll leave you to stare once again at the above graph for a minute or two, and take in a comment that a distinguished physician colleague of mine recently made: “It’s like the physicians have been given weed killer and the administrators have been given Miracle-Gro.”

Affordable Care Act funding in question after health insurance taxes repealed

The Cadillac Tax, Health Insurance Tax and Medical Device Tax were recently repealed, raising questions over how the Affordable Care Act will be funded in the future. Yahoo Finance’s Anjalee Khemlani joins Adam Shapiro, Julie Hyman and Dan Howley during On the Move to break it all down.

Andrew Yang Has The Most Conservative Health Care Plan In The Democratic Primary

Daniel Marans of the Huff Post pointed out that Entrepreneur Andrew Yang has had unexpected staying power in the Democratic presidential primary thanks in part to the enthusiasm for his plan to provide every American with a basic income of $1,000 a month.

But the boldness of his signature idea only serves to underscore the unambitiousness of the health care plan he released earlier this month.

In fact, Yang’s health plan, which he bills as an iteration of the left’s preferred “Medicare for All” policy, is more conservative than proposals introduced by the candidates typically identified as moderate. 

Former Vice President Joe Biden, South Bend, Indiana, Mayor Pete Buttigieg and Sen. Amy Klobuchar of Minnesota all at least call for the creation of a public health insurance option that would be available to every American. (Sen. Bernie Sanders of Vermont and Sen. Elizabeth Warren of Massachusetts favor Medicare for All, which would move all Americans on to one government-run insurance plan ― though the two senators disagree on the timeline for implementing the idea.)

In terms of expanding health insurance coverage, Yang says on his website merely that he would “explore” allowing the employees of companies that already provide health insurance the chance to buy into Medicare. 

“We need to give more choice to employers and employees in a way that removes barriers for businesses to grow,” Yang writes.

Under Yang’s plan, people employed by businesses that do not provide insurance, or who are self-employed, would continue to purchase coverage on the exchanges created by former President Barack Obama’s Affordable Care Act.

The decision not to focus on expanding coverage distinguishes Yang dramatically from his competitors. And in the foreword to his plan, he explains that that is a deliberate choice, since enacting single-payer health care is “not a realistic strategy.”

“We are spending too much time fighting over the differences between Medicare for All, ‘Medicare for All Who Want It,’ and ACA expansion when we should be focusing on the biggest problems that are driving up costs and taking lives,” he writes. “We need to be laser focused on how to bring the costs of coverage down by solving the root problems plaguing the American healthcare system.”

When asked about how Yang plans to expand health insurance coverage ― 27 million Americans remain entirely uninsured and millions more have insurance that is so threadbare they do not use it ― Yang’s campaign referred HuffPost to his website. 

Yang would increase health care access through reforms designed to reduce the health care system’s underlying costs, according to his campaign. On his website, he divides those reforms into six categories: bringing down the cost of prescription drugs through bulk negotiation; investing in waste-saving health care technologies; realigning medical providers’ “incentives” away from waste and abuse; increasing investment in preventive and end-of-life health care; making the provision of health care more “comprehensive”; and reducing the influence of lobbyists on the political system.

Yang implies that his rivals have sacrificed cost control in the name of expanding coverage. But when it comes to the specifics, Yang’s competitors have already gotten behind many of the ideas he is proposing ― and sometimes take them a step further. 

For example, Buttigieg has a provision in his health care plan that would prohibit “surprise billing” ― the practice of providing unwitting patients with a large bill after a medical procedure when a doctor who performed it is not in the hospital’s insurance network. Yang does not mention the practice in his health care plan.

One provision of Yang’s plan that genuinely sets him apart is his plan to encourage the replacement of the fee-for-service billing model for doctors with salaries. The latter model is supposed to cut back on duplicative practices and foster more holistic care. Other elements of his plan, such as “incentivizing” gym memberships, healthy eating and bike commuting as a form of preventive health care, have drawn eye rolls from leftists who regard the ideas as paternalistic.

First and foremost, though, many progressives are likely to find fault with Yang’s plan, because they consider his use of the term “Medicare for All” misleading. 

For months on the campaign trail, Yang claimed that he supported Medicare for All, though not the provision of Sanders’ bill ― and its companion in the House ― requiring people with private insurance to enroll in an expanded Medicare program. 

He even aired a television ad casting his commitment to the policy as a reflection of his experience as the father of a special needs child.

Yang says on his campaign website that he is still firmly committed to the “spirit” of Medicare for All. But now that he has introduced a plan of his own, that claim is harder to defend.

Yet the Yang campaign is plowing full-steam ahead with its appropriation of the term in a new 30-second ad, “Caring.”

“If my husband, Andrew Yang, is president, he’ll fight for Medicare for All with mental health coverage,” Yang’s wife, Evelyn, says in the ad. 

Fate of Obamacare uncertain amid tax repeals, lawsuits and Medicare-for-all push consider that Democrats seize on anti-Obamacare ruling to steamroll GOP in 2020

Alice Miranda Ollstein and James Arkin reported that a court ruling last week putting the Affordable Care Act further in jeopardy may provide the opening Democrats have been waiting for to regain the upper hand on health care against Republicans in 2020.

At the most recent Democratic presidential debate, candidates largely avoided discussing the lawsuit or Republicans’ years-long efforts to dismantle Obamacare, and instead continued their intra-party battle over Medicare for All.

But Senate Democrats, Democratic candidates and outside groups backing them immediately jumped on the news of the federal appeals court ruling — blasting out ads and statements reminding voters of Republicans’ votes to repeal the 2010 health care law, support the lawsuit and confirm the judges who may bring about Obamacare’s demise.

“I think it’s an opportunity to reset with the New Year to remind people that there’s a very real threat to tens of millions of Americans,” Sen. Brian Schatz (D-Hawaii) said in an interview. “We Democrats are always striving to improve the system, but, at a minimum, the American people expect us to protect what they already have.”

In 2018, Democrats won the House majority and several governorships largely on a message of protecting Obamacare and its popular protections for preexisting conditions. This year continued the trend, with Kentucky’s staunchly anti-Obamacare governor, Matt Bevin, losing to Democratic now-Gov. Andy Beshear.

The landscape in 2020 may be more challenging for Democrats than it was in 2018, when Republicans had more recently voted to repeal the Affordable Care Act. Republicans also say they now have more ammunition to push back on Democrats’ arguments with the party’s divisions over single-payer health care, which would replace Obamacare, shaping the presidential race.

Moreover, the appeals court’s ruling — which in all likelihood punted any final disposition on the case until after the 2020 elections — eliminates what some Republicans saw as a nightmare scenario: If the court had embraced a lower court ruling striking down the law in its entirety, it would have put the issue before the Supreme Court during the heat of the election, putting tens of millions of Americans’ health insurance at risk.

Still, Democrats believe they can win the political battle over health care, especially in Senate races. At least a half-dozen GOP senators are up for reelection, and Democrats need to net three seats to win back control of the chamber if they also win back the presidency. Democratic strategists and candidates are eager to run a health care playbook that mirrors that of the party’s House takeover in 2018, and say Republicans are uniquely vulnerable after admitting this year that they have no real plan for dealing with the potential fallout of courts striking down Obamacare.

Within a day of the ruling, the pro-Obamacare advocacy group Protect Our Care cut a national TV and digital ad featuring images of Sens. Susan Collins (R-Maine) and Cory Gardner (R-Colo.), warning that if the lawsuit succeeds, “135 million Americans with preexisting conditions will be stripped of protections, 20 million Americans will lose coverage and costs will go up for millions more.”

Other state-based progressive groups told POLITICO they’re readying their own ads going after individual Senate Republicans over the 5th Circuit’s ruling.

Protect Our Care director Brad Woodhouse predicts that it’s just a preview of the wave of attention the issue will get in the months ahead, as Democratic candidates and outside groups alike hammer the GOP on the threat their lawsuit poses to Obamacare.

“If there is one issue in American politics that is going to flip the Senate from Republican to Democratic in 2020, it’s this issue,” he said. “Our message is simple: President [Donald] Trump and Republicans are in court right now, suing to take away the ACA, take away your health care. And if Cory Gardner or Thom Tillis or any of them don’t think that’s an indefensible position, they should ask the 40-plus House Republicans who lost their seats in 2018.”

More than a dozen Republican state attorneys general, backed by the Trump administration, have been arguing in federal court for more than a year that Congress rendered the entire Affordable Care Act untenable when they voted as part of the 2017 tax bill to drop the penalty for not buying insurance down to zero. A district judge in Texas sided with them last year in a sweeping ruling declaring all of Obamacare unconstitutional.

Last week, an appeals court agreed that the elimination of the penalty made the individual mandate unconstitutional, but sent the case back down to the district court to decide whether any of the law could be separated out and preserved. The move all but guarantees the case won’t reach the Supreme Court until after the election, but it maintains the cloud of uncertainty hanging over the health law that experts say drives up the cost of insurance.

Though no one is in danger of losing their health coverage imminently, Democratic challengers in nearly every Senate battleground race, including Arizona, North Carolina, Maine and Iowa, jumped on the court ruling as an opportunity to attack Republicans on health care.

“Democrats have been in the fight to ensure that people across this country have access to affordable health care,” said Sen. Catherine Cortez Masto of Nevada, the chair of the DSCC. “This opinion does not help the Republicans.”

Sara Gideon, Democrats’ preferred candidate in Maine to take on Collins, called the lawsuit a “direct threat to the protections countless Mainers and Americans depend on. She has been reminding voters that Collins’ vote on the 2017 tax reform law triggered the ACA lawsuit in the first place, and she voted to confirm one of the 5th Circuit judges that recently sided with the Trump administration’s arguments against the law.

Unlike the vast majority of her GOP colleagues in the upper chamber, Collins has spoken up against the lawsuit. She has written multiple times to Attorney General Bill Bar, urging him to defend the ACA in court. Collins told POLITICO the day after the ruling that it was “significant” that the 5th Circuit judges were clearly “very uneasy with the thought of striking down the entire law” and instead sent the case back down to the lower court for reconsideration. Collins’ campaign spokesman both emphasized that she believes the government should defend the law and criticized Democrats for defending the unpopular individual mandate.

Tillis, the vulnerable North Carolina senator, said the lawsuit gave Republicans “breathing room” to find a viable replacement for Obamacare and attempted to flip the attack on Democrats by tying them to their presidential contenders.

“I think the fact that they all raised their hands and said we need Medicare for All is also raising their hands and saying the Affordable Care Act has failed,” Tillis said.

Though most of the 2020 presidential candidates have come out against Medicare for All, and more Democratic voters favor a choice between private insurance and a public option, the single-payer debate has given Republicans a potent line of attack that they’re turning to more than ever in the wake of the court’s ruling.

“Obamacare failed to lower health care costs for millions of Americans, and now Democrats want a complete government takeover of our health care system,” said Jesse Hunt, a spokesman for the National Republican Senatorial Committee. “They spent all of 2019 defending their socialist plan to eliminate employer-based health care coverage, and those problems will not subside anytime soon.”

The effectiveness of the GOP attacks will depend largely on the Democratic nominee for president — if it is someone who backs Medicare for All, it will be much more difficult for Senate candidates who don’t support the policy to separate themselves from it. But Democratic activists say they’re confident the GOP’s actions in court will sway voters more than their claims about Medicare for All.

“We can prepare for and counter those attacks by reminding voters that [Republicans are] fighting actively to take health care away,” said Kelly Dietrich, the founder and CEO of the National Democratic Training Committee, which coached more than 17,000 candidates for federal and state office in 2019. “Republicans’ ability to use fear as a tool to win elections should never be underestimated. But the antidote is to fight back just as hard.”

Year in Review: Lots of talk, not a lot of action in healthcare politics

Rachel Cohrs noted that lawmakers and regulators talked big on tackling high drug prices and surprise medical bills in 2019, but agreement on the bipartisan policies remained elusive. Some healthcare policy could be attached to a potential budget deal in December, but it is still unclear whether lawmakers will resolve funding disputes by the end of the year.

Despite major bipartisan legislative packages spearheaded by senior Senate Republican leaders, disputes over details and intense lobbying efforts have so far stalled progress in Congress. Drug makers are fighting a provision in the Senate Finance Committee’s drug pricing bill that would require them to pay back Medicare for drug price hikes faster than inflation, and providers and insurers are warring over how out-of-network medical bills should be handled.

Competing approaches to address surprise medical billing came to a head in December when a bipartisan, bicameral compromise proposal on addressing surprise medical bills emerged, but a key Senate Democrat involved in the negotiations had not signed on as of press time. Despite provider-friendly tweaks, providers still oppose the legislation and it is unclear whether House and Senate leadership have an appetite to include it in must-pass legislation.

Health reform 3.0: Early in the year, Senate health committee Chair Lamar Alexander and ranking Democrat Patty Murray released a wide-ranging plan to lower costs that addresses surprise medical bills; contract reform provisions; cost transparency; and boosting generic competition for Rx drugs. The year ended with a bipartisan, bicameral bill emerging, but at deadline it lacked Murray’s endorsement.

Reducing drug prices: Addressing drug prices was the other issue that dominated the policy landscape. Competing plans emerged, and the House passed a bill in mid-December on a party-line vote.

Grinding to a halt: House Speaker Nancy Pelosi announced a formal impeachment inquiry into President Donald Trump, which soured the prospects of a grand bargain between Trump and Pelosi on drug pricing and complicated the timeline for passing major healthcare policy.

Drug pricing was also a top priority for the Trump administration, but several marquee policy ideas have been stopped by the courts, abandoned, or are forthcoming. The White House decided to retract a prominent initiative that would have required insurers to pass manufacturer rebates directly to patients at the pharmacy counter, and a rule that would have compelled drug makers to include list prices in television advertisements is tied up in court. House Democrats passed a partisan government drug price negotiation bill, but it almost certainly will not become law.

The administration could at any time release a regulation outlining a process to allow states to import prescription drugs from Canada or move forward with a demonstration that would tie payments for physician-administered drugs in Medicare to international drug prices, but it has not yet acted on either proposal.

The 10 most-searched questions on health Reported by Sandee LaMotte of CNN

There were more questions that had people Googling in 2019.

The full list of the most-searched health questions in the United States this year also included questions about the flu, kidney stones and human papillomavirus or HPV:

  1. How to lower blood pressure
  2. What is keto?
  3. How to get rid of hiccups
  4. How long does the flu last?
  5. What causes hiccups?
  6. What causes kidney stones?
  7. What is HPV?
  8. How to lower cholesterol
  9. How many calories should I eat a day?
  10. How long does alcohol stay in your system?

NYU started to answer one of the big questions in the design of a fair healthcare system when they decided to declare their medical school tuition free. If all medical schools were tuition free the graduating doctors wouldn’t have the huge debt and they could have the opportunities to chose primary care and provide care to underserved rural and poorer communities. 

One step at a time and maybe next year Congress can really improve the health care system of our U.S.A.

And to all you interested readers out there Happy New Year! Maybe those in control will start the process of improving the delivery of affordable health care to all and not worry about their future political aspirations. What a change that would be!

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!

Health care spending hit $3.6 trillion in 2018 due to ACA tax, The GDP and Again My Worry Concerning Rural Hospitals

bus559National spending on health care is rising, fueled in part by the reinstatement of an Affordable Care Act tax on insurers, according to a new federal report.

Total national health expenditures last year increased by 4.6 percent to $3.6 trillion last year, the Centers for Medicare and Medicaid Services said. The U.S. spent about $11.172 per person, and national health care spending accounted for about 17.7 percent of the total U.S. economy last year, compared with 17.9 percent in 2017. It was roughly the same as in 2016.

By household, health care spending, which includes out-of-pocket spending, contributions to private health insurance premiums and contributions to Medicare through payroll taxes and premiums, also grew by 4.4 percent.

Private businesses, meanwhile, shelled out $726.8 billion on health care, a 6.2 percent increase from the year-ago period. Most of that goes toward employers’ contributions for insurance premiums. At 20 percent, it absorbed the second-largest shares of health care spending, preceded only by the federal government and households.

Overall, spending by Medicare, Medicaid, and private health insurance grew faster because of the health insurance tax; an annual fee on all health insurers intended to help fund the estimated $1 trillion cost of the ACA. Congress suspended the tax in 2017 and 2019. It was expected to raise $14.3 billion in 2018, according to the Internal Revenue Service.

“It was responsible for a significant portion of the rise we saw,” Micah Hartman, the report’s lead author, told The Wall Street Journal.

As baby boomers age, the pace of health care spending is only expected to grow. Health care’s share of the economy is projected to climb to 19.4 percent by 2027 from 17.9 percent in 2017, according to a previous CMS study cited by the Journal.

The number of uninsured Americans rose by 1 million for the second year in a row to 30.7 million in 2018. The rate of people without health insurance held steady under 10 percent.

The report could draw the ire of Democrats, who have criticized the Trump administration for its attacks on the ACA. The future of the Obama-era health law is in limbo as a panel of three federal appeals court judges weighs whether it’s unconstitutional after Republicans stripped it of the individual mandate in 2017.

Rare Dip in Healthcare’s Share of GDP in 2018

CMS report shows growth in spending on physician services fell slightly

Joyce Frieden, the News Editor of the MedPage points out that overall U.S.healthcare spending increased by 4.6% in 2018 — higher than the 4.2% growth in 2017, but still representing a slight drop in healthcare’s percentage of the nation’s gross domestic product (GDP), the Centers for Medicare & Medicaid Services (CMS) said Thursday.

The increase left the U.S. with health spending of $3.6 trillion in 2018, or $11,172 per person. Some of the spending increase was attributed to growth in private health insurance and Medicare spending due to collection of the Affordable Care Act’s health insurance tax — postponed from 2017 — which raised $14.3 billion in 2018, said Micah Hartman, a statistician in CMS’s Office of the Actuary, during a press briefing hosted by Health Affairs. (The figure for the tax revenue came from the Internal Revenue Service, not CMS.) Other growth drivers included faster growth in healthcare prices. Because the overall economy’s 5.4% growth in 2018 outpaced healthcare spending, the percentage of GDP spent on healthcare dropped slightly, from 17.9% in 2017 to 17.7% in 2018, Hartman said.

Paul Hughes-Cromwick, MA, co-director of Sustainable Health Spending Strategies at Altarum, a healthcare consulting firm here, said in an email that he found the decrease in percentage of GDP “encouraging,” but added that “we can safely predict that this will return to near 18% in 2019 with mildly accelerating health spending and weakening GDP growth.” And “despite all the talk and support for social determinants of health (SDOH) across the political spectrum, government public health activities only grew at 2.4%, the second slowest in the past 7 years (though it is expected that much SDOH activity lies outside formal public health spending).”

Jamie Hall, a research fellow in quantitative analysis at the Heritage Foundation here, said in a phone interview that the decrease in the percentage of GDP “is the first time that’s happened since before Obamacare. So it’s a good sign that some of the Trump administration policies that are oriented toward containing costs are having an effect” — things like short-term, limited-duration insurance policies and efforts to lower the cost of prescription drugs. “We’re sort of more at equilibrium and it’s somewhat more of a stable system at this point,” he said.

Growth in Spending on Physicians Declines

Spending on physician care and other clinical services increased by 4.1% in 2018, down from 4.7% the year before. This was due in part to slower growth in private health insurance, Medicaid, and “residual use and intensity” — the number and intensity of clinician visits — and was not offset by faster growth in healthcare prices, said Aaron Catlin, deputy director in the Office of the Actuary.

Healthcare prices are accelerating from an all-time low measured in 2015, Hughes-Cromwick noted. “If health care price growth returns to a historical pattern, i.e., significantly higher than economy-wide inflation, healthcare spending will definitely accelerate,” consistent with CMS’s long-run projections, he said.

The percentage of uninsured Americans grew by one million people, from 29.7 million to 30.7 million, according to CMS; that was on top of a previous one-million-person increase from 28.7 million in 2016. “We can’t track individuals, so we can’t say where those people came from and the status of their coverage before and after becoming uninsured … but we do show decreases in private health insurance and reductions in other directly purchased insurance,” said Catlin.

This increase in the uninsured “is a huge issue,” said Dan Mendelson, founder and former CEO of Avalere, a healthcare consulting firm here, in a phone interview. “The numbers are on an upward march and it will be a major electoral issue going into 2020.”

But Hall said the uninsured numbers were “quite misleading.” “Of the folks officially considered uninsured, the overwhelming majority of these folks have access to some type of coverage but have chosen not to enroll,” he said. “It’s important that folks not equate a lack of insurance with lack of access to coverage or lack of access to care.”

Private Insurance Enrollment Down

Private health insurance enrollment declined by 1.6 million people, with the drop coming primarily from those enrolled in private plans outside the ACA’s health insurance marketplaces, said Anne Martin, an economist in the Office of the Actuary. The number of enrollees who purchased employer-sponsored health insurance also fell slightly, from 175.6 million to 175.2 million. Medicare enrollment, on the other hand, grew from 57.2 million in 2017 to 58.7 million in 2018, while Medicaid enrollment also rose slightly during the same time period, from 72.1 million to 72.8 million.

Despite the enrollment drop, spending on private health insurance grew by 5.8%, to $1.2 trillion, up from 4.9% the prior year, Martin continued. “The most significant factor in insurance spending was the increase in the net cost of health insurance, which was influenced by the health insurance tax.”

Retail prescription drug spending rose by 2.5% in 2018, to $335 billion, up from a 1.4% increase in 2017. “This faster rate of growth was driven by non-price factors, such as the use and mix of drugs consumed, which more than offset a decline of 1% in prices for retail prescription drugs,” the agency said in a press release. This spending category does not take into account spending on physician-administered drugs or drugs administered in the hospital.

Home Healthcare Spending Up

“The fact that drug spending at the pharmacy is attenuating is a big deal, and it appears to be a combination of the mix of drugs being used,” Mendelson said. “It shows that consumers are using drugs more efficiently, which is good news. I think that change of behavior has been happening for quite some time; it’s durable and it’s a positive effect.”

However, he added, “The other thing is that healthcare costs are still rising much more rapidly than wages, and what it shows is that while costs have attenuated, the fact that they’re still rising faster than wages is squeezing consumers significantly … The fact we’re seeing macro[-level] progress doesn’t help the patient who is facing a $5,000 deductible and trying to figure out how to pay for their healthcare.”

In terms of personal healthcare spending, some of the largest increases were in-home healthcare (up 5.2%), durable medical equipment (up 4.7%), and dental services (up 4.6%). Spending on hospital care in 2018 rose 4.5% to $1.2 trillion, down slightly from a 4.7% increase the year before. The slower growth was attributed to a decrease in out-of-pocket hospital spending growth, decreased residual use and intensity, a slowing in inpatient days in hospitals, and a drop in the growth of hospital spending by the Defense Department.

Overall, 33% of healthcare expenditures in 2018 went for hospital care, 20% went for physician care and other clinician services, 13% to other services, 9% to retail prescription drugs, 8% to government administration and net cost of health insurance, and 5% to nursing care and continuing care retirement communities, according to the agency.

Sally Pipes: Sanders, Warren wants ‘Medicare-for-all’ like Canada – But Canadian health care is awful

Sally Pipes of the Fox News reported that the Democratic presidential candidates Sens. Bernie Sanders and Elizabeth Warren want you to believe Canada’s health care system is a dream come true. And they want to make the dream even better with their “Medicare-for-all” plans. Don’t believe them.

In truth, Canada’s system of socialized medicine is actually a nightmare. It has left hospitals overcrowded, understaffed and unable to treat some patients. Americans would face the same dismal reality if Canadian-style “Medicare-for-all” takes root here.

Canada’s health care system is the model for the “Medicare-for-all” plan that both Sanders, I-Vt., and Warren, D-Mass., embrace.

North of the border, all residents have taxpayer-funded, comprehensive health coverage. In theory, they can walk into any hospital or doctor’s office and get the care they need, without a co-pay or deductible.

Sanders and Warren would one-up Canada by providing all Americans with free prescription drugs, free long-term care, free dental care, free vision care, and free care for people with hearing problems.

Who could possibly object to all that free care?

Well, politicians in Canada object. They say even their country can’t do what Sanders and Warren want because all this free care would cost too much and cause other problems.

But for Sanders and Warren, money is no object. They can just raise taxes as higher and higher and higher. And the huge tax increases needed to fund “Medicare-for-all” would hit us all – there aren’t enough millionaires and billionaires to foot the bill.

It’s true that everyone in Canada has health coverage. But that coverage doesn’t always secure care. According to the Fraser Institute, a Canadian think tank, patients waited a median of nearly 20 weeks to receive specialist treatment after referral by a general practitioner in 2018. That’s more than double the wait patients faced 25 years ago.

In Nova Scotia, patients faced a median total wait time of 34 weeks. More than 6 percent of the province’s population was waiting for treatment in 2018.

Waiting for care is perhaps better than not being able to seek it at all. The hospital emergency department in Annapolis Royal in Nova Scotia recently announced that it would simply close on Tuesdays and Thursdays. There aren’t enough doctors available to staff the facility.

Canadians can’t escape waits like these unless they leave the country and payout of pocket for health care abroad. Private health insurance is illegal in Canada.

Private clinics in Canada are not allowed to charge patients for “medically necessary” services that the country’s single-payer plan covers. And the government has deemed just about every conceivable service “medically necessary.”

For the past decade, Dr. Brian Day, an orthopedic surgeon who runs the private Cambie Surgery Centre in British Columbia, has tried to offer Canadians a way out of the waits by expanding patient access to private clinics. He’s been battling his home province in court for a decade to essentially grant patients the ability to pay providers directly for speedier care.

During closing arguments in Day’s trial before the British Columbia Supreme Court at the end of November, Dr. Roland Orfaly of the British Columbia Anesthesiologists’ Society testified that over 300 patients in the province died waiting for surgery from 2015 to 2016 because of a shortage of anesthesiologists. And that was in just one of the province’s five regional health authorities!

Shortages of crucial medical personnel and equipment are common throughout Canada. The country has fewer than three doctors for every 1,000 residents. That puts it 26th among 28 countries with universal health coverage schemes. If current trends continue, the country will be short 60,000 full-time nurses in just three years.

In 2018, Canada had less than 16 CT scanners for every million people. The United States, by comparison, had nearly 45 per million.

These shortages, combined with long waits, can lead to incredible suffering.

In 2017, one British Columbia woman who was struggling to breathe sought treatment in an overcrowded emergency room. She was given a shot of morphine and sent home. She died two days later.

That same year, a Halifax, Nova Scotia, man dying of pancreatic cancer was left in a cold hallway for six hours when doctors couldn’t find him a bed. Yes, people must sometimes be treated on hallway floors because of severe overcrowding.

In fact, some Canadian hospital emergency rooms look like they belong in poverty-stricken Third World countries.
WBUR Radio, Boston’s NPR station, documented these terrible conditions in a story about a hospital in Nova Scotia earlier this month.

Americans who find the promise of free health care difficult to resist would do well to take a hard look north.

Sure, “Medicare-for-all” as pitched by Sanders and Warren sounds good. But the reality is far from what these two far-left candidates are promising. Like a drug that helps you in one way but causes even more serious problems, “Medicare-for-all” has dangerous side effects that can be hazardous to your health.

Rural hospital acquisitions may reduce patient services

I have already discussed the outcome of Medicare for All on physicians and especially rural hospitals. Beware, especially when we hear of what is happening already! Last week it was reported that one of the hospital systems in Chicago fired 15 physicians and hired NP’s/nurse practitioners to take over their patient care responsibilities.

Also, Carolyn Crist of Reuters noted that although hospitals can improve financially when they join larger health systems, the merger might also reduce access to services for patients in rural areas, according to a new study.

After an affiliation, rural hospitals are more likely to lose onsite imaging and obstetric and primary care services, researchers report in a special issue of the journal Health Affairs devoted to rural health issues in the United States.

“The major concern when you think about health and healthcare in rural America is access,” said lead study author Claire O’Hanlon of the RAND Corporation in Santa Monica, California.

More than 100 rural hospitals in the U.S. have closed since 2010, the study authors write.

“Hospitals in rural areas are struggling to stay open for a lot of different reasons, but many are looking to health-system affiliation as a way to keep the doors open,” she told Reuters Health by email. “But when you give up local control of your hospital to a health system, a lot of things can change that may or may not be good for the hospital or its patients.”

Using annual surveys by the American Hospital Association, O’Hanlon and colleagues compared 306 rural hospitals that affiliated during 2008-2017 with 994 nonaffiliated rural hospitals on 12 measures, including quality, service utilization, and financial performance. The study team also looked at the emergency department and nonemergency visits, long-term debt, operating margins, patient experience scores, and hospital readmissions.

They found that rural hospitals that affiliated had a significant reduction in outpatient non-emergency visits, onsite diagnostic imaging technologies such as MRI machines, and availability of obstetric and primary care services. For instance, obstetric services dropped by 7-14% annually in the five years following affiliation.

“Does this mean that patients are getting prenatal care in their community at a different location, traveling to receive prenatal care at another location of the same health system, or forgoing this care entirely?” O’Hanlon said. “Trying to figure out the extent to which the observed changes in the services available onsite at rural hospitals reflect real changes in patient access is an important next step.”

At the same time, the affiliated hospitals also experienced an increase in operating margins, from an average baseline of -1.6%, typical increases were 1.6 to 3.6 percentage points, the authors note. The better financial performance appeared to be driven largely by decreased operating costs.

Overall, patient experience scores, long-term debt ratios, hospital readmissions, and emergency department visits were similar for affiliating and non-affiliating hospitals.

“Research on these mergers has been mixed, with some suggestions they are beneficial for the community (access to capital, more specialty services, keep the hospital open) and other evidence that there are costs (employment reductions, loss of local control, increase in prices),” said Mark Holmes of the University of North Carolina at Chapel Hill, who wasn’t involved in the study.

“Mergers can have a large impact on a community, so understanding the effect on the resultant access, cost and quality of locally available services is important,” he told Reuters Health by email.

A limitation of the study is that the surveys capture affiliation broadly and don’t specifically describe the arrangements, the study authors’ note. Future studies should investigate the different types of affiliations, such as a full acquisition versus a clinically integrated hospital network, which may show different outcomes, said Rachel Mosher Henke of IBM Watson Health in Cambridge, Massachusetts, who also wasn’t involved in the study.

For instance, certain types of rural hospital affiliations may be better for the community than a full hospital closure, she said.

“However, it’s important to evaluate the potential for negative consequences for the community in terms of reduced service offerings,” she told Reuters Health by email. “New payment models such as all-payer global payments that allow rural hospitals to continue to operate independently with consistent cash flow may be an alternative to affiliation to consider.” But it may not fix the impossible especially if the system pays all at Medicare or Medicaid rates?

Next is to discuss the basis of single-payer healthcare systems and look who is back trying to hold his lead in the Democratic-run for President a guy who can’t even remember where he is, dates, or where he is going, Joe Biden!!!

 

Elizabeth Warren’s Number-Crunchers Out of Sync With Her on Some Big Plans and Is Soaking Rich the Answer. And How Did It Work Out for the French?

73495095_2337220289740950_8378943902677204992_nAs a physician and an economist, I am amazed at the lack of knowledge of both medicine and finance by Ms. Warren and her Team as well as the rest of the Democrats running for President as they tout Medicare for All and give up on Affordable Health Care/ Obamacare. Sahil Kapur and Katia Dmitrieva pointed out that Elizabeth Warren is careful to cite economic experts to back up the costs of her multi-trillion-dollar policy plans. But even those experts disagree among themselves about how or whether those plans will work.

University of California Berkeley economists Emmanuel Saez and Gabriel Zucman advised Warren on her wealth tax and say she could raise $2.75 trillion over a decade by imposing a 2% tax on wealth worth $50 million or more, going up to 3% for a wealth of more than $1 billion.

But Mark Zandi, chief economist at Moody’s Analytics who Warren’s campaign asked to review her separate Medicare-for-All funding plan, which includes an additional 3% tax on wealth over $1 billion among other levies, is skeptical it would bring in that much money.

On health care, Zandi has projected that Warren could raise the $20.5 trillion she estimates it will cost to give everyone free health-care without any new middle-class taxes, even though he disagrees with her vision. Saez and Zucman support her policy in general but their funding approach does raise taxes on the middle class.

The disagreements among those who helped shape and gauge her policies highlight the challenges for Warren as she tries to convince voters that she can generate enough revenue to provide free health care, free public college, universal childcare, forgive a portion of student loans and mitigate climate change, among other ambitious policies.

Saez said in an email that Warren’s health care numbers are “reasonable” — with a caveat.

“Scoring is not hard science, and much will depend on the quality of enforcement. Her numbers assume that enforcement will be excellent,” he said. “We believe this is possible but it will require a big and successful push (a big policy change in and by itself).”

Zandi said the Warren wealth tax will be difficult to enforce, with billionaires likely to use multiple loopholes to avoid it. Several European countries experienced this issue when implementing their own tax programs. Warren has said she would empower the Internal Revenue Service to enforce collection, a promise made by many presidential candidates over the years.

“When considering all of Warren’s policy proposals, which includes a number of different tax increases on the wealthy, tax avoidance may be higher than she is assuming. But this doesn’t mean Medicare-for-All or any of other plans won’t be paid for,” Zandi said in an email.

Warren’s plan to pay for her Medicare-for-All proposal, which she released this month under pressure from rivals, increases her wealth tax and is predicated on avoiding any tax increases on the middle class in the hope of avoiding the political blowback such a move would likely bring.

Under Medicare for All, 98% of the money companies now pay for employees’ health care would be shifted to the government instead.

But Saez and Zucman, who priced out Warren’s tax plan, have floated a different way to pay for Medicare-for-All — a progressive tax that may hit some in the middle class, but would compensate by requiring companies to put the money they would have provided to their employees’ health care into higher paychecks.

Saez said Warren’s employer tax “is a tax on the middle class as economists pretty much all believe that such taxes are effectively borne by workers.” But he said workers are already bearing that cost. “Hence, if you count existing premiums as a pre-existing tax, the Warren plan effectively does not ‘increase’ taxes on the middle class.”

A campaign aide said that Zandi was only scoring her health care plan, while Saez and Zucman were advising her on the wealth tax. Warren tweeted Wednesday, “I knew Mark Zandi was skeptical, so I had him check the numbers on my plan to pay for #MedicareForAll. He confirmed they add up.”

Senator Bernie Sanders, who wrote the Medicare-for-All bill that Warren campaigns on, has released his own suggestions for how to fund it. His ideas include a more aggressive wealth tax than Warren’s and a 4% payroll tax which would hit many Americans though overall they would pay lower costs because of health care savings. He has acknowledged the middle-class would pay more in taxes.

Overall, Zandi backs up Warren’s health care math. He said in the email that Warren can finance her plan without raising taxes on the middle class, even though he doesn’t agree with the policy. And even if the rich don’t pay their fair share, she could find those funds elsewhere.

“Warren’s Medicare for All plan isn’t the only way to provide health insurance to all Americans, rein in growing health care costs and improve health care outcomes,” Zandi wrote in a CNN op-ed that was published on Wednesday. “A more tractable approach in my view is to allow those who like their private health insurance to keep it and to build on Obamacare by giving everyone else an option to get Medicare.”

Mark Cuban: Elizabeth Warren’s Medicare-for-all will take years to achieve

Frank Connor pointed out that Elizabeth Warren unveiled a massive overhaul of the U.S. health care system in her single-payer Medicare-for-all plan. However, Dallas Mavericks owner Mark Cuban believes the proposal will take years to accomplish.

“Getting from where we are, to getting there is not something you can accomplish in 4, 8, 12, or even 20 years,” Cuban told FOX Business’, Maria Bartiromo.

Cuban does, however, believe that health care is a right for everyone and that there is a need for people with lower incomes to have access to healthcare. This, he suggested, may indicate an opportunity for a “hybrid plan.”

“Maybe we can expand Medicaid and Medicare and still have a good capitalist system for health care in the middle,” Cuban said.

Business, he argued, cannot operate when there are communities where there is “disruption and social unrest” and so these areas need a basis of health care.

One of the problems with the health care industry, according to Cuban, is a misalignment of incentives between payers and providers.

“The goal of, hopefully, a health care system is to make people healthy,” he said. “And so you don’t get that, you know, when payers, the insurance companies, and the providers work together.”

Cuban described this as a “malicious circle,” suggesting that the parties involved charge each other more in order to make more money.

“None of their metrics have to do with making people healthier,” he said.

The billionaire businessman does not believe the rise of high deductible insurance programs will lead to the growth of a consumer market in health care or lead to customers shopping for health care pricing. He argued high deductible programs are problematic because they make up such a high percentage of their actual income making it more difficult for them to get care.

Additionally, he noted that people don’t shop for care, they make these decisions based on who they trust.

He also believes that artificial intelligence will help the industry.

“As you get more into artificial intelligence and be able to use data more smartly, then you’re going to see a lot of benefits, particularly in radiology,” he said.

France Tried Soaking the Rich. It Didn’t Go Well.

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What about the idea that Elizabeth Warren pushes that the rich should be taxed to the fullest? Noah Smith noted that in recent years, several prominent economists have brought attention to the problem of growing inequality. These scholars include Thomas Piketty, author of the best-selling book “Capital in the Twenty-First Century,” and Emmanuel Saez and Gabriel Zucman, who in a new book chronicle the rise in American wealth inequality. All three embrace the same solution:  much higher taxes. Piketty has declared that billionaires should be taxed out of existence, and he called for a global wealth tax, while Saez and Zucman helped Democratic presidential candidate Elizabeth Warren design her proposal for a U.S. wealth tax. Piketty and Saez have also suggested taxing top incomes at a rate of more than 80%.

Other economists have struggled to evaluate dramatic proposals like this. Studies on the effects of taxation when rates are moderate might not be a good guide to what happens when rates are very high. Economic theories tend to make a host of simplifying assumptions that might break down under a very high-tax regime. Historical experience is of some help because the U.S. had very high top income taxes in the 1950s, but economic conditions could be very different now.

One way to predict the possible effects of the taxes is to look at a country that tried something similar: France, where Piketty, Saez, and Zucman all hail from.

During the past few decades, as income inequality rose in most rich countries, it stayed relatively constant in France. The biggest reason is government redistribution in the form of taxes and social-welfare spending. France leads its rich-country peers, including the legendarily egalitarian Scandinavian countries, on both measures:

France, therefore, shows that inequality, at least to some degree, is a choice. Taxes and spending really can make a big difference.

But there’s probably a limit to how much even France can do in this regard. The country has experimented with both wealth taxes and very high top income taxes, with disappointing results.

France had a wealth tax from 1982 to 1986 and again from 1988 to 2017. The top rate was between 1.5% and 1.8%, with the total tax rate on fortunes larger than 13 million euros ($14.3 million) hovering at about 1.4%. This is much less than the 6% top rate proposed by Warren (not to mention the 8% proposed by her fellow candidate, Senator Bernie Sanders), but it’s close to the 2% rate Warren would impose on fortunes larger than $50 million.

The wealth tax might have generated social solidarity, but as a practical matter, it was a disappointment. The revenue it raised was rather paltry; only a few billion euros at its peak, or about 1% of France’s total revenue from all taxes. At least 10,000 wealthy people left the country to avoid paying the tax; most moved to neighbor Belgium, which has a large French-speaking population. When these individuals left, France lost not only their wealth tax revenue but their income taxes and other taxes as well. French economist Eric Pichet estimates that this ended up costing the French government almost twice as much revenue as the total yielded by the wealth tax. When President Emmanuel Macron ended the wealth tax in 2017, it was viewed mostly as a symbolic move.

Another French experiment was the so-called supertax, a 75% levy on incomes of more than 1 million euros. Introduced by socialist President François Hollande in 2012, the supertax added to the exodus of wealthy individuals, most notably actor Gerard Depardieu and Bernard Arnault, chairman of LVMH Moet Hennessy Louis Vuitton. Star soccer players threatened to go on strike, and there was fear that France would become a wasteland for entrepreneurs. Meanwhile, the supertax raised much less money than even the wealth tax had — only 160 million euros in 2014. The unpopular tax was repealed two years after its adoption.

France’s experiments with taxing the wealthy at very high rates didn’t raise much money and didn’t prove politically sustainable. The flight of wealthy individuals from the country probably helped reduce inequality on paper, but it’s not clear that their departure left France better off.

It’s possible that similar tax experiments in the U.S. might be more successful than in France. The U.S. economy is much larger than France’s; although a French business owner who moves to Belgium can still do business and move about freely within the European Union, an American mogul who moves to Canada might find access to one of the world’s largest markets restricted. That might allow the U.S. to raise more money from high taxes than France ever could.

But it’s also worth noting that France’s wealth tax and supertax ultimately weren’t that important. Despite repealing the supertax, France managed to increase government revenue and to reduce inequality. The end of the wealth tax will probably be a similar story. France simply didn’t need these flamboyant taxes on the rich to have very high levels of taxation and social spending. That means the U.S. probably doesn’t need them either. Tax increases across the board — on top incomes, capital gains, estates, pass-through businesses, corporations, and so on — might not excite populist firebrands, but they’re probably a more effective strategy for fighting inequality.

‘Save public hospitals’, French health workers urge Macron

Gabriel Bourovitch, Clare Byrne and Aurelle Carabiin looked at the French healthcare system and noted that thousands of French hospital workers demonstrated Thursday over years of cutbacks they say have harmed care in a country with a health system once the envy of the world. Also, remember what I pointed out as Medicare for All pays all doctors and hospital Medicare rates- about 50-60 cents on the dollar. You think when Medicare for All reimburses physicians and hospitals that doctors can pay their staff, their medical education bills, malpractice bills as well as run the hospitals? I think not!

Public hospitals in France have been forced to cut 9.0 billion euros ($9.9 billion) off their debts since 2005, leading to the scrapping of hundreds of beds and dozens of operating theatres while stagnant salaries have fuelled a flight to the private sector.

Calling on President Emmanuel Macron to “save public hospitals”, thousands of hospital doctors, nurses, students, and administrative staff held protests in Paris and a dozen other cities on Thursday.

The protests began in March when emergency room staff, who complain of elderly patients being left for hours on trolleys in corridors while waiting for a bed, began strike action.

Over 260 emergency rooms nationwide are still affected by work stoppages.

On Thursday, staff from other hospital departments joined in the protests.

In Paris, organizers said that some 10,000 demonstrators marched through the city waving placards with a message such as: “Exhausted caregivers = endangered patients”, “Public hospitals in a life-threatening emergency” and “The hospital is suffocating, let’s save it.”

In the southwestern city of Toulouse, 3,000 staff took to the streets, around 400 in Brest and Quimper in the northwest, and a few hundred each in other cities such as Nantes, Lyon, Bordeaux, Lille, and Marseille.

Jean-Michel Carayol, a hospital technician who demonstrated in the Mediterranean port city of Marseille, said the staff were “at the end of their tether and exhausted”.

Monique Aubin, a 61-year-old nurse who also joined the protest, complained of a “lack of materials, even medication” and of being swamped in paperwork which left her little time for patients.

In 2000, the World Health Organization ranked France’s health system the best of 191 countries.

But a study by the Institute for Health Metrics and Evaluation published in The Lancet medical journal in 2017 placed it in 15th place for quality of care.

The country is still one of Europe’s biggest spenders when it comes to healthcare.

In 2016, France spent 12 percent of its GDP on health, well above the western European average of 10 percent, and was also the country where the patient’s share of the health bill was the lowest.

– New winter of discontent? –

The protests have created jitters in the government, which fears that hospital staff could band together with other disgruntled groups such as transport workers who are planning mass strike action in December over pension reforms.

Three health plans in the past two years have failed to appease the anger of beleaguered hospital staff.

In an attempt to head off another winter of discontent, a year after the start of the “yellow vest” revolt, Macron said Thursday the government would unveil plans next week for “substantial” hospital investments.

While arguing that his centrist government had inherited an ailing hospital system, he said he had “heard the anger and the indignation over working conditions” in hospitals.

The protesters are demanding 3.8 billion euros in emergency investment in public hospitals — twice the amount set aside in the draft 2020 budget currently before parliament.

On Thursday, the upper house of the parliament, the right-wing dominated Senate, threw out the draft social security bill at its first reading in protest over what some senators described as Macron’s “disdain” for the workers in the sector.

Economy Minister Bruno Le Maire has warned that hiking health spending will mean having to make cuts elsewhere.

France’s budget deficit is expected to breach an EU limit of 3.0 percent of GDP this year, reaching 3.1 percent.

I am amazed at how easy the voters can be swayed and convinced that everything will be free if “you vote for me!” I say be very wary of what you all wish for because you and the rest of may have to live with the results, as we are all sold a bill of false goods. Be very careful voters!!

 

Warren’s Health Care Plan Will Cost More Than She Says; Hillary’s take on the matters and what does Medicare cover and the VA “new” system!

veteran529Tyler Cowen reported that Elizabeth Warren claims she can pay for her 10-year, $52 trillion health care plan without increasing taxes on the middle class. But both she and her critics are approaching the question wrong. What really matters is the opportunity cost of policy choices, in terms of foregone goods and services — not whether the money can be raised to pay for a chosen policy.

Consider this point in the context of Warren’s plan, which includes a complex series of health-care savings and higher taxes on the wealthy.

NOAH SMITH: Warren Tries to Make Medicare for All as Painless as Possible

One way of financing the plan is to pay doctors in hospitals lower fees (part of “saving” $2.3 trillion). There will then be fewer profitable hospitals, and fewer doctors working fewer hours because some of them might retire earlier than they otherwise would. Fewer hospitals mean they will likely increase their monopolistic tendencies, to the detriment of patients. A related plan to pay hospitals less is supposed to save another $600 billion.

The practical impact of these changes will be to deprive health-care consumers, including middle-class consumers, of goods and services. The larger point is that the real cost of any economic arrangement is not its nominal sticker price, but rather the consequences of who ends up not getting what.

Another part of the plan is to pay lower prices — 70% lower — for branded prescription drugs. That is supposed to save about $1.7 trillion, but again focus on which opportunities are lost. Lower drug prices will mean fewer new drugs are developed. There is good evidence that pharmaceuticals are among the most cost-effective ways of saving human lives, so the resulting higher mortality and illness might be especially severe.

Of course, many critics of the pharmaceutical industry downplay its role in the drug-discovery process. Regardless of the merits of those arguments, they do not show that a 70% cut in prices will leave supplies, or research and development, unchanged.

Another unstated cost of the Warren plan concerns current health-insurance customers: Many of them prefer their current private coverage to Medicare for All. Switching them into Medicare for All is an opportunity cost not covered by Warren’s $52 trillion estimates. Even if you believe that Medicare for All will be cheaper in monetary terms, tens of millions of Americans seem to prefer their current arrangements.

Warren also proposes higher taxes on corporations, capital gains, stock trades and the wealthy, as well as stronger tax enforcement — all of which is supposed to raise more than $10 trillion. Again, regardless of your position on those policies, they will diminish investment and (to some extent) consumption among the wealthy. You might not worry much about the consumption of the wealthy. But the decline in investment will lead to lower wages, less job creation, and fewer goods and services. These are all opportunity costs, for both the middle class and just about everyone else.

Supposedly $400 billion will be picked up from taxes on new immigrants, following the passage of a law legalizing millions now in the country illegally. I favor such legislation. Still, I don’t necessarily see this as a windfall. Yes, more immigrant labor will produce more goods and services. Tax revenue from this new productivity could be used in any number of ways, with universal health-care coverage just one option of many.

You might think that universal health insurance coverage is clearly the highest priority, but is it? America’s health-care sector is relatively costly and inefficient, and even major health-care legislation does not much improve health outcomes. What about investing in green energy or climate change alleviation? Private-sector job creation? Public health measures outside of the health-insurance system, such as fighting air pollution or lead? Checking California forest fires?

Even if you think health care is a human right, there are alternative policies that will benefit human health. They cannot all be carried out, at least not very well.

I don’t mean to pick on Warren. Virtually all politicians, of both parties, fall prey to similar fallacies when presenting the costs of their policies. Warren’s proposals, when all is said and done, are best viewed not as a way of paying for her program but as a series of admissions about just how expensive it would be. Whether or not you call those taxes, they are very real burdens — and many of them will end up falling on the middle class.

How Sen. Warren’s health care plan could impact 401(k)s

Senator Elizabeth Warren’s “Medicare for All” plan may impact your future nest egg. Some critics of the proposal note the presidential hopeful could potentially tax investors, which would make it more difficult to save for retirement. Edelman Financial Engines Founder Ric Edelman discusses with Yahoo Finance’s Zack Guzman, Sibile Marcellus, and ‘The Morning Brew’ Business Editor and Podcast Host, Kinsey Grant.

Hillary Clinton: Warren’s Medicare for All Plan Won’t Ever Get Enacted

Yuval Rosenberg noted that Hillary Clinton said Wednesday that she doesn’t believe Elizabeth Warren’s Medicare-for-All plan would ever become law and that there are better ways to raise revenues than Warren’s proposed wealth tax.

Asked at a New York Times conference whether she thinks the health-care plan released by Warren would ever get enacted, the 2016 Democratic presidential nominee said: “No, I don’t. I don’t but the goal is the right goal.”

In her 2016 campaign, Clinton supported a public health insurance option and rejected calls from Bernie Sanders, her rival for the Democratic nomination, for a single-payer system. On Wednesday, Clinton said she still favors a public option to build on the Affordable Care Act, which lifted insurance coverage rates to 90%. “I believe the smarter approach is to build on what we have. A public option is something I’ve been in favor of for a very long time,” she said. “I don’t believe we should be in the midst of a big disruption while we are trying to get to 100 percent coverage and deal with costs and face some tough issues about competitiveness and other kinds of innovation in health care.”

Clinton also said she supports the health care debate Democrats are having and tried to contrast that with the Republican efforts to repeal the Affordable Care Act. “Yeah, we’re having a debate on our side of the political ledger, but it’s a debate about the right issue, how do we get to health care coverage for everybody that we can afford?” Clinton said.

Warren responded on Thursday. “I’m saying, you don’t get what you don’t fight for,” she said, according to The Times. “You know, you’ve got to be willing to get out there and fight.”

On the issue of a wealth tax, another central element of Warren’s campaign, Clinton said she doesn’t understand how the proposal could work, suggesting it would be too disruptive. Clinton added that there are better ways to raise revenues, get the rich to pay more and combat inequality. “I just think there are better ways of doing it,” she said, adding that she would be in favor of raising the estate tax.

Also, Hillary Clinton called the wealth taxes proposed by Sens. Bernie Sanders and Elizabeth Warren “unworkable” and said they would be “incredibly disruptive” if enforced.

Warren health plan departs from US ‘social insurance’ idea

Ricardo Alonso-Zaldivar reported that Sen. Elizabeth Warren’s plan to pay for “Medicare for All” without raising taxes on the middle class departs from how the U.S. has traditionally financed bedrock social insurance programs. That might impact its political viability now and in the future.

While echoing her party’s longstanding call for universal health care, the Massachusetts Democrat is proposing to raise most of the additional $20.5 trillion her campaign believes would be needed from taxes on businesses, wealthy people and investors.

That’s different from the “social insurance” — or shared responsibility — the approach taken by Democratic presidents like Franklin D. Roosevelt, Harry Truman, and Lyndon Baines Johnson.

Broad financing through payroll taxes collected from workers and their employers has fostered a sense of ownership of Social Security and Medicare among ordinary Americans. That helped derail several Republican-led privatization efforts. And signs declaring “Keep Government Out Of My Medicare” proliferated during protests against President Barack Obama’s health care legislation, which scaled back Medicare payments to hospitals.

The Warren campaign says the reason programs like Social Security and Medicare are popular is that benefits are broadly shared. A campaign statement said her plan would put money now spent on medical costs back in the pockets of middle-class families “substantially larger than the largest tax cut in American history.”

But Roosevelt was once famously quoted explaining that he settled on a payroll tax for Social Security to give Americans the feeling they had a “legal, moral and political right” to benefits, thereby guaranteeing “no damn politician” could take it down.

Medicare passed under Johnson, is paid for with a payroll tax for hospital services and a combination of seniors’ premiums and general tax revenues for outpatient care and prescriptions. Truman’s plan for universal health insurance did not pass, but it would have been supported by payroll taxes.

“If you look at the two core social insurance programs in the United States, they have always been financed as a partnership,” said William Arnone, CEO of the National Academy of Social Insurance, a nonpartisan organization that educates on how social insurance builds economic security.

On Warren’s plan, “the question is, will people still look at it as an earned right, or will they say that their health care is coming out of the generosity of the wealthy?” Arnone added. His group takes no position on Medicare for All.

“It’s not an accident that Social Security is on the chopping block a lot less frequently than so-called welfare programs,” said retirement expert Charles Blahous, a political conservative and a former public trustee overseeing Social Security and Medicare finances.

With Warren’s approach, “you are going to have this clash of interests between the people paying the bills and the beneficiaries,” Blahous added. His own estimates indicate Medicare for All would cost the government about $12 trillion more over 10 years than Warren projects.

The Warren campaign downplays the role of shared responsibility and instead points to promised benefits under Medicare for All.

“Every person in America will have full health coverage, get the doctors and the treatments they need, and no more going broke over medical bills,” the campaign said in a statement. “Backed up by leading experts, Elizabeth has shown how her plan will do this by having the richest 1% and giant corporations pay a little bit more and without raising taxes on the middle class by one penny.”

Under Warren’s plan, nearly $9 trillion would come from businesses, in lieu of what they’re already paying for employees’ health care. About $7 trillion would come from increased taxes on investors, wealthy people, and large corporations. An IRS crackdown on tax evasion would net about $2 trillion. The remainder would come from various sources, including dividends of a projected immigration overhaul and eliminating a Pentagon contingency fund used for anti-terrorism operations.

Sen. Bernie Sanders’ list of options to pay for Medicare for All includes a 4% income-based premium collected from most households.

John Rother, CEO of the National Coalition on Health Care umbrella group, said he can follow Warren’s argument about making the wealthy pay, but it still looks like a hard sell.

“What is different today is the tremendous gap between the well-off and middle-class people,” he said. “In a way, it makes sense as a step toward greater equality, but it is still a little tricky politically because you don’t have that same sense that ‘this is mine, I paid into it, and therefore no one is going to take it away.'” His group has taken no position on Medicare for All.

History records that various payment options were offered for Social Security in the 1930s and FDR favored a broad payroll tax. One competing idea involved a national sales tax.

An adviser’s memo in the Social Security archives distills Roosevelt’s thinking.

“We put those payroll contributions there so as to give the contributors a legal, moral, and political right to collect their pensions and their unemployment benefits,” Roosevelt was quoted as saying.

“With those taxes in there, no damn politician can ever scrap my social security program,” he added. “Those taxes aren’t a matter of economics, they’re straight politics.”

Medicare-for-all could cause ‘enormous’ doctor shortage

Julia Limitone pointed out something I mentioned that I am concerned about in the Medicare for All plan outlined by Sen. Warren. Sen. Elizabeth Warren’s Medicare-for-all plan is a disaster and would lead to an “enormous” doctor shortage, according to FOX News medical correspondent Dr. Marc Siegel.

If Warren’s plan came to pass, doctors would be working for the government, which in turn would decide their pay, Dr. Siegel told FOX Business’ Stuart Varney.

“The government doctors will be paid up to 40 percent less,” he said on Thursday. “Many will leave the profession,”

In countries with socialized medicine doctors earn about half of what primary care doctors make in America, he said.

“I’ve interviewed an Australian physician who’s from Canada, and she’s making about 30 to 40 dollars for a visit at the most,” he said.

But even more than that, a patient wouldn’t necessarily be able to get the care they need, Siegel said.

“I have to wait a month to figure out if someone has a problem up here,” he said.

What’s more, he said, it would hit hospitals hard. Hospitals rely on private insurance to pay for research, medical students and quality care, Dr. Siegel said. Under the plan, they’d get a flat fee from the government, and would not be able to differentiate between medical centers and great care and something that’s of lower quality, he explained.

“Hospitals are going to go belly up,” he warned.

Warren’s campaign said the single-payer plan would cost the country “just under” $52 trillion.

VA launches new health care options under MISSION Act

Because we are celebrating Veterans Day I thought that I would review some of the changes in the VA healthcare system. The VA system represents a health care system that is run by the government and look where that is going…….back to the private health care system. The U.S. Department of Veterans Affairs (VA) launched its new and improved Veterans Community Care Program on June 6, 2019, implementing portions of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (MISSION Act), which both ends the Veterans Choice Program and establishes a new Veterans Community Care Program.

The MISSION Act will strengthen the nationwide VA Health Care System by empowering Veterans with more health care options.

“The changes not only improve our ability to provide the health care Veterans need but also when and where they need it,” said VA Secretary Robert Wilkie. “It will also put Veterans at the center of their care and offer options, including expanded telehealth and urgent care, so they can find the balance in the system that is right for them.”

Under the new Veterans Community Care Program, Veterans can work with their VA health care provider or other VA staff to see if they are eligible to receive community care based on new criteria. Eligibility for community care does not require a Veteran to receive that care in the community; Veterans can still choose to have VA provide their care. Veterans may elect to receive care in the community if they meet any of the following six eligibility criteria:

  1. A Veteran needs a service not available at any VA medical facility.
  2. A Veteran lives in a U.S. state or territory without a full-service VA medical facility. Specifically, this would apply to Veterans living in Alaska, Hawaii, New Hampshire and the U.S. territories of Guam, American Samoa, the Northern Mariana Islands and the U.S. Virgin Islands.
  3. A Veteran qualifies under the “grandfather” provisions related to distance eligibility under the Veterans Choice Program.
  4. VA cannot furnish care within certain designated access standards. The specific access standards are described below:
  • Drive time to a specific VA medical facility
  • Thirty-minute average drive time for primary care, mental health, and noninstitutional extended care services.
  • Sixty-minute average drive time for specialty care.

Note: Drive times are calculated using geomapping software.

  • Appointment wait time at a specific VA medical facility
  • Twenty days from the date of the request for primary care, mental health care, and noninstitutional extended care services, unless the Veteran agrees to a later date in consultation with his or her VA health care provider.
  • Twenty-eight days for specialty care from the date of request, unless the Veteran agrees to a later date in consultation with his or her VA health care provider.
  1. The Veteran and the referring clinician agree it is in the best medical interest of the Veteran to receive community care based on defined factors.
  2. VA has determined that a VA medical service line is not providing care in a manner that complies with VA’s standards for quality based on specific conditions.

In preparation for this landmark initiative, senior VA leaders will visit more than 30 VA hospitals across the country to provide in-person support for the rollout.

The VA MISSION Act:

  • Strengthens VA’s ability to recruit and retain clinicians.
  • Authorizes “Anywhere to Anywhere” telehealth across state lines.
  • Empowers Veterans with increased access to community care.
  • Establishes a new urgent care benefit that eligible Veterans can access through VA’s network of urgent care providers in the community.

VA serves approximately 9 million enrolled Veterans at 1,255 health care facilities around the country every year. We send our military representatives-soldiers, sailors and airmen and women to fight for us and now we are arguing about how to care for them when they are injured, whether physically or mentally. Imagine if we adopt another government-run health care system??

Thank you, all you Vets for all you have done for us to keep us and our beloved country free!

 

Warren’s $52T ‘Medicare-for-all’ plan revealed: Campaign still claims no middle-class tax hikes needed and SNL

74798250_2323921837737462_2762717535395643392_nFinally, we got a view of the cost of Medicare for All plan for health care for all of us. It was so interesting that Saturday Night Live featured it on T.V. With the remarkably versatile Kate McKinnon at the helm, this weekend’s “Saturday Night Live” cold open took aim at Sen. Elizabeth Warren’s $52 trillion “Medicare-for-all” health care plan.

“I am in my natural habitat – a public school on a weekend,” McKinnon’s excitable Warren quipped at an Iowa town hall, complete with fist pumps, some “whoos” and the senator’s signature raspy voice.

She also took a moment to give former Rep. Beto O’Rourke a sendoff after he dropped out of the race last week.

“Let me know how my dust tastes,” she said.

After mentioning that she pays taxes in every state “out of principle,” she took questions from cast members playing ambivalent voters.

Asked why it took her so long to release her health care plan, McKinnon’s Warren answered, “When Bernie [Sanders] was talking ‘Medicare-for-all’, everybody was like, ‘Oh cool,’ and then they turned to me and said, ‘Fix it, Mom.’”

She added that her plan “compares favorably” to former Vice President Joe Biden’s “in that it exists.”

“No one asks how we’re going to pay for ‘Remember Obama,” she said, referring to Biden’s tendency to frequently cozy up to the former president.

She then answered a question about estimates of how much her plan would cost.

“We’re talking trillions,” she answered. “When the numbers are this big they’re just pretending.”

Warren has surged in polls recently as Biden has faded and is in the lead in a new Iowa poll.

Democratic presidential candidate Elizabeth Warren’s long-awaited “Medicare-for-all” funding plan projects the government-run health care system would cost a staggering sum of “just under $52 trillion” over the next decade, with the campaign proposing a host of new tax increases to pay for it while still claiming the middle class would not face any additional burden.

“We don’t need to raise taxes on the middle class by one penny to finance Medicare for All,” Sen. Warren, D-Mass., said in her plan — a copy of which was obtained by Fox News in advance of its release Friday.

In a tweet posted after this report was first published, Warren reiterated that pledge while asserting she can return $11 trillion to American families.

Today, I’m releasing my plan to pay for ‪#MedicareForAll. Here’s the headline: My plan won’t raise taxes one penny on middle-class families. In fact, we’ll return about $11 TRILLION to the American people. That’s bigger than the biggest tax cut in our history. Here’s how:

Some of Warren’s rivals for the nomination are unlikely to buy that claim, after having repeatedly challenged her assertions that the middle class would not be hit by tax hikes and suggested she has not been upfront with voters.

Indeed, the Joe Biden campaign said the “unrealistic plan” would leave only two options: “even further increase taxes on the middle class or break her commitment to these promised benefits.”

“The mathematical gymnastics in this plan are all geared towards hiding a simple truth from voters: it’s impossible to pay for Medicare for All without middle-class tax increases,” Deputy Campaign Manager Kate Bedingfield said in a statement.

The Warren campaign’s detailed Medicare-for-all proposal, however, insists that the costs can be covered by a combination of existing federal and state spending on Medicare and other health care — as well as myriad taxes on employers, financial transactions, the ultra-wealthy and large corporations and some savings elsewhere. Those measures are meant to pay for a projected $20.5 trillion in new federal spending. Notably, they include what is essentially a payroll tax increase on employers, something economists generally say can hit workers in the form of reduced wages.

Like Medicare-for-all’s chief Senate champion, fellow candidate Bernie Sanders, the Warren campaign argues that many of these costs already are being spent in the existing health care system by governments, employers and individuals in the form of premiums, deductibles, and other expenses.

However, unlike Sanders’ plan, Warren’s projects no new tax burden for the middle class. The Warren campaign claims those $11 trillion in individual costs would drop to “practically zero,” while the plan maintains and boosts a funding pipeline from other sources. The plan also carries a total price tag of “just under $52 trillion” over the next 10 years, or slightly less than cost projections for the current system. That factors in current and additional spending; new spending alone would be in the $20 trillion range, compared with roughly $32 trillion for Sanders’ plan.

So how would she pay for it?

Among other proposals, Warren calls for bringing in nearly $9 trillion in new Medicare taxes on employers over the next 10 years, arguing this would essentially replace what they’re already paying for employee health insurance. Further, Warren’s campaign says if they are at risk of falling short of the revenue target, they could impose a “Supplemental Employer Medicare Contribution” for big companies with “extremely high executive compensation and stock buyback rates.”

Whether some of those costs, however, still could be passed on to middle-class employees – as economists argue payroll tax costs often are – remains to be seen. As the Tax Policy Center has noted, it is assumed the “employee bears the burden of both the employer and employee portions of payroll taxes.”

Bedingfield pointed to that component in alleging the plan “would place a new tax of nearly $9 trillion that will fall on American workers.”

Warren also proposes even more taxes on the ultra-rich, expanding on her previously announced signature wealth tax, to tax more of anyone’s net worth over $1 billion (estimated to raise another $1 trillion). Warren also calls for raising capital gains tax rates for the wealthy, taxing more foreign earnings and imposing a tax on financial transactions to generate $800 billion in revenue.

Aside from those and other taxes, the campaign claims they can scrounge up $2.3 trillion with better tax enforcement and policies, as well as additional funds by reining in defense spending.

“When fully implemented, my approach to Medicare for All would mark one of the greatest federal expansions of middle-class wealth in our history,” Warren said in her plan. “And if Medicare for All can be financed without any new taxes on the middle class, and instead by asking giant corporations, the wealthy, and the well-connected to pay their fair share, that’s exactly what we should do.”

Warren has been teasing this plan for weeks, especially after some of her rivals hammered her campaign on the financing issue during the last primary debate.

“Your signature, senator, is to have a plan for everything except this,” South Bend, Ind., Mayor Pete Buttigieg memorably said during last month’s Democratic primary debate.

“No plan has been laid out to explain how a multitrillion-dollar hole in this Medicare-for-all plan that Senator Warren is putting forward is supposed to get filled in,” he charged.

Sen. Amy Klobuchar, D-Minn., also slammed Warren during that debate, saying “at least Bernie’s being honest here in saying how he’s going to pay for this and that taxes will go up. And I’m sorry, Elizabeth, but you have not said that and I think we owe it to the American people to tell them where we’re going to send the invoice.”

Sanders has openly said taxes will increase “for virtually everybody” but argued the system will ultimately cost less than what workers currently pay for premiums and other expenses.

The Warren campaign’s insistence that the middle class will be spared any such costs is likely to face sustained skepticism in the Democratic primary field.

Buttigieg reprised his criticism this week, telling Fox News that his concern about Warren’s plan “is not just the multi-trillion-dollar hole, but also the fact that most Americans would prefer not to be told that they have to abandon their private plan.”

Trump campaign communications director Tim Murtaugh also blasted Warren’s plan Friday as a “total disaster.”

“There are 52 trillion reasons why this plan is a total disaster,” Murtaugh told Fox News. “Best of luck to the fact-checkers who now have to clean up the mess.”

One Emory University health care expert recently told The Washington Post “there’s no question” a Medicare-for-all plan “hits the middle class” in some way. A new study released by the bipartisan Committee for a Responsible Federal Budget also noted it would be “impossible” to finance any such plan using only taxes on the wealthiest Americans.

Aside from the cost issues, Warren did appear to acknowledge this week that Medicare-for-all could result in substantial job losses, calling it “part of the cost issue” when confronted with an estimate that nearly 2 million jobs could be shed.

During that same interview with New Hampshire Public Radio, Warren vowed that she would “not sign any legislation into law for which costs for middle-class families do not go down.”

UPDATE 6-Democrat Warren: Medicare for All would not raise U.S. middle-class taxes ‘one penny’

As we just heard and Reuters published a report noted, Democratic U.S. presidential candidate Elizabeth Warren on Friday proposed a $20.5 trillion Medicare for All plan that she said would not require raising middle-class taxes “one penny,” answering critics who had attacked her for failing to explain how she would pay for the sweeping healthcare system overhaul.

Warren said her plan would save American households $11 trillion in out-of-pocket healthcare spending over the next decade while imposing significant new taxes on corporations and the wealthy to help finance it.

“Healthcare is a human right, and we need a system that reflects our values,” Warren wrote in a 20-page essay outlining her plan. “That system is Medicare for All.”

The proposal to remake the U.S. healthcare system will face scrutiny from Warren’s more moderate Democratic opponents, who have questioned Medicare for All’s practicality.

Warren’s proposal also calls for cuts in defense spending and passing immigration reform to increase tax revenue from newly legal Americans, two steps that would face an uphill battle in Congress. The $20.5 trillion in new spending over 10 years would increase the entire federal budget by a third.

Warren, a U.S. senator from Massachusetts, is one of 17 Democrats vying for the party’s nomination to take on Republican President Donald Trump in the November 2020 election. She is near the front of the pack in opinion polls, having closed in on former Vice President Joe Biden, the early front-runner.

Medicare for All would replace private health insurance, including employer-sponsored plans, with full government-sponsored coverage, and individuals would no longer have to pay premiums, deductibles, co-pays or other out-of-pocket costs.

It would extend Medicare, the U.S. government’s health insurance program for people 65 years and older and the disabled, to cover all Americans, including the roughly 27.5 million – 8.5% of the population – who are currently uninsured.

Warren, a former law professor, has become known for a bevy of detailed policy proposals. But she had faced criticism for not detailing how she would pay for a Medicare for All plan she backs, which was introduced in the Senate by rival Democratic candidate Bernie Sanders of Vermont.

At recent debates, Warren had refused to answer directly when asked whether she would be forced to raise middle-class taxes to cover the costs, even as Sanders acknowledged he would.

More moderate 2020 candidates such as Biden and South Bend, Indiana, Mayor Pete Buttigieg have said Medicare for All would be too disruptive and favor a more incremental approach.

‘MATHEMATICAL GYMNASTICS’

On Friday, Biden’s campaign questioned Warren’s calculations, calling them “double talk” and “mathematical gymnastics” and asserting that middle-class taxes would rise despite her vow.

“It’s impossible to pay for Medicare for All without middle-class tax increases,” said Kate Bedingfield, Biden’s deputy campaign manager. “To accomplish this sleight of hand, her proposal dramatically understates its cost, overstates its savings, inflates the revenue, and pretends that an employer payroll tax increase is something else.”

Warren, speaking to reporters in Iowa on Friday, said she was “just not sure where he (Biden) is going,” adding that her proposal and its costs were authenticated by outside experts.

“Democrats are not going to win by repeating Republican talking points and by dusting off the points of view of the giant drug companies and the giant insurance companies,” Warren said.

House of Representatives Speaker Nancy Pelosi also questioned the feasibility of enacting Medicare for All, saying in an interview with Bloomberg on Friday that Democrats should focus on expanding the Affordable Care Act, commonly known as Obamacare.

Critics like Warren note that the current U.S. healthcare system – a patchwork of private insurance often provided by employers or obtained through Obamacare marketplaces and public programs covering the poor, elderly and disabled – is the most costly in the world despite leaving tens of millions uncovered.

Medicare for All legislation stands little chance of passing Congress, where Democrats control the House and Republicans control the Senate.

The plan relies on aggressive ways of lowering healthcare costs, including major cuts in prescription drug prices and significant reductions in administrative costs by eliminating private insurers.

“She makes some assumptions about how effectively healthcare costs could be contained that may not pan out,” said Larry Levitt, a health policy expert at the Kaiser Family Foundation.

Employers would be asked to repurpose the money they currently spend on workers’ healthcare into Medicare contributions, while billionaires, high-earning investors, and corporations would face trillions of dollars in higher taxes.

In an effort to appease union leaders, some of whom have expressed skepticism about giving up hard-fought healthcare plans, Warren said employers that already offer benefits under a collective bargaining agreement could reduce their contributions if they pass the savings along to workers.

Warren released two letters supporting her calculations from several experts, including Simon Johnson, the former chief economist for the International Monetary Fund; Donald Berwick, who oversaw Medicare in the Obama administration; and Mark Zandi, the chief economist at Moody’s Analytics.

An online calculator launched by Warren’s campaign showed an average family of four with employer-provided insurance would save $12,378 per year.

Warren said with her Medicare for All plan in place, projected total healthcare costs in the United States over 10 years would be just under $52 trillion – slightly less than maintaining the current system.

Here’s How Warren Finds $20.5 Trillion To Pay For ‘Medicare For All’

Danielle Kurtslenben reported that Sen. Elizabeth Warren says paying for “Medicare for All” would require $20.5 trillion in new federal spending over a decade. That spending includes higher taxes on the wealthy but no new taxes on the middle class.

The Democratic presidential candidate released her plan to pay for Medicare for All on Friday after being dogged for months by questions of how she would finance such a sweeping overhaul of the health care system. That pressure has been intensified by the fact that Warren has made detailed proposals a central part of her brand as a candidate.

Medicare for All is a single-payer health care proposal introduced by Sen. Bernie Sanders and co-sponsored by multiple candidates in the presidential race, including Warren. It would virtually eliminate private insurance, including employer-sponsored coverage.

It also represents a political risk, as multiple polls show that introducing a public option for health insurance coverage is more popular than a Medicare for All plan that almost entirely does away with private insurance.

Here’s a look at what Warren has laid out to provide single-payer health care, including proposals to cut costs, where new revenue would come from, where funds would not be taken from and what comes next.

How Warren wants to reduce spending

Warren bases her plan off of a recent analysis from the Urban Institute, which estimated that under current law, Americans would spend $52 trillion over the next decade on health care — that includes many types of spending, from employers, individuals and all levels of government.

In that analysis, the Urban Institute calculated that under a single-payer plan that looks a lot like Medicare for All, costs would total not $52 trillion but $59 trillion over a decade, which would require $34 trillion in new federal spending.

Warren’s plan estimates that total health costs could be held to $52 trillion and that $20.5 trillion in new federal spending would be necessary.

Like Urban, Warren’s plan assumes that Medicare for All would pay doctors what Medicare pays them right now. It would also pay hospitals 110 percent of what Medicare pays right now — slightly less than Urban’s 115 percent assumption.

This question — what to pay hospitals and doctors — is a big part of what determines how much Medicare for All would cost. That’s because Medicare pays doctors and hospitals much less than private insurance.

“This plan aggressively constrains the price of health care, paying doctors, hospitals and drug companies much less,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation. “There would be a lot of adjustment required from hospitals and doctors as their incomes go down.” ( And I will say more about this at the end of this blog post).

Just how seismic such a shift would be would depend in part on how fast the transition is, he added.

“I think how quickly she proposes to transition to this new system will be really important because it would be very disruptive to the health care system,” Levitt said. “You know, a quick transition would be hard and potentially result in shortages or increased wait times for health care.”

Sanders calls for a four-year transition to Medicare for All — a pace that Levitt characterized as “quite quick.” In a Friday blog post spelling out her proposal, Warren said she plans to unveil her transition plan “in the weeks ahead.”

A letter from economists supporting the plan, provided by Warren’s team, argued that these payment rates would work in part because doctors and hospitals would save substantially on administrative costs. Warren’s team also says there would be ways to ensure that vulnerable hospitals, like those in rural areas, would get paid more, so they could stay in business.

Her proposal also establishes savings by projecting that Medicare for All could substantially slow medical cost growth. Warren also stipulates that state and local governments would redirect the more than $6 trillion they currently spend on Medicaid and the Children’s Health Insurance Program (CHIP) to the federal government.

Where the money would not come from

One thing that’s notable about this plan is where the revenue doesn’t come from. Warren had promised at a recent debate that she would not sign a bill that raises health care costs for the middle class.

This plan goes further: Middle-class Americans would no longer pay health premiums or copays and would also not pay new taxes to replace those costs. They would, however, pay taxes on whatever additional take-home pay they would receive from this plan. That would add $1.4 trillion in revenue, her team estimates.

This is a departure from Bernie Sanders’ ideas about how to fund Medicare for All. One of his options is a 4% tax on families earning more than $29,000. At the Democrats’ October debate, he explained that taxes would go up for many Americans under his plan.

“At the end of the day, the overwhelming majority of people will save money on their health care bills. But I do think it is appropriate to acknowledge that taxes will go up,” he said. “They’re going to go up significantly for the wealthy. And for virtually everybody, the tax increase they pay will be substantially less — substantially less than what they were paying for premiums and out-of-pocket expenses.”

Where the $20.5 trillion comes from

Employers are one of the main sources of revenue in this proposal. Warren says she would raise nearly $9 trillion here, a figure that comes from the roughly $9 trillion private employers are projected to spend over the next decade on health insurance. The idea here is that instead of contributing to employees’ health insurance, employers would pay virtually all of that money to the government.

In addition, she will boost her proposed 3% wealth tax on people with over a billion dollars to 6% and also boost taxes on large corporations. Altogether, she believes, taxes on the rich and on corporations would raise an estimated $6 trillion. An additional $2.3 trillion would come from improving tax enforcement.

But there are lingering questions about how much revenue some of these taxes would bring in or how easy it would be to impose a wealth tax in particular.

“Something like half of the wealth of the wealthiest people in America is held in privately held corporations, privately held businesses,” said Howard Gleckman, a senior fellow at the Urban-Brookings Tax Policy Center. “And it’s really hard to value those assets for tax purposes.”

Warren also includes comprehensive immigration reform as part of her plan. Giving more people a path to citizenship would mean more taxpayers, which would mean more tax revenue.

Political ramifications

While Medicare for All is Sanders’ plan, his bill does not include set methods to pay for the plan. Rather, Sanders has included “options” to pay for his health care plan. In a recent interview with CNBC, he said “we’ll have that debate” over how exactly to finance the plan.

As the candidate with “a plan for that,” as one of her slogans goes, Warren has been asked repeatedly whether her health care overhaul plan would raise taxes on the middle class. Warren repeatedly said in response that she would not raise costs for the middle class.

This proposal gives Warren an answer for the next time she is asked how she would pay for Medicare for All, and it means she can say that she wouldn’t impose new taxes on middle-class Americans.

But it also gives her opponents potential new fodder for attacks. Former Vice President Joe Biden has already come out swinging, accusing Warren of fuzzy math. In addition, his team argues that that nearly $9 trillion that employers would pay the government would ultimately hurt workers.

“To accomplish this sleight of hand, her proposal dramatically understates its cost, overstates its savings, inflates the revenue, and pretends that an employer payroll tax increase is something else,” said Biden deputy campaign manager Kate Bedingfield in a statement released Friday.

In fact, another study by a number of economists estimates the true cost of almost $70 trillion over a decade. Wow, what a spending plan and what is our national debt now? About $21 trillion and now we are going to add more and more. When does it end? And remember all the doctors and hospitals, especially rural hospitals, will be paid based on the discounted rates of Medicare. How do doctors then pay for the education debts, their overhead expenses, and their malpractice insurance fees? Interesting! Who then will be taking care of our patients?

Again I ask, where is Obamacare when we need it and how do we pay for it in the future?

 

Some Hospitals Sue Opioid Makers For Costs Of Treating Uninsured For Addiction. Who is Really Treating Our Patients and Words for CMS Administrator Seema Verma. Really??

Screen Shot 2019-10-26 at 11.44.45 PMI had a brother who basically tried to destroy our family with his drinking and his use of drugs. I remember having to home from college and medical school to rescue him many times after my parents were feed up with his abuses and problems with the police. Finally he and his girlfriend wrapped his car around a telephone phone resulting his death. So, I understand the opioid problem but have minimal empathy. We all make our own choices in life and need to stop blaming everyone else but those that use, steal, lie and continue to use opioids. Now, what are the real numbers?

Blake Farmer reported that while thousands of cities and counties have banded together to sue opioid makers and distributors in a federal court, another group of plaintiffs has started to sue on their own: hospitals.

Hundreds of hospitals have joined up in a handful of lawsuits in state courts, seeing the state-based suits as their best hope for winning meaningful settlement money.

“The expense of treating overdose and opioid-addicted patients has skyrocketed, straining the resources of hospitals throughout our state,” said Lee Bond, chief executive officer of Singing River Health System in Mississippi in a statement. His hospital is part of a lawsuit in Mississippi.

Hospitals may find there are downsides to getting involved in litigation, says Paul Keckley, an independent health analyst.

“The drug manufacturers are a soft target,” he says. But the invasive nature of litigation may generate “some unflattering attention” for hospitals, he adds. They’d likely have to turn over confidential details about how they set their prices, as well as their relationships with drug companies.

So despite representing the front lines of the opioid epidemic, most hospitals have been hesitant to pile on.

Just about every emergency room has handled opioid overdoses, which cost hospitals billions of dollars a year, since so many of the patients have no insurance. But that’s just the start. There are also uninsured patients, like Traci Grimes of Nashville, who end up spending weeks being treated for serious infections related to their IV drug use.

“As soon as I got to the hospital, I had to be put on an ice bath,” Grimes says of her bout with endocarditis over the summer, when bacteria found its way to her heart. “I thought I was going to die, literally. And they said I wasn’t very far away from death.”

Grimes is in recovery from her opioid addiction but still getting her energy back after spending a month being treated through a special intravenous line to her heart at Vanderbilt University Medical Center. Most patients could be sent home with a PICC line, but not someone with a history of illicit IV drug use who could misuse it to inject other substances. Vanderbilt and other academic medical centers have recognized this problem and established special clinics to manage these complex patients.

Grimes, 37, says she’s grateful for the care she received, which also included multiple procedures and treatment for pneumonia, hepatitis A and hepatitis C. But like most patients in her situation, she’s uninsured and strapped for cash.

“I can’t pay a thing. I don’t have a dime,” she says. “So they do absorb all that cost.”

Hospitals estimate treating complicated patients like Grimes costs an average of $107,000 per person, according to court documents. The total costs to U.S. hospitals in one year, 2012, exceeded $15 billion, according to a report cited in the suits. And most patients either couldn’t pay or were covered by government insurance programs.

The expense is a leading reason cited by the hospitals that’ve banded together in a handful of lawsuits in Tennessee, Texas, Arizona, Florida, Kentucky, Mississippi and West Virginia. These suits are all separate from the big consolidated federal case in Ohio that includes cities and counties around the country. But the most prominent hospitals in those states, like Vanderbilt, have opted not to join the litigation.

West Virginia University President Gordon Gee, who oversees the state’s largest hospital system, has been urging others to join the suits. He and former Ohio Governor John Kasich established an organization meant to highlight the harm done to hospitals by the opioid crisis.

“I think the more hospitals we have that want to be involved in this in some way, the better off we are,” he says. “You know, there’s always safety in mass.”

By “safety,” Gee acknowledges a central concern for hospitals weighing the risk versus reward of going to court. They may have the tables turned on them by the pharmaceutical companies, since until recently, patients in the hospital were often prescribed large quantities of opioids, contributing to the epidemic.

“I suspect there are some hospitals … who are afraid that if they get into it, those who on the defense side will point out, well, maybe hospitals were really the problem,” he says.

The lead defendant in the suits, Purdue Pharma, did not respond to requests for comment.

Gee says hospitals can claim they were victims of dubious opioid marketing.

Still many high-profile hospitals are sitting out the lawsuits, even though they’re typically the ones that treat the most complicated and expensive patients.

Paul Keckley says if hospitals join the litigation, they may be forced to cough up actual totals for their opioid-related financial damages. That could force hospitals to reveal how much more they charge for some services, compared to the actual costs of providing the care.

“Hospitals basically have charged based on their own calculations and the underlying cost of delivering that care has been virtually non-transparent,” Keckley says. “Then you open a whole new can of worms.”

Keckley says especially big academic medical centers have relationships with drugmakers that they may not want publicly highlighted.

Still, hospitals might benefit without having to put their names on lawsuits and exposing themselves to risk. In Oklahoma, the state won an early opioid lawsuit in August. The payout does not direct money to hospitals, per se. However, Patti Davis, president of the Oklahoma Hospital Association, says they’re happy to see some of the money was earmarked for treatment.

“When we see treatment, we get very excited because it’s our hospitals providing a lot of the treatment,” she says.

But nationally, hospitals can’t count on potential settlement money to trickle down to their bottom lines, says attorney Don Barrett. He’s a Mississippi litigator helping hospitals sue in state courts.

Two decades ago, when the target of litigation was Big Tobacco, Barrett was working for states. He says hospitals didn’t join in, to his surprise. And when the states won those suits and started getting paid damages, hospitals missed out. Only about a third of the money was even spent on health or tobacco control, according to one watchdog’s estimate.

“I guess they thought that the states were going to take care of them, that these local governments were going to take this money and give it to the hospitals where it would do some good,” he says. “Of course, they didn’t give them a damn penny.”

Some states did set up trust funds that might help patients in the hospital stop smoking. But many are using the money to fill potholes, pay teachers and otherwise close gaps in state budgets.

Though not detailed in the lawsuits, many of the participating hospitals are in varying levels of financial distress, and not always primarily because of the opioid epidemic. Facilities owned by Community Health Systems make up a large share of the hospitals suing in Alabama, Florida, Mississippi, Tennessee and Texas. The investor-owned hospital chain, based in Franklin, Tenn., has been struggling mostly because of an outsized debt load taken on during a rapid period of expansion.

A CHS spokesperson declined to comment, citing a policy not to talk about pending litigation.

But Barrett says he expects more hospitals to join the cause rather than relying on states to determine how settlement money is spent.

“We’re not going to allow that to happen this time,” he says. “We can’t afford to allow it to happen this time.”

The Real Cost Of The Opioid Epidemic: An Estimated $179 Billion In Just 1 Year

SelenaSimmons-Duffin reported that there’s a reckoning underway in the courts about the damage wrought by the opioid crisis and who should pay for it.

Thousands of cities and counties are suing drugmakers and distributors in federal court. One tentative dollar amount floated earlier this week to settle with four of the companies: $48 billion. It sounds like a lot of money, but it doesn’t come close to accounting for the full cost of the epidemic, according to recent estimates — let alone what it might cost to fix it.

Of course, there’s a profound human toll that dollars and cents can’t capture. Almost 400,000 people have died since 1999 from overdoses related to prescription or illicit opioids. Since 2016, the number of opioid deaths per year rivals or has exceeded the number from traffic accidents. These are lives thrown into chaos, families torn apart — you can’t put a dollar figure on those things.

But the economic impact is important to understand. The most recent estimate of those costs comes from the Society of Actuaries and actuarial consulting firm Milliman in a report published this month.

“We pride ourselves that this is objective, nonpartisan research,” says Dale Hall, managing director of research at the Society of Actuaries. He adds, “We’re not here to influence any court proceedings.” As actuaries, they calculate financial numbers associated with risks, for instance, for insurance companies.

So how much did the epidemic cost in just one year, 2018? The total number they came to was $179 billion. And those are costs borne by all of society — both by governments providing taxpayer-funded services (estimated to be about a third of the cost) and also individuals, families, employers, private insurers and more.

Screen Shot 2019-10-26 at 11.49.53 PMWhen you start to break that number apart, a picture emerges of how opioid addiction ripples out into communities and across generations.

Overdose deaths: $72.6 billion

It makes sense that the biggest contributor to the costs of the epidemic comes from overdose deaths, according to Stoddard Davenport of Milliman, one of the report’s authors.

“When you think about the course of a person’s life that struggles with opioid use disorder, early mortality is the most significant adverse event that can happen, and I think that bears out when you look at the economic impact,” he says.

Every day, 130 people die from opioid overdoses. Most of them are in the 25-55-age range, right in the middle of their prime working years, and lost earning potential accounts for most of those costs.

“The mortality costs have a small component of end of life health care, coroner expenses and things like that,” he says. “The grand majority of it, however, is composed of lost lifetime earnings.”

Preliminary data suggest overdose deaths dipped in 2018 for the first time in years, but many experts say it’s too early to say whether that marks a turnaround.

Hall points out that whether the annual death toll stays as high as 47,000 in coming years “will be certainly a driver of what these overall economic costs will be.”

Health care: $60.4 billion

The next biggest amount comes from health care costs. The researchers took several large databases of insurance claims that had been scrambled to hide the identity of the patients and flagged people who had been coded as having opioid use disorder. Then the researchers calculated their overall health care costs — not just directly related to their addiction, but any additional costs — and compared them to similar patients without addiction.

Screen Shot 2019-10-26 at 11.50.26 PMNearly one-third ($60.4 billion) of the estimated economic burden of the opioid

“Looking at the difference in costs gives us a sense for how much more complicated is their overall health care picture and what those additional expenses look like for two otherwise comparable people,” Davenport explains.

Opioid addiction is linked to other health problems. Patients might have chronic pain or mental illness that underlies their addiction; infectious diseases like HIV and hepatitis C can spread among injection drug users; and there can also be higher costs for other conditions like anemia, liver disease, and pulmonary heart disease, according to another Milliman analysis from earlier this year.

There are also health costs for people who live in the same household as someone with an opioid use disorder — their lives might be more complicated and their mental and physical health can suffer as a result.

Then there are the costs for infants born dependent on opioids — what’s called neonatal abstinence syndrome. “The epidemic effect is starting to create a second generation that extends down to children and unfortunately newborns as well,” Hall says. In 2018 those costs were $800 million, but they estimate this year they could be almost $1 billion.

There are still more costs the report could not capture, including elevated costs for patients whose opioid use disorder is undiagnosed and potential ongoing expenses for children born with neonatal abstinence syndrome as they grow up.

Lost productivity: $26.5 billion

When someone is addicted to opioids, they might not be able to apply for or hold down a job, or they might be incarcerated and unable to work. The researchers broke this section out into reduced labor force participation, absenteeism, incarceration, short and long term disability, and workers’ compensation.

“What we’re trying to capture is the amount of time that folks are spending not doing economically productive activities,” Davenport says. Other productivity costs — like “presenteeism,” when someone shows up at work but isn’t as productive as they otherwise would be — were not included here.

It’s also worth noting, many of these costs fall to private employers, for instance, and families who have a family member not bringing home income.

“It’s around 30% falling on the federal state and local governments,” he says. “The rest [falls to] the private sector and then of course to individuals.”

Criminal justice: $10.9 billion

Measuring this part of the costs of the epidemic is a different beast. The researchers captured costs related to police, court cases, correctional facilities and property lost to crime, Davenport explains. They drilled down into criminal justice expenses to see “what proportion of those total budgets involve substance use disorders, and then what proportion of that is represented by opioids.”

Having an opioid addiction dramatically increases the chance of being caught up in the criminal justice system. As NPR has reported, only 3% of the general population reported being recently arrested, on parole or on probation. For people with opioid use disorder, that jumped up to nearly 20%.

Child and family assistance and education: $9 billion

The team took a similar approach to calculate the costs for things like food assistance, child welfare, income, and housing assistance, and education. They took those total costs, figured out what portion was related to substance use, and what part of that was related to opioid use.

The epidemic has a profound impact on families and communities — parents with opioid use disorder have to navigate treatment and sometimes battle for custody of their kids; the state has to handle child welfare cases and find new homes for foster kids; and schools are providing counseling for kids with addicted parents.

Screen Shot 2019-10-26 at 11.50.53 PM“Typically an epidemic will start in one place but then it broadens out,” says Hall. “We’re starting to see a broadening out of the impact of the opioid epidemic into some second-generation effects.”

Hall adds there are also “the costs of educating people about the epidemic and ways to prevent future opioid use disorder.” Those costs — mostly from federal grants for elementary and secondary education programs — came out to $1.2 billion last year.

What’s missing: Turning the crisis around

These are some solid numbers that capture the current economic burden of the epidemic. Estimating what it’s going to cost to fix the crisis — to treat those who are addicted, to reduce overdose deaths, and more — is another story.

“The notion of abatement is that we want to deal with the problem that exists but also to begin to remedy it,” says Christopher Ruhm, professor of public policy and economics at the University of Virginia. He worked for several years on a 30-year abatement plan for Oklahoma as part of that state’s case against several drug companies.

For Oklahoma, Ruhm estimated treatment; prevention, education and surveillance for one year would cost $836 million. The judge in the case made his own calculations and ordered Johnson & Johnson to pay $572 million, though the amount has since been adjusted, and the case is currently being appealed.

If you scale Ruhm’s numbers up from that one state to the whole country, you get $69 billion to fund a year’s worth of abatement programs.

“I’m not saying that’s an appropriate calculation in the sense that things could be different in Oklahoma from other places,” Ruhm cautions. There are also costs that might come up on the federal level that wouldn’t be factored in for Oklahoma, such as research into effective addiction treatments.

Still, it gives you a rough idea, as society starts to take stock of what this epidemic is costing already, how much it will cost to try to fix it and who should ultimately pay.

Why Are Insurance Executives Treating Our Patients?

Kevin Campbell believes that peer-to-peer consults waste time and harm patients, I’m wondering where this opinion comes from, his medical degree?

Kevin Campbell reported that in two recent surveys, physicians said that pre-authorizations are burdensome to their practice and that they could lead to adverse patient outcomes. Kevin Campbell, MD, agrees that the insurance companies shouldn’t be part of patient practice, and says that the peer-to-peer review process is even worse.

The opinions expressed in this commentary are those of the author. The following transcript has been edited for clarity.

Insurance companies have been granted far too much control over patient care over the last several decades. Nowhere is it more apparent than when physicians are asked to obtain “pre-approval” for guideline-based, medically necessary procedures. According to one survey from the Medical Group Management Association, 83% of those surveyed said prior authorizations are “very” or “extremely” burdensome to their practice and their staff. Another survey conducted of physicians found that nearly one-third of doctors believe that spending time obtaining pre-authorizations actually led to adverse patient outcomes.

Ninety percent of those practice managers have indicated that the amount of pre-authorizations have significantly increased over the last year. To illustrate the sheer volume of this work, there were 182 million pre-authorization transactions conducted last year alone.

While Congress has given lip service to this issue by hosting a hearing with doctors in September, no real changes have occurred. In fact, the insurance companies have lobbied Congress that these pre-authorizations are needed to reduce costs and prevent unneeded treatments.

I find this practice offensive. Who are insurance executives to decide who needs or does not need a procedure? Who are they to determine the appropriateness of a procedure? Did they go to medical school? Have they ever looked a patient in the eyes and told them they cannot have a life-saving procedure done because it costs too much?

Worse than the pre-authorization is the peer-to-peer consultations. As an electrophysiologist, I spent nearly a decade training at Duke in order to become an expert in the implantation of pacemakers and ICDs and performing ablations. When I have a pre-auth denied, I have to get on the phone and argue my case for the procedure — which is based on ACC and HRS guidelines — to someone who has NEVER even seen a pacemaker, and almost always does not even understand how a pacemaker functions! Often these are retired pathologists, pediatricians, or other non-specialists that are making decisions about MY clinical judgment. In fact, an EP colleague of mine recently told me that he had to do a peer-to-peer consult to argue the appropriateness of an ICD implantation. When he began the consultation, the insurance company representative, who was supposedly an MD, said that he could not justify putting ACID into a patient. The trick here is that this guy did not even know that it was an AICD or a defibrillator and not ACID. This just illustrates the level of incompetence of the reviewing doctors that insurance companies hire to review the appropriateness of procedures.

We cannot stand for this any longer. Insurance companies are working around the clock to avoid paying for care. Our patients and our employers pay insurance companies for coverage. The physicians that care for patients every day — by and large — provide evidence-based care and do what is indicated for patients based on guidelines. It is insulting and frankly disgusting to have someone who has no knowledge of a particular specialty making a determination of care appropriateness on a patient that they have never evaluated and with no expert knowledge on the topic. Moreover, these reviewing MDs are actually compensated for NOT approving procedures.

Our patients are suffering. Our staff is becoming overworked in dealing with pre-authorizations. Our doctors are wasting valuable time on the phone arguing with ignorant MD reviewers employed and incentivized by insurance companies. Let’s take medicine back — contact your congressman or congresswoman today.

Verma to Democrats: Some insurance ‘better than no insurance at all’

Michael Brady noted that CMS Administrator Seema Verma on Wednesday defended the Trump administration’s actions on healthcare, telling the U.S. House of Representatives’ Energy and Commerce Committee that her agency is trying to provide greater access to care in the face of rising healthcare costs.

Verma touted the CMS’ efforts on a range of healthcare issues from health IT interoperability to opioid abuse throughout her testimony, but the committee’s Democratic members met her with fierce criticism. They said that under the Trump administration, the healthcare system is heading in the wrong direction and that the Affordable Care Act is succeeding “despite” the administration’s best efforts to undermine it.

The Democrats were especially concerned about the CMS’ expansion of short-term, limited-duration insurance, a recent drop in the number of people with insurance, waivers for Medicaid work requirements and the administration’s unwillingness to share information about what it’ll do if a court throws out the ACA.

The CMS loosened restrictions on short-term, limited-duration insurance last year to provide more affordable coverage options to consumers who don’t have employer-sponsored insurance but earn too much to receive subsidies for plans offered through ACA exchanges or qualify for federal programs like Medicaid. Unlike plans sold on the exchanges, they don’t have to meet the ACA’s mandates.

Critics, including the committee’s Democratic members, argue that these plans are affordable because they don’t cover as much as ACA-approved plans that have caps of cost-sharing and require payers to cover people with pre-existing conditions. Throughout the hearing, several committee members called them “junk” health plans. And the representatives repeatedly confronted Verma on the lack of ACA protections for consumers.

“What are people with these junk plans supposed to do when they need vital healthcare services that are not covered by these junk plans?” said Rep. Paul Tonko (D-N.Y.).

Verma responded that when the other plans available to people are unaffordable, the short-term plans are “better than no insurance at all.”

“If there were more affordable options available under Obamacare, people wouldn’t have to make compromises,” Verma said.

Several committee members also took aim at the Trump administration for a recent falloff in the number of people who have health insurance. Nearly 2 million more people lacked health insurance in 2018 compared with the year before, according to a report from the U.S. Census Bureau. The report showed that a dropoff in Medicaid coverage caused most of the decline.

“Under this administration, thousands of children and families have lost coverage of basic health services … the numbers just don’t lie,” said Rep. Diana DeGette (D-Colo.).

But the worries about Medicaid weren’t limited to Democrats; Republicans had concerns too.

“How do we ensure that the populations, some of the most vulnerable in our communities, are actually getting the care that we have promised to them?” said Rep. Cathy McMorris Rodgers (R-Wash.).

Committee Democrats also brought up the administration’s approval of Medicaid work requirement waivers, which seem increasingly likely to get struck down by the courts because of HHS’ failure to consider their effects on coverage. Low-income, working-age adults in Arkansas were less likely to have health insurance, work or participate in community engagement activities after the state’s work requirement went into effect, according to a recent study in the New England Journal of Medicine. That’s despite Arkansas’ unemployment rate declining over that period.

“Can you point me to one study that says a work requirement makes people healthier?” asked Rep. Joe Kennedy III (D-Mass.). “Healthier people might work, but working doesn’t necessarily make people healthier.”

Several members of the committee also wanted to know what the administration would do if the 5th U.S. Circuit Court of Appeals were to uphold a lower court ruling that would invalidate the ACA entirely. They were especially frustrated that HHS had “stonewalled” them on their requests for documents about the administration’s contingency plans, especially those related to likely coverage losses and protections for pre-existing conditions.

Committee members also wanted to know why the administration didn’t ask the courts to safeguard the parts of the law that the administration says it supports. They asked about protections for pre-existing conditions or allowing kids to stay on their parents’ health insurance until they are 26 years old.

“Did the administration file some kind of motion in the Texas case to say that the pre-existing conditions should be maintained?” DeGette asked.

“We will maintain what works and we will try to address the problems that we’re having with the ACA,” Verma replied.

She added that people with pre-existing conditions “don’t have the protections today” if they can’t afford the coverage.

“Where is the plan?” asked Rep. Jan Schakowsky (D-Ill.).

An analysis by the left-leaning Urban Institute estimates that roughly 20 million people will lose coverage if the courts toss out Obamacare altogether.

And hopefully, we will hear from Ms. Warren regarding how she proposes to pay for Medicare for All, her answer for the Democrats’ new health care system. I can’t wait to hear how all their plans are going to be paid for.

Happy Halloween to All you Goblins, Devils, Witches and Yes you Politicians that act like Goblins and Devils and Witches and Donkeys!