Five years ago, the late, famed health care economics scholar, Uwe Reinhardt, wrote the following about what he called "the illogic of employer sponsored health insurance,"

Imagine yourself in a bar where a pickpocket takes money out of your wallet and with it buys you a glass of chardonnay. Although you would have preferred a pinot noir, you decide not to look that gift horse in the mouth and thank the stranger profusely for the kindness, assuming he paid for it. You might feel differently, of course, if you knew that you actually had paid for it yourself.

A New Day Brings New Scrutiny To Workplace Health Plans

Last month, an article by Drew Altman, titled, For low-income people, employer health coverage is worse than ACA, explored workplace health insurance affordability issues for low wage workers and workers with chronic illnesses. Altman writes:

We tend to think of everyone with employer coverage as one big group, but it’s really lower wage workers — and, while it’s a different subject, also people with major illnesses — who take it on the chin in the current private health insurance system. They are also the group with employer coverage who would benefit the most from a Medicare-for-All style plan.

The bottom line: Employer-based coverage is by far the largest source of health insurance, and it now provides the least financial protection for lower income workers who need it most.

Altman gets to the heart of the matter when he writes, "We debate affordability in the ACA marketplaces a lot, but we don’t talk about this far larger problem much, if at all."

A week after Altman's article, a report from The Foundation for Research on Equal Opportunity (FREOPP)—a public policy think tank co-founded by Obamacare critic, Avik Roy, designated employer sponsored health insurance as the worst form of private health insurance in the country in terms of underlying cost, sustainability, freedom of choice, and consumer-driven incentives. Worse than individually purchased health insurance, federal employees health benefits, and Medicare Advantage—the country’s other private health insurance programs.

No More Hiding

Tags: Medicaid For All, universal health care, employer sponsored health insurance

No one could read the statistics about our broken health care system and walk away thinking it just needs a few tweaks. But that's exactly what the marketing and public relations arms of the health care industry status quo wants us to think. The campaign to push back on Medicare For All (M4A), Medicare Buy-In, and any kind of universal health care program that competes with the for-profit health care system is in full swing. What these ads lack in originality they make up for in gall. But if history is any guide, millions of health care consumers will fall for the health care status quo's economic propaganda.

Health Care Industry Anti-Medicare For All Ads Are Pathetic

Social and other media outlets are currently awash in anti-Medicare For All ads, funded by health care organizations and other businesses.

The Partnership for America's Health Care Future (P4AHCF), recently sent out a tweet warning of a future of high prices, low quality, and fewer health plan choices under Medicare For All. (Someone should tell them that the future is now.)

Between the higher price tag, the lower quality care, and the loss of choice and employer-provided coverage, a “one-size-fits-all health care solution” is hardly a solution at all. Learn more → https://t.co/Z5Z50kYzm0 pic.twitter.com/JEHK0bKqJU

— Partnership for America's Health Care Future (@P4AHCF) February 25, 2019

I finally agree with what health care policy writers have been saying for months—An American Medicaid or Medicare For All program may be imminent. I reach this conclusion not because of the recent failure by the Republican-majority Senate to repeal and replace the Affordable Care Act (aka Obamacare), but due to the comments of many doctors following this failure. Medical providers sense the change in attitudes away from a for-profit, insurance company driven health care system, and they want to make sure that their role is safe from public backlash and government changes.

And to make it clear on where they stand on this impending new health care world, they are reviving their objections to the “provider” label. Although decades old, doctors hate the provider label now more than ever. They find the use of the term condescending because it links them with other medical care professionals like nurses and physician assistants—people not at their level of expertise. But the primary reason many doctors dislike being called “providers” is that they see it as a “commoditization of the doctor-patient relationship” and now you’re messing with their money.

Commoditization refers to the process by which goods become so similar that their only distinguishing characteristic becomes price. The development of tablets and smartphones are an example of commoditization. They all have the same or similar features like touch screen and syncing with other devices, etc. And even though I prefer Apple products and give the company credit for pioneering much of the technology now available on other devices, I know that I could accomplish pretty much the same tasks with a non-Apple tablet, phone or computer and at a much lower cost.

Apple is not afraid of commoditization; it expects and thrives in this type of environment. It sees the competition as good for customers because it pushes the company to innovate more. Doctors, on the other hand, hate the idea of commoditized health care. They don’t want to compete on service or price. In fact, the real reason doctors and hospitals don’t want electronic medical records or to publish their prices has nothing to do with costs but because they are afraid a competitor will “steal” their patients if they had access to this data. And, of course, doctors think that their product (health care services) is unique

To date, we have protected doctors and hospitals from real competition and allowed them to charge whatever they want for their services. A Medicaid or Medicare For All single payer health care system that includes electronic medical records and price transparency will force doctors and hospitals to compete on price. This type of system is good for the public because it’s one of the few ways, other than forced price reductions, to make health care affordable. Doctors and hospitals won’t like this more transparent health care system, but who cares; it’s coming, and they know it. Continue Reading...

Tags: Medicaid For All, Medicare For All, Affordable Care Act, obamacare

You chose the wrong job. You're the wrong gender. Your lifestyle choices suck. You should pay for your risks. You're a celebrity and should stay out of the health care debate; also that's not how preexisting condition provisions work. The anti-universal health care set has a rational, in their eyes, retort for every appeal for government-paid health care for all.

Mocking the emotions of Medicare For All supporters is so easy it's been pushed down to the level of millennial reporters. And the formula for attacking their opponents is always the same—a charge of too much emotion and not enough facts. The fact that they know little about how health insurance and risk management works, the history of health insurance plan design and access, and the conflict associated with insurers determining risk while seeking profit is unimportant to them.

There's a wall between supporters of government-sponsored health care and those that oppose it that won't come down with appeals to decency and empathy. Still, a change in public policy is the only solution to addressing health care access and affordability. And while it may appear that policy just tilted for anti-government assisted health care reform with the Republican-majority Congress's vote to make health care less affordable for millions, that may not be a bad thing for two reasons.

One, overall the Affordable Care Act (aka Obamacare) is popular among the majority of Americans despite a vicious sounding minority that demonizes people who need assistance paying for health insurance and health care. If Obamacare "supporters" see the nation returning to pre-Obamacare days when coverage could be denied outright or so expensive as to represent a denial, they may demand to return to the protections offered by Obamacare or even greater protections.

Two, Obamacare supporters should take this as a sign to expand their support for health care reform by supporting policies that may potentially reduce health care costs. Policies that focus on alleviating hunger, especially among children and the elderly, should be at the top of the list. Also, addressing homelessness and mental illness is essential to reducing health care costs. These are issues policy advocates, and elected Democrats should include in any federal budget and hold firm on their passage. Of course, there will be opposition, possibly as strong as is currently for Obamacare, but with proper messaging, voters may come start to realize who want to address their needs and concerns.

Not everyone engages with the health care sector every day or even every year, but hunger, homelessness, mental illness and drug addiction are issues most people encounter regularly. Obamacare proponents have nothing to lose by dissecting and addressing the individual drivers of health care costs; it may even be easier than focusing solely on health insurance, which is too complex for most people to understand. Continue Reading...

Tags: obamacare, Poverty, Medicaid For All

Some free-market health care proponents think that universal health care supporters want free, unlimited health care no matter what the price. They are wrong. After reading about $600 EpiPens, $1,000 Hepatitis-C pills and $1 million cancer treatment bills, most people are willing to settle for less.

There are, however, some people that want unlimited health care, including former Democratic candidate for president, Bernie Sanders. Sanders advocates for comprehensive universal health care. According to his website, his (Medicare For All) "plan will cover the entire continuum of health care, from inpatient to outpatient care; preventive to emergency care; primary care to specialty care, including long-term and palliative care; vision, hearing and oral health care; mental health and substance abuse services; as well as prescription medications, medical equipment, supplies, diagnostics and treatments. Patients will be able to choose a health care provider without worrying about whether that provider is in-network and will be able to get the care they need without having to read any fine print or trying to figure out how they can afford the out-of-pocket costs."

But things have changed since Sanders first shared his vision of comprehensive universal health care. One, he lost in the presidential primaries and his platform for comprehensive universal health care disappeared. Two, large, private insurer, Aetna, made a showy announcement of leaving the public exchanges causing some to question the future of health care reform. Three, reality started to sink in as the threat of large premium increases became fact. Cries of Medicare For All have changed to Medicaid For All.

Medicaid For All has all the advantages of Medicare For All. It is an established program often administered by private insurance companies and has lower reimbursement rates than exchange or private insurance plans. And, some think we have already moved in the direction of Medicaid like health plans on the public exchanges. Margot Sanger-Katz of the New York Times recently characterized public exchange plans as Medicaid plans but with a high deductible. She may be right. The exchanges are chock full of HMO and narrow network plans. These plans are popular with exchange plan purchasers because they are often the only affordable option. But that doesn’t mean people like or want them (especially those of us paying full cost for these plans).

So, if Medicaid For All is the route to comprehensive universal health care, the price for all individual health plans will need to come down for everyone. And for comprehensive universal health care to happen employer health insurance needs to go away. Continue Reading...

Tags: Medicaid For All