By Dylan Dusseault
If you’re an insurance executive who’s afraid that Democrats will actually pursue viable healthcare reform, you’re having a great week.
Presidential candidates and prominent progressive policy wonks decided to publicly back off of their demands on Medicare for All and demonstrate that they aren’t prepared to actually fight for healthcare reform.
It’s a dangerous moment for the Medicare for All movement, and candidates need to know they’re not fooling anyone.
Beto O’Rourke, the former Congressman who reportedly raised close to $6.1 million in 24 hours after announcing he’s running for President, gave an odd, garbled answer about why he’s changed his mind since his recent run for Senate, and on second-thought, doesn’t actually support Medicare for All.
Then, The Atlantic ran a piece from Ezekiel J. Emanuel, a physician and academic arguing that the insurance industry has a lot of lobbying power and political influence, so we shouldn’t bother trying to pass Medicare for All.
Next, Senator Kirsten Gillibrand, another high-profile Presidential candidate who has been supportive of Medicare for All, said that she thinks the best way to get to single payer is through a public option that people will gradually shift into.
Everyone seems to have the same recommendation: Medicare for America, the plan from Reps. Schakowsky and DeLauro that is essentially a public option with bells on.
O’Rourke specifically endorsed their bill, Senator Gillibrand described something very similar to it, and Dr. Emanuel actually helped to write (a fact that, along with the speaking fees he has collected from the health insurance industry, is not disclosed for the first 10 paragraphs of his Atlantic piece).
To be fair to Medicare for America, it improves on public options of past. It’s largely based on the plan cooked up at the Center for American Progress (CAP), that would create a public option that offers a fairly robust coverage plan, automatically enroll people without employer sponsored insurance, automatically enroll newborns, and allow employers to buy-on and shift their employees onto a public plan.
It would however, charge premiums to enrollees, and includes deductibles for out of pocket spending for enrollees above a certain income level.
CAP calls it “Medicare Extra for All”, although a more accurate name would be “Medicare for Some”.
There are a lot of reasons that Medicare for Some is weaker than Medicare for All. First off, it’d be even more expensive than our current system. It doesn’t eliminate the massive expense that the for-profit insurance system ads to our system through inefficient claims and appeals departments, marketing budgets, and bloated salaries. It also leaves in place the administrative burden on doctors and medical providers, who are spending about 20% of their revenue dealing with the multi-payer system.
While it would theoretically ensure everyone has health insurance, it wouldn’t ensure everyone could afford to access care (people on employer sponsored insurance are the largest driver of the growing underinsured rate). It would create a two tiered system where people are paying different rates for different quality of care, and doctors could easily choose not to participate in the public system and only see patients with private insurance.
Finally, it’d weaken the public system’s ability to negotiate rates from pharmaceutical companies and medical providers, and add additional expense into the public system.
The main argument for supporting Medicare for America over Medicare for All seems to be political feasibility. Which is patently ridiculous.
There’s no reason to think that the insurance industry would simply roll over and accept Medicare for America. They would fight just as hard to kill it, and they’d use the exact same talking points to do it.
Worse, if it passed, Medicare for America leaves the health insurance industry in place and allows them to maintain their political power. Which means they’ll spend the next years undermining the system until it’s either significantly weakened or completely repealed.
It’s also more complicated than Medicare for All, provides less benefit to the average person, and so is more difficult to sell to the public.
And finally, if you believe, like Senator Gillibrand apparently does, and Beto O’Rourke apparently used to, that single payer is the optimal solution, you shouldn’t cave before you even get to the negotiating table.
Instead of giving in to the industry spin, and moving the starting line back, candidates should go all in on Medicare for All. There’s only one thing that has a louder megaphone than the healthcare industry’s PR team: a Presidential campaign.
These candidates have an incredible platform to demonstrate to the American people the truth about Medicare for All:
Demanding anything less than Medicare for All is a free gift to the insurance industry.
By Wendell Potter
My old colleagues in the insurance industry are up to their old tricks. Bruce Broussard, the CEO of my former employer, Humana, referred to Medicare for All as “a great opportunity” on Tuesday.
It is a great opportunity! Finally, we can have comprehensive universal healthcare.
We can remove the burden of providing health insurance from employers, who—once Medicare is improved and expanded to cover all of us—can raise wages, invest in new markets, create new jobs, and be more competitive internationally.
Medical professionals will no longer be drowning in paperwork. We won’t have to hear any more horrifying stories of people dying while rationing their insulin or losing their life savings from a cancer diagnosis. Or not being able to get the care they need because of the ever-increasing barriers insurance companies are erecting between patients and their doctors.
Of course, these aren’t the opportunities he’s referring to. You see, Humana ostensibly exists to sell health insurance that protects their customers from financial disaster when they need healthcare. But in reality, Mr. Broussard’s top priority is to further enrich Humana’s shareholders (including himself). And he’s doing a very good job of that by soaking taxpayers through the company’s Medicare Advantage plans.
Privately operated Medicare Advantage plans are now among the largest drivers of many insurance companies’ revenue and profit growth. They also profit from the supplemental plans they sell to help cover the coinsurance obligations of people enrolled in the traditional Medicare program. Under the improved and expanded Medicare program that will be created when Congress passes a Medicare for All bill, those supplemental plans will no longer have a market.
Members of Congress on both sides of the aisle have allowed Medicare Advantage plans, which cost the government more, to cannibalize traditional Medicare. Humana and many other companies are ubiquitous advertisers, and their sales pitch is like a siren call. A Humana salesman once told me selling Medicare Advantage plans was like “shooting fish in a barrel”. What the companies don’t highlight is the shortcomings of most Medicare Advantage plans, things like “skinny” networks that severely restrict access to health care providers and provisions that make enrollees pay the full cost of non-emergency care outside of their home regions. Want to spend the winter in Florida? If you’re in one of many Medicare Advantage plans, don’t get sick or hurt while you’re there if you don’t have a big bank account.
That’s why an Improved Medicare for All system is so important. Like the bill recently introduced by Representative Jayapal that covers dental, vision, reproductive, and long-term care in addition to basic medical and emergency services.
The industry knows that healthcare reform is inevitable, but they will try and hijack that movement, using powerful allies in Congress, including their relationships with Democratic leadership, to create a system where they still play a central and expensive role. Then they’ll hop on the bandwagon.
It’s the same game-plan they followed when they systematically weakened the ACA before finally getting on board.
Let’s not let people like that Humana salesman keep fishing in a barrel. We need to remain vigilant, push our elected officials to support a real Medicare for All system, and eliminate the insidious, inefficient, and unnecessary commercial health insurance industry once and for all.
By Wendell Potter
Today, the Trump Administration unveiled their 4.75 Trillion dollar budget proposal, and it’s chock full of that signature brand of waste, fraud, and abuse Trump pledged to eliminate on the campaign trail.
It’s easy to get distracted by the President’s more outlandish scandals and statements, but his budget proposal is actually far more insidious.
This budget would be the U.S government’s largest ever, which wouldn’t be a problem if it weren’t also such a morally bankrupt document.
It contains a 5% increase in defense spending the Pentagon has not requested and 8.6 billion for a border wall. Oh, and don’t forget he has to account for massive corporate tax cuts that made it possible for health insurance giants to avoid paying any federal taxes in 2018.
You can guess what he cut to offset those costs: a jaw-dropping $1.1 trillion in cuts to Medicaid and Medicare over the next decade.
It’s obvious what he’s attempting: Help the special interests loot our tax dollars, and then demand the most vulnerable Americans cover the difference.
Conservatives are supposedly committed to fiscal responsibility. I’m old enough to remember 3 years ago, when they claimed we simply couldn’t afford things like Medicaid expansion, or any program designed to actually help people.
Now, Trump and his conservative allies are weaponizing “fiscal responsibility” in order to force the poor, elderly, children, and the disabled to shoulder the cost of their massively irresponsible tax cut for the richest Americans.
It’s a tone deaf response to the people who voted Republicans out of the House of Representatives, largely because they were seen as a threat to Medicare.
And that new House majority has gotten to work on healthcare reform. Representatives Jayapal (D-WA) and Dingell (D-MI) have put up the most ambitious and comprehensive Medicare for All Bill in American history.
When they proposed their bill, which is the only effective way to actually fix our healthcare system, journalists and hostile politicians immediately demanded to know how we could possibly afford it (despite the fact that it would actually significantly reduce our national health care spending).
On the other hand, when Republicans decided to explode the deficit to offer a tax cut to wealthy people and corporations, very few people asked how they would pay for it. Now we have Trump’s answer: Do more damage to the healthcare system.
There’s no question that our current healthcare system isn’t working. But it’s also obvious that cutting trillions of dollars from programs that help the people that need it the most is not the answer.
Fortunately, there’s very little chance this budget will become law, thanks to the Democratic House. But a budget proposal is more than a dry policy document. It’s a reflection of values, and Trump has shown us who he is. Not the populist drainer of “the swamp” he claimed to be, but instead, a man out to defend the interest of the rich and powerful, no matter the cost to the rest of us.
By Dylan Dusseault
There’s nothing I love more than unlikely friends. Give me a video of a lioness who adopted an antelope calf, and my heart just melts.
But for some reason, I don’t get the same fuzzy feeling about the Partnership for America’s Healthcare Future (P4AHCF): A coalition of insurance companies, big Pharma, and for-profit hospital corporations specifically formed to undermine popular support for Medicare for All.
You see, normally, these three groups love to point the fingers and blame the other for rising prices, inability for patients to access care, and poor health outcomes.
But while the lion adopting the antelope is one of nature’s great mysteries, P4AHCF has a much simpler explanation: they all like making money.
Behind the scenes they’re all profiting from the developed world’s most dysfunctional healthcare system.
Fixing it is their worst nightmare.
Hospitals are scared that they won’t be able to over-charge and have completely non-transparent pricing.
Pharma is terrified that they won’t be able to continue charging American’s twice as much as the rest of the world for prescription drugs.
And the insurance industry is the most worried of all, fearing that people will finally wake up and realize that they’re a burdensome, expensive middleman who, as BIHP’s esteemed Chairman Richard Master recently said, need to go “the way of the horse and buggy”.
That’s why they’ve hired people like Lauren Crawford Shaver, their new Executive Director, who also happens to be a partner at a large DC lobbying firm, and has a long history of working for the DCCC, presidential campaigns, and the Obama administration.
They’re setting themselves up to be the devil on Democrat’s shoulders, whispering in their ear that we don’t need to reform US healthcare, we should just listen to what the industry wants.
They’ll push back against even the smallest half-measures and tell everyone that all we need to do is “build on what’s working” and make small tweaks to the Affordable Care Act.
Nothing is working. We have the most expensive healthcare system in the world, and we have worse health outcomes. Tweaking the ACA is like using bubble gum to fix cracks in a dam. Eventually, the water’s coming through, and we’re all going to drown.
The healthcare system is broken, and needs dramatic bold reforms, but P4AHCF won’t tell you that, because they have no interest in improving American healthcare. They were formed to preserve a system that makes a few people very rich, while American, workers, businesses, families, and patients are left picking up the tab.
Let’s ignore their advice. It’s time for Medicare for All.
By Clark Lunday
Debt, housing, devastating monthly healthcare payments –these are the top concerns of American households according to a new morning consult poll.
It’s not surprising to see that rising premiums are feeding anxiety across the country, but it is disturbing to see healthcare costs ranking at the top.
The poll shows 29% of households rank healthcare as the monthly payment that is the most difficult for them to pay, with 21% more ranking it as their second biggest monthly financial stressor.
To give you an idea of how crazy that number is: It is tied with housing as the top monthly financial stressor. The same amount of people are stressed about paying their monthly premiums and out of pocket costs as making rent or mortgage payments.
Food and transportation only clocked in at 4%.
Hard to think of a better indicator for how broken our healthcare system is.
How are health insurance companies, big pharma, and huge hospital groups getting away with it? Look no further than the latest corporate health blitz on Capitol Hill to kill Medicare for All. They’re lining up the heaviest hitters money can buy to stall popular legislation.
A general rule for Washington: Lobbying money spent directly correlates to harm done by the industry. Their profits come before public opinion.
We cannot fall into a pattern of thinking things were always this bad, or that they’ll always be this bad. Industry lobbyists and their allies in the media flood the discourse with counterprogramming, whatever it takes to temper enthusiasm for a change. And the industry can afford it because they’re getting rich, gouging hardworking families from every zip code.
This isn’t the first poll we’ve seen indicating our healthcare system is financially suffocating people, and it won’t be the last.
We know exactly how to fix this problem. It’s time to make Medicare for All a reality.
By Wendell Potter
We all took notice when three of the largest and most recognizable corporate heavyweights Amazon, Berkshire Hathaway, and JP Morgan inserted themselves in the healthcare debate last January. Now we’re getting a better look into exactly how and why, remarkably because insurance giant United Health Group took legal action to prevent their former employees from defecting to the new project. Though the big splash from the announcement was light on specifics, the significance was clear –Titans of Industry know that private healthcare insurance is broken. I’m glad they’ve taken that step, but we cannot give them excessive credit.
This joint venture, called ABC in court documents, seems to be pursuing the noble goal of lowering pharmacy costs, enhancing the quality of care, and reducing complexity. I’d say that’s an effective diagnosis of clear flaws in our flailing employer-based system. Reforming that system is, however, an incomplete prescription.
The fact is employer-based coverage is plainly inadequate. New data shows that for people dependent on employer-based coverage, more are underinsured now than in 2010. Hard working Americans, thinking they’re covered, are likely to face high out-of-pocket costs and deductibles that renders their insurance shockingly useless. This is the dangerous reality for the millions of people who do not work for ABC partners.
I can tell you from years of industry experience tinkering is not enough, and the sustainable fix is going to take more than well-intentioned innovations and startup culture.
ABC providing better healthcare for people working in a handful of companies is taking a tiny bite out of the real problem. Most people work for small and mid-sized businesses that cannot be realistically expected to follow suit. ABC, if successful, will create a boutique package for Amazon employees, but everyone else is still stuck.
A Medicare for All program addresses the same concerns, comes with the same benefits, and applies to a much larger pool of people. Healthcare security for Americans shouldn’t be dependent on elite membership to a select college of corporations. Let’s attack the problem with a safety net that covers everyone.
By Wendell Potter
Today, Thomas Donohue, who is the President and CEO of the US Chamber of Commerce, vowed to use all of the Chamber’s considerable resources to combat a single payer healthcare system.
That’s some pretty stark evidence that the US Chamber of Commerce has, for a long time, been grifting American businesses to benefit some of their most generous donors: health insurance and pharmaceutical companies.
Our healthcare system, which is heavily reliant on employers to provide insurance, is a disaster for American businesses.
In 2018, a single employer-sponsored family plan cost an average of $19,616. Based on a 40 hour work week, that’s an average of $9.43 per hour per employee. That’s a 5% increase from 2017, doubling the 2.5% inflation rate. The cost of these plans has gone up 20% in the past 5 years.
As these costs go up, American business have been less able to invest money in raising wages, expanding production, creating jobs, or investing in new technologies.
To make matters worse, they’re competing with foreign companies that are based in countries with much more efficient, largely taxpayer funded, healthcare systems, and don’t have these massive costs on their balance sheets.
The US Chamber of Commerce purports to represent the interest of American business. But I can tell you first hand from my time working in the healthcare industry, they’re nothing more than lobbyists for the highest industry bidder.
In 2009, many were shocked to see that the Chamber had spent $150 million on lobbying, but the number made more sense when you saw that America’s Health Insurance Plans (AHIP), the advocacy and PR group for private insurance companies, had funneled $86.2 million to the Chamber to help kill the public option. To add insult to injury, AHIP collected that money from its member groups, which means that enrollees at companies like Aetna, Cigna, Humana, and United HealthGroup inadvertently paid for the lobbying effort.
A Medicare for All system would be a boon to American businesses. It would mean that employers were no longer responsible for providing health insurance to their employees and dependents, and would likely replace constantly rising, and uncontrollable premiums with a much more manageable, and predictable, payroll tax.
It would replace our fundamentally broken system, where there are no incentives to manage costs, with a streamlined, much more affordable, and truly universal healthcare system.
But insurance companies and pharmaceutical groups know that making politicians and voters believe that Medicare for All is somehow “bad for business” can be a powerful tool to stop the growing support in its tracks. That’s why they partner with groups like the US Chamber of Commerce, who will happily take their money and spread their lies.
By Dylan Dusseault
Rep. John Yarmuth (D-KY), who was recently elected to be the Chairman of the House Budget Committee, announced on Tuesday, January 8th, that he had written to the Congressional Budget Office (CBO) for a report on single payer health system proposals.
While that may sound a bit dry and procedural, it’s actually an important and historic moment.
Let’s run through why.
Firstly, some of you might be asking: “What is the CBO?” Great question!
It’s a non-partisan federal agency, housed in the legislative branch, that is responsible for creating reports looking at budget and economic concerns for proposed legislation. The CBO does not make policy recommendations, but the contents of their reports are typically used as the most reliable projections on any new proposed programs. (It should be noted, Yarmuth did not request a cost estimate, but instead asked for a report on how the system would be administered, enrollment, financing options, etc).
Next, it’s important to know why he’s asking for this now. The House Medicare for All Bill, H.R. 676, was first introduced in 2003, and has been reintroduced with every new Congress. Despite the fact that it has collected 124 cosponsors, it’s never been debated in any committee. Because of that, the CBO has never done a report on a single payer proposal before.
All of that is about to change. It was recently announced that Yarmuth’s Budget Committee, as well as the Rules committee led by Rep. Jim McGovern (D-Mass) will be holding hearings this session on Medicare for All. This will be the first time that single payer has been considered by a committee in Congress.
This request for a CBO score reflects the fact that Medicare for All is being taken seriously by the new Congress. It means that Yarmuth plans for his committee hearings to be meaningful, that he wants the members to have the most information possible going in, and that they can be an opportunity to demonstrate to members of Congress and the country how beneficial a Medicare for All system could be.
This is a first step in what will be a long battle to pass Medicare for All, but it’s exciting to see the new Congress beginning the process early.
By Dylan Dusseault
Today, Senator Bernie Sanders and Congressman Ro Khanna announced the Prescription Drug Price Relief Act, which is designed to make drug prices in the US comparable to what patients pay in other countries.
It may not seem like we would need legislation just to ensure US customers aren’t being charged more than everyone else, but we’re the only developed country on earth where the government doesn’t negotiate or set prices for name brand drugs, and the results are a disaster.
1. We pay more for prescription drugs than any other country in the world, and it’s not even close.
2. Americans over 55 are five times less likely to fill a prescription due to cost than their UK counterparts, and 10 times more likely than the same age group in France.
3. We are frequently victims of massive price spikes. Remember “Pharma Bro” Martin Shkreli raised the price of a 60+ year old medication from $13.50 a pill to $750 a pill? Or when Mylan Pharmaceuticals raised the price of the EpiPen from $50 per injector to over $300? Those were just high profile versions of a problem millions of Americans face every day. We can never be sure how much our next dose will cost.
4. American businesses list prescriptions as one of the largest drivers of increasing their spending on health care benefits for their employees, with some even reporting specialty medication costing more than an employee’s annual salary.
5. Our patent system lets companies hold monopolies on producing life-saving drugs that they often hold for decades, using shady practices like “pay to delay” to keep drugs off the market, or even giving patents to Native American tribes.
Essentially, we’re letting Big Pharma stomp all over American patients, businesses, and the government, and it’s time to put a stop to it.
The Prescription Drug Price Relief Act would empower the government to demand that pharmaceutical companies sell prescription drugs to American patients at the median price for the same drugs in 5 countries: France, Germany, the UK, Canada, and Japan.
If the pharmaceutical company refuses, the government would go after their patents, allowing generic companies to enter the market and produce the drug at a reasonable price.
Under this new system, American patients would no longer have to suffer under astronomical prices, and would be able to access medications at the same rate as the rest of the developed world.
By Wendell Potter
One of the reasons—arguably the biggest reason—Republicans lost control of the U.S. House of Representatives Tuesday was their years-long effort to repeal the Affordable Care Act and, make it possible for insurance companies to once again pad their bottom lines by denying coverage to people with preexisting conditions.
Voters were clearly smarter and less gullible than many Republican candidates expected. Having seen polls showing that health care was voters’ top concern, many of the very same members of Congress who voted dozens of times to get rid of the ACA claimed in their campaign ads that they were fighting to protect people with preexisting conditions. Voters from coast to coast weren’t buying it.
For years—in fact, until this year—polls have shown that a majority of Americans were not happy with the ACA. But what Republican members of Congress ignored, at their peril, was that many of those folks were unhappy because the ACA did not go far enough to protect them from unscrupulous, profit-obsessive health insurance companies. They wanted Congress to go much further than the ACA, which kept our expensive and hugely complicated multi-payer system of health care financing in place. More and more Americans wanted private health insurances out of their lives. Forever.
As the former head of PR for two of the biggest for-profit health insurers—Cigna and Humana—I can assure you that health insurance executives have known for years that the companies they lead are among the most despised of all companies the world.
In an article earlier this year about America’s most-hated companies, USA Today noted that “few industries are as widely detested as the insurance industry.” Reading the list, I wasn’t the least bit surprised to see that one of my former employers—Cigna—came in at number 10, and they’re certainly not along in being reviled. I left my job there because of the numerous anti-consumer, anti-patient practices that had been common throughout the industry for years. Before the ACA was passed, for-profit and nonprofit insurers alike charged people with preexisting conditions exorbitant amounts of money for their coverage. Worse, they even refused to sell coverage to as many as one in three applicants because of a preexisting condition. That is why almost 50 million people in the U.S. were uninsured when the ACA became law.
But as I said at the time, the ACA was just the end of the beginning for healthcare reform in this country. Insurers have simply found other ways to please Wall Street, which is constantly breathing down their necks to meet short-term earnings goals. To make up for profits lost from being unable to shun people with preexisting conditions, insurers have herded most of us into plans with “skinny” networks of doctors and hospitals and with such high deductibles that a growing number of Americans can’t even afford to pick up their prescription medications.
Even with employer sponsored insurance, workers are often getting a raw deal. A recent Commonwealth Fund report found that nearly 25% of people with employer-sponsored coverage had such high out-of-pocket costs and deductibles relative to their income they were effectively “underinsured.”
It’s little wonder that pre-election polls indicated that 70 percent of Americans supported Medicare for All. People are simply fed up with private, profit-obsessed health insurers. And despite the industry’s current propaganda campaign to convince lawmakers that our employer-based system of coverage needs to be kept in place, both employers and their workers are increasingly inclined to ditch it.
Now that Democrats control the House, it’s time to do something with it. Even candidates who didn’t explicitly support Medicare for All were elected by voters who overwhelmingly do (recent polling indicates 85% of Democrats support Medicare for All). If they take their responsibility to represent their constituents seriously, they will keep the promises they made to hold hearings, hammer out the details of Medicare for All, and lay the groundwork we’ll need once we have a White House that isn’t openly hostile to healthcare reform. That work needs to start now.