Great information. Thanks. Another reason nurses leave the business is due to assaults on the job. "Although violence in the workplace affects almost all sectors and groups of workers, it is apparent that violence in healthcare settings provides a significant risk to public health and an occupational health issue of growing concern. The healthcare and social service industries have the greatest rates of workplace violence injuries, with workers in these industries being five times more likely to be injured than other workers [4]. In addition, workplace violence in the health sector is estimated to account for about a quarter of all workplace violence [5]. Workplace violence is constantly on the rise in the health industry due to rising workloads, demanding work pressures, excessive work stress, deteriorating interpersonal relationships, social uncertainty, and economic restraints." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9206999/
"We already know the effect in the US of the COVID disinformation campaign, hundreds of thousands of us died who did not have to die". This is a VERY powerful comment you make here in your piece on disinformation. I am relatively new to your writing and I am hoping you can and will direct me to quality studies and data that corroborate it. Thank you Robbie
One of the reasons many people choose medicare advantage plans is that may have little or no premium which is very appealing until one has to deal with significant illness and incurs significant "debt" due to copays and other expenses not covered by their plan.
People with "original medicare" need a supplement and the premiums are significant enough that they may not be affordable to many people. It is a great system but has that downside.
I wonder if you could respond to another factor that contributes to people wanting Medicare Advantage insurance. Many providers no longer accept standard Medicare because it pays below the market reimbursement rates.
And a related question: How did the system getting rigged so that Medicare alone often offers poor access to needed healthcare?
Hi Gary, I will think long and hard about this. Sometimes it is a matter of buying down risk that points people to Part C. Sometimes doctors stop accepting it (I have friends in LA whose doctors said no way - in fact they chose to be concierge altogether).
This is a useful article but you suddenly switch from discussing Medicaid to Improved Medicare-For-All. Your headline does not state the fact that universal Medicaid reimbursement rates would bankrupt all hospitals and most providers. Improved Medicare-For-All is indeed a great goal which would solve many of our huge health care problems. The profit motive is controlling health care to the detriment of all of us patients. Christopher Flory MD
Hi Dr. Flory. Thank you for taking the time to write to me. I did not see the the line to which you referred but, I think the point I should be making is that HR3421 will encompass Medicare, Medicaid and CHIP. The reimbursement strategies will be different for so many facilities. Instead of a fee for all in every case (like Medicare) it will employ global budgets to ensure that facilities have their infrastructure costs covered (including provider salaries). I hope that helps. If I missed the point please let me know...Thanks...Alan
Just gave today's post a quick first read. Federal vs state-based single payer? I'm an agnostic and support both approaches. I'm glad Ro Khanna is stepping up with a commonsense basket of waivers. A few concerns, not of which are show-stoppers compared with the good that could result...
> I live in Texas, population about 30 million. Covering "at least 95%" under Khanna's bill would invite corrupt-to-the-core Texas politicians to exclude perhaps 1,500,000 Texas residents. (Note: by stonewalling Medicaid expansion, these far-right racist mofos currently exclude some 5,000,000 Texas men, women and children despite generous federal incentives. If there's a way to screw up or circumvent a pro-social federal program, Texas will do it from sheer meanness and spite.)
> Across America's mass-incarceration gulag, many prisons and jails offer egregiously poor healthcare for inmates. Will any provision in Khanna's bill, force that to change in states that opt for waivers?
Add'l comments:
> Kudos to One Payer States as a longtime grassroots leader banging the drum for state-based universal care.
> How to sell this concept to conservative politicians, pundits and voters? Advocates might frame it up as a "states' rights" issue.
Thanks for spotlighting this alt approach to giving single-payer universal healthcare a toehold at least somewhere in the US.
"We already know the effect in the US of the COVID disinformation campaign, hundreds of thousands of us died who did not have to die". This is a VERY powerful comment you make here in your piece on disinformation. I am relatively new to your writing and I am hoping you can and will direct me to quality studies and data that corroborate it. Thank you Robbie
Alan, with four simple words, you made my head explode. Figuratively. Brains splattered all over the ceiling. No, I am not meshuga. Well, only a little. The four words: "But wait, there's more!"
In 1973 I got my first job as a copywriter in a Providence, RI ad agency. The copy chief was Arthur Schiff, a talented guy with deep intellect. I stayed two years and learned a lot from Arthur. Later in the 1970s Arthur left the agency to join Dial Media in Warwick, RI. They created the famed Ginsu Knife direct-sales TV commercials. "But wait, there's more!" https://en.wikipedia.org/wiki/Arthur_Schiff. For a time, I myself wrote direct-response commercials for another RI company in the same line of work.
Awesome memory, but that's not why I'm scraping brains off the ceiling. It struck me that Ginsu hard-sell but entertaining and amusing commercials, and those for other consumer products (remember the Ronco brand?), did a fabulous job of selling. And generating immediate consumer response. In those days, viewers had to pick up the phone.
Despite earnest and diligent efforts that you and I are both part of, the drive for Medicare for All has been stuck in neutral for a long time while Big Insurance has been eating our lunch. In the 117th Congress, M4A ended with 122 House co-sponsors. Now, in the 118th? 112 original co-sponsors and not one added since. That's sobering.
We need completely new approaches. Then it struck me: GINSU! (Thank you, Arthur, may you rest in peace.) Why aren't we making tongue-in-cheek-but-serious brief videos promoting direct action for M4A?! Head exploded. Brains all over the ceiling.
Alan, I tried posting this comment to your "Hot Mess Managing Insurance" piece (22 Aug) but when I click "Comment" it defaults to this page. Very frustrating. So, I'm commenting here, but the context is your previous "Hot Mess" piece.
Thanks for this piece. Just so folks know, the Dec 2020 CBO analysis ran 200 pages and included input from economists across the political spectrum — right, left and center. Further, the economist heading the CBO was (and still is) a Trump appointee.
Much of the net cost savings (compared with what we as a nation spend on healthcare today) stems from admin, as you point out. When the CBO included other costs (drug prices, etc), the savings totaled as much as $650 billion a year or more.
Just for scale, consider: it averages out to about $5,000 cash savings for every American household. It's like a hefty #HealthDividend we are NOT enjoying right now, thanks to congressional foot-dragging. If your congress member isn't already co-sponsoring the Medicare for All Act, demand to know why he/she wants to take away your $5,000 annual #HealthDividend! Do they hate you that much?
Alan, I thought I posted this comment to your piece on Black mother and infant mortality, but apparently when I click "Comment" it defaults to this page. Very frustrating. So, I'm commenting here, but the context is your previous piece on racial disparities in pregnancy and infant mortality.
Hmm... I wonder what the mortality stats are for Black doctors managing pregnancies and neonatal care for White moms and their infants. If (repeat, if) outcomes were at least marginally better than for White doctors treating White patients, then a couple of questions come to mind:
(1) Might there be some unintentional bias in the study design (i.e., flaws in the study) and, if not, then...
(2) What factors or qualities might account for the difference — again, if there were one and if it was real and not a statistical artifact.
It's all pure surmise, but someone might peek under the hood to see whether there isn't a valid hypothesis lurking somewhere. Perhaps something testable might be learned about empathic medical practice, beyond the obvious well-known compatibilities of racial healthcare. A longshot, but ¿quien sabe?
More important though is a review of the company done a couple of years ago by the State of Oregon. They found that Pacificsource denied 28% of all claims in one in 2019. Here is a link to that report. See page 8.
Is there a new code for Resistbot? The one given is the same as yesterday. Thank you for all your work on these issues!
Hi Connie, Thank you, Thank you - I have corrected it it is POPDQO
Thank you for being a diligent advocate for healthcare. Have a good weekend.
Great information. Thanks. Another reason nurses leave the business is due to assaults on the job. "Although violence in the workplace affects almost all sectors and groups of workers, it is apparent that violence in healthcare settings provides a significant risk to public health and an occupational health issue of growing concern. The healthcare and social service industries have the greatest rates of workplace violence injuries, with workers in these industries being five times more likely to be injured than other workers [4]. In addition, workplace violence in the health sector is estimated to account for about a quarter of all workplace violence [5]. Workplace violence is constantly on the rise in the health industry due to rising workloads, demanding work pressures, excessive work stress, deteriorating interpersonal relationships, social uncertainty, and economic restraints." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9206999/
"We already know the effect in the US of the COVID disinformation campaign, hundreds of thousands of us died who did not have to die". This is a VERY powerful comment you make here in your piece on disinformation. I am relatively new to your writing and I am hoping you can and will direct me to quality studies and data that corroborate it. Thank you Robbie
Thanks Robbie.
Hi Alan,
Can’t thank you enough for this and for your advocacy.
Looks like non profit is another way to say for profit.
Kindly,
Lori.
Great comments below.
One of the reasons many people choose medicare advantage plans is that may have little or no premium which is very appealing until one has to deal with significant illness and incurs significant "debt" due to copays and other expenses not covered by their plan.
People with "original medicare" need a supplement and the premiums are significant enough that they may not be affordable to many people. It is a great system but has that downside.
beth s
Thanks Beth - What a nice, concise way to put it!!
Hi Alan:
I wonder if you could respond to another factor that contributes to people wanting Medicare Advantage insurance. Many providers no longer accept standard Medicare because it pays below the market reimbursement rates.
And a related question: How did the system getting rigged so that Medicare alone often offers poor access to needed healthcare?
Hi Gary, I will think long and hard about this. Sometimes it is a matter of buying down risk that points people to Part C. Sometimes doctors stop accepting it (I have friends in LA whose doctors said no way - in fact they chose to be concierge altogether).
I found the government released a new Medicare Databook last week and I will examine it for clues. If you like here is the link. https://www.medpac.gov/document-type/data-book/
Data Analysis is Us
Thank you for sounding this alarm!! xx's
You are most welcome.
This is a useful article but you suddenly switch from discussing Medicaid to Improved Medicare-For-All. Your headline does not state the fact that universal Medicaid reimbursement rates would bankrupt all hospitals and most providers. Improved Medicare-For-All is indeed a great goal which would solve many of our huge health care problems. The profit motive is controlling health care to the detriment of all of us patients. Christopher Flory MD
Hi Dr. Flory. Thank you for taking the time to write to me. I did not see the the line to which you referred but, I think the point I should be making is that HR3421 will encompass Medicare, Medicaid and CHIP. The reimbursement strategies will be different for so many facilities. Instead of a fee for all in every case (like Medicare) it will employ global budgets to ensure that facilities have their infrastructure costs covered (including provider salaries). I hope that helps. If I missed the point please let me know...Thanks...Alan
Thanks Gary, I appreciate your comment. You are right the fear of change is powerful. I will ruminate on that.
Just gave today's post a quick first read. Federal vs state-based single payer? I'm an agnostic and support both approaches. I'm glad Ro Khanna is stepping up with a commonsense basket of waivers. A few concerns, not of which are show-stoppers compared with the good that could result...
> I live in Texas, population about 30 million. Covering "at least 95%" under Khanna's bill would invite corrupt-to-the-core Texas politicians to exclude perhaps 1,500,000 Texas residents. (Note: by stonewalling Medicaid expansion, these far-right racist mofos currently exclude some 5,000,000 Texas men, women and children despite generous federal incentives. If there's a way to screw up or circumvent a pro-social federal program, Texas will do it from sheer meanness and spite.)
> Across America's mass-incarceration gulag, many prisons and jails offer egregiously poor healthcare for inmates. Will any provision in Khanna's bill, force that to change in states that opt for waivers?
Add'l comments:
> Kudos to One Payer States as a longtime grassroots leader banging the drum for state-based universal care.
> How to sell this concept to conservative politicians, pundits and voters? Advocates might frame it up as a "states' rights" issue.
Thanks for spotlighting this alt approach to giving single-payer universal healthcare a toehold at least somewhere in the US.
"We already know the effect in the US of the COVID disinformation campaign, hundreds of thousands of us died who did not have to die". This is a VERY powerful comment you make here in your piece on disinformation. I am relatively new to your writing and I am hoping you can and will direct me to quality studies and data that corroborate it. Thank you Robbie
Sure there were quite a few.
Here is one reference to the Brookings Institute
https://www.reuters.com/article/us-health-coronavirus-usa-economy/u-s-covid-response-could-have-avoided-hundreds-of-thousands-of-deaths-research-idUSKBN2BH1DK
Here is one to a study at Yale https://ysph.yale.edu/news-article/yale-study-more-than-335000-lives-could-have-been-saved-during-pandemic-if-us-had-universal-health-care/
Here is one in the Lancet https://www.eurekalert.org/news-releases/587179
Hope this helps...Alan
Alan, with four simple words, you made my head explode. Figuratively. Brains splattered all over the ceiling. No, I am not meshuga. Well, only a little. The four words: "But wait, there's more!"
In 1973 I got my first job as a copywriter in a Providence, RI ad agency. The copy chief was Arthur Schiff, a talented guy with deep intellect. I stayed two years and learned a lot from Arthur. Later in the 1970s Arthur left the agency to join Dial Media in Warwick, RI. They created the famed Ginsu Knife direct-sales TV commercials. "But wait, there's more!" https://en.wikipedia.org/wiki/Arthur_Schiff. For a time, I myself wrote direct-response commercials for another RI company in the same line of work.
Awesome memory, but that's not why I'm scraping brains off the ceiling. It struck me that Ginsu hard-sell but entertaining and amusing commercials, and those for other consumer products (remember the Ronco brand?), did a fabulous job of selling. And generating immediate consumer response. In those days, viewers had to pick up the phone.
Despite earnest and diligent efforts that you and I are both part of, the drive for Medicare for All has been stuck in neutral for a long time while Big Insurance has been eating our lunch. In the 117th Congress, M4A ended with 122 House co-sponsors. Now, in the 118th? 112 original co-sponsors and not one added since. That's sobering.
We need completely new approaches. Then it struck me: GINSU! (Thank you, Arthur, may you rest in peace.) Why aren't we making tongue-in-cheek-but-serious brief videos promoting direct action for M4A?! Head exploded. Brains all over the ceiling.
Thanks!
Alan, I tried posting this comment to your "Hot Mess Managing Insurance" piece (22 Aug) but when I click "Comment" it defaults to this page. Very frustrating. So, I'm commenting here, but the context is your previous "Hot Mess" piece.
Thanks for this piece. Just so folks know, the Dec 2020 CBO analysis ran 200 pages and included input from economists across the political spectrum — right, left and center. Further, the economist heading the CBO was (and still is) a Trump appointee.
Much of the net cost savings (compared with what we as a nation spend on healthcare today) stems from admin, as you point out. When the CBO included other costs (drug prices, etc), the savings totaled as much as $650 billion a year or more.
Again, that's NET cost savings after fully covering every man, woman and child in the US. https://www.commondreams.org/news/2020/12/11/seems-good-policy-cbo-shows-medicare-all-could-cover-everyone-650-billion-less-year
Just for scale, consider: it averages out to about $5,000 cash savings for every American household. It's like a hefty #HealthDividend we are NOT enjoying right now, thanks to congressional foot-dragging. If your congress member isn't already co-sponsoring the Medicare for All Act, demand to know why he/she wants to take away your $5,000 annual #HealthDividend! Do they hate you that much?
Alan, I thought I posted this comment to your piece on Black mother and infant mortality, but apparently when I click "Comment" it defaults to this page. Very frustrating. So, I'm commenting here, but the context is your previous piece on racial disparities in pregnancy and infant mortality.
Hmm... I wonder what the mortality stats are for Black doctors managing pregnancies and neonatal care for White moms and their infants. If (repeat, if) outcomes were at least marginally better than for White doctors treating White patients, then a couple of questions come to mind:
(1) Might there be some unintentional bias in the study design (i.e., flaws in the study) and, if not, then...
(2) What factors or qualities might account for the difference — again, if there were one and if it was real and not a statistical artifact.
It's all pure surmise, but someone might peek under the hood to see whether there isn't a valid hypothesis lurking somewhere. Perhaps something testable might be learned about empathic medical practice, beyond the obvious well-known compatibilities of racial healthcare. A longshot, but ¿quien sabe?
Thank you Alan.
Hi Lori - I did some digging around and found that Pacific source is a nonprofit insurance company in the Pacific NW serving WA, OR ID, Montana, etc.
I found that in 2019 they were fined 135000 for not responding to appeals and complaints quickly enough. - here is a link to that https://www.thelundreport.org/content/pacificsource-pays-135000-fine-service-appeals-violations
More important though is a review of the company done a couple of years ago by the State of Oregon. They found that Pacificsource denied 28% of all claims in one in 2019. Here is a link to that report. See page 8.
https://dfr.oregon.gov/business/reg/DFR-market-regulation/Documents/pacificsource-mc-rhea-2020.pdf
Good luck.