Health Care Reform

August 13, 2019

Would workers really be sad if health insurers didn’t grab a third of their pay?

With the 2020 presidential campaign obsessing early about health insurance rather than costly health care overall, voters may wish to reframe their thinking about coverage and candidates’ views on making it affordable. Their chief query may need to be this: Just how much of the vig should the bagman take?

That may be a blunt a way to put it, but is the vernacular of the criminal “protection” racket all that out of place here? Michael Hiltzik, a financial columnist for the Los Angeles Times, makes pretty much the same argument, that the bagman’s share ought to be zero. Why not get rid of health insurers, he asks in a bit of evidence-based hyperbole? He finds the companies don’t fulfill much of a public mission, save, as a former insurance executive describes it, to make themselves money and to persuade all of us that they are essential. Indeed, as Hiltzik sees it, insurers are not just a rip-off but a failure in their own terms:

“Let’s start by examining what the insurers say are their positive contributions to healthcare. They claim to promote ‘consumer choice,’ simplify ‘the health care experience for individuals and families,’ address ‘the burden of chronic disease,’ and harness ‘data and technology to drive quality, efficiency, and consumer satisfaction.’ (These claims all come from the website of the industry’s lobbying organization, America’s Health Insurance Plans (AHIP). They’ve achieved none of these goals. The increasingly prevalent mode of health coverage in the group and individual markets is the narrow network, which shrinks the roster of doctors and hospitals available to enrollees without heavy surcharges. The hoops that customers and providers often must jump through to get claims paid impose costly complexity on the system, not simplicity. Programs to manage chronic diseases remain rare, and the real threat to patients with those conditions was lack of access to insurance (until the Affordable Care Act made such exclusion illegal). Private insurers don’t do nearly as well as Medicare in holding down costs, in part because the more they pay hospitals and doctors, the more they can charge in premiums and the more money flows to their bottom lines. They haven’t shown notable skill in managing chronic diseases or bringing pro-consumer innovations to the table.”

July 16, 2019

Will GOP attack on Obamacare foil good plans to better kidney disease care?

by Patrick A. Malone

More than 37 million Americans who suffer from chronic kidney disease soon may see big changes in the way their disabling condition gets treated, potentially also reducing the $100 billion that the federal Medicare program pays for care of the body’s crucial blood cleaning organs.

President Trump issued an executive order calling on the federal government to use all means possible to attack kidney disease in three key ways:

Reduce the number of patients who suffer from kidney failure;

July 3, 2019

Suffering of rural poor a reminder of how much health policy debates matter

by Patrick A. Malone

Twenty Democrats who are campaigning for president took to network television for four hours and two nights last week to put health care as a central issue of their campaigns.

The format of this initial candidate “debate,” including hand-raised answers to complex issues, failed to allow the presidential aspirants to delve much into the details of their proposals. But tons of news coverage followed on — and likely will keep doing so up until Americans enter the voting booth — about Medicare, the government health coverage for seniors, and how it might be expanded to benefit tens of millions more. Those interested may wish to check out this podcast primer on the issue.

These future-looking discussions also already have tended to eclipse a key part of the existing Affordable Care Act, the Obama Administration initiative that remains a subject of hot dispute a decade after its passage: The expansion of Medicaid, the federal program to assist the poor and working poor with health coverage.

June 24, 2019

With 2020 race kicking into next gear, voters have lots to ponder on health care

by Patrick A. Malone

Starting this week in Miami, 20 Democrats over the course of two nights will try to make the case that they deserve to be elected President. Now what will they and Republicans have to say about health care, which voters have declared a troubling issue that’s on the top of their minds?

In recent weeks, the current administration and members of the GOP could not have made clearer that Medicaid, Medicare, and, of course, the Affordable Care Act will be major matters to tussle over, still. Is health care a fundamental right or a privilege? Should the government assist the poor, working poor, and middle class with more affordable health care? Plenty of recent developments with federal social safety net programs will give politicians much to talk with voters about, including:

In Arkansas, a GOP-embraced notion — that the elderly, disabled, chronically ill, and children, as well as others who get health care help through the federal Medicaid program also should work for their benefits or prove they cannot work — has flopped, as opponents warned it would. Instead, Harvard researchers found that Draconian measures requiring Medicaid recipients to repeatedly prove they could not work, were seeking employment, or had some kind of jobs “caused thousands of poor adults to lose coverage without any evidence the target population gained jobs,” the Kaiser Health News service reported. KHN’s article said, “the Harvard study is the first to provide evidence that the [Medicaid policy] change left [program participants] uninsured and did not promote employment. The results, based on a telephone survey of about 3,000 low-income adults in Arkansas, concluded that the law befuddled enrollees and that its mandatory reporting requirements led many to unnecessarily lose coverage.”

June 11, 2019

Faith-based charity as the answer to crushing medical debt? Only in America.

by Patrick A. Malone

Praise be: Churches nationwide are leaping in with their congregations’ blessing and financial support, putting up small sums to buy up and wipe out one of the huge shames of the American health care system: patients’ medical debt.

The faithful work with RIP Medical Debt, a nonprofit organization based in Rye, N.Y., that provides the know-how to many kinds of donors to help eliminate bills that can crush patients and their loved ones for a lifetime, the Kaiser Health News service reported. Roxie Hammill wrote how this all works in modern medicine:

May 16, 2019

Hospitals rip employer health plans with prices up to 3 times what Uncle Sam pays

by Patrick A. Malone

Big businesses, which beat on their employees to be more cost-conscious, efficient, and productive, may need to take a page out of their own books if they hope to better control the soaring health care costs that they’re also shoving off onto their workers.

That’s a key takeaway from new research by the independent, nonprofit RAND Corporation into prices paid in 25 states to 70 hospital systems by job-provided health insurers in 2017. They provide coverage for most Americans, more than 180 million of us, and RAND found that private employer-sponsored health plans paid hospitals on average twice or even three times as much as Uncle Sam did through the Medicare program for the same services at the same hospitals.

Hospitals bellyache about tight-fisted Medicare prices that Uncle Sam can negotiate due to big dollars and huge number of patients covered under its senior health care plan. Although hospitals call the government-negotiated prices too low and an unfair benchmark, they provide realistic insights into hospitals’ bottom-line charges in what is one of the biggest areas of Americans’ health care costs. As RAND researcher Christopher Whaley told Modern Healthcare, an industry-covering news organization:

May 10, 2019

Modern medicine may be great at making money but not at making sense

by Patrick A. Malone

Spending’s askew when billions go for unproven surgical robots while lack of affordable care leads thousands of poor, black, and brown patients to need diabetic amputations

If U.S. health care leaders look ahead to 2020 and wonder why their sector of the economy will be one of the key concerns of presidential candidates and voters, they can only blame themselves for allowing the public to conclude that the industry’s big money and big profit drives have gone haywire.

How unbalanced have the nation’s health care priorities become that, on the one hand, surgeons and hospitals keep pushing to spend billions of dollars more for robotic surgeries that doctors themselves are doubting, while, on the other hand, researchers blame economic and racial disparities for playing a big role in requiring tens of thousands of patients — especially those who are black and brown and poor — to undergo diabetic amputations?

April 17, 2019

Cost of medical billing soars to half a trillion dollars—and half may be wasted

by Patrick A. Malone

When patients battle with the desperate extremes of a disease like a fast-spreading cancer, it isn’t just the radiation and chemo therapies that sap their spirits, there’s a demoralizing runner-up concern: The constant battling with doctors, hospitals, and insurers over medical bills.

Medical billing and insurance-related costs are so over the top that they pile up a half-trillion-dollars a year in burdensome administrative costs — half of which is excessive and wasteful, according to new research from the Center for American Progress, a left-leaning think tank.

The center reviewed past studies of administrative costs in U.S. health care, seeking to address criticisms of their methods and conclusions. Still, the new findings raise points that may stagger patients, policy makers, and politicians, say Emily Gee, a health economist for the group, and Topher Spiro, its vice president for Health Policy and a senior economic fellow.

April 7, 2019

Politicians disconnect from good sense, even as U.S. health care worries soar

by Patrick A. Malone

When it comes to something as crucial as health care, let’s keep it simple: Americans deserve better than this …

Can President Trump keep up his barrage of counter-factual assertions and political reverses on federal help for those needing health insurance, a key part of the Affordable Care Act? After resurrecting in federal courts the decade-long debacle of Republican efforts to kill Obamacare—including its protections for preexisting conditions—Trump flipped yet again. He heard an earful from party leaders that they have no way to cover tens of millions who would lose their health insurance if the ACA gets tossed out by courts, and he apparently awoke to the reality that the GOP can’t eliminate the law when Democrats control the House. So, the president then insisted that the GOP, after failing to do so for years, would present a better alternative and enact it, repealing Obamacare, too—at some time after the 2020 elections. If Republicans win back the House, keep control of the Senate, and he is reelected.
Even as the president asserted the GOP’s superiority in health care policy, the Los Angeles Times and the Philadelphia Inquire reported that a key element of Trumpcare is bringing back consumer nightmares. Patients initially might like the short-term health insurance plans the administration has pushed as an ACA alternative. Officials have relaxed rules on them so they can last longer than the few months permitted under Obamacare. The plans may carry lower monthly premiums. But they come with skimpy benefits. Which consumers are rediscovering. They’re getting sick and hoping to rely on short-term policies, only to find they owe doctors and hospitals thousands of dollars—but their insurance won’t help them with a penny.

April 4, 2019

As GOP keeps slashing at health coverage, big strains of caregiving ignored

by Patrick A. Malone

Americans have real reason to fear a health care catastrophe: If loved ones suffer major injury or illness, who will feed, bathe, and care for them 24/7 after they get out of the hospital and recuperate at home? Who will take time off from work to set up and take them to unending and long medical appointments? Who will wait for and get all the pills and devices they need?

The nation has been locked in a decade-long battle over health insurance that helps cover medical costs, but caregiving, a crucial part of the social safety net, gets short shrift, writes Aaron E. Carroll, a professor of pediatrics and health research and policy expert at Indiana University School of Medicine. As Carroll noted in a timely and personal column for the New York Times “Upshot” feature:

Americans spend so much time debating so many aspects of health care, including insurance and access. Almost none of that covers the actual impossibility and hardship faced by the many millions of friends and family members who are caregivers. It’s hugely disrupting and expensive. There’s no system for it. It’s a gaping hole.