Biden’s costly failure to stop Medicare privatization experiment in Ohio: Maximilian Brockwell and James Tyler Moore

Published: Feb. 16, 2022, 5:38 a.m.

https://www.cleveland.com/opinion/2022/02/bidens-costly-failure-to-stop-medicare-privatization-experiment-in-ohio-maximilian-brockwell-and-james-tyler-moore.html

Maximilian Brockwell and James Tyler Moore are first-year medical students at Northeast Ohio Medical University. Both serve on the leadership board for the local chapter of Students for a National Health Program.

ROOTSTOWN, Ohio — On Jan. 19, President Joe Biden spoke to a press conference touting the accomplishments of his first year in office, praising his administration’s COVID-19 response and approach toward health care policy. Conveniently, he failed to mention one glaring issue that will affect more than 2.4 million aging and vulnerable Ohioans — he has spent an entire year squandering the opportunity to protect them from a dangerous Donald Trump-era plan to privatize Medicare.

The pilot program, which began to roll out in 2021, introduces private companies known as “direct contracting entities” (DCEs) as middlemen between the Medicare program and health care providers. This experimental model currently spans 38 states, including Ohio. On paper, the rationale is to reduce cost by spreading financial responsibility between the government and third parties. However, under the false guise of risk-sharing, private groups can siphon massive amounts of cash away from seniors to line their own pockets.

Watchdog organizations are raising alarms about the myriad ways DCEs can take advantage of the system. DCEs would negotiate with hospitals and physician groups, and if successful, will automatically switch patients to this new insurance plan without informed consent. While there is an option to opt out after the fact, the opaque process will add to an already confusing maze of hurdles seniors must navigate to access necessary medical care. It may also lead to many patients being forced to find new physicians if they don’t want to participate.

The amount of funds distributed to a DCE is determined by the “risk scores” of their patients, a value estimating a person’s cost of care. This naturally incentivizes a trick called “upcoding,” which is a process where providers are pressured to use diagnoses with higher risk scores and thus higher levels of reimbursement. The companies then keep the difference between their allowance from Medicare and the true cost of treatment. Financial analysis has shown that just a 0.1-point increase in risk scores across the Medicare population would lead to overpayments nationwide in the range of $15 billion, including $3.5 billion in profits for the middlemen.

Perhaps unsurprisingly, more than half of DCEs already approved to participate are owned by private investors, including hedge funds with little experience in health care. Their goal is simple: increase profit margins. Efficiency will be an afterthought in this overcomplicated system, and the autonomy of Medicare patients across the country will be caught in the crosshairs.

All of this is happening under the watch of the Centers for Medicare & Medicaid Services, the federal body that oversees Medicare under the direction of the executive branch, independent of congressional oversight. The buck stops with Joe Biden, and so far, he has failed to act to prevent this private takeover of Medicare coverage.

In his Jan. 19 remarks, Biden boasted that, “We cut health insurance premiums for millions of American families,” yet Medicare premiums and deductibles are both set to increase by nearly 15% in 2022. It is hard to see how allowing the program to be taken over by Wall Street investors could have any alleviating effect on its potentially massive cost to the country or to individual beneficiaries.

Thousands of concerned health care professionals have joined together to halt this program through petitions and letter writing. There is still time for citizens’ voices to be heard, and for Biden to act, while the program is still in its infancy. Before Ohio taxpayers’ money is wasted and their right to choose their own Medicare coverage has been stripped, Biden should walk the walk of health care reform by doing the right thing and protecting Medicare recipients, not the legacy of Trump, or the profits of the middlemen.

The Need for Democratization in Healthcare Reform

Written by SNaHP member Edward Si

The one key political prerequisite required to bring about healthcare reform in the United States is to reform politics itself and make it more democratic. Polls conducted by the Pew Research Center show that 63% of Americans favor a single payer system while a poll from the Hill shows 69% support. Even if there is a margin of error of around 13% or 19% respectively, this still demonstrates popular support for universal healthcare. 

The problem is that the United States is not a direct democracy. The closest thing we have to direct democracy in America is our presidential elections, but those are still not examples of direct democracy because the candidate with fewer votes can still win. In addition, unlike other countries, America does not hold national referendums in which the electorate votes “yes” or “no” on a single issue. Sure, some states have statewide referendums, but the referendum does not exist at the federal level. Perhaps a single payer system could work at the state level, but I believe the state would also need power to negotiate healthcare related costs.

Instead we have a flawed representative democracy that does not necessarily respond to the will of the people. People in congressional districts vote for a representative to Congress, but it is easy to gerrymander these districts to force a certain outcome. The two party system makes it so single-issue voters are forced to choose the party whose other policies they may not support (or likewise voters shun a party because the party has a few values they do not like). To top it all off, some representatives do not represent the interest of the people who voted for them in the first place. Instead they represent the lobbyist hired by the multi-billion dollar industry (healthcare included) who donated to their aligned super PACs. It goes without saying that the majority of people are not multi-billion dollar corporations and cannot match their influence.

It is fair to say that America is not a true democracy and was not intended by the Founding Fathers to be one. However, I believe most of our politicians and citizens will enthusiastically claim that America is indeed a democracy whether or not they understand the fine print.

It is clear that the road to healthcare reform is shared and preceded by political reform as well.
The two go hand in hand. Somewhere along the line it will be necessary to break the stranglehold that corporations have on politics and/or introduce a pass legislation to make our system more responsive to the people. Ultimately those who support healthcare reform should also support greater democratization of our political system.

 

source: https://www.pewresearch.org/fact-tank/2020/09/29/increasing-share-of-americans-favor-a-single-government-program-to-provide-health-care-coverage/

https://thehill.com/hilltv/what-americas-thinking/494602-poll-69-percent-of-voters-support-medicare-for-all

ACTION ALERT: Join SNaHP’s Invite-a-Friend Campaign to Recruit Allied Professions

To achieve #singlepayer, we need allied stakeholders across the health professions.

SNaHP is expanding its membership to health professions students in cognate fields — and we need your help! If you haven’t already, we encourage you to mention SNaHP to your friends in public health, policy, management, nursing, and physician assistant programs. Invite them to join SNaHP and follow the SNaHP National Facebook and Twitter pages!

Student membership to SNaHP is free. Members hear first about organizational news and are notified about upcoming events planned by regional chapters.

Has your chapter held any events or activities for new members lately? We want to know! Post or tweet pictures and updates so that our new members can make connections as we advocate together for #singlepayer!

Webinar – SNaHP COVID-19 Virtual Event April 13

Hi SNaHPers!

In the midst of this pandemic many of us are wondering:

How can I help?

What went wrong with the US response to COVID-19?

Would Medicare for All help and how?

What can I do with my free time to advocate?

To answer these questions and provide a space for community discussion on what is going on, Students for a National Health Program (SNaHP) will be hosting a virtual event titled Student Advocacy During a Pandemic: Our Country’s Response to COVID-19 and What We Can Do to Help on Monday, April 13th at 8:00pm ET.

This event will feature:

  • Rachel Madley, SNaHP Education and Development committee co-chair and PNHP-NY Metro Fellow – COVID-19 responses around the world and within in the US 
  • Dr. Miriam Laugesen, Associate Professor Mailman School of Public Health, Columbia University and Thomas Jackson, former SNaHP Political Advocacy committee co-chair – US Public Health Response to COVID-19
  • Dr. Susan Rogers, PNHP President-Elect – COVID-19’s exposure of socioeconomic inequality and health injustice in this country
  • Ashley Duhon, SNaHP Executive Board member – COVID-19’s effect on reproductive healthcare 
  • Ashley Lewis, SNaHP Political Advocacy committee co-chair – Next steps and how to advocate virtually 

Please RSVP here. Zoom meeting details will be sent out on the day of the event to all attendees who RSVP. 

Don’t forget to share this event with your networks, all are welcome!

Updated Information: SNaHP Summit 2020

We are excited to welcome you to the 2020 SNaHP Summit on Saturday, February 15 at the the University of Colorado Anschutz Medical School in Aurora, Colo. (near Denver). Our theme, “Making it to the Mountaintop,” means that SNaHP is moving full speed ahead into this next decade.

Online registration has closed, but on-site registration will be available Saturday, February 15 starting at 8:00 a.m.

Keynote

Our keynote this year is PNHP President-Elect Dr. Susan Rogers

Agenda

You can find the SNaHP Summit agenda HERE with the speaker’s list HERE. Note that in order to save paper, we will not be providing paper copies at the Summit. Instead, you will be able to scan the QR codes with your phone at the registration desk.

Map

A map of the school can be found HERE. We will be in the Ed2 North building, with meals being served in the “bridge.” We will have a light breakfast and boxed lunch available for attendees. And coffee. All the coffee.

Dress code

Come as you are. If you feel comfortable in jeans, do that. If you feel comfortable in dress slacks, do that. 

Article for non-POC meet up

We will host separate breakout sessions for POC and non-POC SNaHPers. If you plan on attending the non-POC meet-up, please read this article in advance to be fully prepared for discussion.

Out-of-town students

Students who are flying in may want to share a ride with other students. Please take a look at our ride-share spreadsheet to connect with other students and coordinate ride-sharing.


The scholarship window is now closed. There will be no assigned student housing this year. Instead, scholarship recipients will be given a housing stipend, which they can use at any location of their choice. The stipend will reflect general lodging prices in Aurora. Students can group up and coordinate to split housing costs using THIS spreadsheet. If you are having trouble finding a housing buddy, please reach out to organizer@pnhp.org and we can assist you.

ACTION ALERT: The A.M.A. must support Medicare for All!

22618981510_ffc09880af_zOn June 8, 2019, at 1:30 PM CST, students, physicians, nurses, allied health care workers, and activists from around the country will unite in Chicago to protest the annual meeting of the American Medical Association (A.M.A.).

Representatives of a rapidly growing coalition of Medicare for All supporters, including National Nurses United, Students for a National Health Program, Physicians for a National Health Program, People’s Action, Public Citizen, The Center for Popular Democracy, The Jane Addams Senior Caucus, various labor unions, teachers, activists, and more, will be taking a stand AGAINST corporate greed, misleading advertising, and the profit motive in health care.

And FOR a system that guarantees quality health care and choice of provider for all Americans, regardless of income.

The action recalls similar campaigns waged throughout the 1960s in which members of the African-American-led National Medical Association, the Medical Committee for Human Rights and the Poor People’s Campaign picketed the A.M.A.’s annual meetings because of its refusal to take a stand against segregated medical services and for allowing local medical societies to discriminate against physicians and patients of color.

When we join together, we can send a powerful message to the A.M.A. and corporate medicine that we won’t stop until every American is guaranteed quality medical care without going into debt or bankruptcy.

Everybody in, nobody out!

Read more about the action against the A.M.A. at https://www.wearethewaym4a.org/

Our elected officials must support Medicare for All

This article was published in The Lens. You can read the original article here.

“Our healthcare system is rotten to the core, and half-measures and meager reforms won’t cut it.”

PNHP demoIn late February, Seattle-area U.S. Rep. Pramila Jayapal, introduced a “Medicare for All” bill in Congress that immediately attracted more than 100 Democratic co-sponsors. The legislation, if passed, would provide comprehensive healthcare coverage — medical, dental, prescriptions, long-term care, mental health, and more — to every resident in the United States, with no copays, premiums, or deductibles.

Medicare for All is a wildly popular policy. Recent polls show that 70 percent of Americans support Medicare for All, including 85 percent of Democrats and 52 percent of Republicans.

Why, then, has our Representative Cedric Richmond not  co-sponsored his fellow Democrat’s bill, one that saves working families money and guarantees healthcare security to every single person in America?

Perhaps he fears that Medicare for All is too pie-in-the-sky. Comprehensive, universal coverage? How could we afford something so extravagant? One estimate from Senator Bernie Sanders’ office calculated that through a combination of progressive income taxes, capital gains and dividends taxes, and limits on tax deductions for the wealthy, we could raise $1.8 trillion over 10 years without needing to raise taxes on the middle and working class.

There are also significant savings associated with transitioning to a Medicare for All program, due to decreased administrative costs and the federal government’s ability to negotiate drug prices. Consequently, even a study from a libertarian think tank, the Mercatus Center, showed that Medicare for All would ultimately save trillions of dollars. Meanwhile, the average family of four with employer-sponsored insurance spent $28,166 on health insurance in 2018. Medicare for All would likely save the average working person thousands of dollars per year by eliminating co-pays, deductibles, and premiums.

Or perhaps Richmond doesn’t want to rock the boat? Isn’t the American healthcare system the envy of the world? But the reality is that we are already spending more money than any other industrialized nation — about double what other rich countries spend per capita — and still achieving worse outcomes.

The U.S. spends a fifth of our GDP on healthcare costs, yet our maternal mortality rate continues to rise, even as the global maternal mortality rate falls. Over the last few years, the rate of congenital syphilis — a completely preventable and debilitating illness — has more than doubled. In Louisiana, Black women are four times more likely to die in childbirth than white women.

Although universal healthcare coverage is not a panacea, it would at least ensure that there are no gaps in coverage during a person’s lifetime, greatly increasing the likelihood that new mothers would receive timely prenatal care.

Perhaps Richmond’s worried about longer wait times, or perhaps he fears that transitioning to Medicare for All will lead to rationing of care. But the reality is that we are already rationing care: patients with money or excellent insurance can get seen quickly, while the rest of us have to wait.

Perhaps Richmond thinks we simply don’t need Medicare for All. After all, thanks to the expansion of Medicaid, hundreds of thousands of Louisianans gained coverage. But currently, 11.4 percent of Louisianans live without health insurance. And for those with insurance, instead of comprehensive care that’s free at the point of service, as Medicare for All would be, insurance companies deliver high premiums, deductibles, copays and denials of service.

Health justice activists have been fighting for universal coverage for decades. Now, in part due to a powerful national coalition formed between National Nurses United, the Democratic Socialists of America, and several other organizations, we are closer than ever before to making this a reality.

Our local New Orleans chapter of the DSA — an organization that has almost 60,000 dues-paying members nationally and hundreds locally — has been building a campaign to demand Medicare for All. We’ve been canvassing our neighborhoods, tabling at public events, organizing community health fairs, and pressuring our politicians. Most importantly, we’ve been listening to the community’s healthcare horror stories. We, the people of New Orleans, are in dire need of better healthcare, and Medicare for All is the only policy tool that can make that happen.

We’ve talked to people who waited weeks to see a specialist because there are so few physicians who accept Medicaid insurance. We’ve spoken with neighbors who paid thousands of dollars in medical bills even though they had insurance. We’ve met people who are afraid to go to the doctor at all — they’re afraid of what they might find and what it might cost. The Medicare for All legislation put forward by Jayapal is sorely needed to correct the inadequacies and failures of our nation’s healthcare system.

Other politicians have also proposed solutions, but they all fall short. Presidential candidate Beto O’Rourke, a former congressman, has spoken in support of the Medicare for America Act, but this program wouldn’t provide universal coverage, and it doesn’t eliminate co-pays, premiums, or deductibles. (Note how the name similarity of “Medicare for All” and “Medicare for America” allows politicians to capitalize on Medicare for All’s popularity by using the #M4A hashtag.)

By retaining private insurance alongside public insurance, Medicare for America would simply perpetuate the tiered, hierarchical system we have now. A crucial aspect of the Medicare for All plan is that it brings everyone together under the same health plan, thus moving us towards a future where everyone has access to the same, high-quality care.

Other approaches, such as the “public option,” which allows individuals to buy into the Medicaid or Medicare programs, have been shown to be deeply ineffective. In 2013, the Congressional Budget Office (CBO) reported that this approach would have “minimal impacts” on the number of uninsured Americans.

Our healthcare system is rotten to the core, and half-measures and meager reforms won’t cut it. We need to pursue radical transformation and effect real change. Right now, we have the political opportunity to do so.

Consistently, when we are talking to our fellow constituents in Richmond’s district, we hear the same refrain: of course we want this, of course we need this, how is it possible that our congressman doesn’t support this?

Soon, for the first time in U.S. history, legislation on the implementation of a single-payer healthcare system will be heard before congressional committees. These hearings will be great opportunities to show Louisianans how transformative a Medicare for All program would be.

Richmond has voiced tentative support for the bill, but we need him to turn that talk into action: we need him to co-sponsor this legislation. As the former head of the Congressional Black Caucus, Richmond is a leader on Capitol Hill. We need his leadership on healthcare. Otherwise, his constituents will continue to endure substandard care, to be driven into medical bankruptcy, and to die of preventable illnesses.

If Richmond truly believes that all Louisianans, no matter their income or their age or their medical history, deserve comprehensive healthcare, he will co-sponsor the Medicare for All Act and champion it in the halls of Congress. If he chooses not to do that, we hope he’ll tell us: which of his constituents does he believe should go without healthcare?

FracesGillFrances Gill is a medical student and co-chair of the Health Care Committee in the New Orleans chapter of the Democratic Socialists of America. The DSA is a national organization with chapters in New Orleans and Baton Rouge. Email healthcare@dsaneworleans.org for more information.

ACTION ALERT: Justice for the police shooting of Stephanie Washington!

SNAHP IconOn Tuesday, April 16th 2019, an Officer of the Yale Police Department fired his weapon during a motor vehicle stop, and the unarmed passenger, Stephanie Washington, was shot and injured. Her life is permanently changed by the trauma she experienced this day at the hands of the police.

The members of Students for a National Health Program know that health is more than just access to a doctor. Health is freedom from all forms of oppression and violence. To this end, we condemn acts of police brutality and stand in solidarity with Stephanie Washington, New Haven Black Lives Matter, and all others affected by this issue.

Join us in supporting Yale SNaHP students demanding that the Yale Police Department and the officer involved be held accountable for the shooting of Stephanie Washington.

Please sign this petition demanding reform from the Yale Police Department in light of these events: https://forms.gle/SK846Lj3nGT88f2XA

Private health insurance is harmful to your health

The following commentary was published in the Syracuse Post-Standard by local members of Students for a National Health Program and Physicians for a National Health Program at SUNY Upstate Medical University: Dr. Sunny Aslam, assistant professor of psychiatry; Robertha Barnes, MS/MD student; Sydney Russell Leed, MD/MPH student; Kunfeng Sun, MS3; Mike Vidal, MS/MD student; Azwade Rahman, MD/MPH student; Ella Cappello, MS2.

“The profit motive of corporations does not lend itself to caring for the sickest among us..”

hands-699486_1920At the Martin Luther King Day Health Justice Conference at Upstate Medical University, the keynote speaker stated, “Politics is nothing more than medicine but on a societal level.” Her figurative use of the word “medicine” means that elected officials have the responsibility to diagnose and treat issues that affect their communities. As current and future health care providers, we have the duty to do what is best for each patient, and more broadly, to speak up for legislation that can improve the health of all our patients. Because governmental policies have the power to affect the medical outcomes of our patients, it makes sense for us to speak up in support of the New York Health Act (NYHA) and Medicare for All.

Today, every candidate for the 2020 presidential election (including the current president) is talking about health care, and specifically the role that private insurance should have in American health care. The private health insurance industry has had more than half a century to lower costs and improve outcomes, but it has failed miserably, resulting in tens of thousands of premature deaths each year. The profit motive of corporations does not lend itself to caring for the sickest among us, as insurance companies only profit when people are healthy, or when care is denied. The sickest patients often end up on government plans due to job loss, affordability, medical bankruptcy, poverty and expiration of coverage. Physicians know that the administrative burden of confirming coverage, submitting claims and filling out forms for multiple insurers contributes to delays in care and time away from patients.

With the newly elected New York state Assembly and Senate, patients and doctors see the possibility of change with the New York Health Act (NYHA). However, the powerful private insurance industry is pressuring newly elected state officials, many of whom ran on a pro-NYHA platform, to include some role for private insurers. As we’ve learned over the past 50 years, private insurance won’t work to lower costs and guarantee access. In fact, the more privatized health care is, the higher the cost. We as current and future health care providers support the NYHA because it will get us back to the relationship between a physician and the patient, without insurance bureaucrats in between.

Single-payer opponents most often cite the 2018 RAND study to claim the NYHA will increase taxes and amount to a “government takeover” of health care, but the study also predicts that most New Yorkers would pay less under the NYHA. Families would no longer pay an average of $28,000 per year for a private plan covering a family of four. Instead of workers and employers paying premiums to a private insurance company, all state residents would be covered with no co-pays, deductibles, co-insurance, or premiums. Medical bankruptcy would be a thing of the past. Opponents who scream about increased taxes don’t point out that the NYHA will reduce overall costs for almost every family. Unlike private insurance plans, with their narrow “networks” of approved providers, the NYHA would provide more choice, as all doctors and hospitals would be “in-network”; treatments would be determined by patients and doctors, not an insurance company motivated by profit.

Many say we can’t afford universal health care, but we are already paying for it. The U.S. spends nearly 20 percent of our gross domestic product on health care, roughly double the per capita rate of high-income countries with national health plans. Yet we have the shortest life expectancy and higher infant and maternal mortality rates. With the money saved by drastically reducing administrative costs from private insurers and negotiating down prescription drug prices and other supplies, we can cover all Americans without breaking the bank. Access to primary and preventative care will save even more money and lives over the long run.

One of our members works with homeless men and women at local shelters. Many of these patients require urgent examinations for addiction and psychiatric illness, but insurance companies require “prior authorization” before we can see the patient at all. This treatment is often life-saving as well as money-saving, since otherwise the patient will end up with an expensive trip to the emergency room. More importantly, delays in care for mental health and substance abuse can result in death.

It’s time to end the needless suffering and death, medical bankruptcies and endless paperwork imposed by private insurance. We hope Gov. Andrew Cuomo and our state legislators pass the NYHA. It’s the only way to cover all those who live in New York, save money and save lives.