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World hits coronavirus milestones amid fears worst to come and Consider Rationing Health Care and the Effect of Virtual Classrooms and the Effect of All These Protests on Disease Management.

The world surpassed two sobering coronavirus milestones last Sunday—500,000 confirmed deaths, 10 million confirmed cases—and hit another high mark for daily new infections as governments that attempted reopenings continued to backtrack and warn that worse news could be yet to come.

“COVID-19 has taken a very swift and very dangerous turn in Texas over just the past few weeks,” said Gov. Greg Abbott, who allowed businesses to start reopening in early May but on Friday shut down bars and limited restaurant dining amid a spike in cases.

California Gov. Gavin Newsom rolled back reopenings of bars in seven counties, including Los Angeles. He ordered them to close immediately and urged eight other counties to issue local health orders mandating the same.

South Africa’s health minister warned that the country’s current surge of cases is expected to rapidly increase in the coming weeks and push hospitals to the limit. Health Minister Zwelini Mkhize said the current rise in infections has come from people who “moved back into the workplace. It was therefore inevitable that there would be cluster outbreaks as infections spilled over from communities into places of congregation such as mines, factories, taxis and buses.”

New clusters of cases at a Swiss nightclub and in the central English city of Leicester showed that the virus was still circulating widely in Europe, though not with the rapidly growing infection rate seen in parts of the U.S., Latin America and India.

Poland and France, meanwhile, attempted a step toward normalcy as they held elections that had been delayed by the virus.

Wearing mandatory masks, social distancing in lines and carrying their own pens to sign voting registers, French voters cast ballots in a second round of municipal elections. Poles also wore masks and used hand sanitizer, and some in virus-hit areas were told to mail in their ballots to avoid further contagion.

“I didn’t go and vote the first time around because I am elderly and I got scared,” said Fanny Barouh as she voted in a Paris school.

In Texas, Abbott appeared with Vice President Mike Pence, who cut campaign events from upcoming visits to Florida and Arizona because of rising virus cases in those states.

Pence praised Abbott for both his decision to reopen the state, and to roll back the reopening plans.

“You flattened the curve here in Texas … but about two weeks ago something changed,” Pence said.

Pence urged people to wear masks when unable to practice social distancing. He and Abbott wore face masks as they entered and left the room, taking them off while speaking to reporters.

HHS Secretary Alex Azar, meanwhile, defended the fact that President Donald Trump has rarely worn a mask in public, saying he doesn’t have to follow his own administration’s guidance because as a leader of the free world he’s tested regularly and is in “very different circumstances than the rest of us.”

Addressing spikes in reported coronavirus cases in some states, Azar said on NBC’s “Meet the Press” that people “have to take ownership” of their own behaviors by social distancing and wearing masks if possible.

A reported tally Sunday from Johns Hopkins University researchers said the death toll from the coronavirus pandemic had reached 500,108.

About 1 in 4 of those deaths—more than 125,000—have been reported in the U.S. The country with the next highest death toll is Brazil, with more than 57,000, or about 1 in 9.

The true death toll from the virus, which first emerged in China late last year, is widely believed to be significantly higher. Experts say that especially early on, many victims died of COVID-19 without being tested for it.

To date, more than 10 million confirmed cases have been reported globally. About a quarter of them have been reported in the U.S.

The World Health Organization announced another daily record in the number of confirmed coronavirus cases across the world—topping over 189,000 in a single 24-hour period. The tally eclipses the previous record a week earlier at over 183,000 cases, showing case counts continue to progress worldwide.

Overall, the U.S. still has far and away the most total cases. At more than 2,450,000—roughly twice that of Brazil. The number of actual cases worldwide is much higher.

New York, once the nation’s pandemic epicenter, is now “on the exact opposite end,” Gov. Andrew Cuomo said in an interview with “Meet the Press.”

The state reported five new virus deaths Saturday, its lowest reported daily death toll since March 15. During the state’s peak pandemic in April, nearly 800 people were dying every day. New York still leads the nation in COVID-19 deaths with nearly 25,000.

In the state of Washington, Gov. Jay Inslee put a hold on plans to move counties to the fourth phase of his reopening plan as cases continue to increase. But in Hawaii, the city of Honolulu announced that campgrounds will reopen for the first time in three months with limited permits to ensure social distancing.

Britain’s government, meanwhile, is considering whether a local lockdown is needed for the central English city of Leicester amid reports about a spike in COVID-19 among its Asian community. It would be Britain’s first local lockdown.

“We have seen flare-ups across the country in recent weeks,” Home Secretary Priti Patel told the BBC on Sunday.

Polish voters were casting ballots, in person and by mail, for a presidential election that was supposed to have taken place in May but was chaotically postponed amid the pandemic. President Andrzej Duda, a 48-year-old conservative backed by the nationalist ruling Law and Justice party, is running against 10 other candidates as he seeks a second five-year term. Iwona Goge, 79, was encouraged to see so many people voting in Warsaw. “It’s bad. Poland is terribly divided, and people are getting discouraged,” she said.

French voters were choosing mayors and municipal councilors in Paris and 5,000 towns and cities in a second round of municipal elections held under strict hygiene rules. Key battlegrounds include Paris, where the next mayor will preside over the 2024 Summer Olympics.

Italy was honoring its dead later Sunday with an evening Requiem concert in hard-hit Bergamo province. The ceremony in the onetime epicenter of the European outbreak came a day after Italy registered the lowest daily tally of COVID-19 deaths in nearly four months: eight.

European leaders were taking no chances in tamping down new clusters. German authorities renewed a lockdown in a western region of about 500,000 people after about 1,300 slaughterhouse workers tested positive. Swiss authorities ordered 300 people into quarantine after a “superspreader” outbreak of coronavirus at a Zurich nightclub.

Africa’s confirmed cases of COVID-19 continued to climb to a new high of more than 371,000, including 9,484 deaths, according to figures released Sunday by the African Centers for Disease Control and Prevention.

Justice Department Issues Warning About Fake Mask Exempt Cards

Jason Slotkin reported that The Department of Justice has issued an alert about a card circulating online falsely claiming that holders are legally exempt from wearing a mask. Public health officials overwhelmingly recommend wearing a mask when going out in public.

Public health experts overwhelmingly agree that one of the best ways to slow the spread of the coronavirus is to wear a mask. Still, the seemingly straightforward recommendation to secure a covering over one’s nose and mouth has proven one of the pandemic’s more partisan issues.

The Department of Justice is now warning that a card circulating online is falsely claiming its holder is lawfully exempt from wearing a mask.

A recently issued alert by the department is urging the public not to heed information printed on the fraudulent cards, which purport to carry the authority of the “Freedom to Breathe Agency,” which is neither a federal nor a state agency.

The fake card states that wearing a mask will incur mental or physical risk for the holder. The card also posits that the Americans with Disabilities Act forbids raising questions about the health condition aggravated by mask usage. Penalties are threatened if a business owner does not act accordingly.

“If found in violation of the ADA you could face steep penalties. Organizations and businesses can be fined up to $75,000 for your first violation and $150,000 for any subsequent violations. Denying access to your business/organization will be also reported to FTBA for further actions,” the card reads, according to images that have been posted online.

At least some versions of the card appear to bear an official looking Justice Department insignia. In its alert, the department disavowed any role in the card’s creation or dispersal, saying, “These postings were not issued by the Department and are not endorsed by the Department.”

The department also said not to rely on information included on the card and instead to visit the Americans with Disabilities Act website.

It’s unclear how many cards are in circulation, but it appears to have been spread via a Facebook page belonging to a group calling itself the Freedom to Breathe Agency.

The Centers for Disease Control and Prevention has been recommending people wear cloth or fabric face coverings since April. Many states and localities have gone on to require or urge their wearing in public — especially in enclosed spaces. Businesses large and small have also adopted the recommendation, requiring both staff and customers to wear them.

Masks have emerged as a major political flashpoint — often in response to stay-at-home orders that state and local governments put in place to slow the outbreak. Despite his own government’s guidance, President Trump has said he will not be wearing a face mask, and protesters in multiple states have been seen without masks as they amassed in defiance at coronavirus restrictions.

In many online videos, staffers at food and retail establishments have been seen contending with customers who refuse to cover their faces.

The CDC — still — recommends wearing a mask when going out in public.

Dr. Saphier on prolonged school and summer camp closures: The mental health effects for kids are real

David Montanaro of Fox NewsFox reported that news medical contributor Dr. NicoleSaphier said Wednesday that the mental health effects on children during the coronavirus shutdowns are a real concern, as many summer camps have declined to open this year.

Speaking on “Fox & Friends,” Saphier said “94 percent of superintendents” across the country are not ready to talk about plans for reopening schools in the fall, raising concerns about the effects on children.

“This conversation is being prompted by surveys out of Italy and China where they reported that children were experiencing anxiety up to 70 percent of the time, saying that they were having feelings of anxiety or difficulty breathing. Those surveys were done from March and April. I would like to see more modern ones or more up-to-date ones. Let me tell you, as a mother having three kids at home, the mental health effects of these shutdowns are real,” she said.

Saphier said she’s concerned that the negative impact on children will be long-lasting if they continue to be kept at home rather than going to school. “Going to school for children is not just the fundamental basics of education. It’s learning conflict resolution, socialization skills and building the very necessary relationships and my biggest concern is that the mental health effects are going to be here to stay,” she said, adding that doctors have learned more about COVID-19, including that children are “significantly less susceptible to illness” and they are less likely to transmit the virus than adults.

“There are smart ways that schools can come together and get those kids back in session.”

Sen. Lamar Alexander, R-Tenn., said last week that there is a “growing awareness” among Americans that kids need to go back to school as soon as possible and plans must be created to do that in a safe way.

In an interview on “America’s Newsroom” with hosts Sandra Smith and Ed Henry, the chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee pointed out that while kids must be kept safe from coronavirus, both children and their parents are “about up to here with remote learning.” “Any teacher or parent can tell you [about] the emotional [and] the intellectual impact, especially among minority kids,” Alexander told the “Newsroom” hosts.

“I mean, this is a time when we’re all talking a lot about racial injustice and disproportionate effects on low-income and minority kids. The single best thing we can do to help minority children [and] low-income children is to get them back in school. That’s where they learn. That’s where they learn to deal with other children. That’s where many get one meal, sometimes two,” Alexander concluded.

Dr. Fauci says George Floyd protests provide ‘perfect recipe’ for new coronavirus surges

Brie Stimson of Fox News noted that recent protests across the U.S. over the death of George Floyd could lead to new surges in coronavirus cases, Dr. Anthony Fauci  warned Friday.

“It is the perfect set-up for the spread of the virus in the sense of creating some blips which might turn into some surges,” Fauci, a member of President Trump’s Coronavirus Task Force, told radio station WTOP-FM in Washington, D.C.

“It is the perfect set-up for the spread of the virus in the sense of creating some blips which might turn into some surges.”

— Dr. Anthony Fauci 

His comments came as the U.S. edged closer to 2 million confirmed infections and 110,000 virus-related deaths, and the globe neared 7 million infections and 400,000 deaths since the pandemic began, according to Johns Hopkins University.

After months of confinement due to governors’ stay-at-home orders, thousands across the country have taken to the streets for more than a week to protest the police-custody death of Floyd – a black man who succumbed after a white officer kneeled on his neck for nearly nine minutes on May 25 in Minneapolis.

“As I sat in front of the TV and watched the screen go from Washington, D.C., to New York City, to Los Angeles, to Philadelphia, I got really concerned,” Fauci told the Sunday Times of London. “I was going, ‘Oh my goodness. I hope this doesn’t set us back a lot.’ [After] all of the work in trying to maintain the physical distance and doing all the things, I became very concerned that we might see a resurgence.”

While some in the massive crowds have worn masks, others haven’t — and no one is social distancing, he said.

The protests bring together people from different areas, many of them virus hotspots, Fauci said. The participants then return home and create a “perfect recipe” for a resurgence of the virus.

Chanting and yelling, as people typically do during protests, also increases the risk of spread, he said. “I get very concerned, as do my colleagues in public health, when they see these kinds of crowds,” Fauci said. “There certainly is a risk. I can say that with confidence.”

The only thing public health officials can do is constantly remind people to be careful and always wear a mask, Fauci, the director of the National Institute for Allergy and Infectious Diseases, told WTOP.

Officials in cities with protests have urged demonstrators to get tested for the virus. Cities such as Seattle and San Francisco have set up mobile testing centers for protesters. “It’s a difficult situation. We have the right to peacefully demonstrate and the demonstrators are exercising that right,” Fauci added. “It’s a delicate balance because the reasons for demonstrating are valid and yet the demonstration itself puts oneself at an additional risk.”

Note Well-Arizona’s rules for rationing healthcare in the COVID-19 pandemic should terrify you

Michael Hilzik pointed out a scary fact regarding the rationing of healthcare.  You may think that the coronavirus and COVID-19, the disease it causes, are frightening enough. But Arizona has just activated a rulebook for rationing hospital care that is truly terrifying.

In brief, the rules allow hospitals to deny critical healthcare resources such as ventilators to patients based on medical judgments about their likelihood of living even five more years despite surviving COVID-19.

In practical terms, that means that on average, older adults are more likely to be denied care than younger persons. Those with medical conditions other than COVID-19 would be more vulnerable to denials than those judged to be healthier, whatever their age.

Health care planning must do everything possible never to need [Crisis Standards of Care].

National Academies of Science, Engineering and Medicine

Under the rules, doctors making triage judgments that deprive patients of necessary care will be immune from legal liability.

Arizona’s so-called crisis standards of care, or CSC, isn’t unique among the states. But it provides an up-to-the-minute look at the harsh choices facing medical personnel across the country thanks to our unfit and unprepared political leadership, if one can call it leadership at all.

From the federal government down through the states, the vacuum of leadership has exposed millions of Americans to sickness and death while reducing our healthcare system to a patchwork of overwhelmed facilities.

The lack of planning and preparedness is the outstanding failure of the response to the crisis in the United States. That’s the implicit judgment of the National Academies of Science, Engineering and Medicine.

The academies stated in an assessment of crisis standards of care in March that the primary principle was that “health care planning must do everything possible never to need CSC.”

The academies also specified that in the current pandemic, “public trust is essential.” That means that leaders would have to be “proactive, honest, transparent and accountable” when discussing the condition of their healthcare systems and institutions.

Has that happened? The answer obviously is no. President Trump and Republican governors such as Arizona’s Doug Ducey and Florida’s Ron DeSantis have suppressed statistics showing the true rate of infection in their states. Trump’s approach to the crisis has been focused in large part in trying to minimize its impact, even denying its existence.

States other than Arizona have similar rulebooks to be dusted off in a major emergency. Arizona, however, is the only state that has activated its crisis standard of care procedures — so far.

Arizona residents have been among the most resistant to wearing face masks in the coronavirus crisis. (Statista)

“A lot of states actually have activated their crisis standards of care plans,” Cara Christ, director of Arizona’s Department of Health Services, said during a press conference Monday with Ducey. That appears to be untrue. Though most states have prepared a crisis plan, no others have activated it.

Several, however, may be on the verge of doing so, at least regionally, since the surge in cases is placing immense stresses on local capacities. In California, for example, Riverside County’s ICU beds were reported to be 99% occupied over the weekend and Los Angeles County is projecting the possibility of running out of hospital beds in two to three weeks and exhausting its intensive care unit beds sometime in July.

In Imperial County, an agricultural county on the Mexican border where 23% of tests are coming back positive for COVID-19, 500 patients were transferred to adjoining counties to relieve the local pressure, Gov. Gavin Newsom said Monday.

California is one of several states ranking as leading hot spots of coronavirus infection, though its statewide test positivity average of 5.9% over the last seven days remains lower than other surging states such as Arizona (24.4%), Florida (15.6%) and Texas (14.1%).

All those states are guilty of having reopened commercial and retail establishments, as well as public facilities such as beaches, too soon — notably before it was clear that they had adequately clamped down on the community spread of the coronavirus.

Newsom has urged Californians to continue social distancing and mask-wearing throughout the crisis; his error was to give local officials too much latitude to decide for themselves when they could reopen their economies. Now Newsom is signaling that such deference may be coming to an end.

Newsom pressured Imperial County into rolling back its reopening, in part by threatening that “the state of California will assert itself and make sure that happens” if officials fail to do so. As my colleague Taryn Luna reports, he also has hinted at statewide orders aimed at imposing anti-virus rules, though he has not been specific.

In other states, governors have been more permissive and even interfered with local officials’ judgments. Until June 17, Ducey forbade cities and counties to impose stricter rules than the state. In practical terms, that prevented them from keeping bars, restaurants and retail establishments closed or requiring residents to wear masks in public.

Ducey relented under pressure from the mayors of Phoenix, Tucson and Flagstaff and in the face of an undeniable surge in COVID-19 cases.

The politicization of mask-wearing, a fundamental tool to defeat the virus, has hampered America’s response. (Yougov)

Ducey’s indulgent approach to social distancing measures probably contributed to his constituents’ failure to embrace them. Polls taken from late March through the end of April showed that only 30% to 40% of Arizona residents regularly wore face masks in public; in California, New York and New Jersey, the rate was as high as 60%.

Arizona waited until March 30 to issue a stay-at-home policy, long after other states. Ducey lifted the policy early, on May 15.

Ducey joined Trump at an indoor political rally in Phoenix on June 23 at which an estimated 3,000 persons were in attendance, crammed shoulder to shoulder and mostly maskless — even though a week earlier the city had ordered masks to be worn. Ducey wore a mask bearing the Arizona state seal, but Trump was maskless.

Not until Monday did Ducey reimpose anti-virus measures, prohibiting large gatherings, ceasing the issuance of new special event licenses, and closing bars, gyms, movie theaters, waterparks and tubing rentals. His order will remain in effect through the month. He didn’t order masks to be worn in public.

By then, the state already had activated its crisis standards of care, or rationing plan. Let’s take a look.

Like other states’ plans, Arizona’s relies chiefly on a metric known as a SOFA Score, for “sequential organ failure assessment.” The score is based on the condition of six major organ systems: lungs, circulatory, heart, kidney, liver and neurological.

Arizona assigns points to patients according to their SOFA score range, to a maximum of four points for the most severely affected. Then it adds up to four more points for a subjective assessment of a patient’s survivability: two points for those whose death is expected within five years despite successful treatment of COVID-19, and four for those whose death is expected within one year despite successful treatment. Priority for treatment is given to those with lower scores.

The guidelines state that judgments are to be made regardless of “race, ethnicity, color, national origin, religion, sex, disability, veteran status, age, genetic information, sexual orientation, gender identity, quality of life, or any other ethically irrelevant criteria.”

But several of these factors obviously will play into the point system. Black patients on average tend to suffer from more medical conditions than others, in part because their incomes are lower on average and their access to medical care more limited. Older residents also suffer from more health challenges. And how do medical personnel assess a patient’s “quality of life”?

Some of these factors are especially relevant in Arizona, where residents 65 and older constitute 23% of the adult population, above the national average of 20.7%. Florida skews even older, with 25.6% of its adult population 65 and older.

The prospects of subjective judgments creeping into triage judgments is great because the SOFA score itself, despite its apparent objectivity, is an imperfect tool.

The scores are “poor predictors of individual patients’ survival,” the National Academies found in its assessment of crisis standards. That’s especially true for patients suffering acute respiratory failure, one of the key symptoms of COVID-19.

As a result, “these scores are not suitable for excluding patients with acute respiratory failure… from receiving critical care” in the pandemic.

One can’t blame Arizona for implementing a rationing plan aimed at delivering crisis care to those judged most likely to benefit from it. But its leaders can be blamed for allowing the state to reach the point where rationing is deemed necessary. The seeds of its disaster were planted long ago.

Fauci says new mutation of coronavirus spreads quickly: report

Jack Hobbs in the New York Post reported that the country’s top infectious disease expert said Thursday that a more infectious strain of the coronavirus may be emerging.

Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, made the claim Thursday in an interview with The Journal of the American Medical Association.

Fauci said research suggests Italy was devastated by a different strain of the coronavirus than the one that originated in Wuhan, China.

The main difference between the two, Fauci said, is that Italy’s version passes from person to person more effectively, making it even more difficult to contain.

“It just seems that the virus replicates better and may be more transmissible,” says Fauci.

The study he references, which was released by researchers affiliated with the Sheffield COVID-19 Genomics Group, states that the new strain “has become the most prevalent form in the global pandemic.”
However, the researchers also found no evidence that this new strain causes worse symptoms than the original.

As of Thursday, The United States had more than 2.7 million confirmed cases, the highest in the world and Dr. Fauci also is warning us that the U.S. could see 100,000 Coronavirus cases a day if this surge continues.

What do we do to protect ourselves and conquer this disease?

And remember to celebrate Independence Day, the Fourth of July! Remember why we celebrate this holiday!

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!!!

 

Waiting to Be Saved: A Health Care Fairy Tale and Why Most Americans Can’t Afford to Get Sick and is Health Insurance Affordable?

17308963_1134320833364241_8656274778864181034_nLindsey Woodworth of the National Interest recently noted that the wait times in emergency rooms are so out of control that researchers recently tested whether aromatherapy would make waiting in the ER more tolerable.

It didn’t.

Over a decade ago, the Institute of Medicine offered an ominous warning: “Underneath the surface, a national crisis in emergency care has been brewing and is now beginning to come into full view.”

Now the view is quite clear. ERs are packed and wait times are growing longer each year. In fact, even if you’re having a heart attack, you may have to wait to get to the doctor.

The problem is, patients get sicker the longer they wait.

Oh, by the way, sicker patients cost more to care for.

I am an economist at the University of South Carolina. In a new study, I analyzed how ER wait times affect health care costs. I found that a 10-minute increase in ER wait time among the most critical patients will increase the hospital’s cost to care for the patient by an average of 6%. Some critical patients are currently waiting close to an hour, according to my study.

Costs grow a little more slowly among patients who begin their wait in a better condition.

An intriguing relationship

Health care costs are an issue of national concern. Presidential candidates have focused on health care reform as a major issue in the 2020 presidential election.

One complication in lowering health care costs, however, is that reductions in health care spending could compromise patient outcomes – spend less on health care, and you might very well jeopardize health.

Yet, this is exactly what makes the finding that ER wait times exacerbate costs so intriguing. It suggests that targeting ER wait times could both improve patient outcomes and lower the cost of care. A double win like this hardly ever occurs in health care.

Longer wait = higher costs

One major challenge in measuring the effect of ER wait times on costs is that ERs prioritize sicker patients. This means that relatively healthy patients have longer waits. The sickest patient in the ER will always get treated first. A lot of resources will probably get poured into this patient, making his costs quite high. On the other hand, a patient who arrives at the ER with a splinter will wait in the ER for hours. Treating this patient will be super cheap.

This creates a persistent correlation between long waits and low costs. On the surface, this correlation can deceptively send the signal that longer ER wait times reduce health care costs.

To uncover the real effect of ER wait times on costs, I needed to use a “trick” in my research to untangle the mess. The “trick” I used was to leverage something in the ER that slightly bumps patients’ wait times but has nothing to do with their health at their time of arrival. Triage nurses provided the answer.

These nurses are the people who determine the order in which patients are seen. Yet, because triage nurses are not robots, they sometimes differ in terms of their judgments. This means that some triage nurses are “tougher” than others – at least “tougher” in the sense that they’ll look at a problem and not see it as quite so urgent. This causes their patients to have longer wait times, on average.

It is effectively a coin toss whether a patient will get a tough triage nurse, so the patients who get a tough triage nurse look remarkably similar to the patients who do not, in terms of their health at arrival. Yet, the patients who get a tough triage nurse have to wait in the ER longer.

The study revealed that the patients who had longer wait times only because they coincidentally got a tough triage nurse had higher health care costs by the end of their visits. In other words, longer ER wait times cause health care costs to go up.

Why? It seems that patients’ health deteriorates the longer they wait. Therefore, by the time they get to the doctor, it takes more resources to get their health up to speed.

What’s the treatment?

How might ER wait times be reduced and costs lowered?

Fixing ER wait times will require taking a step out of the emergency room and looking at the whole health care system.

Drs. Arthur L. Kellermann and Ricardo Martinez recently wrote in The New England Journal of Medicine: “The quickest way to assess the strength of a community’s public health, primary care, and hospital systems is to spend a few hours in the emergency department.”

ER overcrowding often occurs when people are blocked from care elsewhere. For instance, when people with Medicaid are unable to find primary care physicians who accept their insurance, they often resort to ERs instead.

Another contributor to ER overcrowding is a recent shift in how patients are admitted to hospitals. It used to be that primary care physicians directly admitted their sick patients to the hospital if inpatient care was required. Now, many first recommend that their patients go first to the emergency room.

Inpatient wards inside hospitals can also contribute to ER overcrowding. Often inpatient wards get filled with high-paying, elective-case patients. These patients take up valuable bed space, leaving little room for ER patients who need to be hospitalized. As a result, the ER patients who have already been seen by the ER doctor end up staying in the ER waiting for an inpatient bed to become available. This practice of “ER boarding” generates a log jam inside the emergency room. Patient volumes balloon and the overcrowding prolongs all patients’ waits.

Growth in ER wait times shows no sign of slowing. Therefore, policymakers should consider system-level changes that would take the pressure off of ERs. It is time to turn the tide on ER wait times given their impact on both patient outcomes and the overall cost of care.

Why Most Americans Can’t Afford to Get Sick

Simon F. Haeder reviewed the financial costs of health care finding that Americans are being bankrupted by the costs of providing health care. Medical bankruptcy has been a talking point for many Democratic candidates as they make their individual cases for health care reform. This begs a few questions about how widespread these bankruptcies are and what causes them.

  1. How big a problem is medical bankruptcy?

Medical bankruptcy, which refers to situations where individuals were forced into bankruptcy because of medical bills, loss of income due to sickness or accident, or both, is widespread in the U.S.

While the exact contribution of medical bills to the number of bankruptcies is difficult to determine, one important study prior to the Affordable Care Act found that medical debt was the single biggest contributor to bankruptcies for well over 60% of Americans. Even today, while the overall number of bankruptcies has been cut in half over the last decade to roughly 750,000 in 2018, a recent study indicated that two-thirds of bankruptcies are connected to medical bills.

It is interesting to note that the concept of medical bankruptcy is entirely alien to Europeans.

  1. How did the Affordable Care Act help?

Individuals have gained coverage via the Medicaid expansion, their parents’ insurance or the insurance marketplaces. Moreover, other ACA insurance regulations have added protections for all Americans with insurance.

  1. Who’s still vulnerable?

Close to 30 million Americans remain uninsured. While a significant number are eligible for varying degrees of public support, the refusal by many states to expand their Medicaid programs creates challenges. It is important to note that while the ACA expanded coverage to millions, it did little to reign in the biggest contributor to medical bankruptcy: high medical costs.

Even Americans with insurance are not immune to the specter of medical bills. While the ACA limited deductibles and out-of-pocket payments, many insurance plans still require consumers to pay tens of thousands of dollars annually.

Similarly, many Americans may incur bills ranging in the hundreds of thousands of dollars from so-called surprise bills. Inaccurate provider directories can compound these problems, misleading patients to believe they seek care from a provider in their network.

Finally, evidence from ACA and commercial plans, as well as Medicare Advantage, has highlighted problems with regard to “artificial local provider deserts,” situations in which providers are located in the area but excluded from the network. These situations might force patients into seeking costly out-of-network carefully aware of the potential financial consequences.

  1. How do concerns about medical costs affect Americans beyond medical bankruptcy?

Half of Americans have less than US$1,000 in savings. This lack of financial security has implications for how Americans access medical care. A study found that costs have kept 64% of Americans from seeking medical care. Millions of Americans are skipping their medications for the same reason. Avoiding needed medical care often has implications for people’s health and well-being. Of course, it may also ultimately force them to seek care in more expensive settings, like emergency departments or at advanced stages of the disease.

New medical bankruptcy study: Two-thirds of filers cite illness and medical bills as contributors to financial ruin

Physicians for a National Health Program looked at the contributors to financial ruin and found that medical problems contributed to 66.5% of all bankruptcies, a figure that is virtually unchanged since before the passage of the Affordable Care Act (ACA), according to a study published yesterday as an editorial in the American Journal of Public Health. The findings indicate that 530,000 families suffer bankruptcies each year that are linked to illness or medical bills.

The study carried out by a team of two doctors, two lawyers, and a sociologist from the Consumer Bankruptcy Project (CBP), surveyed a random sample of 910 Americans who filed for personal bankruptcy between 2013 and 2016, and abstracted the court records of their bankruptcy filings. The study, which is one component of the CBP’s ongoing bankruptcy research, provides the only national data on medical contributors to bankruptcy since the 2010 passage of the ACA. Bankruptcy debtors reported that medical bills contributed to 58.5% of bankruptcies, while illness-related income loss contributed to 44.3%; many debtors cited both of these medical issues.

These figures are similar to findings from the CBP’s medical bankruptcy surveys in 2001 and 2007, which were authored by three researchers in the current study (Himmelstein, Thorne, and Woolhandler), and then-Harvard law professor Elizabeth Warren. As in those earlier studies, many debtors cited multiple contributors to their financial woes.

The current study found no evidence that the ACA reduced the proportion of bankruptcies driven by medical problems: 65.5% of debtors cited a medical contributor to their bankruptcy in the period prior to the ACA’s implementation as compared to 67.5% in the three years after the law came into effect. The responses also did not differ depending on whether the respondent resided in a state that had accepted ACA’s Medicaid expansion. The researchers noted that bankruptcy is most common among middle-class Americans, who have faced increasing copayments and deductibles in recent years despite the ACA. The poor, who were most helped by the ACA, less frequently seek formal bankruptcy relief because they have few assets (such as a home) to protect and face particular difficulty in securing the legal help needed to navigate formal bankruptcy proceedings.

Relative to other bankruptcy filers, people who identified a medical contributor were in worse health and were two to three times more likely to skip needed medical care and medications.

Dr. David Himmelstein, the lead author of the study, a Distinguished Professor at the City University of New York’s (CUNY) Hunter College and Lecturer at Harvard Medical School commented: “Unless you’re Bill Gates, you’re just one serious illness away from bankruptcy. For middle-class Americans, health insurance offers little protection. Most of us have policies with so many loopholes, co-payments, and deductibles that illness can put you in the poorhouse. And even the best job-based health insurance often vanishes when prolonged illness causes job loss—just when families need it most. Private health insurance is a defective product, akin to an umbrella that melts in the rain.”

In the article, the authors note that “medical bills frequently cause financial hardship, and the U.S. Consumer Financial Protection Bureau reported that they were by far the most common cause of unpaid bills sent to collection agencies in 2014, accounting for more than half of all such debts.”

The study’s senior author Dr. Steffie Woolhandler, an internist in the South Bronx, Distinguished Professor at CUNY/Hunter College and Lecturer in Medicine at Harvard commented: “The ACA was a step forward, but 29 million remain uncovered, and the epidemic of under-insurance is out of control. We need to move ahead from the ACA to a single-payer, Medicare for All system that assures first-dollar coverage for everyone. But the Trump administration and Republicans in several states are taking us in reverse: cutting Medicaid, threatening to gut protections for the more than 61 million Americans with pre-existing conditions, and allowing insurers to peddle stripped-down policies that offer no real protection.”

Study co-author Robert M. Lawless, the Max L. Rowe Professor of Law at the University of Illinois College of Law noted: “In the Supreme Court’s words, bankruptcy is a fresh start for the ‘honest but unfortunate debtor.’ Our study shows that for many bankruptcy debtors, the misfortune continues to come from the way we pay for health care. Bankruptcy may provide a fresh start, but it comes at a high financial and emotional cost for those who file. Filing for bankruptcy can stop the financial bleeding that the health care system imposes, but curing that system’s ills is the only lasting solution.”

Health insurance is becoming more unaffordable for Americans

Megan Henny of FOX Business pointed out that Americans who receive health insurance through their employers are finding it increasingly unaffordable, as out-of-pocket costs continue to outpace wage growth, according to a new study.

Over the past decade, the combined cost of premiums and deductibles grew quicker than the median income in every single state, according to a study released Thursday by the Commonwealth Fund, a New York-based nonprofit that advocates for expanded health insurance coverage.

Last year, on average, middle-income workers spent 6.8 percent of their income on employer premium contributions, or fixed costs they pay every month. Deductibles, which you pay before your health insurance kicks in, accounted for 4.7 percent of median income on average.

That number is even higher in some states, however. In nine states — Arkansas, Florida, Georgia, Louisiana, Mississippi, Nevada, New Mexico, North Carolina, and Texas — premium contributions accounted for 8 percent or more of median income, reaching a high of 10 percent in Louisiana.

In Louisiana, on average, employees pay more than $5,000 in premiums. The state’s median household income is $46,145.

Workers in the majority of states put between 6 to 8 percent of median household income toward premiums, although in thirteen states — Alaska, Washington, Utah, Colorado, North Dakota, Iowa, Wisconsin, Michigan, Indiana, Maryland, Massachusetts, and New Hampshire — workers paid as little as 4.1 percent.

Worse for workers is that despite the high premiums, they’re still “potentially exposed to high out-of-pocket costs because of large deductibles,” the study said.

Last year, the average deductible for single-person coverage plans was $1,846, with average deductibles ranging from $1,308 in Washington, D.C., to $2,447 in Maine. Across the country, average deductibles compared to median income were more than 5 percent in 18 states, but ranged as high as 6.7 percent in Mississippi.

In 2018, the combined cost of premiums and deductibles exceeded 10 percent of median income in 42 states, compared to seven states in 2008. That means people could spend more than 16 percent of their incomes on premiums and deductibles in Mississippi, which has the second-lowest median income in the U.S., compared to an average cost burden of 8.4 percent in Massachusetts, which has a median income among the nation’s highest.

“Higher costs for insurance and health care have consequences,” the study said. “People with low and moderate incomes may decide to go without insurance if it competes with other critical living expenses like housing and food.”

So, in the midst of all this discussion of Medicare for All and modifications of the Affordable Care Act/ Obamacare the question is, is a single-payer health care system the answer and how is it created, managed and financed?

 

Again, Democrats Spar at Debate Over Health Care, How to Beat Trump and Could Medicare for All Really Go Horribly Wrong?

 

deal549[5953]Was there anything different about last week’s Democratic debate? Bill Barrow, Will Weissert and Jill Colvin reported that the Democratic presidential candidates clashed in a debate over the future of health care in America, racial inequality and their ability to build a winning coalition to take on President Donald Trump next year.
The Wednesday night faceoff came after hours of testimony in the impeachment inquiry of Trump and at a critical juncture in the Democratic race to run against him in 2020. With less than three months before the first voting contests, big questions hang over the front-runners, time is running out for lower tier candidates to make their move and new Democrats are launching improbable last-minute bids for the nomination.
But amid the turbulence, the White House hopefuls often found themselves fighting on well-trodden terrain, particularly over whether the party should embrace a sweeping “Medicare for All” program or make more modest changes to the current health care system.
Sens. Elizabeth Warren of Massachusetts and Bernie Sanders of Vermont, the field’s most progressive voices, staunchly defended Medicare for All, which would eliminate private insurance coverage in favor of a government-run system.
“The American people understand that the current health care system is not only cruel — it is dysfunctional,” Sanders said.
Former Vice President Joe Biden countered that many people are happy with private insurance through their jobs, while Mayor Pete Buttigieg of South Bend, Indiana, complained about other candidates seeking to take “the divisive step” of ordering people onto universal health care, “whether they like it or not.”
Democrats successfully campaigned on health care last year, winning control of the House on a message that Republicans were slashing existing benefits. But moderates worry that Medicare for All is more complicated and may not pay the same political dividend. That’s especially true after Democrats won elections earlier this month in Kentucky and Virginia without embracing the program.
“We must get our fired-up Democratic base with us,” said Sen. Amy Klobuchar of Minnesota. “But let’s also get those independents and moderate Republicans who cannot stomach (Trump) anymore.”
The fifth Democratic debate unfolded in Atlanta, a city that played a central role in the civil rights movement, and the party’s diversity, including two African American candidates, was on display. But there was disagreement on how best to appeal to minority voters, who are vital to winning the Democratic nomination and will be crucial in the general election.
Sens. Kamala Harris of California and Cory Booker of New Jersey said the party has sometimes come up short in its outreach to black Americans.
“For too long, I think, candidates have taken for granted constituencies that have been a backbone of the Democratic Party,” Harris said. “You show up in a black church and want to get the vote but just haven’t been there before.”
Booker declared, “Black voters are pissed off, and they’re worried.”
In the moderators’ chairs were four women, including Rachel Maddow, MSNBC’s liberal darling, and Ashley Parker, a White House reporter for The Washington Post. It was only the third time a primary debate has been hosted by an all-female panel.
Buttigieg — who was a natural target given his recent rise in the polls to join Biden, Warren and Sanders among the crowded field’s front-runners — was asked early about how being mayor of a city of 100,000 residents qualified him for the White House.
“I know that from the perspective of Washington, what goes on in my city might look small,” Buttigieg said. “But frankly, where we live, the infighting on Capitol Hill is what looks small.”
Klobuchar argued that she has more experience enacting legislation and suggested that women in politics are held to a higher standard.
“Otherwise we could play a game called ‘Name your favorite woman president,’ which we can’t do because it has all been men,” she said.
Another memorable exchange occurred when Biden — who didn’t face any real attacks from his rivals — was asked about curbing violence against women and responded awkwardly.
“We have to just change the culture,” he said. “And keep punching at it. And punching at it. And punching at it.”
Harris scrapped with another low polling candidate: Hawaii Rep. Tulsi Gabbard, who has criticized prominent Democrats, including 2016 nominee Hillary Clinton.
“I think that it’s unfortunate that we have someone on the stage who is attempting to be the Democratic nominee for the president of the United States who during the Obama administration spent four years full time on Fox News criticizing President Obama,” Harris said.
“I’m not going to put party interests first,” Gabbard responded.
But the discussion kept finding its way back to Medicare for All, which has dominated the primary — especially for Warren. She released plans to raise $20-plus trillion in new government revenue for universal health care. But she also said implementation of the program may take three years — drawing criticism both from moderates like Biden and Buttigieg, who think she’s trying to distance herself from an unpopular idea, and Sanders supporters, who see the Massachusetts senator’s commitment to Medicare for All wavering.
Sanders made a point of saying Wednesday that he’d send Medicare for All legislation to Congress during the first week of his administration.
Booker faced especially intense pressure Wednesday since he’s yet to meet the Democratic National Committee’s polling requirements for the December debate in California. He spent several minutes arguing with Warren about the need to more appropriately tax the wealthy, but also called for “building wealth” among people of color and other marginalized communities.
“We’ve got to start empowering people,” Booker said.
Businessman Andrew Yang was asked what he would say to Russian President Vladimir Putin if he got the chance — and joked about that leader’s cordial relationship with Trump.
“First of all, I’d say I’m sorry I beat your guy,” Yang said with a grin, drawing howls of laughter from the audience.
Is Warren retreating on Medicare-for-all?
Almost one week before the fifth Democratic presidential debate, Elizabeth Warren released the latest plan in her slew of policy proposals: An outline detailing how, if elected, she would gradually shift the U.S. toward a single-payer health care system.
“I have put out a plan to fully finance Medicare for All when it’s up and running without raising taxes on the middle class by one penny,” the Massachusetts senator wrote in a post introducing the plan. “But how do we get there? Every serious proposal for Medicare for All contemplates a significant transition period.”
It was a marked shift from her previous calls to quickly bring the country toward Medicare-for-all and, notably, included similar tenets laid out in the health care proposals of more moderate candidates, like former Vice President Joe Biden and South Bend, Indiana Mayor Pete Buttigieg.
In the transition plan, Warren said she would take several steps in her first 100 days in office to expand insurance coverage, like pushing to pass a bill that would allow all Americans to either buy into a government-run program if they wanted, or keep their private insurance. It would extend free coverage to about half of the country, including children and poor families. She would also lower the eligibility age for Medicare to 50 and let young people buy into a “true Medicare-for-all” option.
“Combining the parts into a whole reveals a bit of a mess,” wrote David Dayen of The American Prospect, a progressive magazine. “After putting forward a comprehensive cost control and financing bill, Warren split that apart and asked people to accept two bruising fights to get to her purported end goal. It’s reasonable for people to see that as a bait and switch.”
Rivals portrayed the move as a retreat from one of her most high-profile positions on an issue that voters repeatedly rank as one of the most important. A campaign spokesperson for Biden called the senator’s health stance “problematic,” while Buttigieg’s spokeswoman Lis Smith criticized the latest measure as a “transparently political attempt to paper over a very serious policy problem.”
Vermont Sen. Bernie Sanders, who has wholeheartedly pledged to fight for a single-payer health system, took a swipe at Warren when accepting an endorsement on Friday from the largest nurses’ union in the country.
“Some people say we should delay that fight for a few more years — I don’t think so,” he said, according to The Washington Post. “We are ready to take them on right now, and we’re going to take them on Day One.”
The similarities come as Warren, who experienced a somewhat momentous surge in the polls, has begun to falter. In early October, her national polling climbed to 28 percent, according to a Fox News poll, but since then, her numbers have steadily declined. In the latest Iowa poll, Buttigieg pulled ahead of Warren by a staggering nine percentage points, indicating the 37-year-old could be a serious contender.
The timing of the seeming loss of campaign momentum appears to be tied to the release of her sweeping Medicare-for-all proposal at the beginning of November. Warren said it could be paid for with a series of taxes, largely via new levies on Wall Street and the ultra-wealthy (and, she’s repeatedly stressed, none on the middle class).
According to a recent poll conducted by the Kaiser Family Foundation and Cook Political Report, while universal coverage is popular with a majority of Democratic voters, almost two-thirds of voters in key swing states said a national health plan in which all Americans receive their health coverage through a single-payer system was not a good idea.
It also precludes the start of the next debate in Georgia, during which Warren will very likely face fierce criticism and scrutiny over her $20 trillion Medicare-for-all plan and remember the cost is really closer to$52-$72 trillion>
Still, Warren told reporters over the weekend that “my commitment to Medicare for All is all the way,” according to The Associated Press.
And Rep. Pramila Jayapal, the Washington Democrat who introduced the House version of the Medicare-for-all bill, called the plan a “smart approach to take on Big Pharma & private-for-profit insurance companies.”
Medicare for All’s thorniest issue is how much to pay doctors and hospitals. Any new system could become a convoluted mess if it goes wrong.
Earlier this month, Sen. Elizabeth Warren unveiled her $20.5 trillion package to finance Medicare for All, a system that would provide comprehensive health insurance to every American and virtually erase private insurance.
If its details are made reality, it would be nothing short of a sweeping transformation of the way Americans receive and pay for their medical care.
The proposal attempts to address one of the thorniest problems that any candidate pushing for a single-payer system in the US faces: how much to pay doctors and hospitals.
Dismantling the current payment structure and replacing it with another would likely require some tough trade-offs, experts say, creating winners and losers when the dust settles.
Sen. Elizabeth Warren recently unveiled details of her Medicare for All health plan, a system that would provide comprehensive health coverage to every American and virtually erase private insurance.
If its details are made reality, it would be a sweeping transformation in the way Americans get and pay for their medical care. Its the only financing model for universal coverage that a Democratic presidential candidate has rolled out in the primary so far.
It attempts to address one of the thorniest problems any candidate pushing for a single-payer system in the US faces: how much to pay the country’s doctors and hospitals. Pay them too little, and you risk wreaking havoc on their bottom line — and possibly forcing a wave of hospital closures as some critics have warned. Pay them too much, and it becomes much more expensive to finance care for everybody.
“The challenge is that when you expand Medicare to new populations, they’re going to use more healthcare,” Katherine Baicker, a health policy expert who serves as the dean of the University of Chicago Harris School of Public Policy, told Business Insider. “But that means there is going to be a substantial increase in demand for healthcare at the same time that you’re potentially cutting payments to providers.”
Warren has proposed big cuts in payments to many hospitals and doctors in her $20.5 trillion package to bring universal healthcare to the United States. Single-payer advocates argue that eliminating private insurance would lower administrative burdens on doctors and hospitals, freeing them up to treat more insured patients.
Several outside analyses of Medicare for All proposals suggest it can lead to considerable savings through negotiation of lower prices and reduced administrative spending.
The cuts in Warren’s plan are steep, because private insurers currently pay around twice as much as Medicare does for hospital care, according to research from the Center for American Progress, a liberal think tank. Warren’s reform blueprint sets them in line with the Medicare program. Doctors would be paid at the Medicare level while hospitals would be reimbursed at 110% of Medicare’s rate.
‘A recipe for shortages’
As a result, those rates would lower doctor pay by around 6.5%, according to an estimate from economists who analyzed the Warren plan. For hospitals, who are used to bigger payments from private insurers, the payments under Warren’s plan would be roughly enough to cover the cost of care, the economists said.
Baicker says the healthcare system may not be prepared to meet the rapid rise in demand, especially if payments fall at the same time.
“You’re going to see people wanting more services at the same time you pay providers less, and that’s a recipe for shortages unless something else changes,” she said.
That echoes a report from the nonpartisan Congressional Budget Office released in May. It found that setting payments in line with Medicare would “substantially” lower the average amount of money providers currently receive. “Such a reduction in provider payment rates would probably reduce the amount of care supplied and could also reduce the quality of care,” the CBO report said.
Business Insider reached out to the five largest hospital systems to ask the possible effects of lowering payment rates to Medicare levels and whether they would be prepared to weather the transition.
Only one responded: the 92-hospital Trinity Health System based in Michigan.
“Trinity Health supports policies that advance access to affordable health care coverage for all, payment models that improve health outcomes and accelerate transformation, and initiatives that enhance community health and well-being,” spokeswoman Eve Pidgeon told Business Insider.
Pidgeon said that Trinity Health welcomes the dialogue around “critical questions” of financing and access to coverage, and would “analyze Medicare for All proposals as more details emerge.”
The healthcare industry generally opposes Medicare for All
“Trinity Health has a rich tradition of honoring the voices of the communities we serve, and we will continue to dialogue around policy proposals designed to improve affordability, quality and access for all,” Pidgeon said.
The healthcare industry generally opposes Medicare for All, arguing that it would lead to hospital closures and hurt the overall quality of care for Americans.
The American Hospital Association is staunchly against it. In a statement to Business Insider, executive vice president Tom Nickels called it “a one-size -fits-all approach” that “could disrupt coverage for more than 180 million Americans who are already covered through employer plans.”
“The AHA believes there is a better alternative to help all Americans access health coverage – one built on improving our existing system rather than ripping it apart and starting from scratch,” Nickels said.
Meanwhile, the American Medical Association, the nation’s largest physician organization, came out against the single-payer system, though its membership nearly voted to overturn its opposition in June, Vox reported. The group since pulled out of an industry coalition fighting the proposal.
While many big hospitals could face payment cuts, others could benefit, particularly those that mainly serve people with low incomes or who don’t have insurance.
“If you’re a facility serving a lot of Medicaid and uninsured patients today, you might come out ahead here,” Matthew Fiedler, a health policy expert at the Brookings Institution, told Politico. “But the dominant hospitals in a lot of markets that are able to command extremely high private rates today will take a big hit. I don’t think we’d see hospitals closing, but the question is: What would they do to bring down spending?”
Chris Pope, a healthcare payment expert and senior fellow at the conservative Manhattan Institute, said fewer dollars would ultimately mean a cutback in services hospitals would be able to offer. “The less you pay, the less you’re going to get in return.”
“What would likely happen is if you give a fixed lump sum of money, they would start dialing back on access to care,” Pope told Business Insider. “You’re just not going to be able to have a scan done when you need one done.”
The impact on hospitals and doctors
I have pointed these next few points before but thought that it would be worth mentioning again. The surging cost of hospital bills has fanned consumer outrage in recent years as people struggle to afford needed care and helped elevate support for some type of government insurance plan, whether its the more incremental route allowing people to simply buy into a public insurance option or Medicare for All.
In a preview of battles to come, Congress has struggled to pass legislation addressing exorbitant and confusing hospital bills, an issue with widespread public support and bipartisan interest that the White House backed as well, the Washington Post reported in September. Its movement grinded to a halt amid an onslaught of outside spending from doctor and insurer groups.
Dr. Stephen Klasko, chief executive of the Jefferson Health hospital system in Pennsylvania, said the political debate has oversimplified the difficult decisions that would need to be taken in moving to Medicare for All.
“They haven’t been willing to talk about what you would really have to do to bring a dollar and a quarter down to a dollar,” Klasko said, referring to candidates like Warren and Sanders who back universal health coverage.
The hospital executive said that while the nation’s healthcare system is “inefficient” and “fragmented,” slashing overhead wouldn’t necessarily improve the quality of care.
“This myth that there’s these trillions of dollars of administrative costs that are out there in the ether, that’s not true. Every dollar you take away is somebody’s dollar,” Klasko said.
He added that pricing reform on the scale that Warren proposes “is doable,” though there’s likely a caveat.
“It will change how consumers interact with the healthcare system and they won’t get everything they want,” he said.
I’m not sure that Medicare for All will be the Democratic party’s continual push as the debates continue and they realize that moderation to develop a health care system will be the only way to challenge a run against President Trump. I wonder when the rest of the Democratic potential candidates realize that besides the gaffs that former Vice President Biden makes, that improving the Affordable Care Act is the only strategy that may work.
Now I want to wish all a Happy Thanksgiving and hope that we all will appreciate all that we all have and as Mister Rogers said we all need to be Kind, and be Kind and also be Kind. Enjoy you Turkey Day!

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!

Whistleblower Alleges Fraud At A Large Medicare Advantage Plan In Seattle and on and on about the last Democrat Debate and more on Medicare for All

72488737_2301802426616070_6529440653267435520_nWhat a unique world we live in. Bernie Sanders, a man running for the position of President, ignores his symptoms of heart disease, has a heart attack, needs stents for his coronary arteries which are obstructed and a few weeks later is back on the difficult road to running for President. What a jerk who I am sure is ignoring his doctor’s advice, who I’m sure has discussed his post-procedure heart disease restrictions including taking stress, etc. easy for at least 6 weeks, or that what is what I would tell my patient. And this is the man who is telling us all how we should all be deciding our health care system. Unbelievable!! Now, with all the whistleblowers coming out of the woodworks, Fred Schulte points out another whistleblower. Group Health Cooperative in Seattle, one of the United States’ oldest and most respected nonprofit health insurance plans, is accused of bilking Medicare out of millions of dollars in a federal whistleblower case.

Teresa Ross, a former medical billing manager at the insurer, alleges that it sought to reverse financial losses in 2010 by claiming that some patients were sicker than they were or by billing for medical conditions that patients didn’t actually have. As a result, the insurer retroactively collected an estimated $8 million from Medicare for 2010 services, according to the suit.

Ross filed suit in federal court in Buffalo, N.Y., in 2012, but the suit remained under a court seal until July and is in its initial stages. The suit also names as defendants two medical coding consultants — consulting firm DxID of East Rochester, N.Y., and Independent Health Association, an affiliated health plan in Buffalo, N.Y. All denied wrongdoing in separate court motions filed late Wednesday to dismiss the suit.

The Justice Department has thus far declined to take over the case but said in a June 21 court filing that “an active investigation is ongoing.”

The whistleblower suit is one of at least 18 such cases documented by Kaiser Health News that accuses Medicare Advantage managed care plans of ripping off the government by exaggerating how sick their patients were. The whistleblower cases have emerged as a primary tool for clawing back overpayments. While many of the cases are pending in courts, five have recovered a total of nearly $360 million.

“The fraudulent practices described in this complaint are a product of the belief, common among [Medicare Advantage] organizations, that the law can be violated without meaningful consequence,” Ross alleges.

Medicare Advantage plans are a privately run alternative to traditional Medicare that often offers extra benefits such as dental and vision coverage but limits the choice of medical providers. They have exploded in popularity in recent years, enrolling more than 22 million people, just over 1 in 3 of those eligible for Medicare.

Word of another whistleblower alleging Medicare Advantage billing fraud comes as the White House is pushing to expand enrollment in the plans. On Oct. 3, President Trump issued an executive order that permits the plans to offer a range of new benefits to attract patients. One, for instance, is partly covering the cost of Apple watches as an inducement.

Group Health opened for business more than seven decades ago and was among the first managed care plans to contract with Medicare. Formed by a coalition of unions, farmers and local activists, the HMO grew from just a few hundred families to more than 600,000 patients before its members agreed to join California-based Kaiser Permanente. That happened in early 2017, and the plan is now called the Kaiser Foundation Health Plan of Washington. (Kaiser Health News is not affiliated with Kaiser Permanente.)

In an emailed statement, a Kaiser Permanente spokesperson said: “We believe that Group Health complied with the law by submitting its data in good faith, relying on the recommendations of the vendor as well as communications with the federal government, which has not intervened in the case at this time.” Ross nods to the plan’s history, saying it has “traditionally catered to the public interest, often highlighting its efforts to support low-income patients and provide affordable, quality care.”

The insurer’s Medicare Advantage plans “have also traditionally been well regarded, receiving accolades from industry groups and Medicare itself,” according to the suit.

But Ross, who worked at Group Health for more than 14 years in jobs involving billing and coding, says that from 2008 through 2010, the company “went from an operating income of almost $57 million to an operating loss of $60 million.” Ross says the losses were “due largely to poor business decisions by company management.”

The lawsuit alleges that the insurer manipulated a Medicare billing formula known as a risk score. The formula is supposed to pay health plans higher rates for sicker patients, but Medicare estimates that overpayments triggered by inflated risk scores have cost taxpayers $30 billion over the past three years alone.

According to Ross, a Group Health executive in 2011 attended a meeting of the Alliance of Community Health Plans, where he heard from a colleague at Independent Health about an “exciting opportunity” to increase risk scores and revenue. The colleague said Independent Health “had made a lot of money” using its consulting company, which specializes in combing patient charts to find overlooked diseases that health plans can bill for retroactively.

In November 2011, Group Health hired the firm DxID to review medical charts for 2010. The review resulted in $12 million in new claims, according to the suit. Under the deal, DxID took a percentage of the claims revenue it generated, which came to about $1.5 million that year, the suit says.

Ross says she and a doctor who later reviewed the charts found “systematic” problems with the firm’s coding practices. In one case, the plan billed for “major depression” in a patient described by his doctor as having an “amazingly sunny disposition.” Overall, about three-quarters of its claims for higher charges in 2010 were not justified, according to the suit. Ross estimated that the consultants submitted some $35 million in new claims to Medicare on behalf of Group Health for 2010 and 2011.

In its motion to dismiss Ross’ case, Group Health called the matter a “difference of opinion between her allegedly ‘conservative’ method for evaluating the underlying documentation for certain medical conditions and her perception of an ‘aggressive’ approach taken by Defendants.”

Independent Health and the DxID consultants took a similar position in their court motion, arguing that Ross “seeks to manufacture a fraud case out of an honest disagreement about the meaning and applicability of unclear, complex, and often conflicting industry-wide coding criteria.”

In a statement, Independent Health spokesman Frank Sava added: “We believe the coding policies being challenged here were lawful and proper and all parties were paid appropriately.”

Whistleblowers sue on behalf of the federal government and can share in any money recovered. Typically, the cases remain under a court seal for years while the Justice Department investigates.

How would Warren pay for ‘Medicare for All’? Enough evasion, it’s past time for answers.

Chris Truax points out that the last 2 months al anyone who watches the politicians suggesting that Medicare for all is the solution to the healthcare crisis has bombarded the news. Medicare for All will create winners and losers. It’s all very well to say you can’t make an omelet without breaking some eggs unless you’re the egg.

When it comes to doing things, Elizabeth Warren has a plan for everything — and she’s happy to tell you all about it. But when it comes to paying for things, I’m sorry to say, the Massachusetts senator dodges and deflects like a Donald Trump defender.

It’s estimated that “Medicare for All” will cost the federal government an extra $3 trillion a year. That’s more than $9,000 annually from every man, woman, and child in America. Despite being asked, again and again, Warren refuses to acknowledge that paying for this is going to require an across-the-board tax increase — and a pretty massive one, at that. Instead, she keeps talking about how “costs” will go down before she changes the subject to how stressful it is to have your insurance canceled when you get sick or when you have to cope with your mom having diabetes. That’s very true, I’m sure. But we’re talking fiscal policy here.

Warren To Release Plan To Pay For ‘Medicare For All’

Yuval Rosenberg of The Fiscal Times noted that now, just last week Massachusetts Sen. Elizabeth Warren said Sunday she will roll out a plan to pay for an expansive single-payer health care system in the coming weeks, promising the plan would decrease overall costs for the middle class.

“I plan over the next few weeks to put out a plan that talks, specifically, about the cost of ‘Medicare for All’ and how we pay for it,” Warren said at the end of a town hall here at Simpson College. “I will not sign a bill into law that does not reduce the cost of health care for middle-class families.”

Warren’s aides have long suggested she was studying ways to pay for the health care plan originally backed by Vermont Sen. Bernie Sanders, one of her leading rivals for the 2020 Democratic presidential nomination. In recent days, Warren has faced criticism from lower-profile candidates in the race — especially South Bend, Indiana, Mayor Pete Buttigieg and Minnesota Sen. Amy Klobuchar — for her failure to explain how she would pay for the ambitious plan, which would replace private health insurance with generous, universal coverage paid for by the federal government.

“Everybody who is running for president right now knows that families are getting crushed by the high cost of health care,” Warren told the crowd of nearly 500 people. “They also know that the cheapest possible way to make sure that everyone gets the health care that they need is Medicare for All.”

Warren’s statement came after her standard 40-minute stump speech and three questions from attendees, none of whom asked about Medicare for All. The addition appeared to be an attempt to short-circuit recent criticisms of her health care plan.

Warren has previously promised, most recently at the Oct. 15 debate, that no middle-class family would see an increase in overall health care costs. And her aides have said since at least September that she was evaluating ways to pay for Medicare for All. She does not plan to significantly alter the details of the legislation she’s co-sponsored with Sanders in the way Sen. Kamala Harris (D-Calif.) did with her own health care proposal over the summer. Warren said she had been working on the problem of how to pay for the legislation for “months and months.”

“It’s just a little more work until it’s finished,” she said.

For a campaign that has long prided itself on detailed policy proposals, releasing a plan to pay for Medicare for All — which is sure to generate intense scrutiny from the media and her rivals for the nomination — is a high-risk but likely necessary move. Whether or not a plan for Medicare for All would lower costs for the middle class would rely heavily on complicated details, including how progressive the tax system supporting the plan is and how aggressively the government is able to control the cost of health care.

Estimates of how much the plan would cost vary wildly, as do estimates of how much switching to a single-payer system would increase or decrease overall health care costs.

Buttigieg, in particular, has aggressively questioned how Warren would pay for the plan, and said she is being dishonest by not saying whether or not taxes would go up for middle-class families. Sanders has said taxes would likely go up, while overall costs would drop. But Warren has resisted the question, arguing that admitting taxes would rise is equal to accepting a dishonest Republican framing of the issue. Warren has also attacked Buttigieg’s plan for failing to cover every American, dubbing it “Medicare for all who can afford it.”

“Your signature, Senator, is to have a plan for everything. Except this,” Buttigieg said at the debate. “No plan has been laid out to explain how a multi-trillion-dollar hole in this Medicare for All plan that Senator Warren is putting forward.”

Soon, Buttigieg will get his answer.

She ended your last weekend rally asking the “people” to give her a little more time and she will announce how she proposes to pay for it. More important, is her plan, probably an increase of taxes for all, including Middle Americans, to pay for it…. realistic???? Remember, nothing in any of the political “experts” proposals are ever free. Someone, you and I, have to pay for it in some way or another!!

Winners and losers in Medicare for All

There’s a very unpleasant collectivist feel to this. It’s all very well to say you can’t make an omelet without breaking some eggs … unless you’re the egg. About 56% of Americans — more than 180 million — have private health insurance through an employer. Medicare for All would sweep that all away, whether the people who have that insurance like it or not, in the name of the common good. Perhaps worse, as Warren knows perfectly well but steadfastly refuses to admit, there are going to be winners and losers. Costs might go down in the aggregate, but individuals and families aren’t aggregates.

Elizabeth Warren’s choice: ‘Medicare for All’ purity or a path to beating Trump?

For example, Warren keeps saying that the total you pay for health care would end up being less under Medicare for All because it will eliminate out-of-pocket costs like premiums and copays. That’s an oversimplification at best, especially since she hasn’t said how she would finance this enormously expensive project.

But it is a given that everyone will pay higher taxes, and it’s older people who spend more on premiums and out-of-pocket health care costs — a lot more. Consequently, older people will be far more likely to see these higher taxes offset by a decrease in the cost of their health care. By contrast, younger people and families at healthier stages of their lives would still be paying new taxes but will see fewer benefits.

 Your Two-Minute Summary of Tuesday’s Democratic Medicare-for-All Debate

Tuesday night’s Democratic presidential debate once again highlighted the candidate’s deep divides over Medicare for All. After opening questions related to the House impeachment inquiry into President Trump, the debate quickly turned to the health care reform plan backed by Senators Elizabeth Warren and Bernie Sanders.

Warren again tried to reframe the question of whether she would raise middle-class taxes to pay for the plan. “Costs will go up for the wealthy. They will go up for big corporations. And for middle-class families, they will go down,” she said. “I will not sign a bill into law that does not lower costs for middle-class families.”

Pete Buttigieg, who last month called Warren “extremely evasive” on the tax question, pounced. “No plan has been laid out to explain how a multi-trillion-dollar hole in this Medicare for all plan that Senator Warren is putting forward is supposed to get filled in,” he said, touting his “Medicare for All Who Want It” proposal as a better alternative. “I don’t understand why you believe the only way to deliver affordable coverage to everybody is to obliterate private plans, kicking 150 million Americans off of their insurance in four short years,” he said to Warren. “Why unnecessarily divide this country over health care when there’s a better way to deliver coverage for all?”

Warren jabbed back at Buttigieg, saying his “Medicare for All Who Want It” plan is really “Medicare for All Who Can Afford It.”

Joe Biden and Amy Klobuchar, both of whom support building on the Affordable Care Act with a public option, also attacked Medicare for All as expensive and impractical. “The difference between a plan and a pipe dream is something that you can actually get done,” Klobuchar said. “And we can get this public option done.”

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

Klobuchar took the opportunity to criticize Warren again. “At least Bernie is being honest here, and saying how he’s going to pay for this and that taxes are going to go up,” she said. “And I’m sorry, Elizabeth, but you have not said that, and I think we owe the American people to tell them where we will send the invoice.”

A political strategy: The attacks on Warren are widely seen as a sign that she’s now the Democratic frontrunner — and they’re likely a sign that, as tiresome as the repeated tax question might get, Warren is going to keep getting asked it by the media, Democratic rivals, and Republicans. She’s pointedly not willing to answer directly (or take the bait) and say that she will raise taxes, even as she continues to argue that overall costs under Medicare for All will go down for the middle class. Her caginess on the question suggests she thinks that higher taxes on the middle class, or the very word “taxes,” might be toxic in an election campaign against Trump. But her dodging hasn’t hurt her so far.

What the polls say: The latest Kaiser Family Foundation tracking poll found that 51% of those surveyed favor Medicare for All, while 47% oppose it. A majority of Democrats and about half of independents support a national Medicare-for-all plan, while more than 70% of Republicans oppose the idea. Support for a public option is higher, at 73%. A CBS News poll released Tuesday found that 59% of voters believe that a government-run plan should “compete with private insurance” as under a public option, while 32% said they would want it to replace private insurance. But polls have also found that support for Medicare for All or other health plans can shift significantly depending on the arguments presented.

The bottom line: Larry Levitt of the Kaiser Family Foundation reminds us that there is no simple answer to the question of ultimate costs, and that a wide variety of outcomes are possible depending on how Medicare for All is implemented. “A Medicare for all plan could be designed so that many people, including those who are middle class, pay less in taxes than they are paying now in premiums, deductibles, and copays,” Levitt tweeted Tuesday. “It depends entirely on the details.”

J&J Pulls Baby Powder From Market

FDA testing reveals chrysotile fibers in one lot of embattled product of the J&J babypowder, which the courts are suggested cause ovarian cancer.

John Gever the managing editor of the MedPage reported that Johnson  & Johnson is recalling one lot of its famous baby powder because of possible asbestos contamination, the FDA announced Friday.

“FDA testing has found that a sample from one lot of the product contains chrysotile fibers, a type of asbestos,” the agency said in a press release. “Consumers who have Johnson’s Baby Powder lot #22318RB should stop using it immediately and contact Johnson & Johnson for a refund.”

Although Johnson & Johnson agreed to initiate the recall, it stopped short of admitting that the product really was contaminated. It questioned “the integrity of the tested sample and the validity of the test results,” suggesting that it might not even be a genuine Johnson & Johnson product.

The company has consistently denied that its baby powder — on the market for more than a century — has ever been contaminated with asbestos, but the company has faced numerous lawsuits from consumers alleging that they or loved ones developed cancer because of asbestos in talc components. The baby powder is popular not only for use on babies; many women have used it to reduce “feminine odors” as well.

The FDA said it has tested some 50 cosmetic products since 2018 for asbestos contamination, including two lots of Johnson’s Baby Powder. One was negative and the other was positive. This lot of baby powder is not the first to test positive and the FDA has previously issued alerts on others.

“The FDA expects to issue the full results from this survey, including all tested products having both positive and negative results, by the end of the year,” the agency said.

 

The Big Push for Medicare Advantage, Trump’s Counter Health Care Proposal and Dumb Bernie!

rights328Michael Rainey reported that Medicare is shaping up as one of the most important issues in the 2020 election, with several leading Democrats offering proposals that would significantly expand the program. President Trump jumped into the fray with an executive order last week that he claimed would protect and improve the Medicare system, in part by promoting broader use of private Medicare Advantage plans. Those plans are quite lucrative for the private insurers that sell them, Bloomberg’s John Tozzi said Wednesday, and they’ll be pushing hard to sell more of them when Medicare enrollment begins next week.

Enrollment in Medicare Advantage has more than tripled in the last 20 years, and now about a third of all Medicare beneficiaries get coverage through private plans. If current trends continue, more than half of all beneficiaries will be in Medicare Advantage by 2025, according to Tozzi.

How it works: Those who sign up for Medicare Advantage pay the same monthly premiums as regular plans but agree to certain limits imposed by the insurers, such as a restricted network of doctors, and also receive a wider range of benefits, which can include drugs plans and dental care. Insurers get a fee from the government for each person who signs up and is responsible for managing their plans to ensure a profit. In 2019, the average fee for each of the roughly 22 million participants was $11,545 – which comes to a total of about $254 billion.

Big numbers for insurers: Insurers see Medicare Advantage as “as a lucrative market they can’t afford to pass by,” Tozzi said, especially as sales of traditional, employer-based insurance plans slow. Medicare is now the biggest part of UnitedHealthcare’s business and the insurance giant is expanding to reach 90% coverage of the market next year. Other major players including Humana and Aetna are also expanding their coverage, and competition in the space is growing.

More generous benefits: Recent rule changes have allowed private insurers to offer new benefits within Medicare Advantage, such as meal delivery, air-conditioners, and in-home help. Regular fee-for-service Medicare doesn’t offer such options due to concerns about fraud.

A potential political battle ahead: Insurers increasingly rely on the revenues and profits from Medicare Advantage and can be expected to fight any effort to restrict – or, as some Democrats are calling for, eliminate – the existing private system. And as the plans become more generous – and, as critics have pointed out, more expensive for the government – seniors are likely to resist changes as well, complicating any Democratic effort to enact sweeping changes in the Medicare system.

Targeting ‘Medicare For All’ Proposals, Trump Lays Out His Vision For Medicare

Selena Simmons reported that President Trump gave a speech and signed an executive order on health care Thursday, casting the “Medicare for All” proposals from his Democratic rivals as harmful to seniors.

His speech, which had been billed as a policy discussion, had the tone of a campaign rally. Trump spoke from The Villages, a huge retirement community in Florida outside Orlando, a deep-red part of a key swing state.

His speech was marked by cheers, standing ovations and intermittent chants of “four more years” by an audience of mostly seniors.

Trump spoke extensively about his administration’s health care achievements and goals, as well as the health policy proposals of Democratic presidential candidates, which he characterized as socialism.

The executive order he signed had previously been titled “Protecting Medicare From Socialist Destruction” on the White House schedule but has since been renamed “Protecting and Improving Medicare for Our Nation’s Seniors.”

“In my campaign for president, I made you a sacred pledge that I would strengthen, protect and defend Medicare for all of our senior citizens,” Trump told the audience. “Today I’ll sign a very historic executive order that does exactly what — we are making your Medicare even better, and … it will never be taken away from you. We’re not letting anyone get close.”

The order is intended, in part, to shore up Medicare Advantage, an alternative to traditional Medicare that’s administered by private insurers. That program has been growing in popularity, and this year, premiums are down and plan choices are up.

The executive order directs the Department of Health and Human Services to develop proposals to improve several aspects of Medicare, including expanding plan options for seniors, encouraging innovative plan designs and payment models and improving the enrollment process to make it easier for seniors to choose plans.

The order includes a grab bag of proposals, including removing regulations “that create inefficiencies or otherwise undermine patient outcomes”; combating waste, fraud, and abuse in the program; and streamlining access to “innovative products” such as new treatments and medical devices.

The president outlined very little specific policy in his speech in Florida. Instead, he attacked Democratic rivals and portrayed their proposals as threatening to seniors.

“Leading Democrats have pledged to give free health care to illegal immigrants,” Trump said, referring to a moment from the first Democratic presidential debate in which all the candidates onstage raised their hands in support of health care for undocumented migrants. “I will never allow these politicians to steal your health care and give it away to illegal aliens.”

Health care is a major issue for voters and is one that has dominated the presidential campaign on the Democratic side. In the most recent debate, candidates spent the first-hour hashing out and defending various health care proposals and visions. Only two candidates, Sen. Bernie Sanders, and Sen. Elizabeth Warren — between a Medicare for All system — support the major divide and a public option supported by the rest of the field.

Trump brushed those distinctions aside. “Every major Democrat in Washington has backed a massive government health care takeover that would totally obliterate Medicare,” he said. “These Democratic policy proposals … may go by different names, whether it’s single-payer or the so-called public option, but they’re all based on the totally same terrible idea: They want to raid Medicare to fund a thing called socialism.”

Toward the end of the speech, he highlighted efforts that his administration has made to lower drug prices and then suggested that drugmakers were helping with the impeachment inquiry in the House of Representatives. “They’re very powerful,” Trump said. “I wouldn’t be surprised if … it was from some of these industries, like pharmaceuticals, that we take on.”

Drawing battle lines through Medicare may be a savvy campaign move on Trump’s part.

Medicare is extremely popular. People who have it like it, and people who don’t have it think it’s a good thing too. A recent poll by the Kaiser Family Foundation found that more than 8 in 10 Democrats, independents and Republicans think of Medicare favorably.

Trump came into office promising to dismantle the Affordable Care Act and replace it with something better. Those efforts failed, and the administration has struggled to get substantive policy changes on health care.

On Thursday, administration officials emphasized a number of its recent health care policy moves.

“[Trump’s] vision for a healthier America is much wider than a narrow focus on the Affordable Care Act,” said Joe Grogan, director of the White House’s Domestic Policy Council, at a press briefing earlier.

The secretary of health and human services, Alex Azar, said at that briefing that this was “the most comprehensive vision for health care that I can recall any president putting forth.”

He highlighted a range of actions that the administration has taken, from a push on price transparency in health care to a plan to end the HIV epidemic, to more generic-drug approvals. Azar described these things as part of a framework to make health care more affordable, deliver better value and tackle “impassable health challenges.”

Without a big health care reform bill, the administration is positioning itself as a protector of what exists now — particularly Medicare.

“Today’s executive order particularly reflects the importance the president places on protecting what worked in our system and fixing what’s broken,” Azar said. “Sixty million Americans are on traditional Medicare or Medicare Advantage. They like what they have, so the president is going to protect it.”

Trump’s New Order For Medicare Packs Potential Rise In Patients’ Costs

Julie Appleby reported that vowing to protect Medicare with “every ounce of strength,” President Donald Trump last week spoke to a cheering crowd in Florida. But his executive order released shortly afterward includes provisions that could significantly alter key pillars of the program by making it easier for beneficiaries and doctors to opt-out.

The bottom line: The proposed changes might make it a bit simpler to find a doctor who takes new Medicare patients, but it could lead to higher costs for seniors and potentially expose some to surprise medical bills, a problem from which Medicare has traditionally protected consumers.

“Unless these policies are thought through very carefully, the potential for really bad unintended consequences is front and center,” said economist Stephen Zuckerman, vice president for health policy at the Urban Institute.

While the executive order spells out few details, it calls for the removal of “unnecessary barriers” to private contracting, which allows patients and doctors to negotiate their own deals outside of Medicare. It’s an approach long supported by some conservatives, but critics fear it would lead to higher costs for patients. The order also seeks to ease rules that affect beneficiaries who want to opt-out of the hospital portion of Medicare, known as Part A.

Both ideas have a long history, with proponents and opponents duking it out since at least 1997, even spawning a tongue-in-cheek legislative proposal that year titled, in part, the “Buck Naked Act.” More on that later.

“For a long time, people who don’t want or don’t like the idea of social insurance have been trying to find ways to opt-out of Medicare and doctors have been trying to find a way to opt-out of Medicare payment,” said Timothy Jost, emeritus professor at Washington and Lee University School of Law in Virginia.

The specifics will not emerge until the Department of Health and Human Services writes the rules to implement the executive order, which could take six months or longer. In the meantime, here are a few things you should know about the possible Medicare changes.

What are the current rules about what doctors can charge in Medicare?

Right now, the vast majority of physicians agree to accept what Medicare pays them and not charge patients for the rest of the bill, a practice known as balance billing. Physicians (and hospitals) have complained that Medicare doesn’t pay enough, but most participate anyway. Still, there is wiggle room.

Medicare limits balance billing. Physicians can charge patients the difference between their bill and what Medicare allows, but those charges are limited to 9.25% above Medicare’s regular rates. But partly because of the paperwork hassles for all involved, only a small percentage of doctors choose this option.

Alternatively, physicians can “opt-out” of Medicare and charge whatever they want. But they can’t change their mind and try to get Medicare payments again for at least two years. Fewer than 1%of the nation’s physicians have currently opted out.

What would the executive order change?

That’s hard to know.

“It could mean a lot of things,” said Joseph Antos at the American Enterprise Institute, including possibly letting seniors make a contract with an individual doctor or buy into something that isn’t traditional Medicare or the current private Medicare Advantage program. “Exactly what that looks like is not so obvious.”

Others said eventual rules might result in lifting the 9.25% cap on the amount doctors can balance-bill some patients. Or the rules around fully “opting out” of Medicare might ease so physicians would not have to divorce themselves from the program or could stay in for some patients, but not others. That could leave some patients liable for the entire bill, which might lead to confusion among Medicare beneficiaries, critics of such a plan suggest.

The result may be that “it opens the door to surprise medical billing if people sign a contract with a doctor without realizing what they’re doing,” said Jost.

Would patients get a bigger choice in physicians?

Proponents say allowing for more private contracts between patients and doctors would encourage doctors to accept more Medicare patients, partly because they could get higher payments. That was one argument made by supporters of several House and Senate bills in 2015 that included direct-contracting provisions. All failed, as did an earlier effort in the late 1990s backed by then-Sen. Jon Kyl (R-Ariz.), who argued such contracting would give seniors more freedom to select doctors.

Then-Rep. Pete Stark (D-Calif.) opposed such direct contracting, arguing that patients had less power in negotiations than doctors. To make that point, he introduced the “No Private Contracts To Be Negotiated When the Patient Is Buck Naked Act of 1997.”

The bill was designed to illustrate how uneven the playing field is by prohibiting the discussion of or signing of private contracts at any time when “the patient is buck naked and the doctor is fully clothed (and conversely, to protect the rights of doctors, when the patient is fully clothed and the doctor is naked).” It, too, failed to pass.

Still, the current executive order might help counter a trend that “more physicians today are not taking new Medicare patients,” said Robert Moffit, a senior fellow at the Heritage Foundation, a conservative think tank based in Washington, D.C.

It also might encourage boutique practices that operate outside of Medicare and are accessible primarily to the wealthy, said David Lipschutz, associate director of the Center for Medicare Advocacy.

“It is both a gift to the industry and to those beneficiaries who are well off,” he said. “It has questionable utility to the rest of us.”

Elizabeth Warren Has Many Plans, But on Health Care, She’s ‘With Bernie’

Sahil Kaput noted that Elizabeth Warren has a plan for everything — but on the crucial 2020 issue of health care, she’s borrowing from a rival and fellow progressive — Bernie Sanders.

The presidential candidate who made a mark with her signature “I have a plan for that!” is the only one of the five top-polling Democrats without a sweeping proposal of her own to remake the health care system. She has instead championed Sanders’ legislation to replace private insurance by putting every American in an expanded Medicare program.

“I’m with Bernie on Medicare for All,” Warren said recently in New Hampshire when asked if she’d devise a blueprint of her own. “Health care is a basic human right. We need to make sure that everybody is covered at the lowest possible cost, and draining money out for health insurance companies to make a lot of profits, by saying no.”

Warren’s deference to a rival is unusual for a candidate who has styled herself as the policy wonk with a program for everything from cradle to grave. It has allowed her to attract many liberal voters who supported Sanders in 2016, leading her to a dead heat with former vice president Joe Biden for the top spot in the Democratic field. And if Sanders were to eventually drop out of the race before Warren, her embrace of his most popular plan could keep his supporters in her camp.

Sean McElwee, a left-wing activist, and researcher with Data For Progress said that Warren cannot afford to go soft on Medicare for All.

“It’s the best option for the campaign to stay in alignment with Sanders on health care through the general election,” he said. “These Sanders voters have the highest risk of voting third party or staying home, and you have to keep them mobilized.”

Weeks before Warren, a Massachusetts senator, announced that she was exploring a presidential run last December, she sounded less wedded to the Sanders proposal, describing a three-step approach to health care.

“Our first job is to defend the Affordable Care Act. Our second is to improve it and make changes, for example to families’ vulnerability to the impact of high-priced drugs,” she told Bloomberg News. “And the third is to find a system of Medicare available to all that will increase the quality of care while it decreases the cost of all of us.”

As Warren was rising in the polls, her allies began to pick up signals that Sanders supporters were questioning her commitment to progressive ideas. Since June, Warren has given them little ammunition to claim she’s going soft on Medicare for All, a defining issue for many left-wing voters.

“The biggest concern Warren has from the left is this idea that, at the end of the day, Sanders is the one true progressive,” McElwee said. “If your main issue is Medicare for All, and that’s a central tenet of your politics, Warren probably can’t win you. But she doesn’t want you to hate her. She wants to be your fallback option.”

At the same time, Warren faces attacks from Biden for supporting a plan that would replace Obamacare, which Democrats bitterly fought for in 2009 and 2010. “The senator says she’s for Bernie. Well, I’m for Barack,” the former vice president said in the third Democratic debate in September. “I think Obamacare worked.”

Biden’s plan would build out Obamacare and have a public option for those who want it.

Health care consistently ranks as the top issue for Democratic voters. Government-run health care is popular among Democrats and Americans overall, but that support dips once voters are given the arguments against it, including that it would require higher middle-class taxes and abolish employer-sponsored coverage.

Medicare for All, which lay at the heart of Sanders’ stronger-than-expected 2016 campaign, has become a litmus test for some progressive activists and voters. To them, it indicates a candidate’s belief in universal health care and willingness to take on private insurers who they say are gouging consumers for profit.

In Los Angeles on Friday, Warren was asked if her health care vision would raise middle-class taxes. She evaded the question and said working families would see their overall medical costs reduced, referring to the end of premiums and out-of-pocket expenses. “The very wealthy and big corporations will see their costs go up, but middle-class families will see their costs go down,” she said.

Surveys show that Sanders voters clearly prefer Warren as their second choice. But it doesn’t cut both ways — Warren’s supporters are more split among Sanders, Biden and Kamala Harris as their second choice.

Mary Anne Marsh, a Democratic consultant based in Boston, said that if Warren believes Sanders has the best plan, she has to “be all in on it — and if she’s got elements of her own to put in it, she needs to do that.”

The Sanders health care plan tracks with the “big structural change” Warren has called for, a message that also appeals to mainstream Democrats who backed Hillary Clinton in 2016. Maintaining that cross-section of support is critical to Warren’s path to the nomination. Biden is dominating with moderate and conservative Democrats, some of whom worry that running on Medicare for All will cost Democrats the general election.

“By supporting Bernie Sanders’ health care plan, Elizabeth Warren improves the chances of Bernie Sanders voters supporting her if she’s the nominee, thereby avoiding some for the heartburn Bernie gave Clinton and her supporters all the way through Election Day,” Marsh said.

A voter at her event in Keene, New Hampshire, asked Warren how she would handle the transition from private insurance to a government-run system.

“What we’ve got on Medicare for All is a framework,” she said. “And it doesn’t have the details, and you’re right to be antsy.”

To contact the reporter on this story: Sahil Kapur in Washington at skapur39@bloomberg.net

To contact the editors responsible for this story: Wendy Benjaminson at wbenjaminson@bloomberg.net, John Harney

Pete Buttigieg explains why he’s against Medicare for All

As reported by Adriana Belmont, Mayor Pete Buttigieg stands apart from other Democratic presidential candidates when it comes to health care policy. Unlike frontrunners Sens. Bernie Sanders (I-VT) and Elizabeth Warren (D-Mass.), he does not support for Medicare for All, but rather an alternative.

“I am a candidate who believes Medicare for All is not as attractive as Medicare for All Who Want It,” Buttigieg said at The New Yorker Festival. “Because it gives people a choice.”

Through Buttigieg’s plan, everyone would automatically be involved in universal health care coverage for those who are eligible. It would also expand premium subsidies for low-income individuals, cap out-of-pocket costs for seniors on Medicare, and limit what health care providers charge for out-of-network care at double what Medicare pays for the same service. However, those who still want to stay on private insurance can do so.

When asked whether or not this is a matter of “having your cake and eating it too,” Buttigieg responded: “Why not?”

“This is how public alternatives work,” Buttigieg said. “They create a public alternative that the private sector is then forced to compete with.”

This differs from other candidates like Sanders and Warren, both vocal supporters of a single-payer health system. Sanders has even gone so far as to call for the elimination of private insurance companies. Buttigieg, however, sees his plan as an opportunity for private insurance companies to step up.

“The way I come at it is with a certain humility about what’s going to happen,” Buttigieg said. “Because one of two things will happen. Either, there’s really no private option that’s as good as the public one we’re going to create … which means pretty soon everyone migrates to it and pretty soon it’s Medicare for all.”

“Or, some private plans are still better, in which case we’re going to be really glad we didn’t command the American people to abandon them whether they want to or not,” Buttigieg said. “I’m neutral on which one of those outcomes happen.”

According to Politico, although there is no official cost for what Medicare for All Who Want It would cost, a campaign adviser said the federal spending would “be in the ballpark” of $790 billion.

“The core principle is not whether or not the government is your health insurance provider,” Buttigieg said. “The core principle for me is you get covered one way or the other. That’s what Medicare for All Who Want It entails.”

Bernie Sanders admits he was ‘dumb’ for ignoring symptoms ahead of heart attack

Sen. Bernie Sanders (I-Vt.) is turning his heart attack into a PSA.

The 2020 candidate was hospitalized last week with what his doctors later said was a heart attack, leading Sanders to suspend his campaign events and a forthcoming Iowa ad buy. Sanders hasn’t said if he’ll resume campaigning before the Oct. 15 primary debate, but he does have a universally agreeable message in the meantime.

Sanders gave a health update at his home on Tuesday, telling reporters he was on his way to meet with a new cardiologist. “I must confess, I was dumb,” he said. Despite being “born” with “a lot of energy” and usually handling multiple rallies a day without a problem, “in the last month or two,” Sanders said he’d been “more fatigued than I usually have been.” “I should’ve listened to those symptoms,” Sanders continued, and then advised listeners to do the same “when you’re hurting when you’re fatigued when you have pain in your chest.”

Bernie Sanders is meeting a cardiologist this morning. A new doctor he has not met with before. Before he left he told reporters that he was “dumb” and should’ve listened to the warning signs his body was sending him prior to his heart attack.

Sanders first tied his hospitalization to his campaign in a tweet last week expressing his thanks for “well wishes,” “great doctors,” and “good health care.” “No one should fear going bankrupt” if they experience a medical emergency, he continued, and added in a call for “Medicare for All!”

What a dumb comment but it seems to follow how dumb Bernie is to neglect his heart disease however, he is telling us all about health care. And remember that Bernie has Congressional Blue Cross Blue Shield health care insurance, the best in the world!