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

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

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

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

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

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

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

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

Affordable Care Act funding in question after health insurance taxes repealed

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

There were more questions that had people Googling in 2019.

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

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

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

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

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

US Health-Care Prices Are Off the Charts, Pros and Cons of Public vs Private healthcare and possible Financing of Medicare for All

After listening to the debates and the House debating and finally voting to approve the Articles of Impeachment I can actually say that I am embarrassed for we Americas and our Country. We all look like such fools! I say this because I have read critically the transcripts of the phone call that President Trump made to the President of Ukraine, listened to the witnesses in the case and have found no credible data to support an Impeachment. But how can one argue with the Hate of the party that lost the 2016 election? But on to discuss additional information on healthcare.

Michael Rainey of the Fuscal Times reported that a CT scan of the abdomen typically costs more than $1,000 in the U.S., but the same procedure in the U.K. costs $470, while in the Netherlands it costs just $140. Those numbers come from a new report, released Tuesday by the Health Care Cost Institute and the International Federation of Health Plans, that compares private insurance health-care prices in the U.S. to those in a sample of other wealthy countries – and finds that the U.S. is just about always the most expensive.

“The median prices paid by private insurance for health care services in the United States was almost always higher than the median prices in the eight other countries included in the iFHP study,” the report says. “Figure 1 [below] shows the prices paid for medical services in each country as a percent of the US price.”

Note that U.S. prices are marked by the red dots. In almost every case, the prices in other countries are just a fraction of the U.S. price. (Avoid getting cataract surgery in New Zealand, apparently.) 

The report also looks at drug prices, and finds that with only one exception, prices in the U.S. are the highest in the group. Harvoni, used to treat hepatitis C, costs $4,840 in South Africa and $12,780 in the Netherlands, but it costs more than twice that ($31,620) in the U.S. Similarly, a Humira pen, used to treat arthritis, costs $860 in the U.K., but $4,480 in the U.S.

“Drug prices for most countries were less than half the US price for most of the administered and prescription drugs included in the study,” the report says.

Writing about the report Tuesday, Vox’s Dylan Scott said that high medical prices in the U.S. have many causes, but one in particular stands out: “The US is still the wealthiest country in the world. It’s home to the world’s leading biopharmaceutical industry. It tends to have the most cutting-edge treatments. All this contributes to higher prices here than elsewhere. But one big and unavoidable culprit is the lack of price regulation.”

American health care is a farce

Rick Newman reported that the cost of private health insurance is skyrocketing. Medicare will run short of money soon. About 28 million Americans still lack health insurance.

Are your elected officials on it? NOPE! Why should they be. They get generous coverage through a choice of plans and enjoy taxpayer subsidies covering most of the cost. So they’ve taken care of themselves, which is the only thing that matters in Washington.

Wait, that’s not quite correct. Republicans are also determined to keep hacking away at the Affordable Care Act, now in place for 9 years. A GOP lawsuit—backed by the Trump administration—claims the entire ACA is unconstitutional, because in 2017 Congress repealed the penalty for people who lack insurance. It’s a convoluted argument, yet an appeals court recently upheld part of the case and sent the rest back to a lower-court judge, to assess which other parts of the ACA to kill. The law isn’t dead yet, and it might ultimately survive, but it could take the Supreme Court to rescue the ACA from its third or fourth near-death experience.

So here’s the story: There’s a health care crisis in the United States, with millions of people lacking care and many millions more facing costs that are rising far faster than their incomes. Health care costs are devouring both the family and the federal budget. And many workers stay in jobs they’re not suited for simply for the health benefits. Yet Republicans are trying to take care away from about 18 million Americans, and repeal the ACA’s prohibition against denying coverage to people with preexisting coverage. Their answer to giant problems of access and affordability is to make coverage even harder to obtain and drive up costs even more.

The Democrats have answers! Presidential candidates Bernie Sanders and Elizabeth Warren want to annihilate the private insurance system and create a government program, Medicare for All, which would be 15 times larger than the ACA Republicans hate so much. Sure, that’ll work. In response to obstinate political opposition, peddle a fantasy plan that generates even more furious resistance. And tell voters you refuse to compromise because it’s more important to stand for the right thing than to actually accomplish something that could improve people’s lives.

There are better ideas out there. Democrats such as Joe Biden, Pete Buttigieg and Amy Klobuchar favor enhancements to the ACA and a new public option that would provide coverage to nearly all the uninsured while leaving private insurance in place, for those who want to stick with that. It will never get Republican support, since Republicans favor the law of the jungle over government aid. But a Bidenesque plan could happen in the unlikely event a few reddish states grow momentarily sensible and elect a few pragmatic Democrats, including a majority in both the House and Senate.

If that doesn’t happen, we can look forward to posturing on both sides that will fool some voters into thinking politicians care, without accomplishing anything likely to help. The Trump administration is pushing a new plan that would allow states to import prescription drugs from Canada, which enforces price controls that make drugs cheaper. Great idea, as long as Canada has no problem diverting drugs meant for Canadians back to America, where many of the drugs come from in the first place. Why doesn’t America just impose its own price controls? Because pharmaceutical companies own Senate Majority Leader Mitch McConnell and many other members of Congress, who won’t let it happen. So Trump is hoping more principled Canadian legislators will help Americans gets cheaper drugs made in America by American companies.

At least you’ll be free of all these worries once you turn 65, and Medicare kicks in. Except Medicare is going to run short of money starting in 2026, and will eventually be able to pay only about 77% of its obligations. So here’s the real health care plan: Don’t get sick until you turn 65, and then, get just 77% as sick as you would have otherwise. Or just move to Canada.

Pros and cons of private, public healthcare

A study by Flinders University found that the rising cost of private health cover and public hospital standards raise concerns among heart patients to obtain the best outcomes.

In one of the few direct comparisons, medical researchers in South Australia have analyzed data from pacemaker and defibrillator implant surgeries in all public and private hospitals in New South Wales and Queensland between 2010 and 2015 to make an assessment of medical safety outcomes, including infection levels and mortality.

Overall the outcomes were quite similar, says lead researcher Flinders cardiologist and electrophysiologist Associate Professor Anand Ganesan, who joined other Flinders University and University of Adelaide researchers in a new article just published in the Royal Australasian College of Physicians Internal Medicine Journal.

“There is growing community interest in the value of private health insurance and, to date, there are few head-to-head studies of the outcomes of care in public and private hospitals to compare the same service with adjustments for differences in patient characteristics,” says Associate Professor Ganesan, a Matthew Flinders Research Fellow and National Heart Foundation Future Leader Fellow.

“We believe our results are of community interest for patients to assess the value and benefit of private health insurance, as well as for policymakers who decide on resource allocations between the public and private healthcare systems.”

He stressed that further “head-to-head” studies are needed across all major medical procedures to provide patients and clinicians in both the public and private system with the most up-to-date safety information.

The population level study of pacemaker complications found few key differences in overall major safety issues, although there were slightly higher infection rates in public hospitals but slightly lower acute mortality rates compared to the private hospital system.

This could be connected to the greater number of older, frail patients relying on private health cover—and greater number of people in the public system—although further studies were needed to explain these differences.

Associate Professor Ganesan says more regular comparative assessments of public versus private hospital care quality are very important, particularly for Australian health consumers.

Australia’s hospitals account for more than 40% of healthcare spending with a cumulative cost exceeding $60 billion per annum. Hospital care in Australia is delivered by a combination of 695 public (or 62,000 beds) and 630 private sector hospitals (33,100 beds).

The research paper, “Complications of cardiac implantable electronic device placement in public and private hospitals” has been published in the Internal Medicine Journal.

Budget watchdog group outlines ‘Medicare for All’ financing options

So, one of my oppositions to the program Medicare for All has been the question as to financing the program. The Committee for a Responsible Federal Budget (CRFB) on Monday released a paper providing its preliminary estimates for various ways to finance “Medicare for All,” as the issue of how to pay for such a health plan has taken center stage in the Democratic presidential primary.

“Policymakers have a number of options available to finance the $30 trillion cost of Medicare for All, but each option would come with its own set of trade-offs,” the budget watchdog group wrote. 

The issue of how to pay for Medicare for All — single-payer health care that eliminates premiums and deductibles — has become a key discussion topic in the Democratic presidential race.

Sen. Elizabeth Warren (D-Mass.), one of the top tier 2020 hopefuls, recently said that she would release a financing plan for her Medicare for All proposal after being criticized by some of her rivals in the primary race for refusing to give a direct answer about whether she’d raise taxes on the middle class to pay for the massive health care overhaul. 

CRFB said most estimates find that implementing Medicare for All would cost the federal government about $30 trillion over 10 years.

“How this cost is financed would have considerable distributional, economic, and policy implications,” the group wrote.

CRFB provided several options that each could raise the revenue needed to pay for Medicare for All. These included a 32 percent payroll tax, a 25 percent surtax on income above the standard-deduction amount, a 42 percent value-added tax, mandatory premiums averaging $7,500 per capita, and more than doubling all individual and corporate tax rates.

The group estimated that Medicare for All could not be fully financed just by raising taxes on the wealthy.

CRFB also estimated that cutting all nonhealth spending by 80 percent, or by more than doubling the national debt, so that it increased to 205 percent of gross domestic product, could finance Medicare for All.

The group said that the financing options it listed could be combined, or that policymakers could reduce the cost of Medicare for All by making it less generous.

“Adopting smaller versions of several policies may prove more viable than adopting any one policy in full,” CRFB wrote. 

CRFB said that most of the financing options it listed would on average be more progressive than current law, but most of the financing options would also shrink the economy.

Out-of-pocket costs for Medicare recipients will rise in the New Year

Dennis Thompson reviewed the future costs of Medicare since the Democratic primary discussion seems to point to Medicare or All. He noted that the standard monthly premium for Medicare Part B would rise $9.10, to $144 a month, the U.S. Centers for Medicare and Medicaid Services (CMS) announced.

The annual deductible for Part B also will increase $13 to $198 per year, CMS said.

Both increases are relatively large compared to 2019, when the Part B premium rose $1.50 a month and the deductible $2 for the year.

“This year there’s an unusual tick up in the Part B premium that could be a real concern for people living on a fixed income,” said Tricia Neuman, director of the Henry J. Kaiser Family Foundation’s Program on Medicare Policy.

The Part B premium increase will affect people enrolled in original Medicare as well as those who are covered under Medicare Advantage, said David Lipschutz, associate director of the Center for Medicare Advocacy.

“One thing I definitely wanted to make clear is that the increase in the Part B premium itself also applies to everyone on Medicare Advantage,” he said. “People on Medicare Advantage have to continue to pay the part B premium.”

Some, but not all, Medicare Advantage plans cover the Part B premium as part of their package, Lipschutz added.

The annual inpatient hospital deductible for Medicare Part A is also increasing to $1,408 a year, up $44. In 2019, the increase was $24.

These cost increases will wipe out much of the 1.6% cost-of-living (COLA) increase for Social Security benefits in 2020, CBS News reported. The COLA amounts to about $24 extra a month for the average retiree.

Medicare Part A covers inpatient hospital stays, nursing facility care and some home health care services. Part B covers doctor visits, outpatient hospital treatment, durable medical equipment, and certain home health care and medical services not covered by Part A.

Unless Congress acts, the prescription benefit in Medicare Part D also will start drawing a lot more money out of the pockets of seniors taking pricey drugs, the experts added.

The Affordable Care Act (ACA) included a provision that limited how much a senior with Part D would pay out-of-pocket after reaching a “catastrophic coverage” threshold, Neuman and Lipschutz said.

Once they reach that threshold, seniors pay 5% of their prescription costs. Until then, they pay 25% of the costs for brand-name drugs and 37% of generic drug costs.

But that ACA provision expires this year. When that happens, the catastrophic coverage threshold will jump $1,250, the Kaiser Family Foundation estimates. People will have to pay $6,350 out-of-pocket before reaching the threshold.

“There will be a jump up in the threshold, which means that people with high drug spending will have to pay more before they can get this extra help,” Neuman said.

Both the Senate and the House of Representatives have bills in the works that could address this Part D increase, but it’s hard to predict whether Congress will be able to cooperate on a solution, Neuman and Lipschutz said.

“No matter what your allegiances are, everyone agrees something should be done about the high cost of prescription drugs,” Lipschutz said.

It’s not all bad news, however.

Folks with Medicare Advantage are expected to pay lower premiums, even with the increase in Part B, according to the CMS.

On average, Medicare Advantage premiums are expected be at their lowest in the past 13 years, and 23% lower than in 2018, the CMS said.

Medicare Advantage enrollees also will have more plans to choose from. The Kaiser Family Foundation estimates that the average beneficiary will have access to 28 plans, compared with a low of 18 in 2014.

Original Medicare is the traditional fee-for-service program offered by the federal government, while Medicare Advantage plans are an alternative provided through private insurance companies.

Medicare beneficiaries spent an estimated $5,460 out-of-pocket for health care in 2016, according to the Kaiser Family Foundation. About 58% went to medical and long-term care services, with the remainder spent on premiums for Medicare and supplemental insurance.

So, the ultimate question is :

Equal health care for all: A philosopher’s answer to a political question

The University of Pennsylvania staff asked the question-Should access to health care, especially in life-threatening situations, depend on whether you can afford it? Absolutely not, says Robert C. Hughes, Wharton professor of legal studies and business ethics, who compared health care systems in the U.K., Canada, and Australia. He writes about this question and other issues in a recent paper titled, “Egalitarian Provision of Necessary Medical Treatment.”

Hughes identifies two key features of an egalitarian health care system. First, he argues, it would protect people’s liberty to ensure that access to money does not decide if people get the health care they need. Second, it would promote stability and encourage people to be law abiding. “The central finding of [my research] is that it’s morally necessary to make sure that people’s finances don’t affect their ability to get truly medically necessary treatment,” he says.

Hughes favors universal health care coverage in the U.S. Further, in order to ensure that everybody has access to the medical care they need, he says one option is to eliminate private health insurance for coverage provided under “Medicare for All,” the solution that Democratic presidential candidates Elizabeth Warren and Bernie Sanders have proposed. Hughes explores what legislators, the pharmaceutical industry, and other health care providers could do to ensure a fair health care system where private parties don’t get to decide who is eligible for what treatments.

I mentioned my embarrassment and disappointment in our political system we all have to give thanks for all the good things in our lives. As Christmas approaches we all should reflect on the good in our lives and enjoy the Holiday including family and friends. Merry Christmas, Happy Hanukkah, and Happy Kwanzaa! And I hope Santa leaves coal in all the stockings of our politicians who can’t even do the job that we the voters asked them to do when we voted them in. Oh, how you are making a mockery of the system in the games that you all are playing!

I have been avoiding the discussion regarding single payer system, what it is, how it would work and what are the consequences, etc.? More to come! 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Disgraceful fearmongering

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

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

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

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

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

‘Medicare for All’ would be worse

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

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

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

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

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

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

Sunday Deadline Looms For Affordable Care Act Open Enrollment

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

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

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

December 15 is the deadline to shop for 2020 plans.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rare Dip in Healthcare’s Share of GDP in 2018

CMS report shows growth in spending on physician services fell slightly

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

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

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

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

Growth in Spending on Physicians Declines

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

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

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

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

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

Private Insurance Enrollment Down

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

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

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

Home Healthcare Spending Up

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

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

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

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

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

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

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

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

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

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

Who could possibly object to all that free care?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rural hospital acquisitions may reduce patient services

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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!!