‘Tis the season for articles about charities doing great work for those in need. This is not one of them. The charity I want to discuss does great work, but I want to write about how it could increase its impact if its work was required viewing by all Americans. The charity is Remote Area Medical (RAM); founded by the late, British-born philanthropist and adventurer, Stan Brock.

The first time I heard of RAM was in a 2008 interview with Stan Brock on the 60 Minutes television newsmagazine. Remote Area Medical and its thousands of medical and other professional volunteers, provides free medical, dental, and vision care to people who attend their free “pop-up” medical clinics. Stan Brock started the charity in 1985 to help people in third world countries get needed health care. But on that 2008, 60 minutes program, Stan was being interviewed about RAM clinics in Tennessee, USA.

According to a report in USA Today (2018), the United States is one of the wealthiest countries in the world in terms of gross national income (GNI) and gross domestic product (GDP)—ranked #11 and #2, respectively. America is not a third world country and it’s not remote, but somehow needs the free health care services offered by RAM. How RAM got to America is a story of unaffordable private and public (Medicare and Medicaid) health insurance. A significant number of Americans who receive RAM health care services, have or have access to health insurance but cannot afford the premiums and/or out-of-pocket costs the plans require. And many others do not know how to apply for low-cost or free health care.

Nothing says “failing private health care system” like the buckets of pulled teeth noticeable at any RAM event, or the thousands of people that line up the night before the clinics open in their area, to receive preventative health care. Which leads me to this: what if all Americans had to attend a RAM clinic once per year in exchange for tax-free health insurance premiums (employer group health insurance) and other government-subsidized health care benefits? It’s easy to love your private health insurance, as CNN.com likes to remind Medicare For All supporters. It’s hard to look at buckets of extracted teeth, made necessary because most private medical plans don’t provide preventative dental care. Continue Reading...

Tags: Remote Area Medical, health care , Medicare For All, Stan Brock

We expect private health insurers to be anti Medicare For All (M4A). Criticizing M4A proposals is just time and money to them, and they have plenty of both. They have no desire to reduce the cost and complexity of health insurance or health care. Besides, you can’t solve a problem that you do not think exists. Attacking something without coming up with a better solution is easy and unfair, but even these tactics would not work for private health insurers without the support of their major corporate clients. So why do major corporations back the health care status quo, and why do we reward corporations that don’t support affordable health care for all?

It’s A Bro Thing, A Control Thing, And A Money Thing

It was just over one year ago that Amazon, Berkshire Hathaway, and JPMorgan Chase announced their joint health care venture. The three business giants said they were combining forces to “provide low-cost, high quality service from a (health care) company ‘free from profit-making incentives and constraints.” But soon after the announcement one of the Big 3, JPMorgan Chase CEO, Jamie Dimon, promised not to compete with private health insurers and would instead restrict the new venture’s efforts to helping the employees of the three companies. We know why Jamie tried to walk back his threat to upend private health insurance—some of his company’s clients are in the health care industry—but why do other major companies support the industry, and do not publicly support Medicare For All?

I can think of a few reasons.

Despite surveys showing that health care costs are a major concern of all private companies, large companies seem to prefer private health insurance to a government-run or universal system. No major corporation has cut all ties with the health insurance status quo. Instead, corporations work with major health insurers to support each other's profits and shareholder returns at the expense of the country. Also, many leaders of “American industry” believe that they know more about health insurance and health care than health care policy analysts, government officials, and economists. They think the private sector is just generally better at running any business even if it has public policy implications. Continue Reading...

Tags: health insurance , health insurance costs, Tax-exempt health insurance, employer sponsored healthinsurance, Medicare For All

There’s a fair amount of fear on display these days from some of the most powerful people and institutions on the planet. Trump's afraid of Nancy Pelosi. Billionaires at Davos are afraid of Ocasio-Cortez. Microsoft’s afraid of affordable housing and homeless advocates. And the health care status quo is afraid of losing its ability to charge whatever it wants for its products and services. If history is any indication, this high-powered group of scaredy-cats will ignore their opposers or attempt to appease them with small (in proportion to their total resources) gestures.

Just look at how they've responded so far.

Appease: Trump, unwilling to admit defeat to Nancy Pelosi, agrees to temporarily not get his way.

Ignore: Michael Dell, CEO of Dell Technologies and billionaire attendee at Davos, says voluntary philanthropy is a better solution to inequality than taxing the uber rich. (Like that's worked so far.) He also falsely claimed that increasing rich peoples’ taxes hurts economic growth. Bottom line: Mr. Dell thinks that he knows better than the government how to “fix” inequality.

Appease (with a catch): Microsoft, responds to years’ of criticism for exacerbating the affordable housing crisis in the city of Seattle, by creating a multi-hundred-million-dollar housing loan program, along with a much smaller grant to address homelessness. This is a loans-to-pay-for-future-loans program in lieu of higher taxes; with a much smaller grant program thrown in to make it appear more generous. (Where does this I know how to address housing policy issues better than government attitude come from?)

Appease (latch onto): Health insurers and hospitals, in an attempt to forestall Medicare For All, are rolling out small-scale programs to address social determinants of health—‘the circumstances in which people are born, grow, live, work, and age’ that affects their health status and leads to health inequality. (Marmot, Sir Michael, The Health Gap (The Challenge Of An Unequal World): Bloomsbury Press, 2015). By making a small financial commitment now against health care inequality, which was never a major concern of theirs, health insurers and hospitals, hope the public will ignore their ever-increasing, opaque prices and poor health outcomes, on the part of hospitals and doctors. Continue Reading...

Tags: health inequality, Social determinants of health, health care , Medicare For All

Employers may be wary of their health insurance partners but they share in an opposition to single-payer health insurance.

You would think that large employers would say to heck with the health insurance and health care status quo. You would think that they have had enough of the annual negotiation performances played by brokers, consultants, and health insurance representatives. You would think this, but you would be wrong. Large employers are generally opponents of a single-payer (e.g., Medicare For All) system that would replace their private group insurance plans. They may not enjoy participating in the ritual pretense of controlling health insurance costs, but they find it preferable to the alternative—losing control of a powerful financial tool.

There are several reasons why big companies and the health care industry do not support Medicare for All or single-payer health insurance.

Large organizations that are not part of the health care industry oppose single-payer because they would no longer be able to use health insurance as a recruitment/retainment tool, or as way of manipulating the total compensation their employees receive. These organizations may also benefit financially from health care industry stocks. And you've got to figure that large corporations don’t want to upset each other because the shoe could easily be on the other foot, so it is best to have each other’s backs.

Health care organizations have even more at stake in the single payer debate. According to a Kaiser Family Foundation report, health care employment accounted for about 9% of all employment in the U.S., in 2017. The industry, with the exception of some groups like Physicians for a National Health Plan (PNHP) and a few others, vehemently opposes single-payer health insurance. The Healthcare Leadership Council, a health care industry lobbying group, lists insurers, hospitals, drug makers, medical device manufacturers, pharmacies, health product distributors, and information technology companies as part of the health care industry. Add to that the thousands of companies and freelancers that support these organizations... The bottom line is that the health care industry employs millions of people, and makes tons of money for Wall Street—a gig they would like to keep.

Small Employers Will Save Us

Health care reform isn’t over. Everyone agrees that health care costs is THE problem we must resolve, and that the solutions proposed by insurers and adopted by private sector organizations large organizations are band aids. So far the reforms taken to make health care more affordable and available involve transferring costs from one group to another. Large organizations can play this shell game better and longer than smaller companies because insurers realize from time to time they have to let the big guys win (or think that they've won). Small employers on the other hand do not have this kind of clout, and usually follow the lead of larger organizations when it comes to plan design, financing, and other health insurance reforms. Continue Reading...

Tags: Medicare For All, Single-payer

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

It seems everyone working in the health insurance and health care industries feels entitled to large profits. And they will do or not do just about anything to get their share of the multi-trillion dollar a year health care "market." Doctors thumb their noses at "low" Medicare and Medicaid payments, limiting the number of patients in these programs that they will treat. Health insurers balk at insuring the very sick without government subsidies to reduce their financial risk. Pharmaceutical companies threaten to curb drug innovation unless they are allowed to impose astronomical markups on existing products and enjoy long patent periods. And hospitals do whatever the heck they want to make a buck--different prices for the same care with no transparency or explanation. And these are only four of the big players in the health care market; there are many others elbowing for their share.

Under these conditions, American health care reform that tries to lower costs is dead on arrival. The powerful groups benefitting from our overpriced health care system aren't going to accept a pay cut. Some may suggest incentives to get doctors to accept lower reimbursements, like subsidizing their student debt or even reducing the requirements and the number of years it takes to become a doctor. Others may suggest performance bonuses, like the ACA tried.

There are a lot of good sounding suggestions for lowering health care costs, including drug re-importation, universal use of electronic health records, value-based health care pricing, hospital consolidation, competitive bidding for supplies, focus on tertiary care, etc. You name a health care cost cutting idea, and great minds have already penned it.

One health care cost cutting idea receiving more attention is allowing future American doctors to enroll directly into medical school instead of first getting a 4-year undergraduate degree. Medical students and the country would save a lot of money, and their student loan excuse to demand high salaries falls away. Many countries with similar or better health care outcomes require 5-6 years of schooling to become a doctor versus 8 in the U.S. But American doctors won't easily give up the prestige of being a doctor and, therefore, will continue to demand higher salaries. Continue Reading...

Tags: Medicare For All, obamacare, Affordable Care Act

I recently heard a story of a diabetic Medicaid patient that developed gangrene on her foot and leg. Gangrene occurs when tissue decays or dies due to a loss of its blood supply or because of a bacterial infection. It's a concern for many people with diabetes because of how diabetes affects the body--including possible damage to the nerves and weakening of the immune system. Treatments for gangrene include surgical removal of the decaying or dead skin, amputation of the affected body part or antibiotics.

The first surgeon that examined the diabetic Medicaid patient's foot and leg concluded that amputation of the affected area was the appropriate course of care given the severity of the gangrene. He immediately scheduled surgery for later that day. Fortunately a second surgeon disagreed—concluding that the gangrene could be treated with surgical removal of the dead and dying skin. The surgery to remove the dead skin was performed by the second surgeon and the patient still has all of her limbs and is being monitored.

I won’t speculate why the first surgeon prescribed amputation to treat the gangrene, but I did wonder if the patient’s insurance coverage had anything to do with his rush to cut. And there is evidence to back up my worries. There is lots of evidence that diabetic amputees are more like to be poor and minority. Or course, this is not entirely the fault of doctors. Many poor minorities don’t seek regular or preventive care to treat their diabetes, making some amputations necessary. But not all of them…

And there’s more… A disease management program designed to help minority diabetes patients revealed the difference in blood testing rates between whites and ethnic minorities. Blacks and Hispanics had lower testing (to determine how well their diabetes is being controlled) rates than whites. A study of this vendor-based disease management pilot program for Medicare patients concluded that it did “not appear to improve diabetes care or mitigate racial/ethnic disparities among these patients…” The program failed.

But what’s a problem without a solution? Fortunately, health care reform is already addressing the diabetes crisis. A pilot diabetes prevention program run by the YMCA received praise and dollars from a grant program established by the Affordable Care Act program. According to an article on npr.org,

It's the first prevention program to meet requirements under the Affordable Care Act to gain Medicare coverage, HHS says, including undergoing an independent audit to confirm that it's effective and saves money. The Obama administration is recommending that Medicare cover the program for at-risk Medicare beneficiaries. Continue Reading...

Tags: Medicare For All, Affordable Care Act, Diabetes