Category Archives: Theodore Roosevelt

Health Insurance Inflation Hits Highest Point in Five Years and More on Medicare; and What is this about Abortion and SATs?

57358059_1998437466952569_3700281945192660992_nFirst of all, I must yell and scream at the idiots in the States, you know who you are, that have or are in the process of passing the most restrictive abortion bills. This is especially Alabama where Governor Kay Ivey signed the strictest anti-abortion law. Legislation to restrict abortion rights has been introduced in 16 states this year. The Alabama Senate approved a measure on last week that would outlaw almost all abortions in the state, setting up a direct challenge to Roe v. Wade, the case that recognized a woman’s constitutional right to end a pregnancy. The legislation bans abortions at every stage of pregnancy and criminalizes the procedure for doctors, who could be charged with felonies and face up to 99 years in prison. It includes an exception for cases when the mother’s life is at serious risk, but not for cases of rape or incest — a subject of fierce debate among lawmakers in recent days. The House approved the measure — the most far-reaching effort in the nation this year to curb abortion rights and was just signed by the Governor.

What the heck are you thinking, not even for rape or incest? You are forgetting the women who bare the brunt of your idiot decisions. Do you think that the Supreme Court will overturn Roe versus Wade, passed in 1973? Get real and attend to the real multiple crises out there!

And diversity scores on the SAT exams??? Again, what are you all thinking? I know to correct the “crises of rich parents who got their “unfortunate” children into the best of colleges. Next, the strategy to get our children into good colleges will be to take courses to improve their test-taking abilities, but now they will have to figure out how to improve their adversity scores. Mom and Dad, we need to move into the ghettos of Scarsdale, get on food stamps, get fired from your high paying jobs and become homeless. I know this all sounds crazy, but that is where we are.

Shelby Livingston wrote that the health insurance inflation rate hit a five-year peak in April, possibly because managed care is rising.

The Consumer Price Index for health insurance in April spiked 10.7% over the previous 12 months—the largest increase since at least April 2014, according to a Modern Healthcare analysis of the U.S. Bureau of Labor Statistics’ unadjusted monthly Consumer Price Index data.

In contrast, the other categories that make up the medical care services index—professional services and hospital and related services—rose 0.4% and 1.4% in April, respectively. The CPI for medical care services in April rose 2.3%, while overall inflation increased 2% year over year.

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Because of the way the BLS calculates the health insurance index, the change year over year does not reflect premiums paid by customers, but “retained earnings” after paying out claims. These earnings are used to cover administrative costs or are kept as profit.

The BLS redistributes the benefits paid out a portion of the health insurance index to other non-insurance medical care categories, such as physician services.

The likely reason health insurance inflation is rising is because of growth in managed care, including Medicare Advantage, Medicaid managed care and commercial insurance, according to Paul Hughes-Cromwick, an economist at Altarum. He noted that added administrative costs increase insurance price growth.

Hughes-Cromwick said the increase in the health insurance index could also be driven by the fact that insurers’ medical loss ratios may be decreasing as high premiums, particular in the individual health insurance exchanges, exceeded anticipated claims.

The medical loss ratio reflects the percentage of every premium dollar spent on medical claims and quality improvement. Insurers must pay at least 80% of premiums on those things and if they don’t, they must issue rebates to plan members, as part of the Affordable Care Act.

In response to rising inflation, a spokeswoman for America’s Health Insurance Plans, the industry’s biggest lobbying group, commented that “consumers deserve the lowest possible total costs for their coverage and care.” She pointed out the medical loss ratio requirements and said health insurers spend 98 cents of every premium dollar on medical care, operating costs that include care management, and preventing fraud, waste, and abuse.

Affordable Care Act exchange insurers hiked premiums higher than necessary in 2018 and now expect to pay out $800 million in rebates to individual market customers this year because they did not meet the medical loss ratio threshold, according to a Kaiser Family Foundation analysis published this month. Because medical loss ratios are declining, health insurers in the individual, small group and large group markets expect to issue $1.4 billion in rebates based on their 2018 performance, the analysis stated.

Still, health insurance profits have been on the rise. The eight largest publicly traded insurers posted net income of $9.3 billion in the first quarter of 2019, an increase of 29.9%. They made a combined $21.9 billion in profits over the course of 2018.

Medicaid waiver loophole sparks transparency concerns

Robert King noted that the CMS is doing a poor job in ensuring the public knows about major changes to Medicaid, including the installation of work requirements, a federal watchdog said Friday.

The Government Accountability Office’s report found that the CMS has limited transparency for amendments to existing Section 1115 waivers. That has allowed some states to score approval for their work requirements while skirting some rules, such as projecting how the changes will impact Medicaid enrollment.

The government watchdog noted that two of the four states it studied did not seek public comment on changes that could significantly impact Medicaid beneficiaries.

The transparency requirements for an amendment are more relaxed than a new waiver application, the GAO said. Arkansas and New Hampshire both added work requirements to their Medicaid programs through amendments to their existing Section 1115 waivers.

Currently, new waivers or extension requests must include whether the state thinks that enrollment will decrease and any spending changes. While amendments must address the impact on beneficiaries and explain the changes, there are fewer requirements for what information must be disseminated to the public.

The GAO also found that the CMS had inconsistent transparency requirements for amendments.

For example, the CMS determined Massachusetts’ amendment to waive non-emergency medical transportation was incomplete because the application didn’t include a revised design plan. However, the CMS-approved Arkansas’ work requirement amendment even though it did not include a revised design plan.

The GAO recommended that the CMS develop standard transparency requirements for new waivers, extension requests, and significant Section 1115 amendments.

In response, HHS said it has already implemented policies to improve transparency. GAO said those changes “do not apply to amendments.”

The CMS also lacks policies for ensuring that major changes to a pending application are transparent.

The report comes as the Trump administration is appealing a federal judge’s decision to strike down Medicaid work requirement programs in Kentucky and Arkansas.

Seven other states have received CMS approval for work requirements. Those states are Arizona, Indiana, Michigan, New Hampshire, Ohio, Utah, and Wisconsin. Another six states—Alabama, Mississippi, Oklahoma, South Dakota, Tennessee, and Virginia—have applications pending federal approval.

Industry enters new battle phase over surprise billing

Susannah Luthi reported that the knives are out over legislation to end surprise medical bills and specifics haven’t even been unveiled yet. But will this solve the problems of the healthcare crisis?

The industry is pushing back hard against a particular principle laid out by President Donald Trump last week.

The administration wants all out-of-network charges from a doctor at an in-network hospital to be wrapped into a single bill from the hospital.

How this provision will technically play out in policy is yet to be seen, as the Senate health committee plans to release its legislative package on surprise medical bills this summer.

But the administration’s position has roiled hospital groups and specialty physicians like emergency doctors, radiologists, and anesthesiologists, who don’t always share the same insurance network as hospitals and have higher than average charges.

“Untested proposals such as bundling payments would create significant disruption to provider networks and contract without benefiting patients,” American Hospital Association CEO Rick Pollack said in a statement shortly after Trump made his remarks. He reiterated the AHA’s position that all Congress needs to do is enact a ban on balance billing and leave the rest to the industry to figure out.

Specialty physicians argue that a single bill will complicate all the billing processes on the back-end with hospitals and insurers.

Dr. Sherif Zaafran, a Texas anesthesiologist, said he doesn’t see room within the White House framework for a policy he could support. He sees it as undercutting specialty physicians’ independence from hospitals. “As a patient, I think a single hospital bill on the surface sounds really good, but in the reality of how most of us practice it’s probably not very practical,” Zaafran said. “A single bill would imply you’re marrying the system for how a physician gets paid with other components that bill completely separately.”

He expects a resulting policy would end up cutting pay for both hospitals and ancillary physicians—hospitals taking a hit as they try to collect the fee and reimburse the physician, and physicians taking a hit if hospitals need to negotiate with insurers on their behalf.

“There are downstream effects that folks haven’t thought through,” Zaafran said.

But the administration’s stance shows how thinking around policy has morphed during months of scrutiny of the issue. And analysts have been documenting the trajectory of high ancillary physician charges in part to lay out the argument for payment bundles.

Discussions started last fall with an initial legislative push from a bipartisan group led by Sens. Bill Cassidy (R-La.) and Michael Bennet (D-Colo.). Cassidy and his co-sponsors introduced a draft proposal to cap out-of-network charges at a regional average. Not long after, Sen. Maggie Hassan (D-N.H.) pitched arbitration to settle disputes between insurers and providers.

As the months passed, the debate transitioned into a look at the underlying contracts between hospitals and insurers—even as policy analysts note that the problem of surprise medical bills is limited to a small number of hospitals.

Experts and economists from think tanks like the Brookings Institution, American Enterprise Institute, and the Urban Institute have weighed in, aided by data from states that have tried to curb the practice in the individual insurance markets that fall under their regulating power.

Several have warned that if lawmakers don’t handle the policy carefully, they could end up inflating overall costs, leading to higher premiums and expenses in an already costly system.

Joyce Frieden pointed out the solutions proposed by the President and hopefully most of the GOP.  President Trump announced an initiative Thursday aimed at ending the problem of surprise medical billing, in which patients undergoing procedures at in-network hospitals receive unexpectedly high bills because one or more of their clinicians was out of network.

Trump called surprise billing as I just outlined, “one of the biggest concerns Americans have about healthcare” and added, “The Republican Party is very much becoming the party of healthcare. We’re determined to end surprise medical billing for American patients and that’s happening right now.” He thanked the mostly Republican group of lawmakers who came to the White House to discuss the initiative, including Senators Lamar Alexander (R-Tenn.), Maggie Hassan (D-N.H.), Bill Cassidy, MD (R-La.), and John Barrasso (R-Wyo.) and representatives Kevin Brady (R-Texas), Devin Nunes (R-Calif.), and Greg Walden (R- Ore.).

Trump then announced guidelines that the White House wants Congress to use in developing surprise billing legislation. They include:

  • In emergency care situations, patients should never have to bear the burden of out-of-network costs they didn’t agree to pay. “So-called ‘balance billing’ should be prohibited for emergency care. Pretty simple,” he said
  •  When patients receive scheduled non-emergency care, they should be given a clear and honest bill up front. “This means they must be given prices for all services and out-of-pocket payments for which they will be responsible,” Trump said. “This will not just protect Americans from surprise charges, it will [also] empower them to choose the best option at the lowest possible price”
  •  Patients should not receive surprise bills from out-of-network providers that they did not choose themselves. “Very unfair,” he commented
  •  Legislation should protect patients without increasing federal healthcare expenditures. “Additionally, any legislation should lead to greater competition, more choice, and more healthcare freedom. We want patients to be in charge and in total control,” the president said
  •  All types of health insurance — large groups, small groups, and patients on the individual market should be included in the legislation. “No one in America should be bankrupted unexpectedly by healthcare costs that are absolutely out of control,” said Trump

He noted that “we’re going to be announcing something over the next 2 weeks that’s going to bring transparency to all of it. I think in a way it’s going to be as important as a healthcare bill; it’s going to be something really special.”

Also at the announcement was Martin Makary, MD, MPH, a surgical oncologist at Johns Hopkins University in Baltimore. “When someone buys a car, they don’t pay for the steering wheel separately from the spark plugs,” he said. “Yet, in healthcare, surprise bills and overpriced bills are commonplace and are crushing everyday folks … People are getting hammered right now.”

Trump also introduced two families who had experienced high medical bills. Drew Calver, of Austin, Texas, said that after a heart attack 2 years ago, “although I had insurance, I was still billed $110,000 … I feel like I was exploited at the most vulnerable time in my life just having suffered a heart attack, so I hope Congress hears this call to take action, close loopholes, end surprise billing, and work toward transparency.”

Paul Davis, MD, of Findlay, Ohio, said that his daughter was billed nearly $18,000 for a urine drug screening test. “She had successful back surgery in Houston and at a post-op visit, because she was given a prescription for narcotic pain relief — which she used as directed — the doctor said, ‘Oh, by the way, I’d like to get a urine specimen.’ Fine; she did it. A year later, a bill showed up for $17,850.”

He noted that her insurance company’s Explanation of Benefits said that the insurer would have paid $100.92 for the test had it been done by an in-network provider. “This type of billing is all too common … The problem of improper billing affects most [of] those who can afford it least. We must put aside any differences we have to work together to solve this problem.”

“Today I’m asking Democrats and Republicans to work together; Democrats and Republicans can do this and I really think it’s something [that is] going to be acted on quickly,” Trump said.

Healthcare groups responded positively to the announcement, with one caveat. “The AHA commends the Administration and Congress for their work to find solutions to this problem,” Rick Pollack, president, and CEO of the American Hospital Association (AHA), said in a statement. “The AHA has urged Congress to enact legislation that would protect patients from surprise bills. We can achieve this by simply banning balance billing. … Untested proposals such as bundling payments would create significant disruption to provider networks and contracting without benefiting patients.”

“ACEP appreciates the White House weighing in on this important issue and welcomes congressional action to address surprise medical bills,” said Vidor Friedman, MD, president of the American College of Emergency Physicians (ACEP), in a statement. “Emergency physicians strongly support taking patients out of the middle of billing disputes between insurers and out-of-network medical providers.”

“ACEP is concerned about the administration’s call for a single hospital bill,” he continued. “Such a ‘bundled payment’ approach may seem simple in theory for voluntary medical procedures. But if applied to the unpredictable nature of emergency care, this untested idea opens the door to massive and costly disruption of the health care system that would shift greater costs to patients while failing to address the actual root cause of surprise bills — inadequate networks provided by insurers.”

The president also mentioned another one of his administration’s healthcare initiatives. “We may allow states to buy drugs in other countries … because the drug companies have treated us very, very unfairly and the rules and restrictions within our country have been absolutely atrocious,” he said. “So we’ll allow [states], with certain permission, to go to other countries if they can buy them for 40%, 50%, or 60% less. It’s pretty pathetic, but that’s the way it works.”

And now back to Medicare. As you all probably remember the reason that physicians decided not to support the national plan was the confusion regarding reimbursement or payment to physicians. But the insurance companies as well as organized labor who opposed the compulsory system on the grounds that its passage would deprive the labor movement of an extremely effective issue with which to organize workers.

Also, with the entry of America into the First World War the interest in the passage of a compulsory health care bill waned. Because of the anti-German hysteria, the AALL bill opposition became more organized with the biased thoughts that mandatory health insurance was the product of a German conspiracy to impose Prussian values on America.

Renewed interest in mandatory health insurance didn’t emerge until during the New Deal as a consequence of the report of the Committee on Economic Security, the committee appointed by President Roosevelt in 1934. As the Depression worsened the President and his advisors were eager to offer an alternative social welfare package. Roosevelt and his advisors particularly those of the Committee on Economic Security advised the passage of a comprehensive social security system to include unemployment insurance, old-age security, and government-administered-health-care insurance.

The final report by the Committee on the Costa of Medical Care was issued in 1932, by the Committee under the chairmanship of Dr. Ray Lyman Wilbur who was the former Secretary of the Interior and former President of the AMA. The Committee actually concluded that the infrastructure in medicine as well as the medical services in the United States were inadequate and made recommendations for changes. And, despite the favorable climate especially among labor leaders, politicians and social scientists the President’s Committee on Economic Security recommender unemployment insurance and social security but not the passage of a mandatory health insurance bill.

But Roosevelt wanted to keep the subject of health insurance and therefore established an Interdepartmental Committee to Coordinate Health and Welfare Activities immediately following the passage of the Social Security Act and ordered his staff to keep the subject out there before the public. Over the next few years it was the subject of many books and extensive studies by the federal government, but no bill yet.

More to come!!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Generous Joe: More “Free” Healthcare For Illegals Needed

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

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

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

Answer: A lot.

The Question, The Answer

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

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

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

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

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

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

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

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

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

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

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

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

The Cost of Illegal-Alien Healthcare

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

But that’s beside the point.

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

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

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

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

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

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

NYC Promises ‘Guaranteed’ Healthcare for All Residents

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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