Value-Based Payment is the New For-Profit Health Care Industry
This is an intriguing article about the history of the value based payment movement by the insurance industry, and debunks commonly held beliefs.
AJR4 clears Assembly Health Committee
California Assembly Joint Resolution 4, which asks Biden to discontinue the privatized ACO/REACH Medicare program, has passed the California legislature.
Why we want Medicare for All
Photo by Павел Сорокин: https://www.pexels.com/photo/surgeons-performing-surgery-2324837/ Corinne sent in this nice summary with a good cartoon about why we need Medicare for all. Published in a Humboldt County paper. https://enewspaper.times-standard.com/html5/reader/production/default.aspx?pubname=&edid=e094e4a2-d922-4a43-8982-54b8ff0a1f5d&pnum=4
Fraud and Medicare Privatization
There have been a series of recent public reports and discussions about fraud on the part of corporations participating in the Medicare Advantage program.
Abortion and Single-Payer Healthcare
Access to abortion can be restricted or denied by employer-based for-profit health plans. This discussion, Abortion Access and the Right to Healthcare will discuss the advantages of a single-payer system for access to reproductive healthcare.
How Hospitals and Insurers Fail the Public
Wendell Potter worked in the health insurance industry. He became very familiar with the manipulations and maneuvers of the for-profit systems. He now writes a newsletter and speaks to educate us about the failings of this for-profit system. On September 27, 2022 he published an article about the failings of large hospital systems. This article relates nicely to the articles in the New York Times earlier in the week (links below.) This trio of articles reveals how the current system with for-profit insurance, and megalomaniacal hospital systems has failed the American public. Yet more reason to implement a single-payer non-profit health care system.
More Non-profit Profit
At the same time the New York Times published an article about non-profit hospitals using debt collectors to pursue indigent patients (—–), they published a second article detailing how a another enormous “non-profit” hospital chain abused its non-profit status to undermine one of its hospitals in a poor neighborhood while enhancing hospitals it owned in wealthier suburban neighborhoods.
While both hospital chains are classified “non-profit” by the IRS, they exhibit the same predatory behaviors as profit-seeking businesses. Where does the extra money go? Some of it is used to build new facilities in wealthier neighborhoods, further increasing the income of the “non-profit” chains. It is not used to improve the facilities in poor neighborhoods
How can we stop this? A single-payer national health care system would fund hospitals with global budgets. This eliminates the impetus for hospitals to minimize community services in order to generate “non-profit”-profits. It also provides an integrated system for determining the placement of additional medical facilities. There would no longer be the stimulus to continually increase services in wealthy areas in order to maximize income. Hospitals could actually focus on patient care and community service.
Profitable Non-profits
What does it mean to be non-profit? The NY Times today published the article They Were Entitled to Free Care. Hospitals Hounded Them to Pay The article describes how one large “non-profit” national hospital chain hounds poor patients and sends debt-collectors after them if they cannot pay hospital bills.
Medical debt is the largest cause of personal bankruptcy in the US. This article describes the billion dollar tax break given to one “non-profit” organization.
The “profit” does not flow into the bank accounts of shareholders, but it is clearly not being used to care for the poor. It is used to expand the hospital chain, build new facilities, and promote the hospital to well-off patients. That behavior furthers consolidation in the healthcare industry, increasing prices, and aggravating the failure of the US employer sponsored for-profit insurance system.The solution: single-payer non-profit health insurance for all residents, similar to what every other comparable economically developed country in the world provides.
Privatization, Education, Health Care
Germany began the first public health insurance system under Otto von Bismarck in the late 1800s. These “sickness funds” were initially intended to provide care for low income workers. Over time they expanded to include the entire population.
Other European countries picked up on the idea that a healthy populace meant workers who would be more productive and use less sick time. The society as a whole would benefit from greater general health.
Thom Hartman wrote today about Public Education and the Common Good. In his essay he explains how America decided that an educated populace would mean a stronger nation. Thomas Jefferson suggested that a free public education be provided to a group of citizens who would become wiser leaders for our fledgling democracy. The reasoning became that a better educated population would make better decisions for their country.
European nations came to the idea of public education a bit later than the US. Why has the US not caught up with European nations to see that universal health care is just as vital to the nation as public education. The common good is vastly improved by supporting health care for all. In the same manner that public education supports a healthy democracy, public health care is an enormous boost to the strength of a nation. Healthy citizens are more productive at work, are not distracted by illness, and take less sick time.
Not to mention that healthcare is a human right. It is time for the US to wake up and provide universal single-payer non-profit health care to all its citizens. That would be a tremendous boost to the common good.
Disadvantages of Medicare Advantage
Medicare Advantage was a way of channeling Medicare dollars into private for-profit companies before Direct Contracting Entities or the ACO/REACH program. Medicare Advantage programs require that 85% of income be spent on patient care. The remaining 15% can be spent on administrative expenses or profit. By decreasing patient care spending, the companies can increase their profit.
This has become a profitable mechanism for pulling money away from patient care and into the hands of investors. The MA programs are advertised on television and other media, with famous individuals describing the wonderful care and extra perks they receive. The extra perks (health club memberships, etc) are possible because the MA plans cherry pick (manipulate the system so they choose the healthier individuals) and lemon drop (manipulate the system to drop patients who are sicker and more expensive.)
In August, 2022 CMMS issued a request for comments about the Medicare Advantage Program. This link will take you to the letter that PNHP President Dr Susan Rogers sent to CMMS. It is an excellent explanation of what is wrong with MA and the entire program for the privatization of Medicare.