Reason #4 to Fix Our Democracy - To enact a healthcare system whereby all 330+ million of we the people can receive high quality health care at the lowest system-wide cost #FixOurDemocracyPodcasts #HealthcareforAll
**NOTES:**Congressional Budget Office, Working Paper 2020-08, December 2020, How CBO Analyzes the Costs of Proposals for Single-Payer Health Care Systems That Are Based on Medicare’s Fee-for-Service Program Link: https://www.cbo.gov/system/files/2020-12/56811-Single-Payer.pdf (See pages 121 and 122.)
Congressional Budget Office, Working Paper 2020-08, December 2020 Exhibit 11-1, p. 121, National Health Expenditures Under Current Law and CBO’s Illustrative Single-Payer Options, 2030. Link: https://www.cbo.gov/system/files/2020-12/56811-Single-Payer.pdf
Health Affairs Blog, 2021-2-16, Doctors Adam Gaffney, David Himmelstein and Steffie Woolhandler, Congressional Budget Office Scores Medicare-For-All: Universal Coverage For Less Spending. Link:
https://pnhp.org/news/congressional-budget-office-scores-medicare-for-all-universal-coverage-for-less-spending/
Centers for Disease Control and Prevention, May 16, 2023 - U.S. Uninsured Rate Dropped 18% During Pandemic. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2023/202305.htm - ::text=Highlights from the report include,or 3.7 million in 2019.:text=Forty-three percent of working,to health care (23%25).
The Commonwealth Fund, Surveys, September 29th, 2022. The State of US Health Insurance in 2022. https://www.commonwealthfund.org/publications/issue-briefs/2022/sep/state-us-health-insurance-2022-biennial-survey - :
US Census Bureau, Health Insurance Coverage in the United States: 2021
Written by: Katherine Keisler-Starkey and Lisa N. Bunch, Report Number P60-278, Dated: September 13, 2022 Link: https://www.census.gov/library/publications/2022/demo/p60-278.html
2021-3-11 Health Affairs Blog - Medicare Advantage For All? Not So Fast, Exhibit 1: Medicare Advantage enrollment rates over time. Link: https://www.healthaffairs.org/do/10.1377/hblog20210304.136304/full/
Dr. Ana Malinow, MD Past President of Physicians for a National Health Program (PNHP) video presentation explaining Direct Contract Entities.
Link: https://pnhp.org/direct-contracting-entities-handing-traditional-medicare-to-wall-street
2021-9-29 Health Affairs Blog, Gilfillan and Berwick - Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine,’ Part 1: The Risk-Score Game, How the “MA Money Machine Works.” Link: https://www.healthaffairs.org/do/10.1377/hblog20210927.6239/full/
2021-9-30 Health Affairs Blog, Gilfillan and Berwick - Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine,’ Part 2: Link: https://www.healthaffairs.org/content/forefront/medicare-advantage-direct-contracting-and-medicare-money-machine-part-2-building-aco
2021-8-17 Kaiser Family Foundation - Higher and Faster Growing Spending Per Medicare Advantage Enrollee Adds to Medicare’s Solvency and Affordability Challenges. Findings-Spending per person. Link: https://www.kff.org/medicare/issue-brief/higher-and-faster-growing-spending-per-medicare-advantage-enrollee-adds-to-medicares-solvency-and-affordability-challenges/
2021-3-11 Health Affairs Blog - Medicare Advantage For All? Not So Fast, Exhibit 4: Medicare per beneficiary growth rate. Link: https://www.healthaffairs.org/do/10.1377/hblog20210304.136304/full/
2021-8-17 Kaiser Family Foundation - Higher and Faster Growing Spending Per Medicare Advantage Enrollee Adds to Medicare’s Solvency and Affordability Challenges. - Conclusion. Link: https://www.kff.org/medicare/issue-brief/higher-and-faster-growing-spending-per-medicare-advantage-enrollee-adds-to-medicares-solvency-and-affordability-challenges/
Reason #4 to Fix Our Democracy - To enact a healthcare system whereby we the people can receive high quality health care at the lowest system-wide cost
Hello. I’m Rick Hubbard and this is the fourth in a series of podcasts about our need to fix America’s poorly functioning representative democracy. This podcast series is titled “Reasons to Fix Our Democracy,” and each podcast will highlight “another reason to fix our democracy”.
Today’s reason is to ensure those who represent us, establish and support a health care system that provides high quality healthcare to all 330+ million of us at the lowest, system wide total cost, in a manner that is financially and socially sustainable into the future.
Are you aware that our elected representatives in Congress currently have a study available that can make high quality healthcare available for all 330+ million Americans in a much more cost efficient way? It gains huge cost savings and efficiency by funneling all premiums through a single entity that would have much more power and leverage to provide health care at lower cost.
The study, done by the Congressional Budget Office and released about four years ago, concludes that for the most expensive (meaning - the highest and best for Americans) care level of five alternatives, we could do so at an added cost in the federal budget in 2030 of $290 billion a year.
Think of that. For an increased cost of less than 1/10th of 1 percent of forecast GDP of about 35 trillion dollars in 2030 we can provide good quality healthcare for all 330+ million of us with what amounts to only a 4 percent increase out of about $7 billion of total national health expenditures then.
Compare the above against continuing with our present system.
Our present system costs we the people more money per person, leaves over 27 million of us without any health insurance, plus almost 70 million more working age Americans without adequate insurance, is the biggest cause of personal bankruptcy in America, and is funneling profits from providing us with healthcare to an ever-smaller number of the increasingly wealthiest amongst us.
The Congressional Budget Office thinks the main exception to providing health care to all of us is that about 2 million of the roughly 10 million U.S. residents not lawfully present in the country in 2030 would be entitled to enroll but wouldn’t enroll because of fears about providing information to the federal government. Substantially more than 99 percent of all U.S. residents would be able to get high quality health care.
Additional Economic Benefits Not Included in the CBO Analysis
In addition to the economic effects shown in the CBO analysis, there would very likely be multiple sources of additional economic gains.
When the Covid-19 pandemic hit, almost every one of us, in all states, would have been able to immediately obtain healthcare advice and treatment.
Thus, many more of us would have gotten treatment, fewer would have been as sick or died, and all of those who were not as sick or didn’t die would have been able to continue to work, earn money for themselves and their families, and contribute to America’s economy.
All of us who have deferred getting care because of the high cost, would have been able to seek care, get treatment, get problems with our knees, hips, shoulders and more addressed.
All those helped, would then enjoy a more active lifestyle and most would have been better able to work, earn money for themselves and their families, and contribute to America’s economy.
Americans would live longer on average, and this, in addition to other obvious advantages, would or could increase their lifetime income and contribute to America’s economy.
Employers would have a more stable workforce as absenteeism should drop since more people would be able to seek and get treatment for their medical problems. With more healthier people, employers should find a larger pool of potential workers when filling jobs.
It is fair for Congress to examine the assumptions and facts in this study.
But if the conclusions hold under strict analysis, to serve our public interests Congress should move to implement in both law and policy a healthcare system whereby we the people can receive high quality health care at the lowest system-wide cost.
But with a huge positive result like this for so little extra money, wouldn’t we expect Congress and the Center for Medicare and Medicaid Innovation to be all over this?
But we would be wrong.
Instead, a majority of those who represent us in Congress have set us on a different, more expensive, and more damaging healthcare path. One that actually undermines the health and savings of we the people.
Here’s how.
Buried deep in Obamacare, the Affordable Care Act of 2010, Congress established a new Innovation department, also known as “CMMI,” the Center for Medicare and Medicaid Innovation, and charged it to develop and test new healthcare payment and service delivery models like Medicare Advantage and ACO Reach with the goal of
— Improving patient care.
— Lowering costs, and
— Better aligning payment systems to promote patient-centered practices
Congress further authorized CMMI to then roll out these new programs to the entire US population without further authorization by Congress, though Congress could, if it chose, provide oversight.
The bottom line? Each new program costs MORE money per average person than is paid for those of us enrolled in traditional Medicare with a supplement program.
That’s right. More money per person.
And this current path has the full backing of both our current administration in Washington as well as the previous one.
That extra money paid by the Center for Medicaid Services to these new private entities is paid by us. We are the ones who first paid it to our government in our healthcare payments and taxes.
None of this properly lines up with Congress and the current administration creating a healthcare system whereby we the people can receive high quality health care at the lowest system-wide cost.
Plus, there is more bad news.
Beware, additional dirty secrets underlie these new Medicare Advantage and ACO Reach programs.
You might ask yourself:
How can a Medicare advantage program make money when it advertises its premiums to be 30 to 40% less than a traditional supplement program with Medicare? In addition to lower premiums, they advertise extra benefits, for eye, ear, and more.
How can they take in less revenue from enrollees and offer extra benefits, and still make more money than they would under traditional Medicare with a supplement program?
The answer to this has two parts:
Part 1–The majority of their increased revenue is due to up-coding - changing your original diagnosis into a more severe one, that will allow your new insuring entity to receive more money as reimbursement for treatment of your now even more severe up-coded diagnosis.
Part 2–A smaller part of their increased revenue is due to subtly encouraging (i.e., driving out) many of their sickest and most expensive enrollees, via increased premiums, increased co-pays, increased deductibles, and such devices as requiring prior authorization for many expensive, but medically necessary new procedures.
There is a fine line between legitimate up-coding and fraud. This line is aggressively crossed by many of the biggest Medicare Advantage and ACO REACH entities. United healthcare, for example, has paid hundreds of millions of dollars in fines.
These companies can be, and sometimes are, audited by CMS, but the auditing program resources are insufficient in relation to the scale of the problem they are trying to detect.
The result is that gains from up-coding fraudulently exceed the cost of fines and penalties. Plus, no CEOs are being prosecuted and going to jail for doing this. So, there is no disincentive to continuing such behavior. These fines are considered by management to be simply a cost of doing business.
Wall Street is salivating over this. I have seen it described as the largest short-term revenue growth opportunity of any US industry. This by a company that creates algorithms for the up-coding.
Perhaps you are aware that when we citizens enter traditional Medicare within the government, it doesn’t matter whether we are sick or not. We are accepted, based on the average health risk of the entire population of people entering Medicare.
But are you aware of the often-unexplained trap that exists if you actually get really sick after you have left Medicare, or been forced out of Medicare and into a Medicare Advantage or an ACO Reach program without any action or permission on your part?
When you suddenly become severely ill and then run into huge, unexpected costs from increased premiums, deductibles, co-pays, lack of access to the best specialty care centers, plus fights over denial of newly required prior approvals, you might want to return to original Medicare and a supplement program where everything was much more predictable and less expensive.
Here’s the trap. If you can be re-enrolled in Medicare and a supplement program at all, your premium is now going to be based not on the health of an average individual, like when you first enrolled in Medicare, but instead, for example, as a full-blown stage 4 breast cancer victim, and therefore subject to much higher premiums, deductibles and co-pays than if you had simply stayed within the original Medicare and supplementary insurance program in the first place.
Now, knowing that our elected representatives in Congress currently have available a study that, shows Congress and our Executive branch could provide high quality Medicare for all 330 million of us at the highest i.e., most expensive, level at relatively little extra cost in 2030, ask yourself a simple question.
What does any of the behavior described above by Congress and both present and past administrations have to do with properly representing our public interests?
How does this serve the common good of all Americans and our nation?
The answer. It clearly doesn’t. The majority of our representatives in Congress, together with the highest officials in our present administration, are not properly doing the job we have elected them to do, and they are breaking the oath they took to support and defend the Constitution of the United States, to “promote the general welfare” “freely, without any mental reservation or purpose of evasion” and to “well and faithfully discharge” their duties as a member of Congress.
Now we have one more reason to fix our democracy - to obtain a healthcare system whereby we the people receive high quality health care at the lowest system-wide cost.
So friends, it’s time to DO something about this. Go to my website, FixOurDemocracy.us to sign up, and to find supporting state groups. Write your Congressperson and let them know how the system should be reformed. Participate in parades. Carry signs to “Fix Our Democracy.” The road is long, but we can and must fix our representative democracy.
NOTES:
Congressional Budget Office, Working Paper 2020-08, December 2020, How CBO Analyzes the Costs of Proposals for Single-Payer Health Care Systems That Are Based on Medicare’s Fee-for-Service Program Link: https://www.cbo.gov/system/files/2020-12/56811-Single-Payer.pdf (See pages 121 and 122.)
Congressional Budget Office, Working Paper 2020-08, December 2020 Exhibit 11-1, p. 121, National Health Expenditures Under Current Law and CBO’s Illustrative Single-Payer Options, 2030. Link: https://www.cbo.gov/system/files/2020-12/56811-Single-Payer.pdf
Health Affairs Blog, 2021-2-16, Doctors Adam Gaffney, David Himmelstein and Steffie Woolhandler, Congressional Budget Office Scores Medicare-For-All: Universal Coverage For Less Spending. Link:
https://pnhp.org/news/congressional-budget-office-scores-medicare-for-all-universal-coverage-for-less-spending/
Centers for Disease Control and Prevention, May 16, 2023 - U.S. Uninsured Rate Dropped 18% During Pandemic. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2023/202305.htm - ::text=Highlights from the report include,or 3.7 million in 2019.:text=Forty-three percent of working,to health care (23%25).
The Commonwealth Fund, Surveys, September 29th, 2022. The State of US Health Insurance in 2022. https://www.commonwealthfund.org/publications/issue-briefs/2022/sep/state-us-health-insurance-2022-biennial-survey - :
US Census Bureau, Health Insurance Coverage in the United States: 2021
Written by: Katherine Keisler-Starkey and Lisa N. Bunch, Report Number P60-278, Dated: September 13, 2022 Link: https://www.census.gov/library/publications/2022/demo/p60-278.html
2021-3-11 Health Affairs Blog - Medicare Advantage For All? Not So Fast, Exhibit 1: Medicare Advantage enrollment rates over time. Link: https://www.healthaffairs.org/do/10.1377/hblog20210304.136304/full/
Dr. Ana Malinow, MD Past President of Physicians for a National Health Program (PNHP) video presentation explaining Direct Contract Entities.
Link: https://pnhp.org/direct-contracting-entities-handing-traditional-medicare-to-wall-street
2021-9-29 Health Affairs Blog, Gilfillan and Berwick - Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine,’ Part 1: The Risk-Score Game, How the “MA Money Machine Works.” Link: https://www.healthaffairs.org/do/10.1377/hblog20210927.6239/full/
2021-9-30 Health Affairs Blog, Gilfillan and Berwick - Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine,’ Part 2: Link: https://www.healthaffairs.org/content/forefront/medicare-advantage-direct-contracting-and-medicare-money-machine-part-2-building-aco
2021-8-17 Kaiser Family Foundation - Higher and Faster Growing Spending Per Medicare Advantage Enrollee Adds to Medicare’s Solvency and Affordability Challenges. Findings-Spending per person. Link: https://www.kff.org/medicare/issue-brief/higher-and-faster-growing-spending-per-medicare-advantage-enrollee-adds-to-medicares-solvency-and-affordability-challenges/
2021-3-11 Health Affairs Blog - Medicare Advantage For All? Not So Fast, Exhibit 4: Medicare per beneficiary growth rate. Link: https://www.healthaffairs.org/do/10.1377/hblog20210304.136304/full/
2021-8-17 Kaiser Family Foundation - Higher and Faster Growing Spending Per Medicare Advantage Enrollee Adds to Medicare’s Solvency and Affordability Challenges. - Conclusion. Link: https://www.kff.org/medicare/issue-brief/higher-and-faster-growing-spending-per-medicare-advantage-enrollee-adds-to-medicares-solvency-and-affordability-challenges/