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War crowds-out health care resources

Johnson ‘26

(Jake Johnson, xx-xx-xxxx, “‘People Can’t Afford Healthcare’: Sanders Rips Pentagon Request for Another $200 Billion”, Common Dreams, March 20, https://www.commondreams.org/news/pentagon-200-billion)

‘People Can’t Afford Healthcare’: Sanders Rips Pentagon Request for Another $200 Billion “People can’t afford childcare,” said Sen. Bernie Sanders. “And this guy, in addition to giving tax breaks to billionaires, now wants to spend another $200 billion on a war that should never have been fought.” Jake Johnson Mar 20, 2026 US Sen. Bernie Sanders said Thursday that it is absurd for the Trump administration to demand another $200 billion from Congress for an illegal war on Iran after lawmakers already approved $1 trillion in military spending for the year—and while millions of people across the nation are struggling to afford basic necessities. “You got people all over this country, 20% of households, spending 50% of their income on housing,” Sanders (I-Vt.) said in an appearance on MS NOW. “People can’t afford healthcare. People can’t afford childcare. And this guy, in addition to giving tax breaks to billionaires, now wants to spend another $200 billion on a war that should never have been fought.” RECOMMENDED… omar shouts as trump delivers state of the union ‘Not Another Penny for Another Endless War,’ Ilhan Omar Says as Trump Seeks $200 Billion Secretary Hegseth Administers Oath Of Enlistment At Washington Monument ‘Ridiculous’: Pentagon Doesn’t Even Know What to Do With Extra $500 Billion Trump Wants to Spend The senator’s remarks came as President Donald Trump, who has not yet formally requested the funds from Congress, suggested another $200 billion would be a “small price to pay” as the US-Israeli war on Iran heads toward its fourth week with no end in sight. “I think the Trump people are in a bit of panic,” Sanders said Thursday. “They’re losing ground. Gas prices are soaring. There is massive discontent against this war. It’s got to end, and we’ve got to make sure that Trump is neutered in 2026.” With the Trump administration considering a plan to deploy thousands of additional troops to the Middle East amid widespread fears of a ground invasion of Iran—which would explode the price tag of an already costly war—the National Priorities Project (NPP) released an analysis The group estimated that $200 billion would be enough for all of the following this year: Medicaid for the 17 million people who will lose it due to budget cuts and other policies; Food stamps for the 22 million people who will go hungry due to Trump’s budget cuts; Medical care for the 1.8 million veterans of the last forever war who still live with disabilities; and Tripling the number of kids in Head Start, from just over 700,000 to 1.4 million kids. “Pete Hegseth would rather the US bomb Iranian families than feed American families,” wrote NPP’s Lindsay Koshgarian, referring to the Pentagon secretary. “We should remember the lies that led us into war in Iraq a generation ago. That war ultimately cost nearly $3 trillion. We must not go down that path again. Our tax dollars should be helping struggling Americans, not feeding new forever wars.”

1 million lost coverage in a week

Jessica Watts, April 2026, The Impossible Predicament of the Uninsured, https://www.theatlantic.com/magazine/2026/04/health-care-affordability-uninsured-americans/686053/

Many more people are now making that same decision. In 2025, the Republican-controlled Congress voted to let Biden-era subsidies in the ACA, which had helped some 22 million people afford their coverage, expire. Within just two weeks of the cutoff, at the end of December, enrollment had dropped by 1 million people. According to one group’s estimate, families are paying $200, $300, or $1,000 more a month; many have seen their premiums double. In January, President Trump released his proposal for a “Great Healthcare Plan,” which suggests that savings from the former subsidies could be sent directly to “eligible” Americans. But who would be eligible? The proposal makes no mention of the many people who don’t have coverage. Then, in February, the Trump administration released a list of 43 prescription drugs that Americans can buy for reduced prices. But some of these were already available at those prices or in generic forms, and they make up a tiny fraction of the drugs Americans need; the prescription my aunt couldn’t afford, for instance, is not listed. Nothing about Trump’s pronouncements changes the fact that millions more Americans will soon be stuck where my aunt was: in the middle—sometimes insured, sometimes uninsured, but always too poor to get the care they need.

Reducing health care labor collapses employment

Lydia DePillis, March 6, 2026, New York Times, Health Care Has Become the Lifeblood of the Labor Market, https://www.nytimes.com/2026/03/06/business/economy/health-care-hiring-labor-market.html

It is an exceptionally difficult time to find a job in America, as employers work through a hiring hangover from the pandemic and hesitate to invest in new staff with policy changes coming fast and furious from Washington. But the picture is even worse without one sector: health care. The industry, and related professions in the social assistance category, added 693,000 positions last year. Without it, the economy would have lost 570,000 jobs, as business and professional services, retail, the federal government and manufacturing all contracted. Health Care Has Led the Postpandemic Rebound In recent years, the sector has made up for what would have otherwise been negative job growth. 7 million jobs 6 Health care jobs 5 4 – Sectors that added jobs 3 2 1 0 Sectors that lost jobs −1 million jobs 2021 2022 2023 2024 2025 Source: Bureau of Labor StatisticsThe New York Times Health care’s insatiable growth is good news for people who make it into the profession, offering mobility and options for advancement. It’s why nurses in New York City won pay increases and job protections last month after a weekslong strike that had forced hospitals to spend heavily on traveling staff, and why health care positions offer signing bonuses uncommon for most professions. Advertisement SKIP ADVERTISEMENT But it also highlights the sluggishness in the rest of the labor market, where hiring has been glacial. As the unemployment rate has drifted upward, most job postings have attracted qualified candidates quickly — except for medical positions, which are taking longer to fill, said Raj Namboothiry, senior vice president for the United States at Manpower, a staffing company. “Health care has constantly shown gains when the rest of the sectors are on pause,” Mr. Namboothiry said. “This has become America’s most reliable job engine. Health care is keeping the lights on.” Some of the growth is catch-up hiring for a sector that took longer than most to recover from the pandemic after frontline workers burned out and left the field. But the quicker pace could be sustained as the youngest baby boomers retire and need more care, from hospitals to home health aides. “Health care stands out right now because it is doing its natural thing,” said Kosali Simon, a health economist at Indiana University-Bloomington. “What’s not happening is that other sectors are not doing the same. Health care is not as discretionary — it has to grow.” An Ever-Stronger Anchor The growth of the health care industry is not new. Driven by changes in consumer spending and expanding access to insurance as well as the aging population, the health and social assistance sector went from 8.3 percent of total employment in 1990 to nearly 15 percent today, compared with about 8 percent for manufacturing. Health care’s dominance only grows during recessions because people still have to go to the doctor even if they decide to put off buying a new car.

Millions will lose care due to ACA subsidy cuts

 

CNBC, Mar 6, 2026, GOP ‘big beautiful bill’ poised to deliver ‘shock’ to ACA marketplace, health policy experts say, https://www.cnbc.com/2026/03/06/gop-big-beautiful-bill-to-deal-shock-to-the-aca-marketplace.html

Republicans made a number of administrative tweaks to the Affordable Care Act marketplace in their so-called “big beautiful bill.” Many of the changes are technical and went under the radar, but are expected to cause enrollment to decline by millions of people, said health policy experts. The approach is a less flashy way to undercut Obamacare without passing “repeal and replace” legislation. The ACA has gained broad public support since those initial repeal-and-replace bills failed during President Donald Trump’s first term. Trump and congressional Republicans have said the ACA has made health care more expensive, though there is some debate on this point. WASHINGTON, DC – JANUARY 10: Visitors to the U.S. Capitol Building walk down the steps to the visitor’s entrance on a stormy day on January 10, 2026, in Washington, DC. (Photo by J. David Ake/Getty Images) J. David Ake | Getty Images News | Getty Images A series of policy changes in the so-called “big beautiful bill” are undermining the Affordable Care Act marketplace, in ways that may at first seem relatively subtle but which add up to a major change, health policy experts say. That, in turn, has important implications for consumers and the broader health care system for years to come, they said. The law — a multitrillion-dollar package that the Republican-led Congress passed in July — contains a series of administrative measures that make it harder or more expensive for many people to sign up for health insurance on the ACA marketplace, experts said. Those policies concerning the marketplace would add about 3 million people to the ranks of the uninsured over the next decade, the Congressional Budget Office estimated in September. Among them: ending automatic insurance renewals, removing certain financial protections for lower earners, tweaking annual enrollment periods, and barring many immigrants in the country legally from signing up for ACA marketplace insurance or accessing financial aid. Why ACA enrollment is falling for the first time in yearswatch now VIDEO05:04 Americans drop health care insurance coverage as premiums surge However, the administrative maneuvers — many of which are technical in nature and, on their face, may not seem consequential — have largely gone unnoticed by the public, experts said. “A lot of things that are happening are kind of under the radar,” said Jonathan Oberlander, a professor at the University of North Carolina and an expert in health-care politics and policy. “I’d describe the strategy as one of partial stealth,” he said. Other parts of the law — like more than $1 trillion of cuts to Medicaid, the public health program for lower earners — have garnered the bulk of public attention, experts said. Read more CNBC personal finance coverage Women and the K-shaped economy: Lower pay, affordability issues reduce spending Small 401(k) accounts may follow workers to their next job — except Roth money In a jobs apocalypse, look to ‘AI-proof’ skilled trades, career experts say Middle-income homebuyers have $30,000 more buying power than a year ago Average IRS tax refund is up 10.6%, early filing data shows GOP ‘big beautiful bill’ to deal ‘shock’ to the ACA marketplace: health experts As millions claim Trump’s ‘no tax on overtime’ deduction, filers risk mistakes S&P 500 shrugs off 1% daily drops all the time. Investors can too, advisors say Where investors can look for stability as the Iran war rattles markets What the Iran war market turmoil means for those nearing retirement Musk says Grok can help with your taxes. What experts say about AI and tax prep New bill would update anti-poverty program, ‘a critical lifeline’: Warren There’s a push to cut capital gains taxes on home sales to add supply for buyers Iran war and your portfolio: Historical stock market patterns investors should know Trump says ’401(k)s are way up’ — but workers are tapping them at record rates CNBC’s Financial Advisor 100: Best financial advisors, top firms ranked View More The law also didn’t extend enhanced ACA subsidies, which were scheduled to lapse at the end of 2025. The issue ultimately became high-profile, leading to a record-long government shutdown in the fall, and GOP lawmakers in the Senate ultimately voted against an extension. “A lot of people have heard about the subsidy cuts, but I don’t think a lot of people understand the magnitude of what we’re facing in the [ACA] marketplace with all these changes,” Oberlander said. “We’re talking about a shock to the marketplace,” he said. Largest rollback of health insurance coverage A bank of storm clouds hovers over the dome of the U.S. Capitol, on the 30th day of the government shutdown, in Washington, D.C., U.S., October 30, 2025. REUTERS/Kevin Lamarque Kevin Lamarque | Reuters The Affordable Care Act, also known as Obamacare, established a health insurance marketplace where Americans could shop for private health plans. The law, passed in 2010, also created premium tax credits and other assistance to make coverage more affordable for certain enrollees, and expanded access to Medicaid. ACA marketplace enrollees are often small business owners, gig workers, freelancers and others who can’t get health insurance elsewhere, such as via Medicaid, Medicare or coverage through an employer. Obamacare helped drive down the U.S. uninsured rate to record lows in recent years, experts said. Dr. Vin Gupta on how the expiration of enhanced ACA subsidies will affect Americanswatch now VIDEO04:22 Dr. Vin Gupta on how the expiration of enhanced ACA subsidies will affect Americans However, health provisions in the “big beautiful bill” amount to the largest rollback of health insurance coverage in U.S. history, Oberlander said. The share of the U.S. population without health insurance is expected to swell from 7.6% in 2025 to 10.4% by the end of the decade, according to the CBO. Total enrollment in ACA marketplace health plans is expected to fall to 12.5 million by 2028, the CBO estimated in February. That would be about half of last year’s enrollment and represent a near-erasure of all gains in marketplace sign-ups since 2021, when the enhanced subsidies took effect. There are many potential downstream effects of this dynamic, according to health experts. Millions of Americans becoming uninsured pose a serious financial risk to affected households, they said. Millions more will shift to plans with higher deductibles, reducing upfront premiums but leaving them exposed to big medical bills if they need to use their insurance. I’d describe the strategy as one of partial stealth. Jonathan Oberlander professor at the University of North Carolina There are also implications for the health care system at large. Hospitals with higher uninsured populations would likely face financial pressures, in turn impacting everyone who goes to the hospital by reducing resources available to treat people, Oberlander said. “When individuals lose health insurance coverage, they ultimately turn to their local hospital when they need care,” the American Hospital Association wrote in June. “This affects everyone, not only the uninsured, leading to overcrowded emergency departments, longer wait times and increased costs for care, which acts as a ‘hidden tax’ on all.” ‘Repeal and replace,’ by a different name WASHINGTON, DC – JULY 27: Sen John McCain (R-AZ) leaves the Senate Chamber after a vote on a stripped-down, or ‘Skinny Repeal,’ version of Obamacare reform on July 28, 2017 in Washington, DC. McCain was one of three Republican Senators to vote against the measure. (Photo by Zach Gibson/Getty Images) The late Sen. John McCain (R-AZ) leaves the Senate Chamber after a vote on a stripped-down, or ‘Skinny Repeal,’ version of Obamacare reform on July 28, 2017 in Washington, DC. McCain was one of three Republican Senators to vote against the measure. Zach Gibson | Getty Images News | Getty Images Republicans have tried to dismantle the Affordable Care Act for years, partly due to ideological differences in health policy and increased partisan polarization, experts said. Indeed, the ACA was passed into law in 2010 without a single Republican vote. Health policy experts said the administrative policies in the “big beautiful bill” that aim to cripple the ACA amount to a less flashy version of “repeal and replace.” The term refers to previous Republican efforts to scrap large parts of the ACA and replace it with something new. Sign Up for Our Newsletter Your Wealth Weekly advice on managing your money SIGN UP NOW Get this delivered to your inbox, and more info about our products and services. By signing up for newsletters, you are agreeing to our Terms of Use and Privacy Policy. The GOP came close to fulfilling that goal during President Donald Trump’s first term in office. However, the late Republican Sen. John McCain of Arizona cast a decisive thumbs-down vote in the Senate in 2017, scuttling legislation to repeal the health law. President Trump has often said he dislikes the Affordable Care Act. “The best thing we can do, politically speaking, is let Obamacare explode,” he said in the White House in March 2017. “We’ll end up with a truly great health care bill in the future after this mess known as Obamacare explodes,” he added. In October 2017, a few months after the effort to repeal the ACA failed in the Senate, he wrote on social media site X that “ObamaCare is a broken mess.” “Piece by piece we will now begin the process of giving America the great HealthCare it deserves!” he wrote. Trump and congressional Republicans have said the ACA has contributed to rising costs for health care, such as insurance premiums. There is some debate on this point, though, and some experts point to other contributors to rising costs, such as consolidation among health care providers and physician billing practices. Policies in the “big beautiful bill” — including cuts to Medicaid — and the expiration of enhanced premium tax credits will lead about 15 million people to lose health insurance, the CBO estimated in June when scoring the impact of the legislation. ″[That’s] not far outside the scope of what some of the repeal-and-replace plans from 2017 would have done,” said Cynthia Cox, director of the Affordable Care Act program at KFF, a nonpartisan health policy research group. Separately, new rules proposed by the Trump administration in February would further decrease ACA marketplace enrollment by up to 2 million people in 2027, the U.S. Department for Health and Human Service estimated. If adopted, the rules would, among other things, expand access to so-called catastrophic plans with even higher out-of-pocket costs, defray certain state-mandated benefits and add “burdensome” verification requirements for enrollees, according to Katie Keith, director of the Center for Health Policy and the Law at Georgetown University Law Center’s O’Neill Institute. Most Americans like ACA, making repeal difficult In general, Republicans and Democrats fundamentally disagree on the role of government in health care policy. Democrats believe the government should be active and take steps toward giving all Americans access to health insurance, while Republicans tend to favor a more limited government role and view universal coverage as not a priority, experts said. GOP rancor toward the ACA is also fueled in part by partisan hostility, Oberlander said. Resisting Democrats and the expansion of the federal government has become a rallying cry for the party, he said. Sen. Pete Ricketts on health care: Republicans want to empower people by giving them the moneywatch now VIDEO09:16 Sen. Pete Ricketts on health care: Republicans want to empower people by giving them the money However, Obamacare popularity has increased gradually since its inception. Now, most Americans — 58% — have a favorable view of the law, according to KFF, which has tracked public opinion since 2010. Ironically, public opinion started to shift in the ACA’s favor after repeal-and-replace measures failed in Congress around 2017, said KFF’s Cox. Current popularity makes it more politically challenging to repeal the law outright, experts said. Representative Mariannette Miller-Meeks, a Republican from Iowa, from left, US House Speaker Mike Johnson, a Republican from Louisiana, Representative Tom Emmer, a Republican from Minnesota, Representative Steve Scalise, a Republican from Louisiana, and Representative Lisa McClain, a Republican from Michigan, during a news conference at the US Capitol in Washington, DC, US, on Tuesday, Dec. 16, 2025. Johnson will block a push by moderate House Republicans for a vote on renewing expiring Obamacare subsidies, Rep. Mariannette Miller-Meeks (R-IA), from left, House Speaker Mike Johnson (R-LA), Rep. Tom Emmer (R-MN), Rep. Steve Scalise (R-LA), and Rep. Lisa McClain (R-MI), during a news conference on Dec. 16, 2025. Johnson will block a push by moderate House Republicans for a vote on renewing expiring Obamacare subsidies, quashing a last-ditch effort to head off a spike in insurance premiums. Bloomberg | Bloomberg | Getty Images The GOP’s political calculus appears to be that by making Obamacare work less efficiently, Americans will become frustrated with the law, giving lawmakers political cover to eventually replace it, said Casey Burgat, director of the legislative affairs program at The George Washington University’s Graduate School of Political Management. “Most of it has to do with making things harder administratively,” Burgat said. “The nerds call it administrative attrition.” And, many people won’t know it was the GOP who made it harder, he said. It’s a similar dynamic to certain voter registration rules, he said: Adding more administrative hurdles pushes people off the voter registration rolls, Burgat said. ACA policies in the big beautiful bill MIAMI, FLORIDA – NOVEMBER 12: An Obamacare sign is displayed outside an insurance agency on November 12, 2025 in Miami, Florida. House Democrats are said to be looking at steps to force a vote on extending the expiring Affordable Care Act tax credits after Republicans did not address the issue as part of a deal to reopen the federal government. The House is expected to vote today on ending the record-long government shutdown. (Photo by Joe Raedle/Getty Images) An Obamacare sign at a Miami insurance agency on Nov. 12, 2025. Joe Raedle | Getty Images Republicans also said some of the policy changes in the “big beautiful bill” are due to concerns about waste, fraud and abuse. The Paragon Health Institute, a conservative health policy think tank, in May wrote that the measures were “commonsense program integrity provisions” to reduce fraud and spending, and said they would cut back on the “Biden administration’s approach of maximizing enrollment at any cost.” Some health experts have said that, while there has been evidence of fraud, the concerns have been exaggerated. “Fraud should be addressed,” said Cox of KFF. “But this [law] doesn’t just address fraud. It also makes it more difficult for 20 million-some [ACA enrollees] to keep it from year to year.” Here are some of the significant changes, according to experts. Prohibits auto-renewal Among the more consequential changes is the effective end of automatic re-enrollment into one’s existing ACA marketplace health insurance plan, due to the addition of certain verification requirements — around factors like household income, place of residence and family size — before enrolling, Cox said. Previously, households with existing coverage who didn’t act during open enrollment were auto-renewed into the same plan or a similar one for the coming year. Nearly half of enrollees auto-renewed in 2025, according to KFF. Excess subsidies must be repaid in full The bill would eliminate repayment caps for premium subsidies, known as premium tax credits. Most households that receive these federal tax credits opt to get them ahead of tax season. Recipients pay lower health insurance premiums on a monthly basis due to this advance premium tax credit. Most of it has to do with making things harder administratively. Casey Burgat director of the legislative affairs program at The George Washington University’s Graduate School of Political Management However, the tax credit amount is based on household income. Households estimate their annual income for the coming year, which dictates their total premium tax credit. They must repay excess subsidies during tax season, if their annual income ends up being larger than they’d initially estimated. Previously, there was a cap on how much money certain households would have to repay, on a sliding scale based on income, in order to avoid a financial shock during tax season. Now, all excess subsidies will have to be repaid in full, no matter a household’s income. This provision took effect for tax year 2026, meaning people will experience it when they file their taxes in 2027. The law shortens the annual enrollment period for ACA marketplace coverage. Previously, enrollment ran from Nov. 1 to Jan. 15. That enrollment window ends Dec. 15 — or, one month earlier — in all states. In 2025, roughly 40% of enrollees enrolled after Dec. 15, according to the AHA. Additionally, lower-income households — who made up nearly half of ACA enrollees in 2025, according to KFF — had been eligible to sign up for coverage year-round during so-called “special enrollment periods.” They were also eligible for financial aid like premium tax credits. Now, such households are barred from receiving that financial assistance if they sign up during an income-based special enrollment period, according to KFF. Curtails use by legal immigrants The law denies marketplace insurance eligibility for many groups of legal immigrants, experts said. Starting Jan. 1, 2027, many immigrants who are in the country legally — such as refugees, asylees and people with Temporary Protected Status will be ineligible for subsidized insurance on ACA exchanges, according to KFF. Previously, U.S. citizens and immigrants legally in the U.S. were eligible to enroll in an ACA marketplace health plan and get financial assistance like premium subsidies. Ken Griffin: Immigration policy is ‘absolutely’ playing out in labor marketwatch now VIDEO03:07 Ken Griffin: Immigration policy is ‘absolutely’ playing out in labor market Now, that financial assistance will only be available to those with green cards, in addition to: migrants who are in the U.S. via a Compact of Free Association, which include citizens of three Pacific island nations (the Marshall Islands, Palau and Micronesia); and Cuban and Haitian entrants as defined in section 501(e) of the Refugee Education Assistance Act of 1980, according to KFF. “Without ACA subsidies, most immigrant enrollees will discontinue their coverage,” according to the American Medical Association.

The number of who can’t afford care will increase

Richard E. Anderson, MD & The Doctors Company Physician  March 6, 2026, https://kevinmd.com/2026/03/the-future-of-u-s-medicine-10-health-care-trends-in-2026.html, The future of U.S. medicine: 10 health care trends in 2026

Predicting shifts in the health care environment has always been difficult, but this year, the pace of change, driven by regulatory complexity, mounting financial pressures, and artificial intelligence (AI), makes long-term forecasts increasingly uncertain. Each year, TDC Group has predicted emerging health care trends over the next decade, focusing on the challenges, risks, and opportunities that shape the industry. For 2026, in response to increasing complexity, we have highlighted the forces most likely to affect U.S. health care through the coming year. Our research paper, “Healthcare on the Horizon: Predictions for U.S. Healthcare Through 2026“, lays out some of the most pressing issues medical professionals must address. We are committed to helping guide medical leaders through health care’s evolution, assisting them in making critical decisions that shape the future of patient care. ADVERTISEMENT A picture of the health care landscape Medical professionals continue to uphold their commitment to delivering high-quality patient care, despite navigating a health care environment characterized by rapid digital innovation, pervasive misinformation, escalating costs, and persistent fragmentation. Burnout remains a critical concern: The majority of physicians would not recommend a medical career to their children, reflecting the sustained pressures of modern practice. Hospitals face mounting financial challenges as the convergence of increasing medical malpractice losses and reimbursement difficulties drives ongoing facility closures, exacerbating gaps in patient access. Currently, approximately 11 percent of Americans report being unable to access or afford care, a figure likely to rise as health insurance premiums increase in 2026, intensifying burdens on both patients and clinicians. Some access gaps are being addressed through the expansion of distributed care models, with advanced practice clinicians, including nurse practitioners and physician assistants, working in close collaboration with physicians. These teams rely on well-defined roles and advanced teamwork to optimize care delivery. The exponential growth of medical knowledge presents a significant challenge for clinicians. AI, with advanced capabilities in information synthesis and pattern recognition, offers the potential to help clinicians manage knowledge overload and streamline administrative tasks such as scheduling, billing, and prior authorization. The field is rapidly evolving from generative AI to agentic AI, introducing new horizons for autonomous technologies. However, rapid AI adoption introduces complex malpractice and liability issues, underscoring the need for clear standards, informed consent, and adaptive legal frameworks. [Image comparing generative AI and agentic AI architectures within a health care clinical decision support system] Key predictions for health care this year Prediction 1, AI integration and clinical trust: AI will permeate all aspects of health care, but its impact on care will depend on the degree of clinician trust in the technology. Prediction 2, Digital transformation: A $1 trillion migration toward digital-first health care will generate both significant advancements and costly missteps. Prediction 3, Liability and legal volatility: Social inflation, large verdicts, and AI-related evidence will make the courtroom a focal point for unpredictable liability, with legal precedents lagging behind technological advances. Prediction 4, Widening access gaps: Liability-related costs, workforce shortages, and reimbursement pressures will force additional hospital closures, further widening disparities in care access. Prediction 5, Medical liability reform: Tort reform will become a national priority as courts grapple with evolving theories of liability. Prediction 6, Reproductive health care risks: Ongoing uncertainty and liability surrounding reproductive health care will continue to disrupt established standards and require innovative insurance solutions. Prediction 7, Care at home: More care will move to patients’ homes, with teams using defined roles to deliver high-quality care. Prediction 8, Agentic AI and responsibility: Advanced AI will redefine clinical decision-making and accountability. Prediction 9, Information complexity: The proliferation of chatbots, influencers, and direct-to-consumer advertising will both complicate and simplify evidence-based practice; clinicians will remain central to maintaining trust and sound medical judgment. Prediction 10, Enduring physician trust: Physicians will continue to be viewed as the trusted source of medical expertise, though the practice environment will change substantially.

Health care costs rising

Axios, March 5, 2026, https://www.axios.com/sponsored/if-you-feel-like-you-cant-afford-health-care-youre-not-alone

Hand placing a white block with a blue cross on top of a pyramid of white blocks featuring blue health symbols: heart pulse, blood drop, medical kit, syringe, and wheelchair. Health care keeps getting more expensive, and it’s creating growing concern. A challenge: When people delay care because of cost, small health issues are more likely to become serious — and far more expensive — problems later. 36% of adults say they’ve skipped doctor appointments in the past year because of cost. Adding to the concerns about overall affordability is the fact that health insurance premiums are swiftly rising as well. There is a misconception that health plan premiums are prepayments for care — they are not. Premiums are payments into a shared risk pool, similar to auto insurance, and they reflect the price of overall health care, so when care costs rise, your premiums follow. Adding to the frustration: These premium costs are climbing. Family premiums have risen 52% in the last 10 years, leading the U.S. to spend over $5 trillion a year on health care. The positive news: Health providers like Elevance Health are changing the structure of their health plans to be more accessible for patients — aiming to boost affordability and improve health outcomes.

State public option programs fail

 

KFF Health News, 2-18, 26,  State public-option health plans expand but can’t fill gaps left by federal changes, https://www.npr.org/2026/02/18/nx-s1-5717181/nevada-public-option-health-plan-aca

More than 10,000 people have enrolled in Nevada’s new public-option health plans, which debuted last fall with the expectation that they would bring lower prices to the health insurance market. Those preliminary numbers from the open enrollment period that ended in January are less than a third of what state officials had projected. Nevada is the third state so far to launch a public option plan, along with Colorado and Washington state. The idea is to offer lower-cost plans to consumers to expand health care access. But researchers said plans like these are unlikely to fill the gaps left by sweeping federal changes, including the expiration of the subsidies for plans bought on Affordable Care Act marketplaces. President Trump is pictured at the Resolute Desk with OMB Director Russell Vought, Homeland Security Sec. Kristi Noem and Interior Sec. Doug Burgum standing behind him. Health A familiar move with a new twist: Trump tries to cut CDC funds he just signed into law The public option gained attention in the late 2000s when Congress considered but ultimately rejected creating a health plan funded and run by the government that would compete with private carriers in the market. The programs in Washington state, Colorado, and Nevada don’t go that far – they aren’t government run, but are private-public partnerships that compete with private insurance. In recent years, states have considered creating public-option plans to make health coverage more affordable and to reduce the number of uninsured people. Washington was the first state to launch a program, in 2021, and Colorado followed in 2023. Washington and Colorado’s programs have run into challenges, including a lack of participation from clinicians, hospitals, and other care providers, as well as insurers’ inability to meet rate reduction benchmarks or lower premiums compared with other plans offered on the market. Nevada law requires that the carriers of the public-option plans — called “Battle Born State Plans” after a state motto — lower premium costs compared to a benchmark silver plan in the marketplace by 15% over the next four years. But that amount might not make much difference to consumers with rising premium payments from the loss of the ACA’s enhanced tax credits, said Keith Mueller, director of the Rural Policy Research Institute. “That’s not a lot of money,” Mueller said. Three of the eight insurers on the state’s exchange, Nevada Health Link, offered the state plans during the open enrollment period. Insurance companies plan to meet the lower premium cost requirement in Nevada by cutting broker fees and commissions, which prompted opposition from insurance brokers in the state. In response, Nevada marketplace officials told state lawmakers in January that they will give a flat-fee reimbursement to brokers. The public option has faced opposition among state leaders. In 2024, a state judge dismissed a lawsuit, brought by a Nevada state senator and a group that advocates for lower taxes, that challenged the public-option law as unconstitutional. They have appealed to the state Supreme Court. Federal changes create more obstacles Nevada is consistently among the states with the largest populations of people who do not have health insurance coverage. Last year, nearly 95,000 people in the state received the enhanced ACA tax credits, averaging $465 in savings per month, according to KFF, a health information nonprofit that includes KFF Health News. But the enhanced tax credits expired at the end of the year, and it appears unlikely that lawmakers will bring them back. Nationwide ACA enrollment has decreased by more than 1 million people so far this year, down from record-high enrollment last year of 24 million. About 4 million people are expected to lose health coverage from the expiration of the tax credits, according to the Congressional Budget Office. An additional 3 million are projected to lose coverage because of other policy changes affecting the marketplace. The changes to the ACA in Republicans’ One Big Beautiful Bill Act, which President Donald Trump signed into law last summer, will make it more difficult for people to keep their coverage, said Justin Giovannelli, an associate research professor at the Center on Health Insurance Reforms at Georgetown University. These changes include more frequent enrollment paperwork verifying income and other personal information, a shortened enrollment window, and an end to automatic reenrollment. In Nevada, the changes would amount to an estimated 100,000 people losing coverage, according to KFF. “All of that makes getting coverage on Nevada Health Link harder and more expensive than it would be otherwise,” Giovannelli said. State officials projected ahead of open enrollment that about 35,000 people would purchase the public-option plans. Of the 104,000 people who had purchased a plan on the state marketplace as of mid-January, 10,762 of them had enrolled in one of the public-option plans, according to Nevada Health Link. Katie Charleson, communications officer for the state health exchange, said the original enrollment estimate was based on market conditions before the recent increases in customers’ premium costs. She said that the public-option plans gave people facing higher costs more choices. “We expect enrollment in Battle Born State Plans to grow over time as awareness increases and as Nevadans continue seeking quality coverage options that help reduce costs,” Charleson said. According to KFF, nationally the enhanced subsidies saved enrollees an average of $705 annually in 2024, and enrollees would save an estimated $1,016 in premium payments on average in 2026 if the subsidies were still in place. Without the subsidies, people enrolled in the ACA marketplace could be seeing their premium costs more than double. Insights from Washington and Colorado Washington and Colorado are not planning to make any changes to their programs as a result of the expired tax credits, according to government officials in those states. Other states that had recently considered creating public options have backtracked. Minnesota officials put off approving a public option in 2024, citing funding concerns. Proposals to create public options in Maine and New Mexico also sputtered. Washington initially saw meager enrollment in its Cascade Select public-option plans — just 1% of the state marketplace enrollees chose the public-option plan in 2021. But that changed after lawmakers required that hospitals contract with at least one public-option plan by 2023. Last year the state reported that 94,000 customers enrolled, accounting for 30% of all customers on the state marketplace. The public-option plans were the lowest-premium silver plans in 31 of Washington’s 39 counties in 2024. A 2025 study found that in the years since Colorado implemented its public option, called the Colorado Option, coverage through the ACA marketplace became more affordable for enrollees who received subsidies but more expensive for enrollees who did not. Colorado requires all insurers offering coverage through its marketplace to include a public option that follows state guidelines. The state set premium reduction targets of 5% a year for three years beginning in 2023. Starting this year, premium costs are not allowed to outpace medical inflation. Though the insurers offering the public option did not meet the premium reduction targets, enrollment in the Colorado Option has increased every year it has been available. Last year, the state saw record enrollment in its marketplace, with 47% of customers purchasing a public-option plan. Giovannelli said states are continuing to try to make health insurance more affordable and accessible, even if federal changes reduce the impact of those efforts. “States are reacting and trying to continue to do right by their residents,” Giovannelli said, “but you can’t plug all those gaps.”

 

War turns case

Dr. Rondi Anderson, Senior Technical Advisor, RMNCH, February 6, 2026, https://www.projecthope.org/news-stories/story/6-health-issues-were-watching-in-2026/ Project HOPE health experts share the most pressing global health challenges we’re tracking in 2026.

Health systems worldwide are facing unprecedented strain, buckling under the pressures of conflict, displacement, and disease. Despite these compounding challenges, Project HOPE touched more lives than ever in the past year, helping health workers save lives and address the unique needs of their communities. We reached more than 5 million people, provided direct medical services to more than 3.4 million patients, screened 1.2 million people for disease, and donated $82.8 million in essential equipment, medicines, and medical supplies. This year, our focus will remain fixed on addressing the world’s most urgent health challenges — closing gaps in care, reducing vulnerabilities, and tackling emerging threats. From antimicrobial resistance to rising mental health needs, we asked our team of technical experts to share what issues they’re watching most closely in 2026. 1. Rising Conflict, Displacement, and Health System Fragmentation Dr. Rondi Anderson Senior Technical Advisor, RMNCH The number of armed conflicts has reached its highest level in three decades, driving unprecedented displacement and placing immense strain on fragile health systems. Conflicts and natural disasters damage infrastructure, disrupt supply chains, and force health workers to flee, reducing access to essential services. Fragmentation — caused by damaged infrastructure, weakened governance, and disrupted referral systems — further limits the continuity and quality of services. As crises become more prolonged and complex, health facilities face chronic shortages of medicines, electricity, and personnel, while displaced populations often settle in overcrowded, resource-poor environments where access to care is severely restricted. Health indicators deteriorate rapidly in such settings, with preventable conditions worsening due to delayed or absent services and underserved populations at heightened risk, particularly women and children. As the number of forcibly displaced people surpasses 117 million globally, more women are becoming pregnant in such unstable, resource-constrained environments. The implications are serious: Evidence shows that maternal and neonatal mortality in conflict-affected countries can be more than double global averages. Evidence shows that maternal and neonatal mortality in conflict-affected countries can be more than double global averages. Without a strong response, these health outcomes and inequities will continue to widen. Project HOPE responds to humanitarian crises by placing women in the center of primary health care. By doing so, the needs of women and children are addressed, helping reduce the burden of morbidity and mortality. Mother carries child in Gaza outside medical clinic Suzan has nine children and is displaced from her home in North Gaza. Displacement has a higher burden on women and can make even basic medical care impossible. Photo by Motaz Alaaraj for Project HOPE, 2025. 2. Life-Threatening Vaccination Gaps and Outbreak Risks Dr. Endalkachew Melese Senior Technical Director, Infectious Diseases Global immunization efforts — long recognized by the World Health Organization and UNICEF as among the most cost-effective public health investments — are under increasing strain. Misinformation, population growth, humanitarian crises, and declining funding are widening immunity gaps, placing millions of children, adolescents, and adults at risk. As these pressures intensify, decades of progress are beginning to unravel, and vaccine-preventable diseases are resurging worldwide.

 

AMR risks increasing

Dr. Endalkachew Melese Senior Technical Director, Infectious Diseases, February 6, 2026, https://www.projecthope.org/news-stories/story/6-health-issues-were-watching-in-2026/ Project HOPE health experts share the most pressing global health challenges we’re tracking in 2026.

Antimicrobial resistance (AMR) — the ability of microorganisms to resist treatments that were once effective against them — has emerged as one of the most urgent global health threats. In 2021, AMR was linked to 4.7 million deaths worldwide, including over 1.1 million deaths directly caused by drug-resistant infections. Without urgent action, AMR could rival cancer as a leading cause of mortality by 2050, with projected annual fatalities reaching 10 million. The burden of AMR falls disproportionally on low- and middle-income countries, where fragile health systems and limited access to clean water, sanitation, and effective antibiotics create conditions for resistant infections to spread. Young children, older adults, and individuals with weakened immune systems are especially vulnerable. A small group of pathogens account for nearly three-quarters of all AMR-related deaths, while rising resistance to some of the last-effective antibiotics poses an escalating challenge. Without urgent action, AMR could rival cancer as a leading cause of mortality by 2050. Misuse of antibiotics in humans, animals, and plants continues to accelerate resistance, compounded by globalization, migration, and climate change. Left unchecked, AMR jeopardizes the progress of modern medicine and global food security, with the World Bank estimating up to $1 trillion in additional health care costs and $1 trillion to $3.4 trillion in annual GDP losses by 2030. Yet solutions do exist. Strengthening surveillance, improving antibiotic stewardship, preventing infections, and investing in new diagnostics, treatments, and vaccines is critical. Addressing AMR requires a One Health approach — a unified effort to balance and optimize the health of people, animals, and ecosystems. The time to act is now — before the world enters a true post-antibiotic era.

Rural hospitals at-risk of collapse

Bennett, Common Wealth Fund, 2026, February, Kevin Bennett, Celli Horstman, Corinne Lewis, Anthony Shih, https://www.commonwealthfund.org/publications/explainer/2026/feb/why-rural-hospitals-face-funding-crisis-how-it-could-get-worse, Why Rural Hospitals Are Facing a Funding Crisis — and How It Could Get Worse

Residents in remote areas of the U.S. face increasing barriers to critical health services, with more than 200 rural hospitals completely or partially closing since 2005 and 400 more currently at risk of closure Changes to national health policy, including Medicaid work requirements and the elimination of ACA enhanced premium tax credits, are expected to further erode rural health care services With hospital financing largely tailored to urban contexts, a growing number of rural hospitals are closing their doors, leaving many rural residents without a place to go for care. Since 2005, nearly 200 rural hospitals have completely or partially closed, and over 400 — more than 20 percent of rural hospitals — are at risk of closure. Even the hospitals that manage to stay open are cutting critical services to make ends meet. Between 2014 and 2023, for instance, 424 rural hospitals stopped offering chemotherapy services, forcing cancer patients and their families to travel farther to access needed care. Beyond creating barriers for patients, hospital closures worsen workforce shortages as physicians leave the community for employment. Other types of care facilities, like community health centers, are left to pick up the slack, but they can’t offer the same services as a hospital and may face their own financial challenges. And as demand for care rises in the area, so do prices at remaining hospitals. Why are rural hospitals losing money? Health care clinicians and health systems in the United States are largely paid based on how many services they deliver. This is particularly challenging for rural areas, which have smaller populations and fewer patients, resulting in lower demand for services. As a result, rural hospitals often cannot generate enough revenue to pay for their fixed, overhead costs by providing services. While urban hospitals tend to have higher operating costs, they have the patient volume to afford it. A higher proportion of rural hospital revenue, on the other hand, is spent on staying afloat rather than investing in improvements to care and infrastructure. Maternity care offers a useful case study. Though access to maternal health services is critical for safe pregnancy and delivery, low numbers of rural births have forced the closure of maternity wards. In 2024, roughly a third of U.S. counties didn’t have a single obstetric provider or birthing facility. To provide maternity care, rural hospitals must employ specialized staff and have beds and equipment available year-round, but they are only paid when a delivery actually occurs. The low frequency of these deliveries means reimbursements often fail to offset the fixed costs of making these services available. When facing repeated shortfalls, rural hospitals have three choices: lose revenue, which can put them at risk of closure; rely on payment from other services to subsidize operating costs for maternity care; or stop providing this care altogether. They are increasingly choosing the third option, and rural families are paying the price. Complicating matters, a larger share of rural than urban residents are insured by public payers such as Medicare and Medicaid, which typically reimburse less for services than private payers. Within Medicare, an increasingly large share of rural patients are enrolled in Medicare Advantage plans, which tend to have lower provider payment rates than traditional Medicare and higher rates of claims denials. Fewer patients and lower reimbursement rates mean nearly half of rural hospitals operate on negative or close-to-negative margins. How can rural hospitals bolster their finances? Over time, various congressional and federal policies aimed at bolstering rural hospital financing have created a patchwork of payment mechanisms. Medicare, the largest payer for rural health care services, predominantly pays for hospital care through two mechanisms: the inpatient and outpatient prospective payment systems, known as IPPS and OPPS. Under IPPS, Medicare pays a predetermined rate per hospital stay, which should also cover operating and capital costs. Under OPPS, Medicare similarly pays a predetermined rate for each episode of care based on the type and complexity of services delivered. Medicare applies geographic adjustments to IPPS and OPPS payments to account for differences in volume and operating costs in rural versus urban settings. Medicare also has several programs that build on IPPS and OPPS by offering rural hospitals enhanced payments and/or flexibility in regulatory requirements. To qualify, a rural hospital must have low patient volume, have few hospital beds, or be the only hospital within a geographic area, making it critical for maintaining patient access (see the table describing six programs). Nearly all rural hospitals receive funding through one of these three designations. Over half of rural hospitals are designated critical access hospitals. Many rural hospitals also benefit from disproportionate share hospital payment programs in Medicare and Medicaid, which help cover some uncompensated care costs for hospitals that serve a high proportion of low-income patients, untied to geography. Additionally, rural hospitals may receive tax incentives, charitable donations, and private investments through venture capital or private equity. Notably, there are some concerns regarding private investments in hospitals, regardless of geography, with evidence showing it has led to hospital consolidation, closures, and higher consumer prices. Findings are mixed regarding their impact on quality of care. Finally, the Rural Health Transformation Program, included in the 2025 budget bill H.R. 1, provides $50 billion in funding to states. The Centers for Medicare and Medicaid Services (CMS) has stipulated that no more than 15 percent of funds can be used on hospitals or patient care. While these programs are meant to augment insurer payments to hospitals, they do not address the impact that low visit volume has on rural hospitals. Without a stable, baseline level of funding, rural hospitals must find alternative sources of funding to maintain their operations. How has Medicaid expansion impacted rural hospital financing? The Affordable Care Act’s (ACA) expansion of Medicaid eligibility made coverage available to nearly all low-income adults in the 41 states (including the District of Columbia) that opted in. For rural residents in these states, it’s meant that a higher proportion of patient visits are reimbursed, because more rural residents are now insured, leading to increased revenue for hospitals. In the first two years of expansion, Medicaid revenue shares for rural hospitals rose an average of 33 percent — equivalent to about $2 million more in revenue — while uncompensated care costs fell 43 percent. Medicaid expansion is associated with positive operating margins and lower probability of hospital closure. While the benefits of expansion apply to both rural and urban hospitals, rural hospitals experience greater financial gains. What impact might congressional policy changes have on rural hospital financing? The 2025 budget bill, H.R. 1, includes several provisions focused on Medicaid expansion states that are expected to erode the financial stability of rural hospitals. Medicaid spending in rural areas is expected to decrease by $137 billion over the next 10 years, with expansion states seeing the largest reductions. Rural hospitals’ Medicaid revenue could drop by as much as 9.6 percent on average, while uncompensated costs could increase by 35.4 percent. Key changes include: Medicaid beneficiaries who became eligible through the expansion are now required to regularly verify their work status to stay enrolled, and states will need to redetermine their eligibility every six months rather than 12 months. These changes are expected to cause 1.5 million rural Medicaid beneficiaries to lose coverage. A new cap on state-directed payments is expected to accelerate hospital closures. It limits the capacity of state Medicaid programs to provide enhanced payments to rural hospitals, helping to offset low Medicaid reimbursement rates. In addition to H.R. 1, enhanced premium tax credits expired at the end of 2025. Without these credits, which subsidize the cost of ACA marketplace health insurance plans, fewer people will be able to afford coverage, and rural hospitals could lose an additional $1.6 billion in patient revenue.

Rural hospitals lack funds to operate

Chartis Health Care, February 10, 2026,  Rural healthcare challenges deepen as the Rural Health Transformation program ramps up, https://www.chartis.com/insights/2026-rural-health-state-state

For more than a decade, Chartis’ annual study has examined the stability of the rural health safety net in America. Economic, policy, and demographic forces have placed an increasing strain on this safety net. Today, more than 40% of rural hospitals are operating at a loss. As a result, 417 facilities are vulnerable to closure. Care deserts, where services such as obstetrics (OB), chemotherapy, and general surgery are nowhere to be found, are expanding at an alarming rate.1 The Rural Health Transformation (RHT) program is injecting $50 billion into rural healthcare over the next 5 years and promises to address “the fundamental hindrances of improvement in rural health care.”2 This is an unprecedented investment in rural healthcare, but states will only use a small fraction to stabilize rural hospitals. Estimates also indicate that the program won’t offset the nearly $140 billion in expected losses from Medicaid-related cuts stemming from the One Big Beautiful Bill Act (H.R. 1).3 Rural healthcare is at a crossroads. RHT-funded initiatives will support innovation and improve care delivery, but our latest analysis suggests that time is of the essence. Many baseline indicators that Chartis has tracked for more than a decade, as well as new measures, reveal that the challenges facing rural hospitals and the difficulties in accessing care within rural communities are deepening. Key findings from our analysis: More than 40% of all rural hospitals operate in the red. In the 10 states that did not expand Medicaid under the Affordable Care Act, 52% of facilities operate at a loss. More than 200 rural hospitals have closed or converted to models that exclude inpatient care (e.g., Rural Emergency Hospital) since 2010. 417 rural hospitals are vulnerable to closure, including 36% of hospitals in non-expansion states. Access to care continues to decline sharply in rural communities. More than 300 hospitals have eliminated OB services, more than 300 hospitals have eliminated general surgery, and more than 450 facilities have eliminated chemotherapy. Cuts to Medicaid will negatively impact rural hospitals. Nationally, more than 10 million rural residents rely on Medicaid. Medicaid reimbursements account for nearly 10% (or $3.9 million) in net revenue for the typical rural hospital. 89% of rural census tracts are designated as Healthcare Professional Shortage Areas (HPSAs) for behavioral health professionals. In 13 states, 100% of rural census tracts are HPSAs. Key findings from RHT applications: States view telehealth and artificial intelligence (AI) as primary drivers for addressing clinical needs, access to care, and workforce-related challenges. Accordingly, they feature prominently in state RHT programs. States consider interoperability among tech-enabled solutions essential, especially for rural providers that rely on a patchwork of legacy electronic health records (EHRs) and enterprise resource planning systems (ERPs) that need modernization investment. Clinically integrated networks (CINs), which gained momentum in 2025, are integral to state RHT programs that aim to improve care coordination. Efforts to reform certificate of need (CON) laws, which are part of eight state RHT applications, may increase uncertainty rather than solve rural healthcare’s access-to-care issues. How are reduced reimbursements and payer mix changes impacting rural hospitals? Our analysis indicates that more than 10 million rural Americans rely on Medicaid, and at the median Medicaid represents nearly 10% of total net revenue for rural hospitals. The Medicaid-related cuts outlined in H.R. 1 will severely impact cash-strapped rural hospitals. These cuts will affect rural hospitals that are already contending with annual policy-driven reimbursement cuts. Sequestration (an annual 2% cut in Medicare reimbursement) will cost rural hospitals approximately $540 million this year. Bad debt reimbursement (an annual 35% reduction in charity care reimbursement) will make another $148.4 million vanish. An analysis Chartis published in 2025 during the budget reconciliation process revealed the extent to which rural hospitals rely on Medicaid as part of their payer mix. In 33 states, the estimated number of Medicaid enrollees living in rural areas exceeds 100,000. In Kentucky, Texas, and New York, the number of rural residents enrolled in Medicaid in each state is approaching 500,000. Our review of cost data from more than 2,000 rural hospitals revealed that the median annual Medicaid reimbursement was $3.9 million. As a result, a modest 15% reduction in Medicaid revenue would cost rural hospitals over $1.8 billion nationwide, equivalent to more than 21,000 full-time hospital employee salaries. Simultaneously, the popularity of Medicare Advantage also contributes to payer mix disruption. In rural communities, 39% of all Medicare-eligible residents are enrolled in one of these plans. The administrative requirements of these plans can be burdensome for rural hospitals and reimbursement rates may be lower than traditional Medicare. How will states put RHT funds to work? Our review of the RHT program and the 47 state applications publicly available in November and December 2025 revealed inspirational and aspirational initiatives that should positively impact care delivery in rural communities. We also uncovered provisions that may undermine the RHT program’s overall effectiveness and increase safety net instability. The Centers for Medicare & Medicaid Services’ (CMS’s) $10 billion RHT allocation for calendar year 2026 included funds for all 50 states. Based on CMS’ scoring model, Texas received the highest allocation ($281.3 million), while New Jersey received the lowest ($147 million). The 10 non-expansion states received a combined total of $2.2 billion. CMS’s allocation model leverages a multitude of factors and is not necessarily proportional to the vulnerability of the rural hospital safety net in each state or the size of the rural population. In some states, the allotted funds amount to less than $100 per rural resident.4 The table below shows the total allocated funding for fiscal year 2026 per state. Additional state level datail regarding RHT funding and application initiatives can be found here. Although initial public talking points surrounding the RHT program suggested the fund would offer direct relief to rural hospitals, the final text of H.R. 1 included a broad list of eligible entities. It also defined a broad list of allowable uses for the allocated funds. While these allocated funds may seem significant, provider payments cannot exceed 15% in a given budget year per CMS. States also cannot spend more than 20% on capital expenditures and infrastructure. State RHT applications varied in detail but included common themes, such as workforce development, telehealth, partnerships and network development, interoperability, and preventive measures promoting healthier lifestyles. Workforce development: Telehealth: Collaboration (partnerships and CINs): Healthier outcomes: Technology innovation and modernization: Will CON reform efforts help or hurt rural hospitals? Eight RHT applications mentioned CON reform, and the CMS scoring methodology warrants its inclusion in this year’s assessment. The argument for reforming CON laws is rooted in the notion that these measures stifle competition and limit organizations’ ability to expand access in rural communities. That said, CON reform could bring some potential risks for rural health access overall if states don’t deploy it with an eye toward rural hospital stability. In order to fulfill their mission of providing broad-based community care, rural hospitals offer a diverse portfolio of services. Some of these services are profitable, while others are not. Specialized providers (e.g., surgery centers, imaging/laboratory services, and urgent care) are not obligated to offer this array of services and can focus on high-margin outpatient services. At the median, outpatient services generate 85% of revenue for Critical Access Hospitals and 77% for rural and community hospitals. Greater competition for these services will likely siphon vital revenue streams from rural hospitals, further jeopardizing their financial viability. CON law reforms may create more options in the near term, but in the long term, rural communities might not be able to support multiple entities offering similar services. And if rural hospitals close, communities could lose access to low-margin services that specialized providers are unlikely to offer. Economic impacts and job losses will also come with rural hospital closures. How many rural hospitals are operating in the red? The national median operating margin for rural hospitals is 2.0%, with 41.2% of all rural hospitals operating in the red. This overall percentage is an improvement over 2025 (46%), largely due to the stronger financial performance of rural hospitals in expansion states. Among rural hospitals in states that expanded Medicaid under the Affordable Care Act, 34.9% are in the red, and the median operating margin is 2.9%. In 2025, 43% were in the red, and the median operating margin was 1.5%. In the 10 non-expansion states (i.e., Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming), our data continues to show that rural hospitals are not matching the financial performance of expansion-state facilities. In non-expansion states, 52.2% are in the red, and the median operating margin is −0.7%. These metrics are on par with those reported last year (53% in the red with a median operating margin of −1.1%). 41.2% of rural hospitals are in the red The new state-level data show that 86.2% of rural hospitals in Kansas are operating in the red. This is the highest percentage in the nation. Alabama has the second-highest (67.6%), followed by Arkansas (59%) and Wyoming (58.3%). In 15 states, the percentage of rural hospitals with a negative operating margin exceeds 50%. Only six states have fewer than 25% of rural hospitals in the red. Are rural hospitals continuing to close? Our analysis indicates that 206 rural hospitals have either closed or converted to models that exclude inpatient care (e.g., Rural Emergency Hospital) since 2010. Converting to a model such as the Rural Emergency Hospital does allow some healthcare services to remain locally (e.g., emergency care). But the loss of inpatient care forces residents to seek care elsewhere. The following states have experienced the greatest loss in inpatient care through closures and conversions since 2010: Texas (27), Tennessee (18), Oklahoma (13), Kansas (12), and Mississippi (12). The loss of inpatient care, however, continues to be a national issue. During 2025, for example, inpatient care disappeared in states from coast to coast (e.g., California and Maine), and points in between (e.g., Alabama, Idaho, Kentucky, and South Dakota). How many rural hospitals are at risk of closing? Introduced in 2020, our multilevel logistic regression model creates a Rural Hospital Vulnerability index. This index quantifies the number of rural hospitals vulnerable to closure. This model assesses more than a dozen indicators to identify which are statistically significant for determining the likelihood of closure. This year’s analysis reveals that 417 rural hospitals are vulnerable to closure. The number of vulnerable hospitals is 10 or higher in 17 states. Texas has the most (50), followed by Kansas (44), Tennessee (27), Georgia (25), and Mississippi (24). Collectively, these states received $1.1 billion from CMS as part of the RHT program. When considering the percentage of rural hospitals vulnerable to closure in each state, Tennessee has the highest (61%), followed by Arkansas (55%), Florida (52%), Kansas (44%), South Dakota (42%), and Mississippi (42%). Collectively, these states received $1.2 billion from CMS as part of the RHT program. While the overall number of vulnerable hospitals changed slightly since last year’s analysis (417 vs. 432), there are notable shifts at the state level. In Tennessee and South Dakota, the percentage of vulnerable hospitals jumped from 44% and 28%, respectively, to 61% and 42%, respectively. In Mississippi, which has been a weak spot in the rural health safety net for a long time, the percentage of vulnerable hospitals improved from 49% last year to 42% this year. In Kansas, that percentage improved from 47% to 44%. How widespread are America’s rural healthcare deserts? OB: The loss of access to care does not only relate to closed hospitals or conversions to alternative operating models. For more than a decade, we’ve tracked the spread of care deserts across America. Care deserts exist where services such as OB, chemotherapy, and general surgery were once accessible at rural hospitals but are no longer. The deterioration of access to these services has been a stark “sleeper” metric during the closure crisis. It illustrates the difficult decisions hospital leadership teams and community-based boards of trustees must make to keep their doors open. Between 2011 and 2024, 331 rural hospitals stopped offering OB services. This represents approximately 27% of the nation’s rural OB units. Few states have escaped this alarming loss of access to OB within rural communities. Our analysis revealed that Florida lost 71% of its rural OB units, by far the highest percentage in the country, followed by Illinois (48%), Pennsylvania (42%), and New Hampshire (40%). Another 13 states had percentages ranging from 30% to 39%. Only four states (Delaware, Hawaii, Massachusetts, and Utah) have avoided any loss of rural OB units. Chemotherapy: Our analysis reveals a similar rapid decrease in access to chemotherapy in rural communities. Between 2014 and 2024, 448 rural hospitals stopped offering chemotherapy. In Mississippi, more than 50% of rural hospitals that previously offered chemotherapy during our review period no longer do so, followed closely by Texas (49%) and Tennessee (43%). Another seven states had percentages ranging from 40% to 43%. Although Texas has the second-highest percentage loss, the number of facilities dropping chemotherapy (60) is by far the largest in the nation. Only Hawaii, Maryland, Massachusetts, North Dakota, South Dakota, and Vermont have avoided any loss of chemotherapy during the review period. General surgery: General surgery includes many common outpatient surgical procedures. This includes urgent procedures (e.g., burst appendix or gallbladder surgery) and non-urgent procedures (e.g., endoscopy or colonoscopy). Hospitals that offer maternal and birthing care also need to offer general surgery because of the possibility of a cesarean birth and other delivery-related procedures. General surgery is also decreasing in rural hospitals nationwide. Of the 48 states with rural hospitals, 40 have at least one rural hospital that stopped offering general surgery during our review period. Mississippi (44%) has the highest percentage of rural providers that stopped offering general surgery since 2014, followed by Oklahoma (39%), Hawaii (38%), Tennessee (33%), and Florida (30%). Texas (38) has the highest number of hospitals (38) that eliminated general surgery, followed by Mississippi and Oklahoma (25 each). What’s next for rural hospitals? In the months ahead, states will work to implement the programs in their RHT applications before the first program review in September 2026. We expect bumps along the way and perhaps more than a few initiatives that evolve during the journey. Rural hospital leadership teams must devise a new set of key considerations to navigate the continued uncertainty and seize opportunities as they emerge. Hospitals, particularly independent rural hospitals, must prepare to maximize their participation in RHT-funded initiatives. Considerations include: Actively engage in RHT program development through independent outreach, healthcare channels (e.g., hospital associations and state offices of rural health), and state-level representation. Identify staffing shortfalls and develop models based on service line delivery and expansion opportunities associated with RHT initiatives. Determine the level of readiness to successfully leverage new technological approaches to care delivery (e.g., telehealth). Understand which collaborative models (e.g., CINs and partnerships) would yield the greatest financial and clinical benefit. Quantify urgent unmet needs, continuum of care gaps, and population health disparities across hospital service areas. Engage in tech-forward strategies with a focus on interoperability (e.g., EHR, ERP, and HIE). Consider engagement/outreach aimed at helping communities understand the rural health landscape. Consider how market dynamics and rural hospital revenue streams might shift in the wake of CON law reform. Ensure that strategic governance is grounded in data and research relevant to rural healthcare. RHT likely to treat symptoms but not deliver a cure The data we’ve tracked consistently for more than a decade continues to reveal a rural health safety net that is worsening due to declining reimbursement, decreasing access to care, and worsening community health. $50 billion is a historic government investment in rural healthcare. State proposals for leveraging RHT funds are innovative, and we expect many of the initiatives to positively impact healthcare in rural communities. While this is a significant step forward, the RHT program may be too late to prevent more hospitals from closing their doors or removing service lines such as OB or general surgery. The Medicaid cuts that take effect in 2027 will intensify efforts to stabilize the financial viability of rural hospitals. Rural hospitals need to plan for those cuts while using RHT funding at the state level to deliver the maximum benefit from those programs and initiatives to the communities they serve.

AI already almost as good as doctors

 

Katia Riddle, January 30, 2026, https://www.npr.org/2026/01/30/nx-s1-5693219/chatgpt-chatbot-ai-health-medical-advice ‘ChatGPT saved my life.’ How patients, and doctors, are using AI to make a diagnosis

Despite these hazards, Wachter is optimistic about the contributions AI can make to health care and believes the benefits will eventually outweigh the dangers, if they don’t already. “ I actually think it’s going to be a really good thing,” he says. Studies show that large language models are competitive with humans in simulated tests of diagnostic reasoning. A study published in the New England Journal of Medicine found that AI systems could frequently identify difficult cases; a follow-up comparison with a leading human diagnostician showed a slight human advantage. Still, says Wachter, “the AI’s performance was remarkable.” Wachter says AI has already significantly improved his own work and that of his colleagues. He now uses an AI scribing tool that allows him to look his patients in the eye while they talk. “Two years ago I would’ve been sitting there pecking away on my computer.” In a matter of months, he says, he’s also seen widespread adoption among his colleagues of a tool called OpenEvidence – “kind of a ChatGPT for doctors,”which gives them exhaustive knowledge at their fingertips. “I use it all the time,” he says. “We all do.” The future of health care Patients and doctors who are using AI in health care say that the rate at which it is becoming integrated into the system is staggering. “ AI is already a core part of my care team,” says Rosen. At 60, Rosen acknowledges he’s unusually technology literate. The next generation of patients and doctors, he observes, will not have the same learning curve. “Two generations from now,” he says. “No one will give it a second thought.” Medicine and health care in the United States is unique, says Wachter, in that the system is so deeply flawed — and in need of so much help. “If you ask me, what do you think about AI in general, I’m worried,” he says. “I’m worried about what it does to our politics, deep fakes, jobs — all those things are very real,” he says. “It’s just in the corner of the world that I work in, I just see a system that is  falling apart and can’t possibly meet the needs of people without this kind of help.”

Rising costs undermine care

Grace Sparks, January 29, 2026 [Grace is a survey analyst for the Public Opinion and Survey Research team of KFF. Before joining KFF, Grace wrote about polling for CNN and was part of the team at HuffPost Pollster. Grace attended the College of Wooster in Ohio, ,Americans’ Challenges with Health Care Costs, https://www.kff.org/health-costs/americans-challenges-with-health-care-costs/

Editorial Note: This brief was updated on January 29, 2026, to include the latest KFF polling data. It was originally published on December 14, 2021. For many years, KFF polling has found that the high cost of health care is a burden on U.S. families, and that health care costs factor into decisions about insurance coverage and care seeking. These costs also rank as the top financial worry for adults and their families. This data note summarizes recent KFF polling on the public’s experiences with health care costs. Main takeaways include: Just under half of U.S. adults say it is difficult to afford health care costs, and about three in ten say they or a family member in their household had problems paying for health care in the past 12 months. Hispanic adults, young adults, and the uninsured are particularly likely to report problems affording health care in the past year. The cost of health care can lead some to put off needed care. About one-third (36%) of adults say that in the past 12 months they have skipped or postponed getting health care they needed because of the cost. Notably three in four (75%) uninsured adults under age 65 say they went without needed care because of the cost. The cost of prescription drugs prevents some people from filling prescriptions. About one in five adults (21%) say they have not filled a prescription because of the cost while a similar share (23%) say they have instead opted for over-the-counter alternatives. About one in seven adults say they have cut pills in half or skipped doses of medicine in the last year because of the cost. A third of all adults say they have taken at least one of these cost saving measures in the past year, including larger shares of women and those with lower incomes. Health care debt is a burden for a large share of Americans. In 2022, about four in ten adults (41%) reported having debt due to medical or dental bills including debts owed to credit cards, collections agencies, family and friends, banks, and other lenders to pay for their health care costs, with disproportionate shares of Black and Hispanic adults, women, parents, those with low incomes, and uninsured adults saying they have health care debt. Those who are covered by health insurance are not immune to the burden of health care costs. Almost four in ten insured adults under the age of 65 (38%) worry about affording their monthly health insurance premium and large shares of adults with employer-sponsored insurance (ESI) and those with Marketplace coverage rate their insurance as “fair” or “poor” when it comes to their monthly premium and to out-of-pocket costs to see a doctor. Notable shares of adults say they are worried about affording medical costs such as the cost of health care services (including the cost of health insurance and out-of-pocket costs for things like office visits and prescription drugs). About two-thirds of adults say they are either “very worried” (32%) or “somewhat worried” (34%) about being able to afford the cost of health care for themselves and their families. The cost of health care ranks at the top of the list when it comes to things that people worry about affording, followed by food, utilities, and other household expenses. Difficulty Affording Medical Costs Many U.S. adults have trouble affording health care costs. While lower income and uninsured adults are the most likely to report this, those with health insurance and those with higher incomes are not immune to the high cost of medical care. Just under half of U.S. adults say that it is very or somewhat difficult for them to afford their health care costs (44%). Uninsured adults under age 65 are much more likely to say affording health care costs is difficult (82%) compared to those with health insurance coverage (42%). Additionally, a slight majority of Hispanic adults (55%) and half of Black adults (49%) report difficulty affording health care costs compared to about four in ten White adults (39%). Adults in households with annual incomes under $40,000 are more likely than adults in households with higher incomes to say it is difficult to afford their health care costs. (Source: KFF Health Tracking Poll: May 2025) Figure 1 Nearly Half of Adults Say It Is Difficult To Afford Health Care Costs, Including Large Shares of the Uninsured, Black and Hispanic Adults, and Those With Lower Incomes In general, how easy or difficult is it for you to afford your health care costs? Mirrored bar chart showing shares who say it is easy or difficult to afford their health care costs by total, insurance status, race/ethnicity, and household income. Very/Somewhat easy Very/Somewhat difficult Total 56% 44% Insurance status among adults ages 18-64 no data no data Insured 58% 42% Uninsured 18% 82% Race/Ethnicity no data no data Black 50% 49% Hispanic 44% 55% Asian 57% 43% White 61% 39% Household income no data no data Less than $40,000 46% 53% $40,000-$89,999 54% 46% $90,000 + 70% 30% Note: See topline for full question wording. Source: KFF Health Tracking Poll (May 5-26, 2025)Download PNG KFF.org (grey border) When asked specifically about problems paying for health care in the past year, about three in ten (28%) adults say they or a family member in their household had problems paying for care, rising to four in ten among Hispanic adults (41%) and young adults ages 18 to 29 (40%). Among those under age 65, six in ten (59%) uninsured adults report problems paying for health care in the past year, about twice the share of insured adults who say the same (30%). (Source: KFF Health Tracking Poll: November 2025) Figure 2 Reports of Problems Paying for Health Care Highest Among Hispanic Adults, Young Adults, and the Uninsured Percent who say in the past 12 months, they or a family member living with them had problems paying for health care: Single bar showing the percent who say, in the past 12 months, they or a family member living with them had problems paying for health care by total, age, gender, race/ethnicity, household income, and insurance status. Total 28% Age 18-29 40% 30-49 32% 50-64 28% 65+ 13% Gender Women 28% Men 29% Race/Ethnicity Black 32% Hispanic 41% White 25% Household income Less than $40,000 35% $40,000-$89,999 32% $90,000 + 19% Insurance status among adults ages 18-64 Insured 30% Uninsured 59% Note: See topline for full question wording. Source: KFF Health Tracking Poll (October 27-November 2, 2025)Download PNG KFF.org (grey border) The cost of care can also lead some adults to skip or delay seeking services, with one-third (36%) of adults saying that they have skipped or postponed getting needed health care in the past 12 months because of the cost. Women are more likely than men to say they have skipped or postponed getting health care they needed because of the cost (38% vs. 32%). Adults ages 65 and older, most of whom are eligible for health care coverage through Medicare, are much less likely than younger age groups to say they have not gotten health care they needed because of cost. Three-quarters of uninsured adults say they have skipped or postponed getting the health care they needed due to cost. Having health insurance, however, does not offer ironclad protection as about four in ten adults with insurance (37%) still report not getting health care they needed due to cost. (Source: KFF Health Tracking Poll: May 2025) Figure 3 Three-Quarters of Uninsured Adults Say They Have Skipped or Postponed Getting Health Care They Needed in the Past 12 Months Due to Cost Percent who say, in the past 12 months, they have skipped or postponed getting health care they needed because of the cost: Single bar chart showing percent who say they have skipped or postponed getting needed health care in the past 12 months because of the cost by total, age, gender, race/ethnicity, household income, and insurance status. Total 36% Age 18-29 45% 30-49 44% 50-64 35% 65+ 17% Gender Women 38% Men 32% Race/Ethnicity Black 40% Hispanic 43% Asian 27% White 34% Household income Less than $40,000 40% $40,000-$89,999 40% $90,000 + 29% Insurance status among adults ages 18-64 Insured 37% Uninsured 75% Note: See topline for full question wording. Source: KFF Health Tracking Poll (May 5-26, 2025)Download PNG KFF.org (grey border) Skipping care due to costs can have notable health impacts. Nearly two in ten adults (18%) report that their health got worse because they skipped or delayed getting care. Among adults under age 65, those who are uninsured are twice as likely as those with health coverage to say that their health worsened due to skipped or postponed care (42% vs. 20%). About four times as many adults under age 65 (23%) say their health got worse after skipping or postponing care as adults ages 65 and older (6%), most of whom have Medicare coverage. (Source: KFF Health Tracking Poll: May 2025) Figure 4 Nearly Two in Ten Report Their Health Got Worse After Skipping or Postponing Care Due to Cost Percent who say their health got worse because they didn’t get care or postponed care: Single bar chart showing the share who say their health got worse because they didn’t get care or postponed their care by total, age, and insurance status. Total 18% Age 18-29 24% 30-49 23% 50-64 20% 65+ 6% Insurance status among adults ages 18-64 Insured 20% Uninsured 42% Note: See topline for full question wording. Source: KFF Health Tracking Poll (May 5-26, 2025)Download PNG KFF.org (grey border) A 2022 KFF report found that people who already have debt due to medical or dental care are disproportionately likely to put off or skip medical care. Half (51%) of adults currently experiencing debt due to medical or dental bills say in the past year, cost has been a probititor to getting the medical test or treatment that was recommended by a doctor. (Source: KFF Health Care Debt Survey: Feb.-Mar. 2022) Prescription Drug Costs The high cost of prescription drugs also leads some people to cut back on their medications in various ways. About one in four adults (23%) say in the past 12 months they have taken an over-the-counter drug instead of getting a prescription filled because of cost concerns and about one in five (21%) say they have not filled a prescription due to the cost. Additionally, about one in seven adults (15%) say that in the past 12 months they have cut pills in half or skipped doses of medicine due to cost. One-third of the public (33%) say they have taken any of these cost saving measures in the past 12 months. Four in ten women (39%) say they have taken any of these prescription medication measures compared to one-quarter (26%) of men. Additionally, just under half of Hispanic adults (46%) say they’ve either taken an over-the-counter drug, skipped doses, or not filled prescriptions because of the cost, compared to three in ten (29%) White adults who say the same. Similarly, larger shares those with lower incomes report having taken a cost-saving measure in the last year compared to those with higher incomes (41% of those with a household income of less than $40,000 a year vs. 29% of those with an income of $40,000 or more). (Source: KFF Health Tracking Poll: May 2025) Notably, adults with chronic conditions, who tend to have higher health care and medication needs, can often face challenges affording prescriptions. In KFF’s 2023 Survey of Consumer Experiences with Health Insurance, insured adult with a chronic condition were twice as likely as those without a chronic condition to say they had delayed or gone without prescription drugs due to the cost (18% vs. 9%). Figure 5 About Two in Ten Adults Say They Have Not Filled a Prescription or Taken an Over-the-Counter Drug Instead Due to Cost Percent who say in the past 12 months, they have done each of the following due to cost: Multiple split bars showing the percent who have taken steps to reduce the cost of care including taking an over-the-counter drug instead of getting a prescription filled, not filled a prescription for medicine, or cut pills in half or skipped doses of medicine. Taken an over-the-counter drug instead of getting a prescription filled Not filled a prescription for a medicine Cut pills in half or skipped doses of medicine Total 23% 21% 15% Gender no data no data no data Women 27% 24% 18% Men 19% 17% 12% Race/Ethnicity no data no data no data Black 26% 24% 17% Hispanic 38% 26% 18% Asian 28% 23% 15% White 18% 19% 15% Household income no data no data no data Less than $40,000 30% 25% 19% $40,000-$89,999 23% 21% 17% $90,000 + 17% 16% 11% Note: See topline for full question wording. Source: KFF Health Tracking Poll (May 5-26, 2025)Download PNG KFF.org (grey border) Health Insurance Cost Ratings Health insurance provides some financial protection, but premiums and out-of-pocket costs can still present a financial burden for many individuals. Overall, most insured adults rate their health insurance as “excellent” or “good” when it comes to the amount they have to pay out-of-pocket for their prescriptions (61%), the amount they have to pay out-of-pocket to see a doctor (53%), and the amount they pay monthly for insurance (54%). However, at least three in ten rate their insurance as “fair” or “poor” on each of these metrics, and affordability ratings vary depending on the type of coverage people have. Adults who have private insurance through employer-sponsored insurance or Marketplace coverage are more likely than those with Medicare or Medicaid to rate their insurance negatively when it comes to their monthly premium, the amount they have to pay out of pocket to see a doctor, and their prescription co-pays. About one in four adults with Medicare give negative ratings to the amount they have to pay each month for insurance and to their out-of-pocket prescription costs, while about one in five give their insurance a negative rating when it comes to their out-of-pocket costs to see a doctor. Medicaid enrollees are less likely than those with other coverage types to give their insurance negative ratings on these affordability measures (Medicaid does not charge monthly premiums in most states, and copays for covered services, where applied, are required to be nominal). (Source: KFF Survey of Consumer Experiences with Health Insurance) Figure 6 Large Shares of Adults With ESI and Marketplace Coverage Rate Their Insurance Negatively When It Comes to Premiums and Out-of-Pocket Costs Percent who rate the following aspects of their current health insurance as either fair or poor: Split bar chart showing shares of adults by main insurance coverage who rate specific aspects of their current health insurance as either fair or poor. Total insured adults ESI Marketplace Medicare Medicaid The amount they have to pay out-of-pocket to see a doctor 41% 50% 55% 21% 11% The amount they have to pay for their health insurance each month 39% 46% 55% 27% 10% The amount they have to pay out-of-pocket to fill a prescription 32% 35% 43% 24% 14% Note: See topline for full question wording. Source: KFF Survey of Consumer Experiences with Health Insurance (Feb. 21-Mar. 14, 2023)Download PNG KFF.org (grey border) Health Care Debt In June 2022, KFF released an analysis of the KFF Health Care Debt Survey, a companion report to the investigative journalism project on health care debt conducted by KFF Health News and NPR, Diagnosis Debt. This project found that health care debt is a wide-reaching problem in the United States and that 41% of U.S. adults currently have some type of debt due to medical or dental bills from their own or someone else’s care, including about a quarter of adults (24%) who say they have medical or dental bills that are past due or that they are unable to pay, and one in five (21%) who have bills they are paying off over time directly to a provider. One in six (17%) report debt owed to a bank, collection agency, or other lender from loans taken out to pay for medical or dental bills, while similar shares say they have health care debt from bills they put on a credit card and are paying off over time (17%). One in ten report debt owed to a family member or friend from money they borrowed to pay off medical or dental bills. While four in ten U.S. adults have some type of health care debt, disproportionate shares of lower income adults, the uninsured, Black and Hispanic adults, women, and parents report current debt due to medical or dental bills. Figure 7 Four in Ten Adults Currently Have Debt Due to Medical or Dental Bills Percent who say they have each of the following types of debt due to medical or dental bills for themselves or for someone else’s care, such as a child, spouse or parent: Single bar chart showing the percent who say they have different types of debt due to medical or dental bills for themselves or someone else in their care. Medical or dental bills that are past due or that they are unable to pay 24% Medical or dental bills they are paying off over time directly to a provider 21% Debt they owe to a bank, collection agency, or other lender that includes debt or loans used to pay medical or dental bills 17% Medical or dental bills they have put on a credit card and are paying off over time 17% Debt they owe to a family member or friend for money they borrowed to pay medical or dental bills 10% Yes to any of the above 41% Note: See topline for full question wording. Source: KFF Health Care Debt Survey (Feb. 25-Mar. 20, 2022)Download PNG KFF.org (grey border) Vulnerabilities and Worries About Health Care and Long-Term Care Costs At the start of 2026, health care costs are at the top of the list of people’s financial worries, with two-thirds (66%) saying they are at least somewhat worried about affording the cost of health care, including the cost of health insurance and out-of-pocket costs for things like office visits and prescription drugs for themselves and their families. This is larger than the shares who say they worry about affording food and groceries (57%), utilities (57%), housing costs (52%), and gas or other transportation expenses (52%) for their families. Notably, about nine in ten uninsured adults under age 65 say they are worried about affording the cost of health care (88%), but a large share of insured adults are also worried (68%). Health care costs are at the top of household cost worries across insurance types and partisans. (Source: KFF Health Tracking Poll: January 2026) Figure 8 Health Care Costs Are the Top Household Expense the Public Worries About How worried, if at all, are you about being able to afford each of the following for you and your family? Stacked bar chart showing the public’s levels of worry when it comes to affording living necessities. Shown among total adults. Very worriedSomewhat worriedNot too worriedNot at all worried 50% Health care 32% 34% 22% 12% Food and groceries 24% 33% 28% 15% Your rent or mortgage 23% 29% 25% 23% Your monthly utilities 22% 35% 27% 16% Gasoline or other transportation costs 17% 35% 30% 17% Note: Health care includes the cost of health insurance and out-of-pocket costs for things like office visits and prescription drugs. Monthly utilities include electricity or heat. See topline for full question wording. Source: KFF Health Tracking Poll (January 13-20, 2026)Get the dataDownload PNG KFF.org Many U.S. adults may be one unexpected medical bill from falling into debt. About half of U.S. adults say they would not be able to pay an unexpected medical bill that came to $500 out of pocket. This includes one in five (19%) who would not be able to pay it at all, 5% who would borrow the money from a bank, payday lender, friends or family to cover the cost, and one in five (21%) who would incur credit card debt in order to pay the bill. Women, those with lower household incomes, Black and Hispanic adults are more likely than their counterparts to say they would be unable to afford this type of bill. (Source: KFF Health Care Debt Survey: Feb.-Mar. 2022) Figure 9 About Half of Adults Would Be Unable To Pay for an Unexpected $500 Medical Bill in Full, Including Larger Shares of Women, Those With Lower Household Incomes, Black and Hispanic Adults Suppose you had an unexpected medical bill, and the amount not covered by any insurance you may have came to $500, how would you pay the bill? Split bar chart showing how adults would handle an unexpected medical bill of $500, if they’d be able to pay the bill without going into debt, go into debt to pay the bill, or would not be able to pay the bill. Would not be able to pay the bill at allWould go into debt to pay the billWould pay the bill without going into debt 50% Total 19% 30% 50% Gender Women 23% 34% 42% Men 12% 27% 59% Household income Less than $40K 40% 39% 20% $40K+ 9% 26% 64% Race/Ethnicity Black, non-Hispanic 37% 38% 24% Hispanic 25% 41% 32% White, non-Hispanic 13% 26% 59% Note: “Would go into debt to pay the bill” includes those who said that, in order to pay the bill, they would put it on a credit card and pay it off over time; borrow money from a bank, payday lender, or friends or family to pay the bill; make a payment plan with a provider; or pay over time (unspecified) Vol. “Would pay the bill without going into debt” includes those who said they would pay the bill right away or those who said they would put it on a credit card and pay it off in full at the next statement. See topline for full question wording. Source: KFF Health Care Debt Survey (Feb. 25-Mar. 20, 2022)Download PNG KFF.org (grey border) Among older adults, the costs of long-term care and support services are also a concern. Almost six in ten (57%) adults 65 and older say they are at least “somewhat anxious” about affording the cost of a nursing home or assisted living facility if they needed it, and half say they feel anxious about being able to afford support services such as paid nurses or aides. These concerns also loom large among those between the ages of 50 and 64, with more than seven in ten saying they feel anxious about affording residential care (73%) and care from paid nurses or aides (72%) if they were to need these services. See The Affordability of Long-Term Care and Support Services: Findings from a KFF Survey for a deeper dive into concerns about the affordability of nursing homes and support services.

Medical costs rising unsustainably

Robert Pearl, the author of “ChatGPT, MD,” teaches at both the Stanford University School of Medicine and the Stanford Graduate School of Business. He is a former CEO of The Permanente Medical Group, , https://thefulcrum.us/health/political-economic-pressures-healthcare-shift-2026, January 22

In 2026, employer-sponsored premiums are projected to rise at roughly twice the rate of inflation. The annual cost of coverage for a family of four will be $27,000, with employees paying roughly one-quarter of that total out of pocket. Patients already delay or forgo care because of cost. Meanwhile, medical bills remain the leading contributor to personal bankruptcy in the United States. Insurers, who have no control over how medicine is practiced, have relied on tighter prior-authorization requirements, narrower networks and higher rates of claims denial. While these tactics can suppress short-term spending, they have fueled widespread backlash from patients, physicians, employers and lawmakers. In effect, insurers are being squeezed from both sides: rising costs they cannot fully pass on and a public increasingly hostile to how those costs are managed. The likeliest response to pressure: When premiums and out-of-pocket costs exceed what payers and patients can bear, the traditional insurance model begins to fracture. That is where capitation re-enters the conversation. Under capitation, insurers make a fixed, per-patient payment to a physician group or health system to manage most or all care for a defined population. Providers assume responsibility for utilization, coordination and cost control. In return, they gain flexibility in care delivery and the opportunity to share in savings when prevention and chronic disease management succeed. For insurers, the appeal is straightforward: capitation shifts financial risk downstream and reduces reliance on unpopular utilization controls. But moving from fee-for-service to capitation would require major structural change. As a result, insurers in 2026 are more likely to introduce pilot programs, partial risk arrangements and expanded use of generative AI rather than pursue wholesale transformation.

Lack of health care means the Democrats win the midterms now

Robert Pearl, Jan 22, 2026, Political and Economic Pressures Set Up a Healthcare Shift in 2026, https://thefulcrum.us/health/political-economic-pressures-healthcare-shift-2026

Healthcare in 2025 was consumed by chaos, conflict and relentless drama. Yet despite unprecedented political turmoil, cultural division and major technological breakthroughs, there was little meaningful improvement in how care is paid for or delivered. That outcome was not surprising. American medicine is extraordinarily resistant to change. In most years, even when problems are obvious and widely acknowledged, the safest bet is that the care patients experience in January will look much the same in December. But when meaningful change does occur, it is usually because motivated leaders find themselves in rare political and economic conditions. Think of President Barack Obama in 2009, with unified Democratic control of Congress and widespread voter frustration over healthcare costs and coverage. By contrast, President Bill Clinton’s ambitious reform effort collapsed in 1993 when it collided with powerful industry opposition and a divided political environment. If most years prove stagnant, why should anyone expect 2026 to be different? In a word: pressure. Congress, the president, drug manufacturers and insurers are all confronting forces that make inaction increasingly risky. Three external pressures will drive change: 1. Politicians Face Midterm Pressures For Republicans broadly, and for President Trump personally, the 2026 midterm elections present significant political risk. Even a modest shift in “purple” districts could flip control of the House, reshaping committee leadership and reviving the prospect of Trump’s impeachment. The “Big Beautiful Bill” passed by Congress in mid-2025 locked in permanent tax cuts with a multitrillion-dollar price tag, narrowing the universe of spending categories large enough to materially reduce the deficit. With healthcare accounting for nearly 30% of the federal budget (and other categories such as Social Security and defense politically untouchable), medical spending became one of the few remaining fiscal levers. But pulling it also handed Democrats a potent midterm weapon. The shutdown compounded the problem. By linking government dysfunction to healthcare funding and coverage uncertainty, Democrats spotlighted rising medical costs as a symbol of incumbent political failure. As healthcare economics worsen in 2026, the pressure will intensify. Premium increases will outpace wage growth. Deductibles will remain high. Tens of millions of Americans face potential Medicaid coverage losses, while 20 million more will see sharply higher exchange premiums.

 

States can forgive medical debt

 

Alex Olgin, January 21, 2026, How North Carolina erased medical debt for 2.5 million people https://www.npr.org/2026/01/21/nx-s1-5678541/north-carolina-undue-medical-debt-erased

 

North Carolina Gov. Josh Stein, center, flanked by the state’s health secretary, Dr. Dev Sangvai, left, and an executive from Undue Medical Debt, Jose Penabad, speaks about the elimination of medical debt through an initiative involving hospitals and Medicaid in Raleigh, N.C. North Carolina Gov. Josh Stein (center), flanked by the state’s health secretary, Dr. Dev Sangvai (left) and an executive from Undue Medical Debt, Jose Penabad, speaks about the elimination of medical debt through an initiative involving hospitals and Medicaid in Raleigh, N.C. Gary D. Robertson/AP After a routine trip to her mailbox, Dawn Daly-Mack almost threw away an important letter that she thought was junk mail. “I opened it up and it said, ‘Your medical bill has been paid,'” says Daly-Mack, 60, who lives in Gaston, in northeastern North Carolina. “I didn’t believe it.” The letter turned out to be legitimate. Daly-Mack is one of about 2.5 million North Carolinians whose medical debt was erased under a new statewide agreement with hospitals. The hospital wiped away her $459 debt, dating back to a 2014 emergency room visit for a sinus infection. “I was the only breadwinner in the family,” says Daly-Mack, who was caring for her disabled husband and two teenagers at the time. “I was not able to pay the bill.” She was also working then as a nurse at the very same hospital trying to collect from her. Health care leads to millions of dollars in medical debt in the U.S., leaving many people with financial problems for years. Some states are trying pass protections for patients into law. Diagnosis: Debt Trump punted on medical debt protection. Now the battle is in the states Erasing and preventing medical debt All of the state’s 99 hospitals agreed to stop collecting certain debts dating back to 2014. They also pledged going forward to automatically discount care for patients who qualify for financial assistance — without requiring them to apply. For a family of four, that means an annual income of less than $96,000 qualifies. “I’m excited for the people of North Carolina,” says Allison Sesso, CEO of Undue Medical Debt, a charity that uses donor money to buy and erase medical debt. “It pairs not just medical debt relief going backwards, but it fixes the upstream problems.” Hospitals worked with Sesso’s team to identify who qualified for the relief and sent them letters. For Kody Kinsley, the former secretary of health in North Carolina, the issue was personal. “My second year of college, my father had a massive stroke,” says Kinsley. He says that his mom was very anxious about how to pay for his care: “A key thought in her mind was, ‘We don’t have health insurance. Oh my God. We’re gonna end up in debt.'” Luckily, Kinsley figured out how to get a discount from the hospital. Years later as health secretary, Kinsley heard similar stories from all over the state. Even after 675,000 people gained Medicaid coverage through the new expansion in 2023, people would tell him about the old medical debt they still carried. “They had a forward path, but they were still wrestling with that backward,” he says. Kinsley crafted a plan to address that and prevent some patients from accumulating new debt. The state tied additional Medicaid dollars for hospitals to debt relief dating back to 2014 — the earliest date the state could have expanded the health insurance program. Hospitals also agreed to shift the burden of applying for financial assistance away from patients and automatically apply discounts. “People can walk in the front door of a hospital in an [emergency] situation and not feel like they’re taking both their health and their financial well-being at risk in that moment,” Kinsley says. A patchwork of state approaches to medical debt Other states are taking action to tackle this $220 billion problem estimated to impact 1 in 12 Americans. Arizona and New Jersey used state dollars to buy and forgive medical debt. Oregon and Illinois screen patients for financial assistance. Colorado and New York ban medical debt from credit reports. The federal government recently rolled back that same protection. Heather Howard, director of Princeton University’s State Health and Value Strategies program, is encouraged to see the flurry of actions but worries about how uneven the help is across the country.

Millions will lose coverage due to loss of the subsidies

Aneeta Mathur-Ashton, January 1, 2026, https://www.usnews.com/news/national-news/articles/2026-01-01/6-changes-to-national-health-policy-to-watch-in-2026 6 Changes to National Health Policy to Watch in 2026

ACA Subsidies Will Sunset Premium tax credits meant to further reduce the price of healthcare plans bought on the Affordable Care Act marketplace expired on Dec. 31 after Congress declined to address a looming “subsidy cliff.” The credits increased financial assistance and expanded it to those with incomes above 400% of the federal poverty lines. Since the credits were first introduced in 2021, enrollment in the ACA marketplace increased to more than 24 million. 7 Big Moments for Public Health in ‘25 Public health was among the key issues that shaped American politics and policy in 2025. Here’s a look at some of the biggest moments. Aneeta Mathur-Ashton Dec. 29, 2025 US Health and Human Services Secretary Robert F. Kennedy Jr. speaks during an announcement on lowering drug prices from the Roosevelt Room of the White House in Washington, DC, on December 19, 2025. (Photo by Brendan SMIALOWSKI / AFP via Getty Images) The Center on Budget and Policy Priorities projected that almost 22 million people would see their healthcare costs “dramatically rise” or would lose their coverage altogether without the extension. The Urban Institute estimated that 7.3 million fewer Americans would receive subsidized coverage in 2026 and that 4.8 million more would be uninsured in 2026. A vote is scheduled in the House the week of Jan. 5 on a three-year extension of the credits, but the bill is expected to be dead on arrival. State Medicaid Expansion Incentives to End The American Rescue Plan Act of 2021 offered a temporary financial incentive to encourage states to expand Medicaid coverage to more low-income Americans. The act used the 138% poverty level listed in the Affordable Care Act to offer states a two-year, 5% match to the Federal Medical Assistance Percentage, the amount the federal government shoulders, for Medicaid expansion expenditures. The act was successful in getting more states to expand access, with Oklahoma, Missouri, South Dakota and North Carolina being the most recent states to do so between 2021 and 2023 when the act took effect. But the incentive will largely end as it currently exists due to the legislation known as the “big, beautiful bill.” States wishing to qualify for the enhanced funding must have completely expanded their Medicaid programs by Jan. 1. States that have already expanded their programs will retain their existing FMAP levels, and those receiving the two-year bonus will continue to receive it until the period ends. READ: Tracking RFK Jr. on Vaccines Removal of Tax Liability Caps For ACA marketplace enrollees, their premium tax credits are determined based on what they estimate their income will be at the beginning of the year. If the prediction is incorrect and the income is higher than expected, they are expected to repay. The process of repayment to the IRS is known as reconciliation and was expected to be undertaken when enrollees filed their federal income tax returns. For the 2024 and 2025 tax years, enrollees were expected to pay the difference between what they received and what they were eligible for. If a person’s income was less than 400% of the federal poverty line, the amount repaid was capped. Now, under a provision of the “big, beautiful bill,” marketplace enrollees will be expected to repay the full amount they owe. Also, the continuous special enrollment period for people whose incomes are below 150% of the federal poverty line will end. In addition, those enrolling in coverage during a special enrollment period based on their income and not tied to a qualifying life event will not be eligible for the credits beginning this year. Change in Tax Credit Eligibility for Noncitizens The “big, beautiful bill” also included changes to the eligibility requirements for people who are not citizens who wish to receive ACA marketplace premium credits. Credits will be limited to green-card holders, Cuban or Haitian entrants, or Compact of Free Association migrants or citizens of the Marshall Islands, Palau or Micronesia. Previously eligible categories, like refugees, asylum-seekers and those granted temporary protected status, will no longer qualify. The bill also ends a special rule known as the Medicaid waiting list loophole. The rule allowed people who are not citizens whose incomes are below 100% of the federal poverty line and who are ineligible for Medicaid coverage due to their status to receive the premium credits. The changes are expected to take effect Jan. 1. Caps on Federal Loans for Medical Students The “big, beautiful bill” also caps the amount medical students can receive in Federal Direct Stafford Loans and Federal Direct PLUS Loans. Unsubsidized federal loans for professional students will be capped at $50,000 a year with a total cap of $200,000. The amount of loans students can take will be capped, with undergraduate students facing a maximum $257,500. New borrowers will be limited to two repayment options

One Big Beautiful Bill reducing health care coverage

Jasmine Laws, Newsweek, December 30, 2025, https://www.newsweek.com/2026-changes-to-medicare-medicaid-11191542

Newsweek is a Trust Project member In 2026, there are a number of changes coming to the two federal health insurance programs, Medicare and Medicaid, after the Trump administration brought in various policies and bills this year that will shape the future of the programs. Why It Matters Medicaid, the federal program for low-income Americans, provides health care coverage for over 70 million people, while Medicare, the federal program for those older than 65 or potentially those younger if they have certain health conditions, provides health coverage for around 68 million Americans. The upcoming changes have prompted significant concern among recipients, lawmakers and experts, who have warned that millions of Americans will lose access to health care coverage, which they say would have implications on health outcomes nationwide. A young girl walks with her father as he learns to use a walking aid in hospital with a doctor. Stock photo: a young girl walks with her father as he learns to use a walking aid in hospital with a doctor. | Realpictures/Getty Images 2026 Changes To Medicaid Following the passage of President Donald Trump’s One Big Beautiful Bill (OBBB), there will be almost $1 trillion worth of cuts to Medicaid, as part of the administration’s bid to strip the program of “waste, fraud and abuse” and, as the White House said, to protect Medicaid for the “truly vulnerable.” The cuts clamp down on expansions of the program brought in under former President Joe Biden, and under former President Barack Obama via the Affordable Care Act (ACA), in order to generate funds so that Trump could bring in his sweeping tax cuts. The 40 states that expanded Medicaid under the ACA will now face a reduced federal match rate forcing states to shoulder a greater share of the costs—which Julie Donohue, a professor and chair of health policy and management at the University of Pittsburgh, told Newsweek will primarily affect people eligible through the ACA Medicaid expansion “who make less than $21,000 a year.” The Congressional Budget Office (CBO) predicted the cuts would see 1.3 million more Americans left uninsured in 2026, and that the total number of uninsured Americans could continue to rise over the coming years. Donohue said that the changes to Medicaid overall in the OBBB will result in “approximately 10 million low-income people losing insurance coverage.” She said that there are about 15 separate provisions in the law that “limit in some way who can be covered by Medicaid, or reduce the amount of federal spending on Medicaid, or both.” In another bid to cut “waste, fraud and abuse” from Medicaid, the Trump administration is bringing in new requirements for Medicaid eligibility. The new requirements mandate all recipients, unless exempt, to complete 80 hours a month of verified community engagement—which could include education, volunteering, working and more—and to report these hours worked to keep access to the program. Those between 19 and 65 have to complete the hours, unless they have caring responsibilities for very young children, have a disability, are in drug or alcohol rehabilitation, are pregnant and a few other exceptions. The work completed has to be easy for states for verify, and experts have warned that the measure will push many Americans off the program, purely because of the administrative burden of reporting and proving worked hours. States are required to implement these measures by January 1, 2027, but in order to check eligibility prior to that date, they will need to review hours worked by recipients in the run up to the new year, so Medicaid enrollees will have to prove they complete the 80 hours a month up to three months beforehand. Additionally, the OBBB also determines that any states providing Medicaid services to undocumented immigrants will face financial penalties, by losing enhanced federal matching funds. Reflecting on the upcoming changes, Paul Shafer, a professor of health law, policy, and management and co-director of the Medicaid Policy Lab at Boston University, told Newsweek that “in short, we are going to make it harder for people to get and stay enrolled in Medicaid, while at the same time also making it harder to get access to the health care providers that patients need.” He said that those “who are least able to navigate the system, from struggles with confusing work reporting requirements and more frequent renewal paperwork, and those who have unstable housing, who may be more likely to miss an important notice from their state Medicaid agency, will probably struggle the most.” Although, he added that all Medicaid recipients will be impacted in some way. “Medicaid also can serve as a front door to other benefits, like nutrition assistance, so for many families the changes to both Medicaid and SNAP in the OBBB may end up being a double whammy for their budget and their health,” he said. 2026 Changes to Medicare The Trump administration is also bringing in changes to the Medicare program, which includes increases to premium costs, coinsurance amounts, and deductibles for those using Part A and B plans. In the case of Medicare Part B plans, the average premiums are increasing by around 10 percent, or nearly $18 a month, Allison Hoffman, a professor of law, and of medical ethics and health policy at the University of Pennsylvania, told Newsweek. “For retirees on a fixed income, this increase can be a lot,” she said. While there are some increases for other plans, the changes are more “variable,” she added. “For example, in Medicare Part D drug plans, some plans are increasing prices, although many are staying the same or decreasing.” The Centers for Medicare and Medicaid Services (CMS) also announced cost cuts for 15 more commonly used prescription drugs that treat chronic diseases including cancer, diabetes and asthma. These cost cuts were shaped by the Inflation Reduction Act, brought in under the Biden administration, and will mean in 2026, a total of 25 drugs will have new negotiated Maximum Fair Prices (MFPs). It is thought that the drug negotiations “will save money,” Hoffman said. Also, enrollees “might experience some savings in cost sharing, but those savings won’t be dramatic for most people,” she added. Telehealth flexibilities—which allow Americans to access health care while still at home, a crucial benefit for those in rural areas and who find traveling difficult—are also set to end after January 30, 2026. Some states are also testing a new Medicare model next year—including New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington—not by choice, but as part of an experiment. The model involves bringing in a prior authorization process relative to Medicare’s existing processes, meaning recipients will either have to submit prior authorization requests for selected services, or their claim will be subject to pre-payment medical review, but it does not change Medicare coverage or payment criteria. It will also involve “testing the use of [artificial intelligence (AI)] to review and reject inappropriate use of certain care that is considered low value,” Hoffman said. “Prior authorization and denials have been contentious in Medicare Advantage, and it might receive a similar reception in traditional Medicare,” she said. Hoffman said there is also going to be a decrease in the number of private Medicare Advantage plans and prescription drug plans being offered in some areas. “This decrease might leave some areas of the country with no or few options in Medicare Advantage, and some people will lose their current coverage and have had to find an alternative,” she said. “For some of these people, they are facing either higher premiums than they paid before, or less comprehensive coverage.”

People want action on health care; it overwhelms other issues

Lydia Saad and Megan Brenan , December 15, 2025, https://news.gallup.com/poll/699770/cost-leads-americans-top-mind-healthcare-concerns.aspx,  Cost Leads Americans’ Top-of-Mind Healthcare Concerns

29% cite healthcare cost as most urgent national health problem 16% satisfied with cost of healthcare in U.S.; 57% satisfied with own costs Record-high 23% say healthcare system in crisis; 47% see major problems Editor’s Note: This research was conducted in partnership with the West Health-Gallup Center on Healthcare in America, a joint initiative to report the voices and experiences of Americans within the healthcare system. Americans’ already elevated perception that the cost of healthcare is the “most urgent health problem” facing the country rose further this year to 29%, up from 23% a year ago. The latest figure is the highest level recorded since 2004 and also one of the highest readings in the trend dating back to 1987. Cost now outpaces access to healthcare, at 17%, and obesity, at 8%, as what Americans consider to be the nation’s top health problem. These findings are from the West Health-Gallup Health and Healthcare Survey, conducted Nov. 3-25. Cost and access have typically topped the list of health problems in the U.S. since 2000, although they were displaced during the pandemic in 2020 and 2021, as people were mainly concerned about COVID-19. But as that focus lessened, concerns about cost and access returned. Today’s 29% of Americans mentioning healthcare costs exceeds the 16% to 27% range seen in the five years before the pandemic and is one percentage point shy of the record-high 30% measured in 1992. Twenty-nine percent also cited cost as the most urgent health problem in 2004. While up from 2020, mentions of access to healthcare remain below the 22% recorded in the last pre-pandemic measure in 2018 and the record highs of 29% in 2007 and 2008. After obesity, the specific medical issues most often cited as the nation’s top health problem are cancer and mental illness, both at 4%. Mentions of cancer are down sharply from the 10% seen before the pandemic. On the other hand, mentions of mental illness, which peaked at 7% as a concern in 2023, remain higher than the pre-pandemic rates that were mostly below 3%. Record-Low 16% Satisfied With Cost of U.S. Healthcare Low satisfaction with U.S. healthcare costs is another indication of the public’s sharpened concern about affordability. Satisfaction with U.S. healthcare costs is the lowest Gallup has recorded in annual trends since 2001, as 16% now say they are satisfied, compared with 19% a year ago and an all-time high of 30% in the first year of the pandemic. Meanwhile, U.S. adults’ satisfaction with their own healthcare costs remains steady at 57%, similar to where it’s been since 2022. This too was elevated during the pandemic, but the current level is similar to the rate seen for most of the two decades leading up to 2020. A similar picture is seen in the public’s ratings of healthcare coverage, with a strong majority rating their own healthcare coverage positively, while a reduced minority say the same of healthcare coverage nationally. Currently, 65% of Americans say their own healthcare coverage is excellent or good, just slightly below the average of 68% since 2001. At the same time, 24% rate healthcare coverage nationally this positively, down from last year’s 28% and the average of 32% across the trend. Today’s positive rating of U.S. healthcare coverage is the lowest Gallup has recorded in two decades. Record-High 23% Say U.S. Healthcare System ‘in State of Crisis’ Americans’ elevated concern about the nation’s healthcare costs combined with their lower evaluation of coverage may be contributing to a record-high 23% now saying the U.S. healthcare system is “in a state of crisis” and another 47% saying the system has “major problems.” Fewer U.S. adults, 26%, describe the problems as “minor,” and just 3% believe the healthcare system is free of problems. The current findings are a continuation of the pattern seen since 1994, whereby in most years, pluralities or majorities of Americans have said the nation’s healthcare system has major problems. However, the 23% describing the system as being in crisis is the highest in Gallup’s trend to date, by two points over 2009 and 2013 readings. Compared with last year, more say the system is in crisis (up seven points) and fewer say it has major problems (down seven points). Between 2001 and 2011, spanning both George W. Bush’s presidency and the start of Barack Obama’s, Democrats were the most likely to say the healthcare system had major problems or worse. However, since the passage of the Affordable Care Act in 2010, partisans’ views of the healthcare system have been more sensitive to the party in power. That is, Republicans and Democrats have generally offered better assessments of the healthcare system when the sitting president’s party has matched their own. The 81% of Democrats who now say healthcare is in a state of crisis or has major problems is up 10 points since last year and is similar to the group’s 84% record high in 2018, during Donald Trump’s first term. Meanwhile, Republicans’ negative assessment of the healthcare system (64%) has dropped seven points since last year, when Joe Biden was in office. Throughout the trend, independents’ views have generally been similar to those of U.S. adults overall. Nearly Two-Thirds Say Government Should Ensure All Have Coverage When it comes to the public’s preference for government involvement in the healthcare system, 64% of U.S. adults believe it is the federal government’s responsibility to ensure that all Americans have healthcare coverage. This is the highest percentage since 2007 calling for such government intervention, although the reading has been consistently at the majority level over the past decade. Similarly, from 2000 through 2008, majorities of Americans said it was the government’s responsibility to make sure all Americans had health coverage. However, during the Obama administration, as the ACA was drafted, passed into law and implemented, public support for government intervention in this realm was at or below 50%. The reading slipped to a low of 42% in 2013 during the troubled rollout of the ACA healthcare exchanges. The high point in belief that the government should ensure coverage for all was 69%, recorded in 2006. Partisans’ views of the federal government’s responsibility to ensure healthcare for all Americans differ sharply, as they have throughout the trend. Currently, 90% of Democrats and 73% of independents, but just 26% of Republicans, think the government is responsible. This 64-point gap between Democrats and Republicans is among the largest in the 25-year trend, while the reading among independents is the highest for the group by two points. Public Divided Over Private vs. Government-Run Healthcare System At the same time that a majority of Americans see a government role in ensuring universal U.S. healthcare coverage, they are divided over whether the nation’s healthcare system should be based on private insurance or run by the government. Currently, 48% of U.S. adults prefer a private system, while 46% support a government-run system. This is the second straight year that U.S. adults are divided. From 2010, when the measure was first tracked, through 2023, majorities of Americans favored private insurance, with just one exception: 2017, when they were evenly divided in preferences. Democrats’ long-standing majority-level preference for a government-run system persists, as 67% now favor it. This compares with a relatively steady 18% of Republicans and a new high of 51% of independents. Bottom Line Americans’ concerns about the U.S. healthcare system persist, with the cost of healthcare as the nation’s top health problem at its highest level in more than two decades. This rise comes ahead of 2026 premium increases for ACA subscribers, absent any last-minute legislative remedy from Congress and the president. This heightened concern is reinforced by record-low satisfaction with the cost of U.S. healthcare and diminished ratings of the nation’s healthcare coverage overall, even as most Americans remain satisfied with their own coverage and personal healthcare costs. These pressures on affordability and system performance are shaping broader public judgments about the health system. Seven in 10 Americans say the U.S. healthcare system has major problems or worse, including a record-high 23% who believe it is in a state of crisis. Partisan dynamics continue to influence perceptions of system quality. Meanwhile, the highest percentage of Americans since 2007 say the government should ensure that all Americans have healthcare coverage. Approval of the Affordable Care Act has reached a new high, suggesting the law’s standing has strengthened as Americans weigh the trade-offs of the current system and concerns about affordability. Despite rising support for government responsibility, Americans remain closely divided over whether the nation’s healthcare system should rely on private insurance or be run by the government. Together, these findings point to a complex healthcare policy environment — one in which Americans are looking for financial relief while being satisfied with their current coverage and are split along partisan lines over how much to rely on government-backed insurance solutions. Stay up to date with the latest insights by following @Gallup on X and on Instagram and @West Health on X and LinkedIn. Explore more of the data and insights at westhealth.gallup.com. Learn more about how the Gallup Poll Social Series works. View complete question responses and trends (PDF download).

Health care system collapsing, inequality increasing

Blackstock, 2025 [How America’s Health Care System Broke in 2025, https://time.com/7342307/americas-health-care-system-broke-2025/ December 23, Dr. Uché Blackstock is a physician and the CEO of Advancing Health Equity]

Two moments in 2025 revealed how vulnerable the U.S. health care system has become. The first was quiet but consequential. The Centers for Disease Control and Prevention (CDC) revised parts of its vaccine guidance in ways that appeared influenced by political pressure rather than scientific evidence. The second was impossible to ignore. Families across the country received notices that their insurance premiums would rise sharply in 2026 unless Congress extended Affordable Care Act subsidies. The former signaled that national scientific guidance can now tilt toward ideology. The latter showed how fragile and costly it has become simply to stay healthy. Together, they revealed the same truth. America is entering 2026 with a health system that is more politically exposed, more unequal, and more unstable than at any time in recent memory. As a physician, a mother, and the CEO of a health equity organization, I spent 2025 watching these stress fractures deepen. And while the many health-related crises of 2025—such as maternal mortality, clinician burnout, rapid and unregulated adoption of artificial intelligence, rising costs, and un-scientific, ideologically-driven public health guidances—were often perceived as separate, they all reflect a deeper question. Is healthcare in the United States a public good or a political battleground? To move forward in 2026, we must be honest about what this year exposed: the U.S. healthcare system is officially broken. Throughout 2025, the federal government and several state healthcare systems advanced new restrictions on diversity, equity, and inclusion. Health systems scaled back or closed equity offices. Federal grants built to reduce racial and socioeconomic disparities were delayed or eliminated. This impact is not hypothetical. It is felt most acutely by the people already facing the greatest barriers. Black mothers continue to experience the highest maternal mortality rates in the country. Disabled people lose access to essential services. LGBTQ+ youth face narrowing pathways to mental healthcare. Rural communities fall further behind. Equity work is not an optional initiative. It is the safety net that prevents avoidable harm. When equity infrastructure weakens, people die. The cost of care is pushing families to the edge While politicians focus on elections and budget standoffs, families have been absorbing the true cost of an unstable system. In 2025, insurance premiums rose, prescription drug prices increased, Medicaid coverage narrowed, and surprise medical bills continued to wipe out savings As a result, parents rationed asthma inhalers. Pregnant people delayed appointments because their insurance changed mid-year. Adults postponed essential care for chronic conditions until symptoms became too severe to ignore. These are not individual failures. They are predictable outcomes of a system that places the burden of affordability on the very people who can least afford it. The United States spends more on healthcare than any other high-income nation. Yet millions still cannot access the care they pay for. Affordability is no longer a policy topic. It is the dividing line between health and preventable disease. Clinician burnout intensified, revealing the promise and risks of AI In 2025, numerous nurses, midwives, physicians, and emergency workers described conditions that were unsafe for themselves and for patients. As a result, many left clinical practice entirely. Too many of those who remained were stretched beyond their limits. In response, health systems accelerated the use of artificial intelligence. AI was marketed as a solution to workforce shortages, administrative overload, and clinical decision making. Some tools delivered on those promises. Others mirrored and sometimes amplified the racial and socioeconomic biases already embedded in medical data. AI can support clinicians. But without transparency, mandatory bias auditing, privacy safeguards, and community oversight, it risks automating inequity rather than reducing it. Technology cannot correct what a system refuses to acknowledge. A healthcare system cannot function if its workforce is depleted and its technologies are unregulated. Public trust in health institutions continued to erode The CDC’s revised vaccine language was more than a change in wording. It signaled that scientific communication can now shift based on political influence. After years of pandemic misinformation, reproductive health restrictions, and legislative attempts to weaken public health authority, Americans have less trust in the institutions tasked with protecting them. Advertisement For Black communities in particular, viral videos showing mistreatment in medical settings and continued maternal health disparities were not new revelations. They were reminders of long-standing fears. Trust cannot be rebuilt with messaging alone. It requires accountability, consistency, and structural change. How to heal our health care system in 2026 The events of 2025 exposed a health system that is dangerously fragile. Repairing it will require structural commitments that reach far beyond short-term fixes. To restore our health care system’s functionality, trust, and fairness, there are several steps we can take. First, we can protect health equity work with federal and state safeguards. In 2026, we need federal protections that prevent states and health systems from dismantling disparity reduction programs for political purposes. This includes restoring canceled grants, rebuilding equity offices inside health systems, requiring public reporting of disparities data, and safeguarding community partnerships that were defunded. Equity work must be treated as core healthcare infrastructure, not an optional initiative. Advertisement In this vein, we must stabilize access to affordable care with long-term reforms. Families cannot withstand another year of unpredictable premiums and shrinking coverage. Congress must extend ACA subsidies for multiple years rather than temporary increments. States should be incentivized to expand Medicaid and penalized for harmful redetermination practices. We need meaningful regulation of pharmaceutical pricing and stronger oversight of hospital consolidation, which contributed to historic price inflation in 2025. Affordability is not sustainable without structural cost control. We just also take this moment to invest in maternal and reproductive health on a national level. The maternal health crisis is a national emergency. The United States needs a federally-funded maternal health action plan that expands midwifery and doula services, supports culturally affirming models of care, strengthens birthing centers, and restores access to reproductive health services that were restricted or politicized in 2025. Maternal mental health support must be integrated into prenatal and postpartum care. Advertisement This brings us to health care workers. In 2026, the country needs a national healthcare workforce recovery plan that includes competitive wages for nurses and frontline workers, mandatory safe staffing ratios, streamlined licensure mobility to address shortages, expanded loan forgiveness programs, and federal support for training pathways in rural and underserved communities. And as clinicians increasingly leverage AI tools, we must establish guardrails. The rapid deployment of AI in 2025 showed both its potential and its danger. In 2026, the country needs a clear regulatory framework that requires all AI tools to undergo bias auditing prior to approval, mandates transparency in training data, establishes protections for patient privacy, and ensures clinicians are trained to use AI safely rather than being forced to rely on tools they do not understand. Community oversight boards should be established to monitor AI’s real-world impact, particularly on marginalized groups. Advertisement Moreover, we must restore scientific independence and strengthen public health authority.. In 2025, political influence weakened public trust in agencies that should be guiding evidence-based decisions. In 2026, federal and state governments must enact measures that protect scientific guidance from political pressure, rebuild systems that were weakened, fund public health workforce pipelines, and protect reproductive health data from misuse. Public health institutions must be empowered to speak clearly and honestly again. We can help achieve these goals by expanding community-centered and preventive care. Communities filled gaps in 2025 that institutions left behind. In 2026, we must support community health workers, fund mobile clinics and home-based care,, and invest in prevention programs that reduce downstream healthcare spending. These models are evidence-based and cost-effective, and they are essential for rebuilding trust in communities that have been historically marginalized. Advertisement As a Black woman physician and mother raising two Black sons, 2025 often felt like watching a system stretch beyond its limits. But I also saw extraordinary resilience. Families advocating for themselves. Clinicians showing up despite impossible circumstances. Communities stepping in where institutions failed. The question for 2026 is not whether we understand what must change. We do. The question is whether we will choose to build a system where every life is treated with dignity, safety, and care.

AI solves nurse burnout

Health, December 15, 2025, https://www.wolterskluwer.com/en/expert-insights/2026-healthcare-ai-trends-insights-from-experts m 2026 healthcare AI trends: Insights from experts

Bethany Robertson, Clinical Executive, Health Learning & Practice segment

What’s the biggest cultural shift ahead for nurses in 2026, and why is it so critical? “Over the past year we have seen the nursing industry experience significant shifts as transformative care models and technologies like GenAI, virtual nursing and ambient listening tools move from a pipedream to actual implementations. In 2026, leading healthcare organizations will continue to take steps forward with building the infrastructure, training and guidelines needed to facilitate, not hinder nurses’ daily workflows. Under a landscape where workforce shortages, career satisfaction and unbalanced patient ratios are still negatives, health systems implementing these new offerings need their nursing workforce involved in the roll out and subsequent evaluation of these tools. This ensures that the use cases support the issues in their workflow and aren’t seen as a decision made by leadership in absence of nursing’s voice, while also understanding the true impact of the efforts. This cultural shift toward tech adoption will empower nurses to work more efficiently, reduce burnout, and elevate the overall quality of care. Ultimately, these trends will position nursing as a dynamic, technology-supported profession that remains at the forefront of patient-centered innovation.”

AI solves health worker shortages

Guru Singh, November 21, 2025, AI Diagnostics: Revolutionizing Medical Diagnosis in 2026, https://www.scispot.com/blog/ai-diagnostics-revolutionizing-medical-diagnosis-in-2025

AI Diagnostics: Revolutionizing Medical Diagnosis in 2026 Artificial intelligence in medical diagnosis is transforming healthcare delivery, offering unprecedented levels of accuracy and efficiency. In 2026, AI diagnostics has evolved from an emerging technology to an essential component of modern healthcare systems. By leveraging machine learning and deep learning algorithms, AI diagnostic tools can process vast amounts of medical data swiftly and accurately, providing healthcare providers with invaluable insights for better patient care. The impact of AI in diagnostics cannot be overstated. As healthcare facilities worldwide face increasing demand and workforce shortages, AI-powered diagnostic tools offer solutions that enhance both efficiency and accuracy. In diagnostic laboratories, AI-based diagnostics are streamlining workflows, reducing manual tasks, and improving precision. The integration of AI diagnostic tools with laboratory information management systems has created a more connected ecosystem where samples can be tracked in real-time and results delivered faster than ever before. Among the leading solutions in the AI medical diagnostics space, Scispot stands out for its intuitive interface, seamless integration capabilities, and AI-driven insights that transform how labs interact with their data. Applications of AI in Medical Diagnostics Medical Imaging One of the most prominent applications of AI in diagnostic medicine is in medical imaging. AI algorithms, particularly deep learning models, have demonstrated exceptional capabilities in analyzing radiological images such as X-rays, MRIs, CT scans, and ultrasounds. In a notable collaboration between Massachusetts General Hospital and MIT, researchers developed AI algorithms specifically for radiology applications. The AI system achieved a remarkable 94% accuracy rate in detecting lung nodules, significantly outperforming human radiologists who scored 65% accuracy in the same task. This implementation has relieved radiologists of mundane tasks, allowing them to focus more on complex cases and personalized patient care. Similarly, a South Korean study revealed that AI-based diagnosis achieved 90% sensitivity in detecting breast cancer with mass, outperforming radiologists who achieved 78%. The AI system also demonstrated superior capabilities in early breast cancer detection with 91% accuracy compared to radiologists at 74%. Pathology and Laboratory Diagnostics Create precise, industry-standard custom reports with visual data, automatically send updates via email, Slack, WhatsApp, or SMS, and track delivery status using Scispot’s alt-LIMS Diagnostic AI has made significant inroads in pathology and laboratory diagnostics. AI algorithms can analyze tissue samples, blood tests, and other laboratory results with remarkable precision, helping pathologists identify abnormalities that might otherwise be missed. Deep learning algorithms have shown impressive accuracy in diagnosing melanoma cases in dermatology, while AI in medical diagnostics has greatly advanced clinical microbiology through improved detection, identification, and measurement of microorganisms. Scispot’s AI-powered platform exemplifies how AI diagnostic tools can enhance laboratory workflows. Through its GLUE integration engine, Scispot connects with over 200 lab instruments out-of-the-box, including LC-MS systems, plate readers, and sequencers, enabling real-time data flow between instruments and software systems. This eliminates manual data transfer and reduces transcription errors, ensuring more accurate and efficient diagnostics. Genomics and Precision Medicine AI for medical diagnostics has revolutionized genomic analysis, enabling more precise identification of genetic variations that affect treatment responses and disease susceptibility. AI algorithms can process vast amounts of genomic data quickly, helping identify rare genetic variants and their potential impact on patient care. In cancer diagnostics, AI has shown remarkable capabilities. AI-powered diagnostic tools for cancer detection have reached a 93% match rate with expert tumor board recommendations, helping healthcare providers make decisions based on each patient’s unique characteristics. This application of AI-based diagnostic tools is particularly valuable in the growing AI in cancer diagnostic market, where precision and personalization are paramount. Transform biospecimen data into insights using no-code tools in biobanking LIMS. Automate qPCR calculations, gene expression analysis, and genetic variant detection for enhanced research with Scispot The integration of AI with genomic analysis has led to significant discoveries. For example, AI analysis of hundreds of exomes in medulloblastoma cases has identified specific molecular subgroups, allowing doctors to administer precise treatment doses. Predictive Analytics and Clinical Decision Support AI-powered diagnostics excel in predictive analytics, helping healthcare providers anticipate disease progression and patient outcomes. By analyzing patterns in patient data, AI can identify risk factors and predict potential complications before they occur, enabling proactive interventions. Johns Hopkins Hospital and Microsoft Azure AI collaborated on implementing AI-driven predictive analytics, leveraging vast amounts of patient data, including electronic health records, medical imaging, and genomic information. Their AI algorithms were trained to predict patient outcomes, such as disease progression, readmission risks, and response to treatments, significantly improving patient care. AI-powered Clinical Decision Support Systems provide immediate assistance during patient care by analyzing multiple data sources, including medical imaging, bio-signals (ECG, EEG, EMG), vital signs, demographic information, and laboratory results. With nearly 400 FDA-approved AI algorithms specifically for radiology, these systems process vast amounts of healthcare data with unprecedented speed and accuracy. Benefits of AI in Diagnostics Improved Accuracy and Reduced Errors One of the most significant advantages of AI diagnostics in medicine is its ability to improve diagnostic accuracy. Traditional methods often rely on human judgment, which can be subject to fatigue, bias, and other limitations. Diagnostic errors affect approximately 5% of the population each year, but AI diagnostic tools are tackling this challenge through early detection and quick clinical alerts. AI systems help minimize medical errors through various approaches. Machine learning algorithms enable Clinical Decision Support Systems to analyze patient data and make predictions that support diagnosis and treatment planning. Natural Language Processing helps AI systems extract valuable information from unstructured clinical notes, creating a detailed understanding of patient conditions. The impact on accuracy is substantial. As mentioned earlier, AI-based diagnosis achieved 90% sensitivity in breast cancer detection, surpassing radiologists’ 78%. Similarly, in dermatology, AI algorithms have demonstrated comparable or superior performance to dermatologists in diagnosing skin lesions, including melanoma. Faster Results and Efficiency AI-powered diagnostic tools significantly reduce the time required for diagnosis. Traditional diagnostic processes often involve multiple manual steps, from sample collection to result interpretation, which can be time-consuming and resource-intensive. AI automation streamlines these processes, enabling faster results and more efficient resource allocation. In radiology, AI algorithms can analyze images within seconds, providing immediate insights to radiologists. This accelerated diagnostic process is crucial in emergencies and critical care scenarios, where every minute counts. Similarly, in laboratory settings, AI-based diagnostics can process and interpret test results rapidly, reducing turnaround times and improving patient care. Scispot’s implementation has demonstrated significant efficiency gains. A leading diagnostic chain in Mumbai that adopted Scispot reported a 40% reduction in workflow errors and enhanced patient satisfaction through instant report access. The platform’s automation capabilities streamline sample management, reducing manual tasks and enhancing accuracy through features like barcode-based tracking and direct integration with analyzers such as Roche Cobas, Sysmex, and Beckman Coulter. Cost-effectiveness and Resource Optimization AI in medical diagnostics offers substantial cost-saving opportunities. By automating routine tasks and improving diagnostic accuracy, AI reduces the need for repeat tests, minimizes treatment delays, and optimizes resource allocation. The healthcare industry stands to save billions through AI implementation, with estimates suggesting annual savings between $200 to 360 billion. Moreover, AI diagnostic tools help address workforce shortages in healthcare. With many professionals nearing retirement, automation has become essential to maintain accuracy and offset staffing challenges. According to Siemens Healthineers, 95% of lab professionals believe automation is essential for enhancing patient care, while 89% see it as critical to meeting demand amid workforce shortages.

AI solves health care cost problems

 

Guru Singh, November 21, 2025, AI Diagnostics: Revolutionizing Medical Diagnosis in 2026, https://www.scispot.com/blog/ai-diagnostics-revolutionizing-medical-diagnosis-in-2025

AI Diagnostics: Revolutionizing Medical Diagnosis in 2026 Artificial intelligence in medical diagnosis is transforming healthcare delivery, offering unprecedented levels of accuracy and efficiency. In 2026, AI diagnostics has evolved from an emerging technology to an essential component of modern healthcare systems. By leveraging machine learning and deep learning algorithms, AI diagnostic tools can process vast amounts of medical data swiftly and accurately, providing healthcare providers with invaluable insights for better patient care. The impact of AI in diagnostics cannot be overstated. As healthcare facilities worldwide face increasing demand and workforce shortages, AI-powered diagnostic tools offer solutions that enhance both efficiency and accuracy. In diagnostic laboratories, AI-based diagnostics are streamlining workflows, reducing manual tasks, and improving precision. The integration of AI diagnostic tools with laboratory information management systems has created a more connected ecosystem where samples can be tracked in real-time and results delivered faster than ever before. Among the leading solutions in the AI medical diagnostics space, Scispot stands out for its intuitive interface, seamless integration capabilities, and AI-driven insights that transform how labs interact with their data. Applications of AI in Medical Diagnostics Medical Imaging One of the most prominent applications of AI in diagnostic medicine is in medical imaging. AI algorithms, particularly deep learning models, have demonstrated exceptional capabilities in analyzing radiological images such as X-rays, MRIs, CT scans, and ultrasounds. In a notable collaboration between Massachusetts General Hospital and MIT, researchers developed AI algorithms specifically for radiology applications. The AI system achieved a remarkable 94% accuracy rate in detecting lung nodules, significantly outperforming human radiologists who scored 65% accuracy in the same task. This implementation has relieved radiologists of mundane tasks, allowing them to focus more on complex cases and personalized patient care. Similarly, a South Korean study revealed that AI-based diagnosis achieved 90% sensitivity in detecting breast cancer with mass, outperforming radiologists who achieved 78%. The AI system also demonstrated superior capabilities in early breast cancer detection with 91% accuracy compared to radiologists at 74%. Pathology and Laboratory Diagnostics Create precise, industry-standard custom reports with visual data, automatically send updates via email, Slack, WhatsApp, or SMS, and track delivery status using Scispot’s alt-LIMS Diagnostic AI has made significant inroads in pathology and laboratory diagnostics. AI algorithms can analyze tissue samples, blood tests, and other laboratory results with remarkable precision, helping pathologists identify abnormalities that might otherwise be missed. Deep learning algorithms have shown impressive accuracy in diagnosing melanoma cases in dermatology, while AI in medical diagnostics has greatly advanced clinical microbiology through improved detection, identification, and measurement of microorganisms. Scispot’s AI-powered platform exemplifies how AI diagnostic tools can enhance laboratory workflows. Through its GLUE integration engine, Scispot connects with over 200 lab instruments out-of-the-box, including LC-MS systems, plate readers, and sequencers, enabling real-time data flow between instruments and software systems. This eliminates manual data transfer and reduces transcription errors, ensuring more accurate and efficient diagnostics. Genomics and Precision Medicine AI for medical diagnostics has revolutionized genomic analysis, enabling more precise identification of genetic variations that affect treatment responses and disease susceptibility. AI algorithms can process vast amounts of genomic data quickly, helping identify rare genetic variants and their potential impact on patient care. In cancer diagnostics, AI has shown remarkable capabilities. AI-powered diagnostic tools for cancer detection have reached a 93% match rate with expert tumor board recommendations, helping healthcare providers make decisions based on each patient’s unique characteristics. This application of AI-based diagnostic tools is particularly valuable in the growing AI in cancer diagnostic market, where precision and personalization are paramount. Transform biospecimen data into insights using no-code tools in biobanking LIMS. Automate qPCR calculations, gene expression analysis, and genetic variant detection for enhanced research with Scispot The integration of AI with genomic analysis has led to significant discoveries. For example, AI analysis of hundreds of exomes in medulloblastoma cases has identified specific molecular subgroups, allowing doctors to administer precise treatment doses. Predictive Analytics and Clinical Decision Support AI-powered diagnostics excel in predictive analytics, helping healthcare providers anticipate disease progression and patient outcomes. By analyzing patterns in patient data, AI can identify risk factors and predict potential complications before they occur, enabling proactive interventions. Johns Hopkins Hospital and Microsoft Azure AI collaborated on implementing AI-driven predictive analytics, leveraging vast amounts of patient data, including electronic health records, medical imaging, and genomic information. Their AI algorithms were trained to predict patient outcomes, such as disease progression, readmission risks, and response to treatments, significantly improving patient care. AI-powered Clinical Decision Support Systems provide immediate assistance during patient care by analyzing multiple data sources, including medical imaging, bio-signals (ECG, EEG, EMG), vital signs, demographic information, and laboratory results. With nearly 400 FDA-approved AI algorithms specifically for radiology, these systems process vast amounts of healthcare data with unprecedented speed and accuracy. Benefits of AI in Diagnostics Improved Accuracy and Reduced Errors One of the most significant advantages of AI diagnostics in medicine is its ability to improve diagnostic accuracy. Traditional methods often rely on human judgment, which can be subject to fatigue, bias, and other limitations. Diagnostic errors affect approximately 5% of the population each year, but AI diagnostic tools are tackling this challenge through early detection and quick clinical alerts. AI systems help minimize medical errors through various approaches. Machine learning algorithms enable Clinical Decision Support Systems to analyze patient data and make predictions that support diagnosis and treatment planning. Natural Language Processing helps AI systems extract valuable information from unstructured clinical notes, creating a detailed understanding of patient conditions. The impact on accuracy is substantial. As mentioned earlier, AI-based diagnosis achieved 90% sensitivity in breast cancer detection, surpassing radiologists’ 78%. Similarly, in dermatology, AI algorithms have demonstrated comparable or superior performance to dermatologists in diagnosing skin lesions, including melanoma. Faster Results and Efficiency AI-powered diagnostic tools significantly reduce the time required for diagnosis. Traditional diagnostic processes often involve multiple manual steps, from sample collection to result interpretation, which can be time-consuming and resource-intensive. AI automation streamlines these processes, enabling faster results and more efficient resource allocation. In radiology, AI algorithms can analyze images within seconds, providing immediate insights to radiologists. This accelerated diagnostic process is crucial in emergencies and critical care scenarios, where every minute counts. Similarly, in laboratory settings, AI-based diagnostics can process and interpret test results rapidly, reducing turnaround times and improving patient care. Scispot’s implementation has demonstrated significant efficiency gains. A leading diagnostic chain in Mumbai that adopted Scispot reported a 40% reduction in workflow errors and enhanced patient satisfaction through instant report access. The platform’s automation capabilities streamline sample management, reducing manual tasks and enhancing accuracy through features like barcode-based tracking and direct integration with analyzers such as Roche Cobas, Sysmex, and Beckman Coulter. Cost-effectiveness and Resource Optimization AI in medical diagnostics offers substantial cost-saving opportunities. By automating routine tasks and improving diagnostic accuracy, AI reduces the need for repeat tests, minimizes treatment delays, and optimizes resource allocation. The healthcare industry stands to save billions through AI implementation, with estimates suggesting annual savings between $200 to 360 billion. Moreover, AI diagnostic tools help address workforce shortages in healthcare. With many professionals nearing retirement, automation has become essential to maintain accuracy and offset staffing challenges. According to Siemens Healthineers, 95% of lab professionals believe automation is essential for enhancing patient care, while 89% see it as critical to meeting demand amid workforce shortages.

AI should augment humans in health care

Guru Singh, November 21, 2025, AI Diagnostics: Revolutionizing Medical Diagnosis in 2026, https://www.scispot.com/blog/ai-diagnostics-revolutionizing-medical-diagnosis-in-2025, Angie Nasr is the Chief Nursing Officer (CNO) at Medely, a leading healthcare staffing platform that connects nurses and other healthcare professionals with flexible job opportunities. With a rich background in clinical nursing and healthcare management, Angie plays a crucial role in ensuring the quality and safety of care provided through Medely’s platform. Angie earned her Bachelor of Science in Nursing (BSN) and later her Master of Science in Nursing (MSN) from the University of California, Los Angeles (UCLA). With over 15 years of experience in the healthcare industry, Angie has held various nursing and leadership positions, where she developed a deep understanding of the challenges faced by both healthcare professionals and facilities. Her hands-on experience in clinical settings, coupled with her leadership roles, has equipped her with the expertise to advocate for and support Medely’s network of healthcare professionals.

Human-AI Collaboration Despite the remarkable capabilities of AI diagnostics, human oversight remains essential. Healthcare professionals must understand both the strengths and limitations of AI diagnostic tools to use them effectively and interpret their outputs correctly. The ideal approach is one of collaboration rather than replacement, with AI augmenting human expertise rather than substituting for it. Clinicians need appropriate training to work effectively with AI systems, understanding when to rely on AI recommendations and when human judgment is needed. Angie Nasr February 18, 2026, https://medcitynews.com/2026/02/healthcares-ai-obsession-is-missing-the-point-on-nursing-shortages/ Healthcare’s AI Obsession Is Missing the Point on Nursing Shortages Healthcare leaders must resist using AI as a substitute for staffing. Instead, invest in workforce optimization technology that empowers nurses, creates flexible pathways, and addresses the systemic issues driving burnout. I was six years old when my sister was born, and I remember it vividly. In the hospital nursery, I saw rows of tiny newborns and nurses moving between isolettes with practiced precision. The moment stuck with me because years later, I found myself in the same environment. As a former NICU nurse at UCLA, I was caring for the city’s most vulnerable patients — an experience that has continued to guide me throughout my nursing career and my life. As AI increasingly dominates our conversations around both healthcare strategy and everyday culture, I’ve realized that my years working nights, weekends, and holidays taught me something crucial: The work us nurses do at the bedside can’t be automated. When a newborn’s oxygen saturation drops unexpectedly, and a split-second clinical judgment has the potential to alter the course of someone’s life, we need real human experience and intuition. Admittedly, artificial intelligence is transforming healthcare operations. Technology can free up time by automating straightforward but time-consuming tasks such as scribing and supporting clinical decision-making through early warning systems. When deployed thoughtfully, AI genuinely improves our ability as nurses to focus on patient care. By MedCity News and PointClickCare At the same time, many healthcare executives are betting heavily on AI to ease workforce pressures, a trend reflected in the more than 80% of health system leaders who expected generative AI to significantly impact their organizations in 2025. This hope is understandable because the need is great. The World Health Organization projects a global shortage of 11 million healthcare workers by 2030, with 4.5 million of those being nurses. One-third of nurses now report burnout severe enough to consider leaving the profession. With these staffing shortages top of mind, many organizations’ first instinct is to plug new AI tools into every function possible, hoping the technology will patch these ever-widening gaps. But this approach misses a critical distinction. AI that supports nurses is fundamentally different from AI that replaces nurses. The core challenges facing bedside nursing can’t be automated. Strong nursing depends on years of hands-on experience that comes from being present with patients. No algorithm can hold a hand during a difficult diagnosis, reposition a post-surgical patient, or read the subtle cues that a family doesn’t understand a care plan. This is our irreplaceable work. When AI creates new problems The nursing profession’s skepticism about AI isn’t unfounded. National Nurses United found that 60% of nurses don’t trust their employers to prioritize patient safety when implementing AI. One in four healthcare workers worries about being replaced by AI, with nurses significantly more concerned than physicians. Sponsored Post Balancing the Role of Physicians and AI [Video] At the ViVE conference in LA, Smarter Technologies Chief Medical Officer Ruben Amarasingham MD talked with Katie Adams about the company’s larger goals for AI: to improve the accuracy of data and make healthcare less burdensome for physicians and clinicians. By Smarter Technologies and MedCity News In facilities using automated nurse handoffs, nearly half of nurses reported that these automated reports don’t match their assessment and omit critical details — information that wouldn’t be missed in nurse-to-nurse communication. Roughly two out of three nurses whose employers used AI-generated patient acuity measurements said the computer-generated measurement didn’t correspond with their assessment, because the AI failed to account for patients’ psychosocial or emotional needs. The real crisis The real problem behind the nursing shortage — and the issue that AI needs to address — is workforce sustainability. Labor costs comprise over 50% of hospital operating budgets, with 96% of health system CFOs citing labor costs as their top margin pressure, and 99% pointing to nursing shortages as the root cause. The average cost to replace a bedside RN is $61,110, with each 1% change in RN turnover costing or saving the average hospital $289,000 annually. A 2025 study found that nearly two-thirds of nurses experienced high levels of burnout. Insufficient pay, poor leadership support, and abuse from patients all contribute to a workplace environment that is stressful at best and unbearable at worst. I eventually transitioned away from the NICU to outpatient surgery, where I was promoted to director of nursing. When I left the NICU, it wasn’t because I stopped loving those tiny patients; it was because my body couldn’t function. I was working long night shifts, and construction jackhammers prevented me from catching up on sleep during the day. Thousands of nurses face similar impossible choices, missing their children’s school events because of mandatory overtime, developing chronic health issues from rotating shifts, or balancing inflexible scheduling with caregiving responsibilities at home. Nurses shouldn’t have to fear that their work will always take precedence over their personal lives. The outside life experiences nurses bring to the table are part of what empowers them to deliver empathetic care that helps their communities thrive. So what happens when nurses are no longer allowed to live their own lives? When CFOs mandate “eliminating contingent labor” to cut what appear to be higher upfront costs, hospitals lean harder on internal staff. Overtime shoots up, burnout increases, and turnover costs skyrocket. It becomes a vicious cycle: the cost savings from reducing flexible staffing get wiped out by turnover expenses that exceed the original investment. No amount of AI can fix this broken system, nor can it replace the human experiences that make nurses effective caregivers. What actually works We can’t solve the nursing shortage by replacing nurses with AI. But we can use AI to retain nurses in the profession. Flexible staffing models are one area ripe for technological innovation. Research consistently shows that work flexibility is a top priority for nurses, and per diem arrangements help nurses achieve work-life balance. Rather than viewing per diem staff as a last resort, hospitals should integrate them as part of their core workforce, ready when needed. The solution is technology that automates credentials verification, streamlines scheduling, and provides real-time workforce analytics, all freeing up time for nurses to provide compassionate patient care. AI adoption is currently in an intriguing phase, but it’s still early. Despite frequent headlines suggesting that the world’s workforce is on the brink of being “replaced” by AI, the reality — especially in healthcare — is far less certain, and the technology still falls short in many regards. Our priority needs to be promoting technological fluency among our teams and leveraging AI where effective, but always keeping humans central to the process. Meaning, healthcare leaders must resist using AI as a substitute for staffing. Instead, invest in workforce optimization technology that empowers nurses, creates flexible pathways, and addresses the systemic issues driving burnout. That sense of awe I felt at six years old in the hospital nursery represents what we risk losing if we treat nursing as just another task to be replaced by AI. The future of healthcare is about using technology to help nurses thrive, not to automate them away. Image from stock.xchng user ilco

25 million uninsured, causes health problems and death

Jennifer Tolbert, October 8, 2025, The Uninsured Population and Health Coverage, https://www.kff.org/uninsured/health-policy-101-the-uninsured-population-and-health-coverage/?entry=table-of-contents-introduction

Health coverage in the United States is marked by a blend of private and public insurance options that leaves about 8% of the population uninsured. This coverage system has evolved over the years, most recently with the implementation of the Affordable Care Act (ACA), which aimed to reduce the uninsured rate by expanding Medicaid, creating health insurance Marketplaces for individuals, and providing subsidies to make the coverage more affordable. Many factors, including economic conditions, federal and state policy changes, and significant health crises, such as the COVID-19 pandemic, influence the uninsured rate. The ACA and policy changes designed to protect coverage during the pandemic led to increased health coverage overall; however, passage of the 2025 Federal Budget Reconciliation Bill (referred to as the One Big Beautiful Bill Act) along with other policy changes are expected to increase significantly the number of people who are uninsured over the next ten years. What is the Landscape of Health Care Coverage in the United States? Copy link to What is the Landscape of Health Care Coverage in the United States? Health coverage in the U.S. is a complex patchwork of private and public insurance coverage options. In 2023, most residents had private insurance coverage, with nearly half covered by an employer-based plan. About 1 in 5 U.S. residents received coverage through the Medicaid program, the federal and state-financed comprehensive health coverage program for low-income people. Another roughly 15% of the population had health coverage from the federal Medicare program, which covers seniors and people under age 65 with long-term disabilities. About 6% of the population had private non-group insurance either purchased through the ACA Marketplace or off-market, and just over 1% of the population was covered through the military’s TRICARE or VA health care programs. The uninsured rate for the total population was 7.9% for the year (Figure 1). (In some cases, people have multiple forms of coverage. For example, about 12 million people are enrolled in both Medicare and Medicaid and are classified in these figures as covered by Medicaid.) Figure 1 Health Insurance Coverage of the Total Population, 2023 Employer (48.6%)Military (1.3%)Non-Group (6.2%)Uninsured (7.9%)Medicare (14.7%)Medicaid (21.2%) Source: KFF estimates based on the 2023 American Community Survey, 1-Year Estimates.Get the dataDownload PNG KFF.org Trends in the Uninsured Rate Copy link to Trends in the Uninsured Rate In 2023, there were 25.3 million uninsured residents ages 0-64, and the uninsured rate among the population ages 0-64 was 9.5%, the lowest rate in U.S. history (Figure 2). The analysis of the uninsured population focuses on coverage among people ages 0-64 since Medicare offers near-universal coverage for seniors—just 457,000, or less than 1%, of people over age 65 were uninsured. Figure 2 Uninsured Rate of People Ages 0-64, 2010-2023 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 0 2 4 6 8 10 12 14 16 18 20% 10.9% 10.0% 10.2% 10.4% 10.9% 13.5% 16.8% 17.0% 17.4% 17.8% 10.2% 9.6% 9.5% Note: Due to disruptions in data collection during the first year of the pandemic, the Census Bureau did not release ACS 1-year estimates in 2020. Includes individuals ages 0 to 64. Source: KFF analysis of 2010-2023 American Community Survey, 1-Year EstimatesGet the dataDownload PNG KFF.org Prior to the implementation of the ACA, gaps in the public insurance system and lack of access to affordable private coverage left over 40 million people without health insurance. The ACA expanded Medicaid coverage to nearly all adults with incomes up to 138% of the federal poverty level (FPL) (the poverty level in the continental U.S. is $15,650 for a single individual in 2025) and created new health insurance Marketplaces through which individuals can purchase coverage with financial help to afford premiums and cost-sharing. Following the passage of the ACA in 2010 and the rollout of the coverage provisions, the number of uninsured people ages 0-64 dropped to 27 million in 2016. The ACA envisioned that all states would adopt the Medicaid expansion; however, a Supreme Court ruling in 2012 made expansion optional for states. As of early 2025, 40 states and Washington, D.C. had adopted the ACA’s Medicaid expansion (Figure 3). Figure 3 Status of State Action on the Medicaid Expansion Decision AdoptedNot Adopted TX TX CA CA MT MT NM NM AZ AZ NV NV CO CO WY WY OR OR UT UT MN MN ID ID KS KS NE NE SD SD AK AK ND ND OK OK MO MO WA WA GA GA FL FL MI MI IL IL IA IA WI WI AR AR AL AL NC NC NY NY MS MS LA LA PA PA TN TN OH OH VA VA KY KY IN IN ME ME SC SC WV WV MD MD VT VT NH NH MA MA NJ NJ HI HI DE DE Source: KFF Status of State Medicaid Expansion Decisions TrackerGet the dataDownload PNG KFF.org The declines in uninsured rates following implementation of the ACA coverage expansions were largest among poor and near-poor individuals, particularly adults. People of color, who had higher uninsured rates than White people prior to 2014, had larger coverage gains from 2013 to 2016 than White people, although the coverage disparities were not eliminated. Before implementation of the ACA, expansions of Medicaid coverage and the enactment of the Children’s Health Insurance Program (CHIP) helped to lower the uninsured rate for children. Changes in the 1980s and early 1990s expanded Medicaid eligibility levels for children and pregnant people, and the establishment of CHIP in 1997 provided coverage for children with incomes above Medicaid thresholds. When states implemented CHIP, extensive outreach efforts along with the adoption of streamlined processes facilitated enrollment of children in Medicaid and CHIP and reduced the number of uninsured children. After declining through 2016, the number of uninsured people and the uninsured rate began increasing in 2017 and continued to grow through 2019. Generally favorable economic conditions as well as policy changes during the Trump Administration, such as reduced funding for outreach and enrollment assistance, encouraging periodic Medicaid eligibility checks, changes to immigration policy related to public charge rules, and approval of some demonstration waivers to restrict enrollment led to a decline in Medicaid enrollment, which likely contributed to the increase in uninsured people. With the arrival of the COVID-19 pandemic, policies adopted to protect coverage drove a decline in the uninsured population from 2019 to 2023. The Families First Coronavirus Response Act required states to keep people continuously enrolled in Medicaid in exchange for enhanced federal funding. Medicaid continuous enrollment ended in March 2023, and most states completed renewals for individuals who enrolled during continuous enrollment by December 2024. In addition, the American Rescue Plan Act (ARPA) provided temporary enhanced ACA Marketplace subsidies to make Marketplace coverage more affordable, and these subsidies were renewed for another three years in the Inflation Reduction Act of 2022. These enhanced subsidies will expire at the end of December 2025 unless Congress acts to extend them. Who is Uninsured in the United States? Copy link to Who is Uninsured in the United States? Most people who are uninsured are adults under age 65, are in working low-income families, are people of color, and, reflecting geographic variation in income, immigration status, and the availability of public coverage, live in the South or West. In 2023, over 8 in 10 people ages 0-64 who were uninsured were adults and 16% were children. Nearly three-quarters (73.7%) of the uninsured population ages 0-64 had at least one full-time worker in their family and an additional 11.2% had a part-time worker in their family (Figure 4). More than 8 in 10 (80.9%) people ages 0-64 who were uninsured were in families with incomes below 400% FPL in 2023 and nearly half (46.7%) had incomes below 200% FPL. People of color comprised 62.9% of the uninsured population ages 0-64 in 2023 despite making up about 46% of residents ages 0-64. Most uninsured individuals (74.2%) were U.S. citizens, while 25.8% were noncitizens in 2023. Nearly three-quarters lived in the South and West. Figure 4 Family Work Status of Uninsured People Ages 0-64, 2023 1 or More Full-Time Workers (73.7%)Part-Time Workers (11.2%)No Workers (15.1%) Note: Includes individuals ages 0 to 64. Source: KFF analysis of 2023 American Community Survey, 1-Year Estimates.Get the dataDownload PNG KFF.org Adults ages 19 to 64 are more likely to be uninsured than children. The uninsured rate among children (5.3%) was less than half the rate among adults ages 19-64 (11.1%) in 2023, largely due to the broader availability of Medicaid and CHIP coverage for children than for adults. Among adults ages 19-64, men had higher uninsured rates than women in 2023 (12.6% vs. 9.5%). Reflecting persistent disparities in coverage, people of color are generally more likely to be uninsured than White people. In 2023, American Indian and Alaskan Native (AIAN) and Hispanic people ages 0-64 had the highest uninsured rates at 18.7% and 17.9%, respectively, which were nearly three times higher than the uninsured rate for White people (6.5%). Uninsured rates for Native Hawaiian or Pacific Islander (NHPI) (12.8%) and Black people (9.7%) ages 0-64 were also higher than the rate for their White counterparts (Figure 5). These differences in uninsured rates are driven by lower rates of private coverage among these groups. Medicaid coverage helps to narrow these differences but does not fully offset them. Figure 5 Uninsured Rates among the Population Ages 0-64 by Selected Characteristics, 2023 Age Adults (19-64) 11.1% Children (0-18) 5.3% Race/Ethnicity AIAN 18.7% Hispanic 17.9% NHPI 12.8% Black 9.7% White 6.5% Asian 5.8% Medicaid Expansion Status Non-expansion States 14.1% Expansion States 7.6% Note: Includes individuals ages 0 to 64. AIAN refers to American Indian/Alaska Native. NHPI refers to Native Hawaiians or Pacific Islanders. Hispanic people may be of any race but are categorized as Hispanic; other groups are all non-Hispanic. Source: KFF analysis of 2023 American Community Survey, 1-Year Estimates.Get the dataDownload PNG KFF.org Noncitizens are more likely than citizens to be uninsured. Nearly one-third of noncitizen immigrants were uninsured in 2023 while the uninsured rate for U.S.-born citizens was 7.5% and 8.9% for naturalized citizens. One in 4 children has an immigrant parent, including over 1 in 10 (12%) who are citizen children with at least one noncitizen parent. Uninsured rates vary by state and by region and were generally higher in states that had not taken up the ACA Medicaid expansion in 2023 (Figure 6). Economic conditions, availability of employer-sponsored coverage, and demographics are other factors contributing to variation in uninsured rates across states. Figure 6 Uninsured Rates Among Population Ages 0-64 by State, 2023 3% 19% United States: 9.5% Note: As of December 2024, these states have not expanded Medicaid: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. Source: KFF analysis of 2023 American Community Survey 1-Year Estimates, and tracking and analysis of state actions related to adoption of the ACA Medicaid expansion. Get the dataDownload PNG KFF.org (grey border) Why are People Uninsured? Copy link to Why are People Uninsured? The fragmented U.S. health coverage system leads to gaps in coverage. While employer-based insurance is the prevalent source of coverage for the population ages 0-64, not all workers are offered coverage by their employer or, if offered, can afford their share of the premiums. Medicaid covers many low-income individuals, especially children, but eligibility for adults remains limited in most states that have not adopted the ACA Medicaid expansion. While subsidies for Marketplace coverage are available for many low and moderate-income people, few people can afford to purchase private coverage without financial assistance. The cost of health coverage and care poses a challenge for the country broadly and is a significant barrier to coverage for people who are uninsured. In 2023, 63.2% of uninsured adults ages 18-64 said they were uninsured because coverage is not affordable, making it the most common reason cited for being uninsured (Figure 7). Other reasons included not being eligible for coverage (27.0%), not needing or wanting coverage (26.6%), and signing up being too difficult (23.9%). Figure 7 Reasons for Being Uninsured Among Uninsured Adults Ages 18-64, 2023 Coverage Not Affordable 63.2% Not Eligible for Coverage 27.0% Do Not Need or Want 26.6% Signing Up Was Too Difficult or Confusing 23.9% Cannot Find a Plan that Meets Needs 18.9% Lost Job 4.7% Note: Includes individuals ages 18 to 64. Respondents can select multiple options. Source: KFF analysis of 2023 National Health Interview Survey. Get the dataDownload PNG KFF.org (grey border) Not all workers have access to coverage through their jobs. In 2023, 64.7% of uninsured workers worked for an employer that did not offer them health benefits. Among uninsured workers who are offered coverage by their employers, cost is often a barrier to taking up the offer. Low-income families with employer-based coverage spend a significantly higher share of their income toward premiums and out-of-pocket medical expenses compared to those with income above 200% FPL. A decade after the implementation of the ACA coverage options, 10 states have not adopted the Medicaid expansion, leaving 1.4 million uninsured people without an affordable coverage option. A coverage gap exists in states that have not adopted the expansion for poor adults who earn too much to qualify for Medicaid coverage but not enough to be eligible for subsidies in the Marketplace. Lawfully-present immigrants generally must meet a five-year waiting period after receiving qualified immigration status before they can qualify for Medicaid. States have the option to cover eligible children and pregnant people without a waiting period, and as of January 2025, 38 states have elected the option for children, and 32 states have taken up the option for lawfully-present pregnant individuals. Under current law, lawfully-present immigrants are eligible for Marketplace tax credits, including those who are not eligible for Medicaid because they have not met the five-year waiting period. Undocumented immigrants are ineligible for federally-funded coverage, including Medicaid and Marketplace coverage, although some states provide fully state-funded health coverage to these individuals. Health care provisions in the 2025 reconciliation package narrow eligibility for federally-subsidized health coverage, including Medicaid and CHIP, Medicare, and Marketplace subsidies, to a limited group of lawfully-present immigrants. These changes take effect on January 1, 2027 and are expected to increase the number of lawfully residing immigrants without health coverage. Though financial assistance is available to many of the remaining uninsured under the ACA, not everyone who is uninsured is eligible for free or subsidized coverage. Nearly 6 in 10 (14.5 million) uninsured individuals in 2023 were eligible for financial assistance through Medicaid or subsidized Marketplace coverage (Figure 8). However, over 4 in 10 uninsured (10.9 million) were outside the reach of the ACA because their state did not expand Medicaid, their immigration status made them ineligible, or they were deemed to have access to an affordable Marketplace plan or offer of employer coverage (Figure 8). Figure 8 Eligibility for Coverage Among Uninsured Population Ages 0-64, 2023 Total Uninsured = 25.3 million Tax Credit Eligible (32.2%)Medicaid Eligible (24.9%)Ineligible for Coverage Due to Immigration Status (18.4%)Ineligible for Financial Assistance Due to Affordable Employer or Marketplace Coverage (19.1%)In the Coverage Gap (5.4%) Note: Totals may not sum to 100% due to rounding. Tax Credit Eligible includes adults in MN, NY, and OR who are eligible for coverage through the Basic Health Plan or similar coverage. This analysis does not account for any policy changes aimed at addressing the “family glitch,” which limited access to Marketplace subsidies for dependents of workers with affordable offers of self-only employer coverage. Source: KFF analysis based on 2024 Medicaid eligibility levels and 2023 American Community SurveyGet the dataDownload PNG KFF.org What are the Consequences of Being Uninsured? Copy link to What are the Consequences of Being Uninsured? Lacking health insurance in the United States can impact a person’s access to health care, their financial situation, and their health status. It can also broadly impact a community’s public health (illustrated by the COVID-19 pandemic) and the economy through lower productivity. Adults who are uninsured are almost five times more likely than adults with insurance to report not having a usual source of care, which is often a key entry point for accessing health care whether for preventive services or for treating existing conditions. Consequently, in 2023, nearly half (46.6%) of uninsured adults ages 18-64 reported not seeing a doctor or health care professional in the past 12 months compared to 15.6% with private insurance and 14.2% with public coverage (Figure 9). Uninsured individuals are also more likely to face cost barriers to accessing needed care. In 2023, uninsured adults were nearly three times more likely to report not getting medical care due to cost compared to publicly insured adults and four times more likely than privately insured adults (22.6% vs 7.7% and 5.1%, respectively). Figure 9 Barriers to Health Care Among Adults Ages 18-64 by Insurance Status, 2023 Uninsured Medicaid/Other Public Employer/Other Private Did Not See Doctor/Health Care Professional 46.6% 14.2% 15.6% No Usual Source of Care 42.8% 11.4% 11.2% Postponed Seeking Care Due to Cost 24.7% 8.0% 6.2% Went Without Needed Care Due to Cost 22.6% 7.7% 5.1% Delayed Filling or Did Not Get Needed Prescription Due to Cost 14.0% 10.2% 5.9% Note: Includes individuals ages 18 to 64. Includes barriers experienced in the past 12 months. Respondents who said usual source of care was the emergency room were included among those not having a usual source of care. All Medicaid/Other Public and Employer/Other Private are statistically different from Uninsured at the p<0.05 level. Source: KFF analysis of 2023 National Health Interview SurveyGet the dataDownload PNG KFF.org (grey border) The lack of access to health care and a delay in seeking care due to costs mean uninsured people are more likely to be hospitalized for avoidable health problems and to experience declines in their overall health. Research also shows that when they are hospitalized, uninsured people receive fewer diagnostic and therapeutic services and have higher mortality rates than those with insurance. Uninsured individuals often face unaffordable medical bills when they do seek care, which can lead to medical debt and other forms of financial instability. Nearly half of uninsured adults reported difficulty paying for health care, compared to 21% of insured adults and over 8 in 10 (84%) uninsured adults said they worried that health care costs would put them in debt or increase their existing debt, compared to 71% of adults with insurance (Figure 10). Uninsured adults are also more likely to face negative consequences due to health care debt, such as using up savings, having difficulty paying other living expenses, or borrowing money. Figure 10 Problems Paying for Health Care and Worries About Health Care Debt by Insurance Status UninsuredInsured 20 40 60 80 100% 49% 21% 84% 71% Problems Paying for Health Care Worried About Health Care Debt Note: Debt could include not being able to pay the bill in full, having to go on a payment plan with the provider, having to put the bill on your credit card to pay off over time, or borrowing from another lender, friend, or family member. Source: KFF Survey on Racism, Discrimination, and Health (June 6- August 14, 2023) and KFF Health Tracking Poll (January 30-February 7, 2024)Get the dataDownload PNG KFF.org Future Outlook Copy link to Future Outlook Driven by pandemic-era policies to promote health coverage, the number of people without insurance and the uninsured rate dropped to historic lows in recent years. Although millions of people lost Medicaid coverage during the unwinding of continuous enrollment, Medicaid enrollment remains higher than in February 2020, before the start of the pandemic. Enhanced Marketplace subsidies adopted during the pandemic led to record Marketplace signups, with enrollment topping 25 million in 2025. States have also taken action to reduce the number of people who are uninsured. In 2023, two states, North Carolina and South Dakota, newly adopted the Medicaid expansion, and several states have expanded state-funded coverage for certain individuals regardless of immigration status. However, actions by Congress and the Trump Administration threaten to reverse these recent coverage gains. Congress passed the 2025 Federal Budget Reconciliation package on July 3, 2025, which makes significant changes to Medicaid and ACA Marketplaces, and President Trump signed the reconciliation package into law on July 4, 2025. The Congressional Budget Office (CBO) estimates that the law will increase the number of people without health insurance by 10 million. The expiration of the enhanced premium tax credits for Marketplace enrollees, which will happen at the end of 2025 unless Congress takes action to extend them, will further increase the number of people without health insurance. CBO projects that over 14 million more people will be uninsured in 2034 due to the combined effects of the reconciliation package and the expiration of the enhanced Marketplace subsidies. In addition to these potential coverage losses, the Trump administration’s increased immigration enforcement activities are likely to have a broad chilling effect that could cause immigrants to decide to disenroll or not enroll themselves or their children, most of whom are U.S. citizens, in health coverage programs even if they are eligible due to immigration-related fears. Enactment of the ACA helped close some gaps in our fragmented health coverage system and led to a significant decline in the number of people who were uninsured. Recent efforts built on that success to further shrink the share of people without insurance. Yet, despite this success and the ACA’s continued favorability—the public has a favorable view of the ACA by a 2 to 1 margin—policymakers enacted cuts to federal support for Medicaid and ACA coverage to fund other budget priorities. The impact on health coverage and people’s ability to access needed health care services will be significant.

Number of uninsured declining

National Center for Health Statistics, June 2025, U.S. Uninsured Rate Drops by 15% Since 2020, https://www.cdc.gov/nchs/pressroom/releases/20250624.html,

The overall number of Americans without health insurance dropped by 4.4 million from 2020 to 2024. These findings are included in a new report to be released on Tuesday by CDC’s National Center for Health Statistics (NCHS). Data show a small increase from 2023 to 2024 in the percentage of uninsured that is not statistically significant. The findings are featured in the report, “Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2024.” It shows that among working-age Americans (those ages 18–64), 11.6% did not have health insurance in 2024, a non-significant decrease from 13.9% in 2020. Highlights from the report include: 8.2%, or 27.2 million, of Americans of all ages did not have health insurance in 2024 compared to 9.7%, or 31.6 million, in 2020. The percentage of uninsured children remained consistent at 5.1% (3.7 million) over the period, despite a significant one-year increase from 3.9% (2.8 million) in 2023. Almost two-thirds (65.4%) of people younger than 65 were covered by private health insurance and more than a quarter (26.6%) were covered by public health insurance in 2024. Among Black, non-Hispanic adults ages 18–64, the percentage who were uninsured decreased by 28% from 14.6% in 2020 to 10.5% in 2024. In 2024, almost 1 in 4 Hispanic adults ages 18–64 (24.6%) lacked health insurance, a greater percentage than Black, non-Hispanic adults (10.5%); White, non-Hispanic adults (7.9%) and Asian, non-Hispanic adults (5.4%). Adults ages 18–64 who live in states that had not expanded Medicaid were almost twice as likely to be uninsured (17.4%) compared to those living in states that had expanded Medicaid (9.3%) in 2024. The percentage of Americans younger than 65 with exchange-based private health insurance increased from 3.8% in 2020 to 5.7% in 2024.

51, 000 will die just from the subsidy cuts

Government & Finance, June 3, 2025, 51,000 Americans Will Die Every Year as a Direct Result of Republican Health Plan: New Analysis, https://www.finance.senate.gov/ranking-members-news/51000-americans-will-die-every-year-as-a-direct-result-of-republican-health-plan-new-analysis#:~:text=%E2%80%9CDespite%20some%20of%20the%20callous,enhanced%20ACA%20premium%20tax%20credits.

Washington, D.C. – Senate Finance Committee Ranking Member Ron Wyden, D-Ore., issued a statement today after a new analysis estimates that more than 51,000 people will die per year as a direct result of the Republican reconciliation bill, and their refusal to extend Affordable Care Act premium tax credits. “Despite some of the callous sarcasm from Republican members of Congress lately, the stakes for this bill are truly life and death for tens of thousands of Americans,” Wyden said. “Taking away health insurance and benefits like home care and mental health care from seniors, people with disabilities, kids, and working families will be deadly. This analysis shows the dire consequences of moving ahead with this morally bankrupt effort.” The analysis, conducted by the University of Pennsylvania’s Leonard Davis Institute of Health Economics (Penn LDI) and the Yale School of Public Health’s Center for Infectious Disease Modeling and Analysis, finds: 11,300 deaths per year from the loss of Medicaid or Affordable Care Act Marketplace coverage due to 7.7 million people losing coverage. 18,200 deaths per year due to the loss of Medicaid coverage among 1.38 million low-income Medicare beneficiaries, causing loss of access to low-income prescription drug assistance. 13,000 deaths per year among Medicaid enrollees in nursing homes due to the rollback of the 2024 nursing home minimum staffing rule. 8,811 deaths per year from the proposed bill’s failure to extend the enhanced ACA premium tax credits.

AI usage triggering prior authorization denials

Jennifer Lubell, March 10, 2025, How AI is leading to more prior authorization denials https://www.ama-assn.org/practice-management/prior-authorization/how-ai-leading-more-prior-authorization-denials

Health insurers’ use of AI is bringing a new level of concern to the burdensome payer cost-control practice known as prior authorization. In a recently released AMA survey (PDF), 61% of physicians said they fear that payers’ use of unregulated AI is increasing prior authorization denials, a practice that will override good medical judgment and exacerbate patient harm. AMA Advocacy Impact Report Learn how the AMA is leading national initiatives to build a health system that is more effective, sustainable and centered on patients. Read the Report “Emerging evidence shows that insurers use automated decision-making systems to create systematic batch denials with little or no human review, placing barriers between patients and necessary medical care,” said AMA President Bruce A. Scott, MD, reacting to the survey results. Physicians should be able to make medical decisions with their patients without interference from unregulated and unsupervised AI technology, said Dr. Scott. The AMA is fighting by challenging insurance companies to eliminate care delays, patient harms and practice hassles. Health plans use prior authorization to control costs, requiring advance approval to obtain a prescription medication or medical service for a patient. Physicians and patients alike view this as a burdensome practice that affects care delivery, clinical outcomes and productivity in physician offices. Spending rises under this practice due to additional office visits, unanticipated hospital stays, and out-of-pocket costs for treatment. In this most recent nationwide survey of 1,000 practicing physicians—400 working in primary care, the remainder in other physician specialties—82% reported that prior authorization sometimes leads to patients abandoning treatment. Over 90% said prior authorization delays care. AI tools have been accused of producing high rates of care denial, in some cases 16 times higher than is typical, according to figures from a 2024 Senate committee report cited in the AMA’s news release. “Using AI-enabled tools to automatically deny more and more needed care is not the reform of prior authorization physicians and patients are calling for,” said Dr. Scott. Other AMA surveys underscore physician concerns about some misuses of health care AI. Results released early in February (PDF) found that 49% of physicians ranked oversight of payers’ use of AI in medical necessity determinations among the top three priorities for regulatory action. To address these concerns, the AMA House of Delegates recently adopted policy supporting advocacy to help ensure that technology is an asset to physicians and not a burden. Based on this policy, the AMA has developed advocacy principles (PDF) that address the development, deployment and use of health care AI, with particular emphasis on: Health care AI oversight. When and what to disclose to advance AI transparency. Generative AI policies and governance. Physician liability for use of AI-enabled technologies. AI data privacy and cybersecurity. Payer use of AI and automated decision-making systems. AMA membership = Great value for physicians Thousands of free CME opportunities to fulfill state requirements A powerful voice fighting for you during uncertain times Research, resources, events and more from the largest physician organization Join the AMA Today Dire consequences for patient care AI concerns notwithstanding, physicians continue to report that prior authorization impedes delivery of necessary medical treatments, jeopardizes quality care and harms patients. More than nine in 10 physicians—94%—reported that prior authorization had a negative impact on clinical outcomes. Eighty percent of doctors surveyed said that prior authorization sometimesleads patients to pay out-of-pocket for a medication, and 31% said payers are rarely or never using evidence-based criteria to make coverage decisions. More distressingly, 29% of physicians reported that prior authorization led to a serious adverse event for a patient in their care. More specifically, these shares of physicians said that prior authorization led to: A patient’s hospitalization—23%. A life-threatening event, or one that required intervention to prevent permanent damage—18%. A patient’s disability, permanent bodily damage, congenital anomaly, birth defect or death—8%. More burdens for physicians Physicians also feel the administrative burden of prior authorization, which reduces their time with patients and negatively affects their practices. On average, physicians and their staff spend 13 hours a week completing the prior authorization workload for a single physician. Forty percent of physicians employ staff whose primary job is to work on this task. These shares of physician respondents also revealed that prior authorization: Somewhat or significantly increases physician burnout—89%. Has increased somewhat or significantly over the last five years—75%. Is often or always denied—31%. In cases of adverse payer decisions on prior authorization requests, 20% of physicians will always appeal. Physicians report various reasons for not appealing health-plan denials, with 67% reported doubts about an appeal’s success based on their past experiences. Over half said patient care could not wait for the health plan’s approval process, and 55% said they had insufficient resources to file an appeal. Stay up to date on prior authorization improvements Get the latest news on the AMA’s fight to eliminate care delays, patient harm and practice hassles. Subscribe Now Prior authorization subscribe The cost of prior authorization The survey also revealed that prior authorization adds significant costs to the U.S. health system, forcing patients to try ineffective treatments and schedule additional office visits. A strong majority of physicians—88%—reported that prior authorization leads to higher overall utilization of health care resources. These shares of physicians reported that prior authorization increases utilization in the following ways: Led to ineffective initial treatment—77%. Additional office visits—73%. Immediate care or emergency department visits—47%. Hospitalizations—33%. Prior authorization can also affect productivity in the workplace, if employees are missing work due to delays in care leading to prolonged illness or attending rescheduled appointments. Nearly 60% of physicians with patients in the workforce said prior authorization has affected work performance among their patients. Insurers must follow through Back in 2018, the AMA joined the American Hospital Association, American Pharmacists Association, Medical Group Management Association, America’s Health Insurance Plans, and Blue Cross Blue Shield Association in releasing a consensus statement (PDF) on how to improve prior authorization. Seven years later, surveyed physicians reported that health plans have made little progress honoring their commitments as outlined in that document. Major payers such as UnitedHealthcare and Cigna pledged to reduce services requiring prior authorization in 2023. But just 16% of physicians who work with UnitedHealthcare and Cigna, respectively, reported that the changes led to a reduction in prior authorization requirements.

 

 

 

 

 

 

Counterplan – health insurance mandate

 

Paul Ginsburg, 9-27, 22, Market Watch, Opinion: Tweak the Affordable Care Act to mandate backstop health insurance, https://www.marketwatch.com/story/tweak-the-affordable-care-act-to-mandate-backstop-health-insurance-11664296755

Universal health coverage in the U.S.—once considered a hopeless goal without imposing a single payer plan—is surprisingly within reach. Thanks to the Affordable Care Act and enhanced subsidies in the American Rescue Plan of 2021, more than 91% of Americans now carry health insurance. Closing the gap would be a win-win-win for the uninsured, healthcare providers, and for policyholders who would see lower premiums through wider shared risk. But using only additional federal subsidies to get to universal coverage would be far too costly. The Congressional Budget Office estimates that permanent extension of the enhanced subsidies alone will cost the government more than $25 billion a year. Pricing subsidies high enough to lure more people to the ACA marketplaces could be several times that figure. A better answer is to create an individual healthcare insurance mandate that would be politically more palatable than the ACA version. Let me explain. The ACA included a tax penalty of up to $2,085 per family for those who didn’t sign up for a plan. Although the ACA’s mandate followed an approach used by a Massachusetts predecessor plan (sometimes referred to as “RomneyCare”), which was broadly accepted in that state, the ensuing partisan battles over whether to repeal the ACA led to a demonization of that approach to mandates. What economists saw as a way to share responsibilities and risks—and keeping down the costs of expanding coverage–was seen by many Americans as government overreach. As a result, Congress repealed the tax penalty in 2019. Imagine an uninsured individual who seeks care at an emergency room. Once the hospital determines that the patient is uninsured and is not eligible for Medicaid, the patient would be auto-enrolled in a “backstop” plan in the ACA marketplace. Just as in all marketplace plans, the backstop plan would pay claims and scale premiums according to ability to pay through existing ACA subsidies. At tax filing after the end of the year, individuals covered by the backstop plan would be retroactively charged a premium based on the number of months not covered by other insurance. Auto-enrollment could effectively create universal coverage, since any time that individuals lacked another source of coverage, they would be covered by the backstop plan. The backstop plan would provide temporary coverage, with individuals then transitioning into traditional individual market plans. Of course, there would be details to work out. Should the backstop plan be run by the government, effectively creating a “public option” insurance plan? Alternatively, private insurers could compete to be designated as the back-up plan for an ACA marketplace. Or multiple private insurers could offer back-up plans on an exchange, with government assigning uninsured individuals to the plans with lower premiums. Additionally the ACA marketplace would likely need to employ various risk-management tools to account for some individuals opting for backstop insurance rather than paying for coverage at a higher premium level. The enhanced subsidies in the American Rescue Plan—initially designed to get the country through the COVID pandemic—could make backstop insurance more acceptable than it might have been in the past since the premiums required when taxes are filed could be smaller than those owed under the original ACA. The fact that the enhanced subsidies were extended through 2025 in the recent Inflation Reduction Act makes it likely that they will continue, although Congressional budgeting practices make it unlikely to convert them to an explicit entitlement. Other countries that use private insurance to achieve universal coverage, such as Switzerland, the Netherlands and Germany, make effective use of mandating individuals to be covered. The approaches used more closely resemble a backstop plan than the original ACA approach of penalties for those uninsured. It would be a shame, having come so close to the goal of universal coverage, for America to back away when the tools are at hand to achieve it.

Single payer results in service access restrictions

 

Janet Trautwein is CEO of the National Association of Health Underwriters, 9-26, 22, MEDICARE FOR ALL WOULD “FIX” WHAT ISN’T BROKEN, https://yonkerstimes.com/medicare-for-all-would-fix-what-isnt-broken/

Medicare for All remains on the congressional docket. Sen. Bernie Sanders, I-Vt., recently re-introduced his bid for a single-payer system, claiming it would guarantee all Americans health coverage while lowering costs and saving lives. That’s a compelling sales pitch. However, the reality is that Medicare for All would outlaw private health insurance and force millions of Americans onto a single government-run plan. And contrary to what its proponents might suggest, Medicare for All would lead to worse care for patients at higher cost. Even the idea’s supporters don’t seem to know what it entails. According to polling from the Kaiser Family Foundation, two-thirds of Medicare for All supporters believe they’d be able to keep their private insurance under a single-payer healthcare system. Sen. Sanders’s bill would ban private plans. That might not sit well with the 14 million Americans who purchase private plans through the Affordable Care Act’s exchanges. Almost three-quarters of enrollees like the plan they have now. Outlawing private insurance coverage also wouldn’t go over well with the 180 million Americans with employer-sponsored coverage. More than seven in 10 are satisfied with their plans. It’s no surprise that overall support for Medicare for All — which usually hovers around 50% — drops to just 37% when people realize it would eliminate private health insurance. Support drops to just 26% when people learn single-payer would lead to delays in care. Delays are endemic to single-payer programs like Medicare for All. That’s because the government would pay hospitals and doctors below-market rates in order to deliver the savings Sen. Sanders promises. Medicare and Medicaid pay less than private insurers do. A single-payer plan would extend those low payment rates to everyone. Providers today charge privately insured patients more to make up for low reimbursements from public plans. They wouldn’t be able to do that under Medicare for All. Providers would have little choice but to restrict access to services. Patients would face long waits for subpar treatment. That’s exactly what happens in other countries with single-payer health care. In the United Kingdom’s National Health Service, there are more than 6 million people waiting for hospital care. Under Canada’s single-payer system, patients face a median wait of nearly six months from the time they’re referred by a general practitioner to receipt of treatment from a specialist. Under Medicare for All, American patients would experience similar fates. That was the conclusion of Phillip Swagel, director of the Congressional Budget Office, who recently told Congress that single-payer would increase “congestion in the healthcare system, including delays and forgone care.” Those delays and forgone care would cost Americans a lot of money — more than $30 trillion over a decade. Less than 10% of the American population is uninsured. There are far more cost-effective ways to expand access to affordable coverage. For example, the additional subsidies provided by the American Rescue Plan Act have helped more than 3 million Americans secure coverage through the Affordable Care Act’s exchanges for less than $10 a month. Extending those subsidies permanently could continue to make private coverage affordable for millions. The Affordable Care Act has also driven down coverage inequities, especially in states that have expanded Medicaid. That’s a testament to the power of building on the parts of our healthcare system that are working. Lawmakers should focus their efforts there — not on Medicare for All.

Millions of kids have no choice but to be uninsured

Robby Ree, 9-24, 22, https://captimes.com/opinion/letters-to-the-editor/letter-argument-for-single-payer-health-care/article_e28553a0-7746-5094-bc1b-7b6d8dbe6910.html, etter | Argument for single-payer health care

Dear Editor: Sally Pipes’ opinion column in the Wisconsin State Journal makes the strongest case for a national single-payer health coverage system. She starts off talking about the recent decline in life expectancy in the U.S., saying, “In fact, much of the decline in life expectancy has little to do with our health care system.” She ends her letter with, “But sometimes, those choices matter more than any system.” If the decline of life expectancy has little to do with our health care system, as she wrote, there’s really no good reason to have a for-profit health coverage system. There’s no good reason for the U.S. to have the highest health care costs and the most medical related bankruptcies. She says that “choices matter more than any system,” but millions of uninsured children in the U.S. have no health coverage choice, with millions more underinsured. With single-payer Medicare for all they would clearly have more choice.

AT: Low Life Expectancy Has Nothing to Do with Health Care

If low life expectancy has nothing to do with health care, we should still try to reduce the price

Robby Ree, 9-24, 22, https://captimes.com/opinion/letters-to-the-editor/letter-argument-for-single-payer-health-care/article_e28553a0-7746-5094-bc1b-7b6d8dbe6910.html, etter | Argument for single-payer health care

Dear Editor: Sally Pipes’ opinion column in the Wisconsin State Journal makes the strongest case for a national single-payer health coverage system. She starts off talking about the recent decline in life expectancy in the U.S., saying, “In fact, much of the decline in life expectancy has little to do with our health care system.” She ends her letter with, “But sometimes, those choices matter more than any system.” If the decline of life expectancy has little to do with our health care system, as she wrote, there’s really no good reason to have a for-profit health coverage system. There’s no good reason for the U.S. to have the highest health care costs and the most medical related bankruptcies. She says that “choices matter more than any system,” but millions of uninsured children in the U.S. have no health coverage choice, with millions more underinsured. With single-payer Medicare for all they would clearly have more choice.

Single payer massively reduces costs through administrative savings, takes costs off employers and saves lives

 

David Stuart, 9-24, 22, https://www.kevinmd.com/2022/09/a-stark-contract-between-american-and-canadian-health-care.html, A stark contract between American and Canadian health care

The United States has the world’s most expensive health care system. It spends about twice as much each year on every American as the Canadian system spends on Canadians. Per capita, the U.S. spends far more than Canada on drugs each year. The U.S. also has far more health care capacity, with more specialists, nurses, hospital beds, CAT scanners, MRI scanners, PET scanners, and radiotherapy treatment units per capita than Canada. This higher capacity can be useful, but it costs a lot of money. The higher health care spending in the U.S. is primarily due to a much higher price for every medical procedure. It isn’t due to more procedures being performed in the U.S. Having a single-payer system in Canada makes the Canadian system much less expensive to run. In Canada, hospitals and physicians easily submit a single monthly bill electronically to the provincial government. In the U.S., physicians and hospitals cannot automate sending their bills to each of hundreds of insurers. Instead, it involves a huge amount of time and expensive paperwork. Consequently, health care administrative costs are almost five times higher in the U.S. than Canada. In this case, government bureaucracy is surprisingly more cost-efficient than the private sector. Billing insurance companies is not the only expensive part of the U.S. system. An insurance company must approve any nonemergency tests, procedures, or treatments before they can be performed. This extra administrative burden is costly. When we moved to Texas, my wife, who is Canadian, was incredulous at the number of people working in U.S. doctors’ offices. The average Canadian physician shares a receptionist and maybe a nurse with a few other physicians. Conversely, a doctor’s office in Houston is overflowing with staff, most of them dealing with insurance companies. The Canadian approach is much simpler: Provincial governments build limited capacity. Canadian patients use this limited capacity to the maximum extent that available resources allow. If there is insufficient capacity, health care providers must apply for permission to build more capacity. That takes time. The net result is that there is never quite enough capacity. This increases wait times, yet it is also very cost-efficient administratively. The bottlenecks effectively control utilization, with no need for daily calls to insurance companies. Because American health care is so expensive, U.S. companies must pay a lot for employee health care insurance. This drives up labor costs in the U.S., while paradoxically keeping wages low. It is, therefore, more expensive to produce something in the U.S. than in Canada and elsewhere. This is one major driving force behind U.S. jobs shifting to other countries. U.S. physicians have a feral fear of liability. An American physician is much more likely to be sued than a Canadian physician. This and other factors drive-up the cost of U.S. malpractice insurance. American physicians also follow more expensive “defensive medicine” processes, ordering tests that might not be necessary medically but that reduce the risk of a successful lawsuit. Costs of compliance with government regulation are probably also higher in the U.S. When I worked at MD Anderson, I received frequent emails from the Office of Compliance that I was obligated to either do or avoid various specific things. I might be fired and might face criminal prosecution if I ignored them. For example, it was illegal to fill out forms requesting a motorized wheelchair for a patient. Such forms could only be completed by very specific professionals. I would have faced stiff criminal penalties if I completed one since I was not authorized to do so. We were also told that if we tried to arrange free chemotherapy for underinsured patients, the government might charge us with using coercion to try to attract patients. Such legal threats from government are substantially less commonplace in Canada. A Canadian physician must maintain a high level of professional conduct, in keeping with the standards of provincial medical licensing bodies. However, there are not constant threats from government, and no need for an institution to have an Office of Compliance. While living in Houston, I was struck that overall, the relationship between the American people and their government appeared to be a somewhat uncomfortable one. This is in keeping with the U.S. imprisonment rate. It’s the highest in the world (639 prisoners per 100,000 population, compared to 104 per 100,000 in Canada). In the U.S., prisons may be highly profitable, privately-owned capitalist ventures in which politicians and others may invest. I suspect this U.S. discomfort with government plays at least some role in the strong support for the Second Amendment. It has probably also played a role in the 2016 election of Donald Trump as a president who promised to “drain the Washington swamp.” In the “Frozen North,” Canadians may strongly disagree with their government. We may even despise it, but we generally do not fear it. In Canada, governments control health care spending largely through strategic, though potentially misguided budget constraints rather than by heavy-handed threats. Life expectancy: Despite the huge amount spent on U.S. health care, American men live an average of 4.5 years less than Canadian men. American women live three years less than Canadian women. In fact, the U.S. ranks a lowly 46th in the world in average life expectancy. Part of this is due to many young Americans being underinsured. A country’s average life expectancy will drop if a lot of young people die prematurely because they don’t have health insurance. When we moved to Texas in 2003, we hired a company to install a swimming pool at our new house. In talking to one of the young workers, my wife was concerned to find that he had unrelenting, disabling stomach pain. He told my wife that because he had no insurance, he could not afford medical care. This would not have been an issue in Canada. A Canadian could always see a doctor. They could go a to any walk-in clinic if they had trouble finding a family physician. They might have to wait a few days or weeks for an appointment if they had a family doctor, but lack of insurance would not prevent them from seeing one.

The wait times argument is silly; those without health insurance have to wait forever

 

Press Republican, 9-15, 22, https://www.pressrepublican.com/editorial-health-care-struggling-in-u-s-canada/article_9ff51dc0-3374-11ed-96e8-0319932a5a1a.html, Editorial: Health care struggling in U.S., Canada

According to the Montreal Gazette of Aug. 20, The Fraser Institute, a conservative-libertarian think tank in Canada, recently released a report on wait times for Canadians trying to get health care. Its latest study found that, in 2021, Canadians waited 25.6 weeks — the longest ever recorded. That is up from 22.5 weeks in 2020. In 1993, when Fraser began tracking, the wait time was 9.3 weeks, so it is on a drastic and, from Americans’ perspective, an intolerable rise. In fact, many Americans would argue that 9.3 weeks is intolerable. Even taking into account that some of the longest waits are for “elective” surgeries, the patients waiting for those surgeries still suffer in their wait. By comparison, a 2016 report found that the average wait time for Americans to get in for a first-time appointment with a doctor was about 24 days. But, again, that’s when Americans can afford to make an appointment at all. An August 2022 PBS NewsHour report noted that about 26 million Americans have no health insurance. Those are Americans who, despite a troubling cough or body ache, choose not to see a doctor out of concern about the out-of-pocket cost. A 2018 NORC poll found about 40 percent of Americans reported choosing to skip a recommended medical test or treatment and 44 percent say they didn’t go to a doctor when they were sick or injured in the last year because of cost. And that’s even with the expanded coverage net offered through the Affordable Care Act. Many of us have heard the stories of friends or family members who find themselves in that unfortunate sweet spot of not making enough to afford a private insurance plan but making too much to qualify for insurance assistance. In both the US and Canada, people are calling for a change. A poll last year found that 62 percent of Canadians believe they should be able to spend their own money for whatever health care they want. And 67 percent favored using private and non-profit clinics to reduce surgical backlogs as a result of the pandemic.

 

Status quo health care rationing excludes the poor, single payer both frees up and creates resources needed to improve health care

 

Drew Angerer,  9-14, 22, https://truthout.org/articles/sanders-calls-state-of-us-health-care-an-international-embarrassment/, Sanders Calls State of US Health Care an “International Embarrassment”

Despite being the wealthiest country in history, he said, the U.S. still sees thousands of deaths and unnecessary suffering due to the country’s inequitable health care system. Meanwhile, the life expectancy of the rich is far longer than that of the average American, he pointed out – partly because health care costs are simply unaffordable to millions of Americans, who either have to take out medical debt or put off getting prescriptions filled or visiting a doctor because of the associated costs. “Sickness should not be a cause of financial ruin,” Sanders said. Even if people try to seek out health care, he added, it can be hard to find a provider, given the shortage of doctors, dental hygienists, nurses, and other critical health care workers. On the other hand, however, there are “more than enough people,” Sanders said, to send bills to people and hound them over money owed. According to Sanders, the reasons for these inefficiencies and inequities is explained by the greed of the health insurance and pharmaceutical companies; profits of Pfizer, Johnson and Johnson and AbbVie increased more than 90 percent last year to over $54 billion. “If you want to know why we are stuck with a dysfunctional health care system that fails the American people but that makes the drug companies and the insurance companies wildly profitable, follow the money,” he said, pointing out that the private health care sector has spent over $10 billion in lobbying since 1998, including over $1.7 billion on campaign contributions.

The biopharmaceutical industry is acquiring innovative biotech firms now, driving breakthroughs across the life sciences.

Alden F. Abbott 22, J.D. from Harvard Law, M.A. in Economics from Georgetown, served as the Federal Trade Commission’s General Counsel from 2018 to early 2021, where he represented the Commission in court and provided legal advice to its representatives, senior research fellow at the Mercatus Center and at the Law and Economics Center of Antonin Scalia Law School at George Mason University, “More government regulation of biopharma would harm patients and the economy”, https://thehill.com/opinion/healthcare/597333-more-government-regulation-of-biopharma-would-harm-patients-and-the

The United States leads the world in creating the new drugs and vaccines that cure or control diseases and improve the health of countless millions around the globe. The “warp speed” development and international distribution of effective COVID-19 vaccines, stemming from mRNA technologies developed and patented in the United States, is only the latest example. But new government meddling could ruin that success story.

American biopharmaceutical companies are also a boon to our economy. Biopharma innovation adds $1.1 trillion a year to the U.S. economy and creates over 4 million high-paying jobs.

This is no accident. It’s due to market-oriented government policies featuring strong patent rights and an absence of excessive regulation and price controls. Biopharma firms have fled other industrialized countries, such as Canada, due to such government restrictions.

Bringing forth successful new drugs is risky and costly, as explained in a 2021 Congressional Budget Office (CBO) study. Only about 12 percent of drugs entering U.S. clinical trials secure Food and Drug Administration (FDA) approval. Meanwhile, average research and development costs per new drug range from roughly $1 billion to $2 billion, according to the CBO. Drug companies must rely on profits from the small portion of successful drugs to cover their huge outlays. Strong patents are key to this strategy.

U.S. biopharma investments in innovation are enormous. The CBO states that in 2019, the industry spent $83 billion on research and development — roughly 10 times what it spent per year in the 1980s. This constitutes a rising share of net industry revenues. What’s more, the sector dedicates a higher proportion of revenues to R&D than other high-intensity R&D industries such as semiconductors and software.

This has borne fruit. Between 2010 and 2019, the number of new U.S. drugs approved for sale increased by 60 percent over the previous decade. Fifty-nine drugs were approved in 2018, a new high. No other country comes close to this.

Unfortunately, biopharma successes are threatened by recent Biden administration regulatory initiatives.

The biopharma industry is rocking and rolling—COVID created momentum, but it’ll be sustained beyond the pandemic

Andrew Bogue 22, senior marketing coordinator @ Medix, “Venture Capital Investment in Life Sciences Drives Growth, Race for Biopharma Talent”, https://www.medixteam.com/venture-capital-investment-in-life-sciences-drives-growth-race-for-biopharma-talent/

Venture capital (VC) investment in life sciences is at an all-time high. In the face of the COVID-19 pandemic, the biopharma industry attracted new interest after a series of highly visible accomplishments. Breakthroughs in vaccines certainly gave investors a glimpse into what was possible, but the plans for the future go well beyond the current pandemic. Health and wellness has taken center stage in an uncertain economy. Now, VC investors are supercharging growth in markets across the United States.

As operations expand, spurred by unprecedented levels of funding, will a tightening and overworked life sciences workforce be able to keep pace with red hot demand? Here’s what the employment landscape looks like so far.

Big Investments Continue Rapid Growth

When it comes to dollars and cents, the future looks bright for the life sciences industry on the whole. To put it plainly, 2021 was a record setting year. Funding for life sciences saw a 35.5 percent gain, with VC deal activity shattering expectations to the tune of $36.3 billion injected into the industry by end of year. Major venture markets, such as the Bay Area, New York, Boston and Los Angeles, continued to lead the pack. However, experts are also predicting growth in additional markets, including Denver, Austin, Washington D.C., Chicago, Philadelphia, Seattle and Boston. In fact, CBRE research indicates that life sciences companies looked to acquire a collective 23.8 million sq. ft. of new lab space in 12 top markets in 2021—a staggering investment that left the construction industry scrambling to keep pace.

Meanwhile, all of this investment has led to production. According to the U.S. Food & Drug Administration, 50 new drugs were approved in 2021 alone. These breakthroughs target diseases and conditions ranging from treatments for diabetes, Alzheimer’s disease and multiple types of cancer.

 

Both innovation and sales are high.

Igor Kruglyak 22, Sr Advisor to the CEO at Avenga, “Pharma will innovate and prosper further: Top 10 pharmaceutical industry trends in 2022”, https://www.avenga.com/magazine/pharmaceutical-industry-trends/

Current business dynamics indicate that innovation will continue to drive growth in the 2022 pharma market. One of the leading players in the industry, Johnson &  Johnson, has reported sales of $23.3bn in the third quarter of 2021, a rise of 10.7% compared to $21.08bn in the same quarter in 2020. Not solely Johnson & Johnson, but the entire industry will grow, based on projected pharmaceutical sales. While the global pharmaceutical manufacturing market has reached $402 billion in 2020, the US and European markets alone will be worth $635 and $315 billion in sales by 2024, respectively. Yet, how is the industry going to move toward 2024’s sales marker in 2022? Trends in the pharmaceutical industry and the pharma companies’ desire to follow them answer this question. Today, we will talk about the ten key pharma trends to embrace in 2022.

Pharma’s 2022 in a nutshell

The industry is in the midst of a fundamental transformation, as the scale of operations is growing. The year 2022 will have pharma companies oriented to staying agile and resilient in regards to disruption bred by the fluctuating market demands and diverse customer needs. A Deloitte’s report states that the majority of pharmaceutical companies recognize evolving customers’ behaviors and attitudes as the most significant factors of transformation. Indeed, today’s pharma clientele require revolutionary pharmaceutical solutions that will render drug development, discovery, prescription, and usage easier and more convenient.

 

Only cites short-term trend—long-term projections say the industry will grow steadily through 2028

*CAGR = compound annual growth rate

Fortune Business Insights 22—nonpartisan market research & analysis firm, “U.S. Pharmacy Market Size, Share & COVID-19 Impact Analysis…”, https://www.fortunebusinessinsights.com/u-s-pharmacy-market-106306

The U.S. pharmacy market size was USD 534.21 billion in 2020. The market is projected to grow from USD 560.00 billion in 2021 to USD 861.67 billion by 2028 at a CAGR of 6.3% in the 2021-2028 period. The impact of COVID-19 has been unprecedented and staggering, with pharmacy witnessing a positive impact on demand across the U.S. amid the pandemic. Based on our analysis, the market exhibited a stellar growth of 5.8% in 2020 as compared to the average year-on-year growth during 2017-2020. The fall in CAGR is attributable to this market’s demand and growth, returning to pre-pandemic levels once the pandemic is over.

Increasing prevalence of diseases in the U.S., aging population, and increasing healthcare expenditures are some of the major factors driving the growth of the pharmaceuticals market in the country. The increasing number of prescription drugs being introduced in the market, along with rising number of outpatient and inpatient admissions in the country is leading to increasing number of prescriptions being filled by retail pharmacies in the country. This rapid growth in number of prescriptions is leading to rise in number of pharmacies in the country for distribution of these drugs.

 

The emergency  room safety net fails

 

BY JOHN P. GEYMANF, 9-2, 22,

The long-standing, loosely-woven patchwork of federal, state and local programs in the U. S. includes the emergency rooms and urgent care clinics of public hospitals, community health centers, and local health departments. Their goal is to serve a long list of vulnerable populations —uninsured and underinsured, chronically ill individuals, people with disabilities, mentally ill individuals, people with communicable diseases, legal and undocumented immigrants, minorities, native Americans, the homeless, substance abusers, and prisoners.1 Medicaid is the principal funding source for safety net care, but varies greatly from one state to another and is often inadequate to the needs.

This paper has three goals: (1) to give examples of how frayed the safety net is today; (2) to summarize the major barriers to establishing a solid and reliable safety net; and (3) to briefly describe what we have learned from attempted policy fixes in past years and what could be done today.

How Frayed Our Safety Net Is Today

Our completely unacceptable safety net, without any real improvement over many years, is the Achilles heel of an out-of-control health care system that leaves the word “care” out of its goals as it profiteers on the backs of patients, families, and even taxpayers as well. Dr. Jack Geiger, founding member and past president of Physicians for Human Rights and pioneer developer of community health centers, issued this challenge 20 years ago:

What we deal with in our work, quite apart from the extremes of genocide, is a variant of that: “Lives less worthy of life.” When we say that the poor have a mortality rate that is multiple times the rate of the rich, when we say that poor children die in our country and in the developing world at rates far higher than those who are better off, we are saying that we permit a condition which in effect says that they are less worthy of life. We are sending this message because we let it happen, because we have social politics that almost assure that it will happen, and we let it happen stubbornly and continually.1

Being “insured” is not a useful metric for tracking the value of the safety net, as shown by these markers of having no safety net while being insured:

+ Even after passage of the ACA in 2010, insurers still discriminate against insured patients by benefit designs that limit access, have high cost-sharing, restrictive drug formularies, and ever-changing networks of physicians and hospitals. They also market inadequate gap insurance that require copays for treatment of such conditions as cancer, heart disease and stroke,2 as well as very profitable short-term plans with very limited coverage up to 1 year that have come to be known as “junk insurance.”3

+ Denial of claims, even including emergency air transport through lengthy pre-authorization processes; 18 percent of claims denied in privatized Medicare plans.4

+ Women’s health care coverage is often limited in both private and Medicaid plans; as a result, women frequently skip essential care, a major factor in the U. S. having the highest maternal mortality rate among high-income countries (#46 in the world)5

+ As a result of increasing cost of premiums, four in ten people with employer-sponsored health insurance do not have enough savings to cover the deductibles.6

+ An Inspector General’s 2014 survey of 1,800 physicians listed on Medicaid managed care rosters found that a majority were unavailable for appointments.7

+ We have a chronically underfunded, limited access system for mental health care, with many mentally ill ending up in jail, where they receive little if any care.

+ Periodic cross-national studies by the Commonwealth Fund of 11 advanced countries consistently find the U. S. last for access, equity and quality of care.8

+ Even when insured, many enrollees receive high surprise medical bills that drag them into poverty that often leads them into medical bankruptcy.9

+ Private insurers often leave unprofitable markets with little advance notice, as  they did at the end of 2016, when they left 1.4 million people in 32 states with fewer choices than before.10

+ Health insurers’ modus operandi is well summarized this way by Gerald Friedman, Ph.D., Professor of Economics at the University of Massachusetts Amherst and author of The Case for Medicare for All:

Health insurers profit by screening customers, segmenting the market so as to exclude those likely to use health care (“lemon dropping”) while attracting the healthy and lucky who use less health care (“cherry picking”). While profitable, such activities add to the cost of America’s bloated health care administration, raising a question that we should ask of all health insurers: how many patients did your company help today? 1

Chronic Barriers to Reform

These are some of the major barriers to achieving a national system of universal coverage with an intact safety net:

Leaving the issue of salvaging a safety net to the states.

Many states give Medicaid low funding priority while a growing number of Republican voters in southern states even favor secession over compromising with a Democratic administration.12 In these present polarized political times, states are diverging sharply on such issues as abortion and women’s reproductive rights, making any unified policy to build a national safety net beyond possibility.

Solid opposition from big business, corporate America, Wall Street stakeholders, and Chamber of Commerce with deep pockets and strong lobbying against reform.

As one example, leading insurance, hospital and pharmaceutical lobbyists have formed the America’s Health Care Future to defeat single payer Medicare for All through heavy lobbying and a targeted disinformation campaign.13Another example: A GOP outside group aligned with Senate Majority Leader Mitch McConnell (R-KY) launched a multi-million-dollar ad campaign against Medicare for All targeting legislators in both parties. With campaign contributions they spread doubts about Medicare for All; the chair of the Democratic Congressional Campaign Committee later said that its costs would be “scary.”14

With its profit-based business model, corporatization, profiteering, and private equity, the corporate controlled health care marketplace, as one-sixth of the nation’s GDP, is doing just fine without reform.

Its momentum to continue its grip on U. S. health care is illustrated by Amazon’s current plan to buy 1Life Healthcare, Inc, which operates a giant primary care practice with more than 180 medical offices in 25 U. S. markets.15

Lack of a public groundswell to reject the Citizens United decision while billionaires control election spending, which portends continuance of conservative barriers to reform in Congress.16

Lack of national commitment, public outrage, and collective moral responsibility to push to alleviate safety net losses by adopting a system of universal coverage.

Larry Churchill, Ph.D., and ethicist at the University of Notre Dame, brings us this perspective in his 1987 book, Rationing Health Care in America: Perceptions and Principles of Justice, as to the significance of what has happened for many years to the less fortunate among us confronted with their own health care:

A health system which neglects the poor and disenfranchised impoverishes the social order of which we are constituted. In a real (and not just hortatory) sense, a health care system is no better than the least well-served of its members.17

Lessons from Failed Policies and What Can Be Done Now?

We could well have learned as far back as 1944 that health insurance must be compulsory in order to eliminate segmentation of risk pools. As Dr. Henry Sigerist, then Director of the History of Medicine at the Johns Hopkins University said at the time:

 

Illness is an unpredictable risk for the individual family, but we know fairly accurately how much illness a large group of people will have, how much medical care they will require, and how many days they will have to spend in hospitals. In other  words, we cannot budget the cost of illness for the individual family but we can budget it for the nation. The principle must be to spread the risk among as many people as possible . . . The experience of the last 15 years in the United States [since 1931] has, in my opinion, demonstrated that voluntary health insurance does not solve the problem of the nation. It reaches only certain groups and is always at the mercy of economic fluctuations . . . Hence, if we decide to finance medical services through insurance, the insurance system must be compulsory.18

 

Our public-private non-system of financing U. S. health care has become big business with the primary goal to make as much money as possible for CEOs and shareholders on the backs of patients and families. Corporate stakeholders and their well-funded lobbyists travel through the revolving door between industry, government and K Street to further their self-interest with little regard for the public interest.

 

Corporate stakeholders in the current non-system, with its widespread disparities and inequities, have been spreading disinformation to convince legislators and policymakers that a system of national health insurance would break the bank and be “socialism.”

 

As noted previously, the Institute of Medicine’s study of 20 years ago concluded that system changes then posed an increasing threat to the safety net. Unfortunately, these current and imminent changes today pose an even greater threat to the future of our safety net:

 

+ Increasing emphasis on states’ rights with wide polarization between major political  parties.

 

+ Widening gulf between red and blue states with increasing sentiment for secession among voters in some southern states.

 

+ Rampant gerrymandering in some states with the electoral map in many states up for grabs in the 2022 midterms.

 

+ The U. S. Senate blocking progressive bills passed in the House whether by the 50-50 Senate membership by party or by the use of the filibuster.

 

Still missing in the public debate over U. S. health care is a sense of public outrage and collective moral responsibility to overcome corporate and political opposition to a system of universal coverage that could prevent so many millions of Americans from falling through a porous safety net.

 

Reform Alternatives under Current Consideration

 

With health care a front-burner issue as we head into the 2022 and 2024 election cycles, these four reform alternatives are up for debate:

 

1. Building on the Affordable Care Act of 2010;

 

2. Medicare for Some: lowering the age of eligibility for Medicare from 65 to 60, together with a public option for sale alongside private plans on the ACA’s exchanges;

 

3. Privatized Medicare Advantage for All; and

 

4. Single-payer Medicare for All

 

The first three of these options would leave in place a deregulated, for-profit, multi-payer financing system with all of its profiteering, wasteful bureaucracy, inequities, and unreliability. Since the 1990s, mergers and consolidation within the private health insurance industry have left the largest (in numeric order: United Health Group, Anthem, Aetna and Cigna) with a collective market share of 48%.19 That level of consolidation has brought more cost-sharing with higher deductibles, reduced access and utilization of care.20 Privatization of public programs has been especially profitable for insurers; as one example, most of United Health’s reported profits in 2021 came from its Medicare Advantage plans and state Medicaid plans without growth in their numbers of enrollees.21

 

The fourth alternative is the only one that can rein in health care costs, improve access and quality of care, and effectively build a solid safety net. (Tables 1 and 2)22

 

 

Medicare for All would usher in a new system of national health insurance for all Americans with comprehensive benefits based on medical need, not ability to pay. Its administrative overhead would drop to about 3 percent, about one-sixth of private insurers’ multi-payer overhead, without cost sharing at the point of service and with mechanisms to rein in profiteering. Had it been in place in 2019, it is estimated that we would have saved more than $1 trillion for the reasons shown in Figure 1.23

 

 

 

Conclusion.

 

Can we ever achieve a safety net that works for all Americans? Based on history, the odds are against it, but it should be possible for the wealthiest nation in the world that brags, incorrectly, that it has the best health care on the planet. Shifting from today’s business model to one of service can also help to re-establish traditional ethical norms of the health care professions. Perhaps we can learn from the history of our missteps over the last 110 years to find the necessary path forward. To that end, we can take hope from these words by Winston Churchill: “Americans will always do the right thing—after they exhaust all the alternatives.”

Single payer saves billions in health care costs without removing private sector incentives; it’s not government run

 

Common Dreams, 8-26, 22, Milwukee Independent, THE CURE: WHY UNIVERSAL HEALTHCARE WOULD ENABLE A HEALTHIER POPULATION TO WITHSTAND THE NEXT PANDEMIC, https://www.milwaukeeindependent.com/syndicated/cure-universal-healthcare-enable-healthier-population-withstand-next-pandemic/

More than 330,000 people in the United States died during the pandemic because they were uninsured or underinsured. That grim statistic was reported recently by researchers at the Yale School of Public Health. In addition to that staggering, preventable death toll, in 2020 alone, our “fragmented and inefficient healthcare system,” cost the U.S. $459 billion more than if we had genuine, universal healthcare. The Yale team prescription to prepare for the next pandemic: Medicare for All. “Our current healthcare system is dysfunctional. It is extraordinarily wasteful and expensive, and it is cruel,” Vermont Independent Senator Bernie Sanders said as he opened a Senate Budget Committee hearing on Medicare for All last month. “The American people understand as I do, that healthcare is a human right and not a privilege, and that we must end the international embarrassment of our great country being the only major nation on earth that does not guarantee health care as a human right to all of its people,” Sanders continued. “Over 70 million Americans today are either uninsured or underinsured… there are millions of people in our country who would like to go to a doctor, who have to go to the doctor, but cannot afford to do so. This is unacceptable, this is un-American, and this cannot be allowed to happen in the wealthiest country on earth.” Sanders has introduced S.4204, the Medicare for All Act of 2022, with fourteen Democratic Senators as co-sponsors. Similar legislation is also before the House of Representatives. Medicare for All would lower the eligibility age for the federal Medicare health insurance program from 65 to the time of birth. Opponents of Medicare for All disparage it as “government-run” healthcare. This criticism is wrong. In the United Kingdom, for example, the NHS, the National Health Service, is government-run. The government owns all the hospitals and clinics, and the doctors, nurses and other staff are government employees. In the U.S., the Veterans Administration and the Indian Health Service are government-run, just like the NHS. With Medicare for All, the government simply pays the bills as the “single payer,” saving enormous amounts of money by removing the health insurance corporations from the equation. The hospitals, medical offices and laboratories all remain unchanged, primarily as private or non-profit institutions, exactly as they are today. This is how our current Medicare system works for those over 65 years old. Medicare for All wouldn’t change that; it merely expands the population covered to everyone. Medicare for All would dismantle the bloated, private insurance bureaucracy, saving hundreds of billions of dollars annually. At the Budget hearing, Committee Chair Sanders summarized, “The six largest health insurance companies in America last year made over $60 billion in profit, led by United Health Group which made $24 billion in the midst of the pandemic in 2021. But it’s not just the profits of the insurance companies…The CEOs of 178 major healthcare companies collectively made $3.2 billion in total compensation in 2020, up 31% from 2019. According to Axios, in 2020, the CEO of Cigna, David Cordani, took home $79 million in compensation while people died.” An analysis produced by the Political Economy Research Institute, PERI, at UMass Amherst, includes a “just transition” for the close to 900,000 people employed by the health insurance industry. Savings provided by a single-payer system could pay for a combination of early retirement and retraining, lessening the impact on those workers. Single-payer, or Medicare for All, makes sense in normal times, but we are not in normal times. The global COVID-19 pandemic has ripped the scabs off of so many sectors of our society, exposing and exacerbating inequities and a lethal lack of preparation. The Yale study puts real numbers to it, noting the disproportionate impact on poor and low-income communities and on people of color. Universal healthcare would lead to a healthier population, more capable of withstanding the impacts of the next pandemic. Regular, preventive doctor visits, the comfort and security of knowing that a needed procedure or hospital visit won’t lead to bankruptcy or add to personal debt, all contribute to a broader resilience. Citing a Gallup poll, the Yale researchers write, “due to apprehension about their ability to pay, 14% of US adults reported that even if they experienced the two most common symptoms of COVID-19, fever and dry cough, they would still avoid seeking care.” Another lesson of the pandemic is that when any of us is exposed, all of us are. Universal, effective and affordable healthcare makes us all stronger and safer. The simplest way to achieve that is Medicare for All.

 

The current health care system kills, rations inequitably, and threatens the economy. Presumption favors change

Dr. Edward T. Chory, 8-21, 22, It’s long past time to reform the US health care system, https://lancasteronline.com/opinion/columnists/it-s-long-past-time-to-reform-the-us-health-care-system-column/article_bb4807b2-1fd4-11ed-8890-6b9f8700df5e.html

As I retired in January 2020 after a 40-year surgical career, the American College of Physicians published a supplement to its journal, Annals of Internal Medicine, endorsing health care reform — a single-payer system. These quotes made the case quite clearly and urgently: — “The U.S. health care system is gravely ill, and the symptoms are many: Costs are too high, many people lack affordable coverage, incentives for hospitals and physicians are misaligned with patients’ interests, primary care and public health are undervalued, too much is spent on administration at the expense of patient care and vulnerable individuals face daunting barriers to care. Health care expenses are the leading cause of private citizen bankruptcies in the United States.” — “The (American College of Physicians) rejects the view that the status quo is acceptable, or that it is too politically difficult to achieve needed change. Dr. Atul Gawande wrote, ‘Better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try.’ By articulating a new vision for health care, the (American College of Physicians) is showing a willingness to try to achieve a better U.S. health care system for all. We urge others to join us.” The buildup to the 2020 election was just getting started and U.S. Sen. Bernie Sanders was beating the drum of “Medicare for All” and making waves. I attended a University of Pennsylvania Leonard Davis Institute of Health Economics conference in February of that year to stoke my passion for reform, only to hear the keynote speaker declare that “Medicare for All” was not politically feasible. That speaker was Paul Starr, a Princeton University sociology and public affairs professor who won the 1984 Pulitzer Prize for nonfiction for his magnum opus, “The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry.” I was crushed. If ever the time seemed right, it was 2020. The pandemic At that same time, a novel coronavirus was beginning to emerge that seemed certain to change everything. But has it? Here we are, two and a half years into a pandemic that has left more than 1 million Americans dead and has exposed the shortcomings of our American health care “system.” Those shortcomings are worse than described by the reformers who pushed for “Medicare for All.” In June, the peer-reviewed journal of the National Academy of Sciences of the United States of America published a study that found that a single-payer universal health care system “would have saved 212,000 lives in 2020 alone” and more than 338,000 lives over the course of the pandemic so far. That study also found that $105.6 billion of medical expenses “associated with COVID-19 hospitalization could have been averted by a single-payer universal health care system over the course of the pandemic.” The outlay of health care expenditures and the lives lost because of inadequate health insurance make the need for reform obvious. “Health care reform is long overdue in the U.S.,” said Alison Galvani, director of the Center for Infectious Disease Modeling and Analysis at the Yale School of Public Health, and that study’s lead author. “Americans are needlessly losing lives and money.” Wasteful and unjust system Among reformers there is disagreement about whether incremental change and expansion of the changes begun with the Affordable Care Act (also known as “Obamacare”) or “Medicare for All” is the best way to address our dysfunctional health care system. Margot Sanger-Katz’s analogy in her New York Times column in September 2019 was a perfect way to describe this choice. Our health care system is an old house. Is it a fixer-upper or should we tear it down and rebuild? Yes, tearing down and rebuilding this gargantuan component of our economy will be resisted by the owners of the goose that lays the golden eggs, but the longer we wait to reform our health care system, the higher the price we will pay eventually to slay the beast. Business magnate Warren Buffett famously described our profit-driven system as a “tapeworm” that saps the competitiveness and efficiency of our economy, as well as the health of every American. Our system is wasteful and unjust. Priorities have been forgotten and profits seem to be deemed more important than patient care. The irony of calling for government-run health care in the face of our government’s long history of inefficient bureaucracy is not lost on me, but the administrative bloat and waste in our current way of providing care is — yes, hard to believe — worse. It’s undeniable that in our current system, too few resources are being used to address the social determinants of disease, where real improved outcomes in quality of life and life expectancy lie. But it is also important to acknowledge that countries that have single-payer health care systems are dealing with increased costs and the dreaded R-word: rationing. Along with the reform of health care financing, we must change how we practice medicine. We — both patients and providers — must change our culture. We have become addicted to high-tech illness intervention. We need to emphasize low-tech primary care, prevention, education and personal responsibility and undertake serious work altering the social determinants of disease such as poverty and racism. We must be willing to consider options other than “Medicare for All,” such as an American version of Germany’s system, in which health insurance is mandatory and health care is provided by statute to people who cannot afford it, but people may buy private health insurance if they wish. First, we must face the fact that our current system of providing health care is too expensive, inequitable and not providing the care we all need and deserve. We can do so much better. As American surgeon Atul Gawande said, this will take “moral clarity,” “ingenuity” and a “willingness to try.”

 

Single Payer cost control measures mean critical drugs do not make it to market

 

Cornell Chronicle, 8-18, 22, Are Costly New Prescription Drugs Worth the Price?, https://news.cornell.edu/stories/2022/08/are-costly-new-prescription-drugs-worth-price

As more and more prescription drugs hit the market with eye-popping price tags, it can be difficult to know whether they’re worth it. Some countries use a relatively straightforward cost-effectiveness analysis to decide. The United Kingdom’s National Institute for Health and Care Excellence, for instance, covers medications based on a single threshold of £20,000-£30,000 per quality-adjusted life year (QALY) gained. Such cost-effectiveness analysis helps countries with single-payer health care to control costs. It has been suggested as a way for Medicare and other U.S. insurers to do the same. But using a single threshold to decide whether a particular medication is cost-effective assumes that all patients value what a medication offers in the same way. As a result, this one-size-fits-all approach can broadly paint costly drugs as not worth the price and prevent new drugs from entering the market, creating a barrier to treatment for patients who would value costlier care. These are the findings of a study published in the July 2022 edition of the Journal of Health Economics. Claudio Lucarelli, associate professor of Health Care Management at University of Pennsylvania’s Wharton School and Leonard Davis Institute Senior Fellow, is the study’s the lead author. Co-authors include Sean Nicholson, director of the Sloan Program in Health Administration in the Cornell Jeb E. Brooks School of Public Policy, and Nicholas Tilipman of the University of Illinois/Chicago. Nicholson is also a member of the faculty in the Department of Economics. The researchers suggest that a better approach than relying on a single threshold would be to also consider the preferences of different patient subpopulations when assessing value. They developed a series of quality-adjusted price indices that accounted for preferences among patients and their prescribing physicians. They focused on colorectal cancer—a disease for which the 6-month cost of medications jumped from $127 in 1993 to $36,300 in 2005. They assessed the value of the different drug regimens using a model that accounts for various outcome measures, the convenience of administration, patient tolerance for side effects, and willingness to accept greater toxicity for greater efficacy. Using this approach that accounts for differences in patient preferences, here’s what they found: While efficacy gains from newer drugs did not justify their high prices for the population on average, they were justified for sicker, late-stage cancer patients. According to the model, if high-cost drugs were restricted based on an average cost-effectiveness analysis, then the sickest patients would experience a welfare loss. “A uniform rule preventing patients with advanced cancer from receiving newer treatments could make their illness even less tolerable because they have no choice but to use a medication that is less effective or comes with more side effects,” Nicholson said. Assessing value is complicated, and few studies have examined whether the value of pharmaceuticals is rising or falling once their attributes and consumers’ valuations of those attributes are considered. With this study, the authors show how it can be done. They propose that health insurance needs to find ways to “allow for differences in value to express themselves in the market”—such as patients with advanced cancer placing greater value on hope and being willing to pay more for drugs that offer the possibility of longer survival. Suggested options include (1) insurers offering a variety of plans with varying premiums that accommodate differences in preferences and (2) allowing patients to internalize treatment costs at the margin by using “top-up” insurance, in which patients pay the incremental cost relative to a fully covered baseline treatment. These suggestions, along with the novel model described in the paper, provide new perspectives for how to value new—and often—expensive prescription drugs.

 

Health care spending increasing, consumers and employers bearing the brunt of the increase

 

Todd Shyrock, 8-15, 22, Health care spending continues decades long rise, https://www.medicaleconomics.com/view/health-care-spending-continues-decades-long-riseA

Almost a third of spending is on insurance premiums and out-of-pocket payments In 2020, health care spending accounted for 19.7% of the nation’s gross domestic product, up from 5% in 1960, according to a report from the Employee Benefits Research Institute. A total of $4.1 trillion was spent on health care in 2020, or $12,530 per person. In 2030, health care spending is projected to account for 19.6% of GDP, a total of $6.8 trillion. A large percentage (31.2%) of total health care spending in 2020 was on health insurance premiums and out-of-pocket costs for employers and individuals. According to the report, employers paid $521.3 billion toward premiums, while workers paid $366 billion. Another $388.6 billion was spent on out-of-pocket costs. The remaining 68.8% of health care spending breaks down as follows: Medicare 20.1%, Medicaid 16.3%, other health insurance programs 3.8%, other third-party payers and programs 17.8%, investment 4.7%, government contributions and subsidies 6.4%. EBRI says that larger employers are much more likely than smaller employers to offer health benefits to workers. Nearly all private-sector employers with 1,000 or more employees offered health benefits in 2021. Similarly, 97.5% of those with 100–999 employees did so as well. Those with lower headcounts were less likely to offer health benefits: 77.9% of employers with 25–99 employees, 52.4% of employers with 10–24 employees, and 24.6% of employers with fewer than 10 employees offered health benefits. According to the report, the share of adults and children with employment-sponsored health insurance fell since 2019. Overall, 70.8% of workers had employment-based health benefits in 2020 either through their own job or through a family member’s job. Only 36.6% of non-working adults had employment-based health benefits. Over one-half (53.9%) of children were covered by employment-based health benefits. Premiums for health insurance have continued to trend upward since at least 1996. In 2021, average annual premiums for employee-only coverage were $7,380. They were $21,381 for family coverage. Despite rising premiums, for the last decade, the percentage of total health insurance premiums paid by workers has been relatively flat. On average, workers paid 22.3% of the premium for employee-only coverage and 28.9% of the premium for family coverage in 2021, according to EBRI data. The report reveals that almost everyone is paying for health coverage. In 2021, only 7.3% of workers were not required to contribute to employee-only coverage, and only 12.6% were not required to contribute to family coverage. In contrast, in 1996, 37.1% of workers were not required to contribute to employee-only coverage, and 19.3% were not required to contribute to family coverage. The types of plans vary, but Preferred provider organizations are the most common type of health plan, covering 46% of workers in 2021. High-deductible health plans covered 28% of workers, health maintenance organizations covered 16%, and point-of-service plans covered 9%. Another trend the report studied was how the percentage of private-sector employees enrolled in a health insurance plan with a deductible has been steadily rising over time. While only 47.6% of employees had a deductible in 2002, 88.5% did in 2021. Among individuals with a deductible, the average deductible increased from $446 to $2,004 from 2002 to 2021 among those with employee-only coverage. And it increased from $958 to $3,868 among those with family coverage. The average copayment for an office visit has remained constant at $27 from 2016–2021. Coinsurance rates for office visits increased modestly, from 20% in 2019 to 20.8% in 2021.

There aren’t enough people to save rural hospitals and Medicaid’s payment rates aren’t high enough

Kyle Wingfield, 8-15, 22, Expanding Medicaid doesn’t solve the problem, https://thebrunswicknews.com/opinion/editorial_columns/expanding-medicaid-doesnt-solve-the-problem/article_58c39ef7-6da9-582e-978a-8dbb20cbe6db.html

Rural hospitals struggle for two basic reasons. One is having too few people nearby: A rule of thumb is that you need a population of at least 40,000 to sustain a local hospital, and 110 of Georgia’s 159 counties don’t meet that threshold. That includes more than 50 counties with hospitals.

The other is their “payer mix.” Having uninsured patients who could be on Medicaid is less of a problem than having too few privately insured patients. Private insurance pays more than the cost of services, offsetting losses from other patients. If a hospital has too few privately insured patients, Medicaid expansion isn’t going to save it.

 

Health care doesn’t save lives

 

Pipes, 8-13, 22, Sally C. Pipes is president, CEO, and the Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute. Her latest book is “False Premise, False Promise: The Disastrous Reality of Medicare for All” (Encounter Books 2020)., Medicare for All Wouldn’t Have Saved Us From COVID, https://townhall.com/columnists/sallycpipes/2022/08/13/medicare-for-all-wouldnt-have-saved-us-from-covid-n2611680

Could Medicare for All have averted more than 330,000 deaths over the course of the COVID-19 pandemic? That’s the claim of a new study published by 10 researchers from four different universities in Proceedings of the National Academy of Sciences.

To arrive at their figures, the authors compared the mortality risks of COVID and other causes of death among the insured and uninsured. Since the uninsured receive less medical care and are more likely to have preexisting conditions like diabetes, the researchers concluded that fewer lives would have been lost if there had been universal health care throughout the pandemic.   It may seem intuitive that having health insurance should result in better health. But that premise is faulty. Studies based on real-world data indicate that the link between insurance and good health is weak. Consider the Oregon Health Insurance Experiment. In 2008, the state expanded Medicaid by lottery, creating the conditions for a natural experiment to determine what kind of impact insurance coverage had on a person’s health.  Researchers compared health outcomes for people who received Medicaid and similarly situated individuals who remained uninsured. They found that “Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years.”   Similarly, when researchers examined the impact of Obamacare for the National Bureau of Economic Research in 2017, they discovered that there were sizeable improvements in access to care not just in the states that expanded Medicaid under the terms of the law but also in those that did not. In the end, they saw “[n]o statistically significant effects on risky behaviors or self-assessed health” despite the expansion of coverage.

Though the government can give people health coverage, it has not found a way to guarantee them access to high-quality medical care. Nine in ten healthcare providers take private insurance, but only 85% accept Medicare and 71% take Medicaid, according to a recent report from the Medicaid and Children’s Health Insurance Program Payment and Access Commission.

In other words, just because a person has health insurance doesn’t mean a doctor will see them.

Moving to a single-payer, Medicare-for-all type system might seem to address this problem. After all, if everyone had the same insurance, then doctors couldn’t discriminate as they do now.

But single-payer systems are notorious for paying providers less than they could command in an open market. Doctors tend to respond to this underpayment by limiting the supply of care they’re willing to provide at the government-dictated price.

Others quit the practice of medicine entirely and pursue different careers. Over time, promising students avoid medical school, preferring fields that are not controlled by the government. The result is a shortage of physicians, especially specialists.

A 2020 report from the Congressional Budget Office concluded that single-payer leads to “congestion” and “delays and foregone care.”

That’s exactly what happens in single-payer systems in Canada and the United Kingdom.

The median wait time to receive treatment from a specialist in Canada following referral by a general practitioner is roughly six months. The median wait for an MRI up north is more than 10 weeks.

It Seems Like the Justice Department Forgot to Read This Key Memo Before Ransacking Mar-a-Lago

As of May, more than 6.6 million people in England were waiting for treatment from the National Health Service. In June, more than 22,000 people waited more than 12 hours to be admitted to the hospital after an emergency department decided to admit them. Less than two-thirds of cancer patients receive their first treatment within two months of an urgent referral from their doctor.

These long delays have a dire impact. Last month, British residents were shocked by the story of a 19-year-old girl who died of cancer after waiting over a year to see her doctor.

Government guarantees of insurance coverage amount to little more than tickets to a waiting list and rationed care. All too often, those waits or outright denials are deadly.

COVID-19 and Monkeypox prove a decentralized health care system won’t stop disease outbreaks, single payer more likely to solve

Miranda Dixon-Luinenburg  Aug 14, 2022, hy monkeypox is a repeat of the data mistakes made with Covid-19, https://www.vox.com/future-perfect/2022/8/14/23302054/monkeypox-data-health-care-covid-collection

The US declared monkeypox a public health emergency this month, but the decision may have come too late. Though states are now required to report cases, and commercial labs have an approved test, a testing bottleneck persists, and cases — which passed 10,000 confirmed cases this week — are likely still being underreported. Any effective public health response to an infectious disease is dependent on having accurate data. If the virus spreads to other populations, such as college dorms — where cases have already been reported — the testing bottleneck could ultimately make it impossible to contain the spread. Reliable demographic information is key to making the right choices for allocating limited tests and vaccines. All of this feels like an uncanny echo of the early mishandling of Covid-19. Limited access to testing, a hobbled federal infrastructure to track cases, and the general lack of communication among different agencies and states complicated the federal government’s ability to make evidence-based public health decisions. Reporting lags on rising cases meant that lockdowns began too late to save tens of thousands of lives. Similarly, certain communities uniquely at risk, like Black and Hispanic people who lacked access to health care, were suffering higher rates of severe illness and death from Covid before policymakers had any way of knowing where to direct public health outreach. But the roots of this deadly problem long predate monkeypox outbreaks or the Covid-19 pandemic. The US has always had a fragmented health care system, with widely disparate experiences for patients based on state, insurance company, or hospital chain. Without systems to reliably record and share population-level data between decision-makers, health care workers can’t focus on helping the patients who need it most. The consequences are worse for marginalized people — such as Indigenous people, people with disabilities, or youth at risk for teen pregnancy — who were already facing inadequate care before the pandemic. It doesn’t have to be this way. The US has an opportunity to learn from the tough lessons of the last few years and build on work to improve transparency and data sharing. With monkeypox already a global public health emergency, it’s vital for the data to be available, promptly and accurately, to coordinate an effective public health response. This is how we can get there. Why does data matter? Evidence-based medicine — the practice of using observation, studies, and randomized controlled trials to test which treatments work — has transformed the medical field over the last century. But for that to work, as Covid showed, you need to have data to inform medical decisions. The US has mandatory reporting systems for some contagious diseases, along with public health concerns like lead poisoning. This usually means that hospitals, clinics, and laboratories are required to report the location, severity of the illness, and treatment provided for any confirmed case. They also must document demographic information, such as race and ethnicity. But that reporting is hobbled by the fact that there is no single agency responsible for the US health care system. Data is collected by federal agencies such as the Department of Health and Human Services — which houses the CDC, the Food and Drug Administration, and the Indian Health Service — as well as the Federal Emergency Management Agency (FEMA), which focuses on supplies and infrastructure for disaster preparedness. But communication among these agencies, the state health departments that report to them, and the hospitals and organizations where data is collected is often challenging, thanks to a fractured system made up of hundreds of different organizations. Data comes in from over 900 health systems, or chains of hospitals under shared management; the largest include about 200 hospitals. But that’s just a fraction of the over 6,000 hospitals across the country. So when, for example, positive test results for Covid-19 or monkeypox, or cases of workplace exposure to pesticides, have to be reported to the state, public health boards in every state must coordinate with hundreds of different organizations and aggregate their data before they can share it with federal agencies. Except during an officially declared public health emergency — which, for monkeypox, is only a week old — the CDC has limited legal power to mandate reporting. Data also isn’t collected the same way everywhere. There is a large number of different electronic health record systems currently in use in the US. They allow medical professionals to document a patient’s diagnosis and treatment, and in theory, share them more efficiently than in the days of paper-based records. But the software systems aren’t designed to be compatible with each other, so they cannot easily exchange data. Even for a popular software platform like Epic, which covers about a third of hospital systems in the US, categories like a patient’s diagnosis — or even something as simple as their height or weight — are often customized for a particular hospital or chain. This makes for a more efficient workflow for the medical professionals on the ground, but it means that every hospital or chain is collecting slightly different information and organizing it differently. In order to piece the information together into a national picture that policymakers can actually use, each individual dataset has to be mapped onto a standardized format, a massive administrative burden that adds to delays. For example, when I worked as a nurse in Canada, different hospitals in the same city used different recordkeeping software. Rather than digitally transferring data, other hospitals would fax a paper copy of their records, which had to be entered manually, leading to delay and data entry mistakes — and this was assuming that we knew the patient had been hospitalized there before. Getting the records of a patient’s medical history from primary care providers or clinics was even more challenging. It wasn’t uncommon for a single patient to end up with two or three duplicate charts, sometimes due to minor spelling errors in their name. With hundreds of different organizations involved, it’s no wonder the US faces greater challenges in maintaining a complete and accurate national-level database than a country like the UK, with a centralized single-payer health care system. The sheer size and varied demographics of the US population add further challenges. “The United States is incredibly diverse in many ways,” is how epidemiologist Katelyn Jetelina puts it. “You know, race, ethnicity, age, health status, state-level policies, rural, urban. There are so many [of what we call] confounders in epidemiology, so many important factors that will influence health and disease. What we see in New York City isn’t necessarily going to be generalizable or translatable to, for example, rural Texas.” Until the US started using commercial labs to ramp up testing capacity for monkeypox in late June, samples could only be processed at state public health labs, with a cumbersome process. Hot spots like New York were overstretched, while other states’ labs sat idle. The delays and poor coordination between clinics and city health departments meant that contact tracing happened too late to contain the spread. If the spread had been caught earlier, patients would have been more likely to minimize their risk and seek out testing and treatment if they were exposed, and there would have been more advance warning on ordering a vaccine supply. Undertesting doesn’t just affect the case numbers reported, but hurts patients’ access to treatment. Tecovirimat, or TPOXX, an antiviral drug that is most effective for treating monkeypox if started early, can’t be prescribed until a test comes back positive, and since it’s not officially approved by the FDA for monkeypox treatment, doctors need to jump through bureaucratic hoops to prescribe it. This leaves many patients suffering from untreated painful lesions for days or weeks. As Jetelina pointed out in a Substack post, monkeypox doesn’t need to go the same way that Covid did; it’s a known disease, with a vaccine already developed, and spreads via close contact rather than being airborne. But the slow initial response, disorganized due to lack of information, means that the window of opportunity to contain monkeypox is closing.

 

Political opposition to health care reform

 

Michael Scott, 8-11, 22, https://www.investopedia.com/u-s-healthcare-strategies-for-containing-costs-5186588, Strategies for Containing U.S. Healthcare Costs

 

Healthcare issues often trigger hot debates because conflicting interest groups that would be affected by changes to the healthcare system have significant economic and political power. They include: independent private practitioners, pharmaceutical giants, integrated insurance, and provider conglomerates to the hospital systems in important positions of influence in every Congressional district. So, even minor reforms meet substantial resistance. [CONTINUES].. Conversion of the Medicare program to a single-payer, Medicare-for-all program has had support from major political figures, but the complexity of switching from the current system and the political impediments it would need to overcome make its adoption unlikely.

 

Expanding Medicare would lower health care costs relative to private insurance

 

Michael Scott, 8-11, 22, https://www.investopedia.com/u-s-healthcare-strategies-for-containing-costs-5186588, Strategies for Containing U.S. Healthcare Costs

 

Healthcare economists, recognizing that Medicare operates at a lower cost than private insurance, have long studied the adoption of its payment structure. They’ve also evaluated its potential for transformation into a broader system as methods for reducing national healthcare spending.

 

The lower rates paid by Medicare, if extended to more providers, would result in substantial savings. If Medicare rates were used for private insurance reimbursement, the reduction in spending would have been an estimated $350 billion in 2021, according to one Kaiser Family Foundation study. More and more frequently, this major restructuring is proposed as a single-payer system.

 

Providing universal care means the programs are not cheaper

 

Michael Scott, 8-11, 22, https://www.investopedia.com/u-s-healthcare-strategies-for-containing-costs-5186588, Strategies for Containing U.S. Healthcare Costs

 

More broadly, many single-payer proposals would provide more generous benefits than the current Medicare program would. By providing richer benefits, such as dental, vision, hearing, and long-term care—and by lowering or eliminating cost-sharing by beneficiaries—these more comprehensive proposals would save less. And, if especially generous, these alternatives could cost more than a system more closely modeled on the current Medicare program would.    

 

Reducing administrative costs makes care net cheaper

 

Michael Scott, 8-11, 22, https://www.investopedia.com/u-s-healthcare-strategies-for-containing-costs-5186588, Strategies for Containing U.S. Healthcare Costs

 

The Congressional Budget Office (CBO) has compared the economics of a comprehensive, single-payer system to those of the status quo. The CBO found that a comprehensive Medicare-for-all program could reduce overall health spending while providing universal coverage, bolstering revenues for clinical services, and eliminating most copayments and deductibles. CBO experts evaluated five alternative structures using different assumptions about provider payments. They considered enrollees’ copays, demand for services, coverage of long-term care, vision, dental, and hearing services, and the impact of a single-payer, governmental plan on Medicaid and other government programs. In 2020, the CBO estimated that spending would fall even as healthcare utilization rose because the single-payer system would involve simpler, less costly administration than the present system with its multiple private insurers and wide variety of plans. The CBO analysis emphasized at the time, the Medicare system spent only 2% of its revenues on administration, while private insurers spent approximately 12% on administrative overhead.

4

 

New rural health care support

USDA, 8-11, 22, Biden-Harris Administration Invests $74 Million to Improve Health Care for People Living in 37 States, Guam and Puerto Rico, https://www.usda.gov/media/press-releases/2022/08/11/biden-harris-administration-invests-74-million-improve-health-care

WASHINGTON, Aug. 11, 2022 – U.S. Department of Agriculture (USDA) Rural Development Under Secretary Xochitl Torres Small today announced that USDA is awarding $74 million in grants to improve health care facilities (PDF, 321 KB) in rural towns across the Nation. These grants will help 143 rural health care organizations expand critical services for 3 million people in 37 states, Guam and Puerto Rico. The investments include $32 million for 67 rural health care organizations to help more than 1 million people living in socially vulnerable communities.

“Under the leadership of President Biden, Vice President Harris and Agriculture Secretary Vilsack, USDA is committed to making sure that people, no matter where they live, have access to high-quality and reliable health care services like urgent care, primary care, and dental care,” Torres Small said. “The Emergency Rural Health Care Grants being announced today will build, renovate and equip health care provider facilities like hospitals and clinics in rural areas in 37 states. Having sustainable and accessible health care infrastructure in rural areas is critical to the health and well-being of the millions of people living in small towns across the Nation.”

The Biden-Harris Administration made these funds available in the Emergency Rural Health Care Grants Programs through its historic legislative package, the American Rescue Plan Act. The Act and this program are examples of the government’s ability to respond quickly to ensure every person and family has access to high-quality health care no matter their zip code.

USDA Rural Development promotes a healthy community and environment through the Emergency Rural Health Care Grants to make sure people, kids and families have access to the health care they need. The grants support the ability of rural communities to provide health care to the people and places in our country that often lack access.

The investments will help rural hospitals and health care providers implement telehealth and nutrition assistance programs, increase staffing to administer COVID-19 vaccines and testing, build or renovate facilities, and purchase medical supplies. They also will help regional partnerships, public bodies, nonprofits and Tribes solve regional rural health care problems and build a stronger, more sustainable rural health care system in response to the pandemic. For example:

In Georgia, Crisp Regional Hospital will use a $1 million grant to recover lost revenue caused by the COVID-19 pandemic. The recovery of lost funds will allow the hospital to continue with critical services in rural Georgia.

In North Dakota, the Rolette County Public Health District will use a $155,000 grant to build a storage unit to house the district’s mobile health clinic. The mobile health clinic helps 14,000 Rolette County residents access health care, nutritional assistance and vaccines. The storage unit will protect the clinic from extreme weather conditions.

In Texas, the Big Bend Regional Hospital District will use a $5 million grant to partner with Preventative Care Health Services Inc., Terlingua Fire & EMS and the city of Presidio. The organizations will establish an after-hours clinic in Presidio and create a part-time primary care clinic in Terlingua. They also will develop a paramedicine program, implement a behavioral health care management program and launch a telemedicine program for residents in Presidio and Terlingua.

States counterplan is more “real world,” as federal action is not likely to happen

William Hsiao, 8-11, 22, Unified Financing Of Health Care In California: The Road Ahead, https://www.healthaffairs.org/content/forefront/unified-financing-health-care-california-road-ahead

The inequitable, ineffective, and wasteful health care system in the US has been extensively analyzed and documented. In the last presidential election cycle, Senator Bernie Sanders (D-VT) proposed a single-payer system, Medicare for All, to solve our health care system deficiencies. He aroused wide public support for it. In early 2022, Congresswoman Pramila Jayapal (D-WA) led 120 congresspersons to introduce the Medicare for All Act of 2022 in the House (H.R. 1976). However, the passage of any federal single-payer bill seems dim because of the strong opposition of powerful vested interest groups and lack of a political majority. Hence, it’s more likely that states may take major initiatives in the intermediate future. What can states do? The governors and legislatures of several states, including California, Washington, Massachusetts, and Oregon, have appointed commissions to develop concrete action plans for implementing single-payer systems. Re-engineering the financing and delivery of our health system will require a well thought out, sound, and bold plan.

“Single payer” means a single source of funding

William Hsiao, 8-11, 22, Unified Financing Of Health Care In California: The Road Ahead, https://www.healthaffairs.org/content/forefront/unified-financing-health-care-california-road-ahead

The Commission agreed on a unified financing plan—a form of single-payer plan—that pools all sources of financing, public and private, into one source to finance a unified benefit package for everyone. The consensus of the Commission was that unified financing would improve equity, be less costly, and increase access to better-quality health care.

 

Health care costs will continue to increase

 

 

Tucker Doherty, 8-10, 20, https://www.politico.com/news/2022/08/10/health-care-inflation-low-change-00050883, Health care providers are shouldering rising costs. That could change soon.

 

While the economy as a whole has experienced record-breaking inflation this year, price increases in the health care sector have been relatively subdued — a trend that could end soon as Medicare and other payers adjust to new economic realities.

 

Rising costs, such as labor, have largely not translated to higher medical prices, in part because they took economic forecasters by surprise. Rates set by Medicare and insurers, which are a key driver of health care costs, are negotiated months in advance and are based on forecasts that largely did not anticipate the current burst of inflation.

 

The disconnect between payment rates and labor costs, among others, has financially squeezed hospitals, nursing homes and other providers. But the fix, which is coming this year, is very likely to raise medical prices for American consumers.

 

Medicare’s forecast for the current fiscal year assumed hospital costs would increase by approximately 2.7 percent, while in reality those costs are on track to rise by more than 5 percent. While this problem is not unique to Medicare, the massive program follows a fixed schedule with long lags and has been slow to adapt.

 

The latest monthly update to the Consumer Price Index released Wednesday continues to show overall inflation near 40-year highs, with prices rising by 8.5 percent over the past 12 months. That elevated level is being driven by double-digit growth for items like gas, food and vehicles.

 

In contrast, consumer prices for medical care services have grown more slowly, at 5.1 percent, with much of the increase attributed to higher profits for private insurers. Prices for medical care commodities — a category that includes items like prescription drugs and wheelchairs — have grown even more slowly at just 3.7 percent over the past 12 months. And because of the way the widely followed CPI is calculated, there is at least a 10-month lag on when drug and device price increases show up.

 

“If you looked at the best measures of health care inflation, you wouldn’t really know that anything unusual is happening right now, which is obviously a stark contrast with the economy as a whole,” Matthew Fiedler, a senior fellow with the USC-Brookings Schaeffer Initiative for Health Policy, told POLITICO.

 

While lower medical prices benefit consumers in the short term, many health care providers are seeing their balance sheets pressured by rising costs.

 

“We’re dealing with really significant rates of increases in input prices directly related to inflation, and a lot of that is driven by the labor side,” American Hospital Association President and CEO Richard Pollack said in an interview. “Hospitals are experiencing pretty significant reductions in their operating margins, if you look at the numbers we’re struggling.”

 

Acute staff shortages related to the Covid-19 pandemic have driven up wages, but providers are now also contending with a tighter labor market overall that has forced every sector to compete for scarce workers.

 

In addition to staff, which account for more than half of an average hospital’s budget, facilities are also feeling inflation’s effect on supplies, drugs, food and energy, according to Pollack.

 

Providers are also grappling with the return of budget sequestration cuts that were temporarily paused during the pandemic, cutting Medicare rates by another 2 percentage points.

 

Providers’ losses are the consumer’s gain, for now. When Medicare pays less for health services, that can translate to lower premiums and cost-sharing for program beneficiaries. And the private sector often follows in the footsteps of what Medicare, the nation’s biggest provider of health care services, does.

 

“I think it’s entirely possible that this will end up being a good thing. I understand why hospitals maybe wouldn’t like it, but from a fiscal perspective and a patient perspective it certainly has lots of features,” said Fiedler.

 

On the other hand, provider groups say low payment rates and staff shortages reduce access to care when facilities are forced to limit operations or close.

 

 

 

High health care costs mean people forgo care

Advisory Board, 8—9, 22, The impact of rising health care costs, in 4 charts, https://www.advisory.com/daily-briefing/2022/08/09/health-care-inflation

 

In the last six months, higher health care costs drove 38% of U.S. adults—an estimated 98 million Americans—to delay or forgo health care treatments, cut back on routine expenses, or borrow money to cover their medical expenses, according to a new poll conducted by West Health and Gallup.

 

Infographic: The patient financial journey

 

Study details and key findings

For the study, West Health and Gallup surveyed 3,001 adults from all 50 states and the District of Columbia between June 2 and June 16. In June, health care inflation was half the overall national inflation rate at 4.5%.

 

Overall, 38% of respondents said they had taken one or more measures to reduce household spending due to rising health care costs, including delaying or skipping medical care or medications, driving less, cutting utilities, skipping a meal, or borrowing money. Notably, 26% of people surveyed reported delaying or avoiding medical care or buying prescription drugs due to higher health care prices.

 

Respondents in households that earned less than $48,000 annually were even more likely to make financial trade-offs because of health care costs. For example, 62% of respondents from households earning less than $24,000 a year, and 51% of respondents from households with an annual income between $24,000 and $48,000 took steps to cut household spending.

 

Financial trade-offs were most common among lower-income households. However, 19% of respondents in households earning at least $180,000 annually said they took steps to reduce overall spending because of higher health care costs. This finding underscores the burden of high health care costs across a wide range of the population.

 

The survey also evaluated how overall inflation is impacting American consumer behaviors. Overall, 59% of respondents said they were driving less, 30% said they were cutting back on utilities, and 21% said they had delayed or skipped medical care or prescription drugs.

 

The survey found that those who cut spending in areas other than health care, such as food and utilities, were likely to cut health care spending as well.

 

For instance, 59% of respondents who cut back on utilities also cut back on medical care and prescription drugs. In addition, 71% of respondents who skipped a meal, 60% of those who borrowed money, 55% of those who drove less, and 51% of those who took any of those measures also cut back on medical care and prescription drugs.

 

“Inflation is hollowing out consumer spending habits across an array of areas,” said Dan Witters, a senior researcher at Gallup. “What is found just under the surface is that after gas and groceries, the role of inflation in reducing the pursuit of needed care is large and significant. And the rising cost of care itself, which is originating from an already elevated level, is having an outsized impact on lessening other forms of spending, compounding the problem.”

 

The survey also evaluated Americans’ concerns about being unable to pay for necessary care in the next six months. Overall, 39% of respondents said they were “extremely concerned” or “concerned” about being unable to pay for care, including 33% of Democrats, 44% of Republicans, and 42% of independents.

 

The high cost of health care has disproportionately affected women and people of color. According to the survey, women are 17% more likely than men to be concerned about being unable to pay for care, and Black adults are 16% more likely than white adults to be concerned.

 

“People have been making tradeoffs to pay for health care for years. Inflation has only made things worse as people are also now struggling with the high price of gas, food, and electricity,” said West Health president Timothy Lash. (Melillo, “Changing Am

 

Health care subsidies already extended and new price caps for the elderly

 

Pallone, 8-7, 22, PALLONE HAILS INCLUSION OF KEY HEALTH CARE PROVISIONS IN THE INFLATION REDUCTION ACT,, https://energycommerce.house.gov/newsroom/press-releases/pallone-hails-inclusion-of-key-health-care-provisions-in-the-inflation

Energy and Commerce Committee Chairman Frank Pallone, Jr. (D-NJ) released the following statement today after the Senate passed the Inflation Reduction Act, which includes key health care provisions that will lower the cost of health care and lifesaving prescription drugs for Americans: “The Inflation Reduction Act is one of the most significant pieces of health care legislation to move through Congress in over a decade. It breaks Big Pharma’s monopoly on prescription drug prices. The bill will lower prescription drug costs for seniors by finally empowering Medicare to negotiate the cost of prescription drugs and capping the amount seniors pay at $2,000 annually. Nearly 20 years ago Republicans prevented the federal government from negotiating fair prices for seniors, and the Inflation Reduction Act reverses that egregious gift to Big Pharma, which will save seniors and Medicare money. This legislation finally levels the playing field and will help ensure seniors are no longer price gouged at the pharmacy counter. It also penalizes Big Pharma companies for unfairly hiking prices on seniors. “The Inflation Reduction Act will dramatically lower the cost of monthly health insurance premiums for millions of Americans and provide families with the peace of mind that comes with knowing they have high-quality health care coverage. Five million Americans have gained access to health care coverage over the last two years thanks to Democrats’ efforts to make it more affordable, and I’m pleased that this legislation will extend those efforts for three more years. “I’m incredibly proud of the health care provisions in this legislation, many of which were originally drafted and negotiated by me and other health committee leaders in the House and then the Senate. The House acted on this legislative package to reduce costs last November and I’m thrilled that the Senate has passed this transformative legislation. I look forward to supporting the Inflation Reduction Act in the coming days and seeing it signed into law soon.” The Inflation Reduction Act includes a number of key provisions that were originally authored and introduced by Pallone and other health leaders in the House before being passed in the House of Representatives last November. Lowering Prescription Drug Costs for Americans: The Inflation Reduction Act will rein in the soaring cost of prescription drugs and cap out-of-pocket costs for millions of seniors. Many of the key provisions in the Inflation Reduction Act to lower prescription drug costs were first proposed by Pallone, Ways and Means Chairman Richard E. Neal (D-MA), and Education and Labor Chairman Robert C. “Bobby” Scott (D-VA) in H.R. 3, the Elijah E. Cummings Lower Drug Costs Now Act, which was introduced in September 2019. The comprehensive bill empowered Medicare to negotiate the cost of prescription drugs and imposed an inflation rebate on pharmaceutical manufacturers that unfairly raised prices on consumers. H.R. 3 also capped seniors’ out-of-pocket costs on Medicare Part D prescription drugs at $2,000 annually. The House of Representatives passed H.R. 3 in December 2019, but the Senate did not act on the bill. Expanding Affordable Care Act (ACA) & Lowering Health Care Costs: The Inflation Reduction Act also makes health care more affordable for millions of Americans by extending through 2025 ACA affordability assistance first included in the American Rescue Plan last year. The landmark law provided financial assistance for more people by enhancing ACA Marketplace premium subsidies for lower-income and middle-income Americans for 2021 and 2022, including those with incomes above 400 percent of the federal poverty line. This ACA provision was first introduced by Chairmen Pallone, Neal, and Scott in March 2018.

Emily Gee, Center for American Progress, 8-11, 22, How the Inflation Reduction Act Reduces Health Care Costs, https://www.americanprogress.org/article/how-the-inflation-reduction-act-reduces-health-care-costs/

The Inflation Reduction Act, when passed by the House of Representatives and signed into law by President Joe Biden, will give a lifeline to people struggling with health costs by providing much-needed financial relief for the health coverage and medications they need to survive and thrive. The bill improves health care and affordability by: Empowering Medicare to negotiate with drug companies to lower prices

Preventing drug companies from raising Medicare prices in excess of inflation

Setting a new cap for Medicare beneficiaries on annual out-of-pocket costs for drugs, plus a $35 monthly cap on insulin cost sharing

Providing more generous subsidies for health insurance marketplace coverage, thereby granting financial help to middle-class families facing high premiums and guaranteeing that lower-income people have a $0 premium plan option

 

Public opposition to single payer’s ban on private insurance

 

Wallowa County Chieftain, August 4, 2022, Medicare for All would ‘fix’ what isn’t broken, https://insurancenewsnet.com/oarticle/medicare-for-all-would-fix-what-isnt-broken

Medicare for All remains on the congressional docket. Sen. Bernie Sanders, I-Vermont, recently reintroduced his bid for a single-payer system, claiming it would guarantee all Americans health coverage while lowering costs and saving lives. That’s a compelling sales pitch. However, the reality is that Medicare for All would outlaw private health insurance and force millions of Americans onto a single government-run plan. And contrary to what its proponents might suggest, Medicare for All would lead to worse care for patients at higher cost. Even the idea’s supporters don’t seem to know what it entails. According to polling from the Kaiser Family Foundation, two-thirds of Medicare for All supporters believe they’d be able to keep their private insurance under a single-payer health care system. Sen. Sanders’s bill, of course, would ban private plans. That might not sit well with the 14 million Americans who purchase private plans through the Affordable Care Act’s exchanges. Almost three-quarters of enrollees like the plan they have now. Outlawing private insurance coverage also wouldn’t go over well with the 180 million Americans with employer-sponsored coverage. More than seven in 10 are satisfied with their plans. That makes sense. Employers compete for employees in part by offering generous health insurance. Workers benefit from the great coverage, and employers benefit by being able to attract and retain quality workers. By forcing everyone onto the same insurance plan, Medicare for All would take that bargaining chip away from employers and employees alike. It’s no surprise that overall support for Medicare for All – which usually hovers around 50% – drops to just 37% when people realize it would eliminate private health insurance.

 

 

Lowering reimbursement rates results in delayed care

 

Wallowa County Chieftain, August 4, 2022, Medicare for All would ‘fix’ what isn’t broken, https://insurancenewsnet.com/oarticle/medicare-for-all-would-fix-what-isnt-broken

Delays are endemic to single-payer programs like Medicare for All. That’s because the government would pay hospitals and doctors below-market rates in order to deliver the savings Sen. Sanders promises. Medicare and Medicaid pay less than private insurers do. A single-payer plan would extend those low payment rates to everyone. Providers today charge privately insured patients more to make up for low reimbursements from public plans. They wouldn’t be able to do that under Medicare for All. The result would be budget deficits for 90% of hospitals, according to one study from FTI Consulting. Providers would have little choice but to restrict access to services – if they’re able to keep their doors open. Patients would face long waits for subpar treatment.\ That’s exactly what happens in other countries with single-payer health care. In the United Kingdom’s National Health Service, there are more than 6 million people waiting for hospital care. Thousands have been waiting for more than two years. Similarly, under Canada’s single-payer system, patients face a median wait of nearly six months from the time they’re referred by a general practitioner to receipt of treatment from a specialist. Under Medicare for All, American patients would experience similar fates. That was the conclusion of Phillip Swagel, director of the Congressional Budget Office, who recently told Congress that single-payer would increase “congestion in the health care system, including delays and forgone care.”

 

Lower funding results in a hospital deficit crisis

 

Wallowa County Chieftain, August 4, 2022, Medicare for All would ‘fix’ what isn’t broken, https://insurancenewsnet.com/oarticle/medicare-for-all-would-fix-what-isnt-broken

Medicare and Medicaid pay less than private insurers do. A single-payer plan would extend those low payment rates to everyone. Providers today charge privately insured patients more to make up for low reimbursements from public plans. They wouldn’t be able to do that under Medicare for All. The result would be budget deficits for 90% of hospitals, according to one study from FTI Consulting. Providers would have little choice but to restrict access to services – if they’re able to keep their doors open. Patients would face long waits for subpar treatment.

Counterplan – Expand ACA

 

Wallowa County Chieftain, August 4, 2022, Medicare for All would ‘fix’ what isn’t broken, https://insurancenewsnet.com/oarticle/medicare-for-all-would-fix-what-isnt-broken

Less than 10% of the American population is uninsured. There are far more cost-effective ways to expand access to affordable coverage. For example, the additional subsidies provided by the American Rescue Plan Act have helped more than 3 million Americans secure coverage through the Affordable Care Act’s exchanges for less than $10 a month. Extending those subsidies permanently could continue to make private coverage affordable for millions. The Affordable Care Act has also driven down coverage inequities, especially in states that have expanded Medicaid. That’s a testament to the power of building on the parts of our health care system that are working. Lawmakers should focus their efforts there – not on Medicare for All.

 

The uninsured and poorly insured drive up health care costs
Medicare for All spreads costs
The Affordable Care Act won’t solve
Single Payer boosts the economy

Ray Fusco, 7-31, 22, https://thebradentontimes.com/letter-the-case-for-medicare-for-all-p24898-158.htm, Bradelton Times, Letter: The Case for Medicare for All

Both sides of the political aisle have been complicit in supporting the profiteering of our health caste system to the detriment of all citizens. The profiteers and politicians care more about their wealth than your health. There is no free lunch in our health caste system consisting of 28 million uninsured, 65 million Medicaid, 44 million Medicare and 167 million Privately insured people. This health caste system is a reprehensible example of income inequality. The unpaid and underpaid costs of service in the system drive up the costs for Private and government health insurance while healthcare corporate greed pushes the costs even higher. Medical debt is a costly burden that weighs on millions of patients who seek life-saving care, it’s the leading cause of bankruptcy in America and the largest source of personal debt among consumers. The current health caste system excludes 28 million people from coverage, places 65 million children, disabled and nursing home patients in the lowest paying insurance level, isolates 44 million medicare recipients into the highest cost population, and allows private insurance to profiteer on 167 million Americans. In 1960, health care accounted for 5% of the gross domestic product (GDP) of the USA by 2020 health care accounted for 19.7% of our GDP. Health care costs do not bring revenue into the country; they take revenue from companies and individuals. The increase in health care costs has not been driven by individual provider (doctors, therapists, etc.) costs but administrative costs and corporate profits. Individual providers would benefit from a single-payer system that would allow them to significantly reduce the administrative costs of billing. The cost of caring for a population is shared by each person in the insured population. When a homogeneous grouping occurs the risks and cost per individual may increase or decrease dramatically. The following data from the Kaiser Family Foundation illustrates the difference in per capita health care spending in 2019 by age group; 0-18 $2,426, 19-34 $3,484, 35-44 $4,694, 45-54 $6,734, 55-64 $10,203 and 65+ $13,016. There are 245 million persons below the age of 65 with health insurance and 44 million 65 or older on Medicare. When these two populations are combined the weighted average for health care spending becomes $5,800. When the politicians cry about the high cost of Medicare and the need for reform they are being disingenuous at best. With Medicare for All you level the healthcare playing field and spread the cost over a huge, diverse population. With Medicare for All, you have a single-payer system that will have the power to lower the overall cost of healthcare and improve the quality of care provided. The US healthcare system costs per capita are twice as much as any other developed nation while ranking 37 for quality of care by the World Health Organization. Congress could significantly lower the pharmaceutical costs for all Medicare recipients today with one simple act. The federal government has already negotiated significantly reduced pharmaceutical rates that are used by the VA, qualifying hospitals, and Community Health Centers. Section 340B of the Public Health Service Act requires pharmaceutical manufacturers participating in Medicaid to sell outpatient drugs at discounted prices to healthcare organizations that care for many uninsured and low-income patients. Congress can mandate Medicare patient eligibility for a 340 B medication discount now instead of playing their current woe is me game. Medicare Advantage plans are taxpayer-subsidized private insurance plans that escalate the cost of healthcare while generating millions of dollars in profits for insurance companies. Three sources of revenue for Advantage plans include general revenues, Medicare premiums, and payroll taxes. The government pays a predetermined amount every year to private insurers for each Advantage member. These funds come from both the Hospital Insurance (HI) and the Supplementary Medical Insurance (SMI) trust funds. These companies are in business to make a profit. To offer $0 premium plans, they must make up their costs in other ways. The reality is that Medicare for All would eliminate the need for Medicare Advantage plans because the overall cost of healthcare would drop significantly enough to offer all the extra benefits provided by advantage plans to all citizens in the US while still costing less than the totality of the current system. The Affordable Care Act (ACA) allows low-income individuals and families to access Private health insurance with the assistance of federal subsidies of the premium costs. The Affordable Care Act does nothing to lower healthcare costs and is a boon for the private insurance industry. The ACA does not eliminate co-pays and deductibles which can be significant. While this is a noble endeavor, Medicare for All would create access for all and have the power to dramatically lower the cost of healthcare. Medicare for All would shift trillions of dollars back into the private employment sector by cutting the cost of healthcare in half. The money saved by industry could be used to increase profits and wages as well as make made in America more economically attainable. There are actually enough dollars to be saved in the current system to pay for Medicare for All while cutting the current cost in half. Some examples of cost eliminations and revenue reappropriations are; saving $616 billion by eliminating Medicaid, saving $9.7 billion by eliminating the Community Health Center program, save $500 billion in excess administrative costs, $150 billion in medical device savings, $150 billion in excess drug costs, save billions of dollars through government bureaucracy elimination, save billions of dollars by eliminating private health insurance profits. The Medicaid program is a shared cost program between the Federal government and each State. In Florida, 20% of the state budget provides payments to private insurance companies for providing Medicaid insurance to its citizens. With Medicare for All, Florida would not have this cost in its budget and could reduce the taxes on its citizens or reallocate these funds for other needed services.

Single Payer lowers costs and increases access, the current system doesn’t provide it
Status quo rations in favor of the lucky
Single payer boosts economic competitiveness

Jay D. Brock, M.D., 7-31, 22, Commentary: Why conservatives should support Medicare for All, https://fredericksburg.com/opinion/columnists/commentary-why-conservatives-should-support-medicare-for-all/article_c8f71d8f-4a3c-50f9-9fa3-bd4aab68e55d.html

Most Americans get it: our dysfunctional health insurance system isn’t working for too many. Thirty million have no insurance. Another 40 million, given skyrocketing out-of-pocket costs, can’t afford to use the insurance they have. Some half-million Americans—most with insurance—undergo a medical bankruptcy each year, and 78% of Virginians worry about affording medical bills. The system, while benefiting a few lucky Americans, isn’t working for most of us. You’d think that making sure every American had not just “access” to health care but care they could actually afford would be a nonpartisan, bipartisan endeavor. Not for most Washington politicians: health care lobbyists spend more than $600 million of our health care dollars each year making sure industry gets its way rather than assuring the rest of us can get affordable care. Conservatives, apparently indifferent to the success and popularity of Social Security and Medicare, both publicly funded, seem to be especially adept at labeling affordable health care for all as some nefarious un-American plot that would destroy America (“Socialism!” “Government control!”) rather than as something that would allow us to keep up with the world’s other advanced nations. So let’s look at seven reasons why conservatives of both parties should be keen to support Medicare for All—a popular single-payer health insurance system funded by public contributions, where health care would still be delivered by America’s excellent private providers. MFA is much cheaper to run, consuming just 2–3% of healthcare dollars rather than the 15–20% it takes to run some private health insurers. Switching to MFA will save 600 billion health care dollars yearly just in administrative costs. That is a lot of money. Better to spend it on patients than on building a bigger medical bureaucracy. MFA also saves money when it “bends the health care cost-curve”—the Holy Grail of health care economists and conservatives alike—because as a monopsony it will lower costs for goods and services it purchases. We could save $100 billion yearly on pharmaceuticals alone. No, essential creative health care industries won’t disappear—they will thrive just as they do in every other advanced nation with affordable universal coverage. Everyone contributes, based on income, not an arbitrary premium, so it’s truly affordable. Universal contributions, by the way, is an idea straight from the conservative Heritage Foundation, based on “personal responsibility”—if you can share in its benefits, you should pay into the system. (It was only when Democrats used it that Republican conservatives began to despise such mandates.) Based on the popularity of other similar government-funded programs, there should be less political interference with MFA than our current system, where politicians frequently put their fingers on the scales of healthcare access. Anyone familiar with the cries of “Keep the government out of my Social Security and Medicare” understands why interfering with these programs is still considered to be the “third rail” of American politics. There is more competition under MFA, as artificial networks of providers that benefit the health insurance industry at the expense of patients are eliminated. All providers will compete for all patients based not on price (which will continue to be negotiated between the insurer and providers) but on service. MFA is great for business. It takes the burden of health care costs off employers. Warren Buffett has called our current health care system the tapeworm of American competitiveness. Funding health care with public dollars will improve American competitiveness, globally and locally. It will also be easier to start a business. Or, since health insurance is no longer tied to one’s employment, for employees to change jobs Public funding of health care will help many areas, urban and rural, where health care access is sorely lacking. These areas don’t suffer from a lack of patients—they have too many patients who cannot afford medical care and either forgo care or receive care for which providers are not compensated. So hospitals go bust, or physicians aren’t to be found. Don’t believe anyone who says MFA will hurt these areas. When everyone has insurance they can afford, the reality is just the opposite. Finally, what about the health insurance industry? As a hugely expensive and entirely unnecessary middleman, its days are numbered. Economists call its eventual demise “creative destruction.” (MFA sets aside billions of saved health care dollars to assure industry employees who lose their jobs will have a “soft landing” economically).

Single payer simplifies billing, giving doctors more time to see more patients

Philllips, 7-30, 22, Jan Phillips of Durango is a retired small-business owner. After 40 years as a health educator, she advocates for health care reform, The Durango Herald, Single-payer system benefits patients, physicians, https://www.durangoherald.com/articles/single-payer-system-benefits-patients-physicians/

The nonpartisan Congressional Budget Office recently estimated payments to physicians under current policies and USP. CBO expects that under a USP system, the number of people accessing care would increase, resulting in 5% to 9% higher revenues. Some researchers project even larger savings to physicians’ pay because of the CBO’s underestimate of savings from administrative simplification and streamlined billing. It’s estimated that 5% of a physician’s current work hours are spent on billing. Less time spent on billing would free them to see more patients.

Single payer increases physician income

Philllips, 7-30, 22, Jan Phillips of Durango is a retired small-business owner. After 40 years as a health educator, she advocates for health care reform, The Durango Herald, Single-payer system benefits patients, physicians, https://www.durangoherald.com/articles/single-payer-system-benefits-patients-physicians/

Yet, many physicians still worry that reform might decrease their income. Even though highly paid, their concerns are understandable given the burden of student debt, the length of medical training and Medicare’s lower fees relative to private insurers. The nonpartisan Congressional Budget Office recently estimated payments to physicians under current policies and USP. CBO expects that under a USP system, the number of people accessing care would increase, resulting in 5% to 9% higher revenues. Some researchers project even larger savings to physicians’ pay because of the CBO’s underestimate of savings from administrative simplification and streamlined billing. It’s estimated that 5% of a physician’s current work hours are spent on billing. Less time spent on billing would free them to see more patients. U.S. hospitals and physicians currently waste time and money contending with multiple payers, each with its own complex and varying coverage rules, payment procedures and formularies. The CBO projects what hospitals spend on administration would fall from 19% to 12% under single-payer; physicians’ administrative overhead would decrease from 15% to 9%; and administrative expenses of other medical providers (for example, dentists, home-health agencies and hospice) would drop from 9% to 6%. In addition, it estimates that physicians and nurses would spend less time on administrative activities, freeing up 4.8% of physicians’ work hours and 18.4% of nurses’ work time. These assumptions are based on research comparing high administrative overhead among U.S. healthcare providers relative to other nations. When Canada transitioned to single-payer in the 1970s, physician income increased and they remained the highest paid professionals in the nation. Physician incomes in Canada have grown faster than incomes of other workers. Although primary care physicians may see the largest boost under single-payer, specialists would continue to be high earners. It’s also estimated that malpractice insurance costs would likely decrease, as they did in Canada, since patients won’t need to sue to cover future medical costs. As patients with unmet medical needs such as hypertension, diabetes and other chronic conditions could afford care, there would be greater utilization and doctors could shift their efforts to address the greatest needs without fear of losing income. To prevent long waitlists for appointments, an increase in residency training programs may be necessary to increase the number of physicians. The bottom line of the CBO analysis is that universal coverage using a single-payer system can be affordably achieved even as benefits are expanded and cost-sharing all but eliminated. The two-fold positive conclusion is that the CBO’s estimate and numerous research papers suggest physician compensation would prosper under single-payer reform while also being enormously beneficial to patients.

“Single Payer” includes “unified financing”

Michael Lighty, July 30,  2022, Commission’s Report Shows Medicare for All Is Logical Next Step for California, https://www.commondreams.org/views/2022/07/30/commissions-report-shows-medicare-all-logical-next-step-california

“Unified Financing” is a term the commission used to describe what is also commonly called Medicare for All or single-payer healthcare.

Discrimination and a lack of access to reproductive health care undermine US soft power and the credibility of the democratic model

Repnikova, July/August 2022, Foreign Affairs, The Balance of Soft Power: The American and Chinese Quests to Win Hearts and Minds, https://www.foreignaffairs.com/articles/china/2022-06-21/soft-power-balance-america-china

Looking ahead, the United States and China will face distinctive challenges in soft-power promotion. Washington’s approach draws scrutiny because of the disconnect between the country’s emphasis on democratic values and its inconsistent adherence to them. Democratic erosion, pervasive racial discrimination, and attacks on reproductive rights at home detract from the United States’ image as an inspirational democracy. In workshops with U.S. State Department officials, I have sensed a growing awareness of the need to address these issues but also a sense of fear that doing so publicly would put the United States at a disadvantage vis-à-vis China. “Wouldn’t it make us look weak?” asked one official when I suggested that U.S. public diplomacy could convey more candor and humility about the challenges facing American democracy.

What is included in, “Medicare for All”/”Single Payer”

Lefkowitz, 2022, Ken Lefkowitz is a former consultant and Senior Director for major corporations, including AstraZeneca and PECO Energy. Ken designed and managed healthcare plans for hundreds of thousands of employees and their dependents. He has negotiated with major health insurers and managed large corporate self-insured plans. A number of his writings about healthcare have been published in the Washington Post, Courier Post/USA Today Network, Philadelphia Inquirer, and the New York Times. Ken earned a BA degree from Brooklyn College, MS degree from City Ken Lefkowitz is a former consultant and Senior Director for major corporations, including AstraZeneca and PECO Energy. Ken designed and managed healthcare plans for hundreds of thousands of employees and their dependents. He has negotiated with major health insurers and managed large corporate self-insured plans. A number of his writings about healthcare have been published in the Washington Post, Courier Post/USA Today Network, Philadelphia Inquirer, and the New York Times. Ken earned a BA degree from Brooklyn College, MS degree from City University of New YorkLefkowitz, Ken. Medicare for All (p. i). Taylor and Francis. Kindle Edition.  Medicare for All: An Economic Rationale

Outline of Medicare For All Before we begin the exploration of our current system’s flaws and shortcomings, it is important to outline the definition of Medicare For All so the reader can gain an understanding of the program’s essentials and parameters. Two Medicare For All bills have been introduced in Congress, one originally in the House by Representative Jayapal, HR 1384 in March 2019, and another in the Senate, S1129, by Senator Sanders in April 2019, who humorously said in a discussion about Medicare For All elements during the Democratic Presidential debates, “I wrote the damn bill.” Quite similar in content, both bills present the key elements of a Medicare For All program, defining it as a single-payer universal healthcare coverage plan. Here are their key elements: Every resident receives a healthcare coverage card; Comprehensive coverage is provided for doctor, hospital, dental, vision, mental health, medical supplies, pharmaceuticals, and long-term care; There are no deductibles or copays; Private duplicate coverage is banned; The plans are exempt from the Hyde Amendment that bans government spending on women’s right to choose. Under each plan, doctors, hospitals, and other medical providers remain independent and operate freely. Patients are free to choose any doctor or hospital since the delivery of care continues to remain in private hands. Continued free choice of each person to select their own doctors and hospitals is assured. Neither plan is a government takeover of healthcare. Only funding and coverage are addressed. Lefkowitz, Ken. Medicare for All (p. 3). Taylor and Francis. Kindle Edition.

 

Turn: More government intervention in the market increases prices; [Counterplan – repeal many regulations]

 

Michael Cannon, CATO, July 19, 2022, Market Concentration in Health Care: Government Is the Problem, Not the Solution, https://www.cato.org/briefing-paper/market-concentration-health-care-government-problem-not-solution

The U.S. health sector is not serving consumers as it should or could. Opaque, excessive, and often unconscionable prices both reduce access to care and threaten to wipe out the health savings account (HSA) balances and other savings of even insured Americans.1 Low‐​quality care costs lives, while bad policy confounds efforts to improve quality.2 Market concentration contributes to these deficiencies. Markets for hospitals, physician services, and health insurance have exhibited increasing concentration over time. “By 2017, in most markets, a single hospital system had more than a 50 percent market share of discharges.”3 In 2016, markets for specialist physicians exhibited what federal antitrust authorities consider a high degree of concentration in 65 percent of metropolitan areas. Markets for primary‐​care physicians exhibited high concentration in 39 percent of metropolitan areas. Hospitals are also driving consolidation in markets for physician services. From 2006 to 2016, the share of primary‐​care physicians who worked for hospitals rose from 28 percent to 44 percent. By 2012, more than 55 percent of all physicians worked for hospitals. In 2016, 57 percent of health insurance markets exhibited high concentration; in 2018, 75 percent did.4 While integrated health care delivery can reduce inputs and improve outcomes, convenience, and other dimensions of quality, the economics literature finds that most consolidation among hospitals, physicians, and insurance companies is inefficient consolidation that unnecessarily increases prices and reduces quality: The research evidence shows that hospitals and doctors who face less competition charge higher prices to private payers, without accompanying gains in efficiency or quality. Research shows the same is true for insurance markets.… Moreover, the evidence also shows that lack of competition can cause serious harm to the quality of care received by patients.5 Mortality from heart attacks and other causes, for example, is lower in more‐​competitive hospital markets and falls when policymakers introduce competition into less‐​competitive markets.6 Research also finds that mortality is lower in more‐​competitive cardiologist markets and that hospital acquisitions of physician practices do not improve quality.7 Increasing competition in health care markets may literally be a matter of life and death. Consolidation also correlates with price opacity. Hospitals in unconcentrated markets are three times as likely to comply with federal requirements that they publish transparent prices for all services as hospitals in highly concentrated markets.8 Inefficient consolidation is largely the result of government interventions that disable the normal market mechanisms of entry, cost‐​consciousness, and competition from doing what they do in other sectors of the economy: improving quality while reducing prices. Government does not need new powers to combat inefficient provider consolidation. It merely needs to stop encouraging such consolidation. To improve health care quality and reduce health care prices, state and federal legislators must repeal or drastically overhaul regulations, tax distortions, and entitlement programs that encourage producers to consolidate. Eliminating harmful regulation and letting consumers control the $4 trillion that fuel the U.S. health sector would restore the normal market mechanisms of entry, competition, and price‐​consciousness that combat inefficient consolidation. Government Intervention in Health Care Encourages Market Concentration State and federal governments intervene in health care markets in various ways and always with the ostensible purposes of improving quality and/​or reducing costs. Such interventions include regulation of health professionals, medical facilities, and health insurance issuers; special tax preferences for health‐​related uses of income (and implicit penalties on other uses of income); and subsidies for health insurance and medical care, including direct government purchasing of both. The unintended consequences of these interventions often include incentives for producers to consolidate to charge higher prices than they could in competitive markets. Regulation Nearly all government regulation inadvertently encourages inefficient consolidation. In general, regulation imposes high fixed costs but low marginal costs. When two firms merge, their total cost of complying with government regulations therefore falls. Regulation thus creates an artificial incentive for firms to consolidate. It places larger firms at a competitive advantage because they can spread the higher fixed costs of regulation over a larger quantity of outputs than smaller firms can. The fixed costs of regulatory compliance inhibit entry, grant larger firms a price advantage that grows as the firm grows, and therefore encourage firms to merge with their competitors. The greater the overall regulatory burden, the greater the incentives for inefficient consolidation. What is true of regulation generally is true of health care and health insurance regulation in particular. The Patient Protection and Affordable Care Act’s (Obamacare’s) “minimum loss ratio” (MLR) rules, for example, require insurers who sell health insurance to small businesses and consumers to spend no more than 20 percent of premium revenue on administrative expenses and quality‐​improvement activities. Large‐​employer plans may spend no more than 15 percent. These and similar regulations encourage consolidation: The fixed costs of complying with the[se] … and other insurance regulations will weigh more heavily on smaller insurers and increase the costs of entry by new insurers.… The MLR rules could encourage insurers to consolidate to obtain product portfolios more likely to meet the minimum MLR requirements (e.g., from pooling expenses or reducing statistical volatility in MLRs), or simply to achieve additional economies of scale in administration.9 Some regulations both add to the overall burden of government regulation and create specific barriers to entry that increase consolidation in health care markets. Clinician‐​licensing laws and the attendant scope‐​of‐​practice regulations disproportionately hinder the entry of integrated, prepaid group plans like Kaiser Permanente, which compete on price by making fuller use of midlevel clinicians. To enter new markets, such systems must develop new workflows to conform to each state’s different and ever‐​changing scope‐​of‐​practice rules. Insurance‐​licensing laws and regulation of medical facilities create similar barriers. Some government regulation appears to exist for the purpose of encouraging inefficient provider consolidation. Thirty‐​five states require health care providers to obtain a “certificate of need” (CON)—that is, a permission slip from government—before entering or expanding their presence in a market. Twenty‐​eight states impose CON requirements on hospitals.10 CON regulation appears to do little other than increase market concentration by blocking entry: A reasonably large body of evidence suggests that CON has been used to the benefit of existing hospitals. Prices and costs were higher in the presence of CON, investor‐​owned hospitals were less likely to enter the market, multihospital systems were less likely to be formed, and hospitals were less likely to be managed under for‐​profit contract.11 Nor does CON regulation appear to improve quality.12 The Federal Trade Commission and Department of Justice write, “CON programs risk entrenching oligopolists and eroding consumer welfare.”13 Twenty‐​two states suspended their CON regulations during the COVID-19 pandemic, an implicit acknowledgment that CON regulation reduces access to care.14 Excessive Insurance A second category of government intervention that encourages inefficient consolidation is policies that make consumers insensitive to prices for health insurance and medical care. These policies include the tax exclusion for employer‐​sponsored health insurance and regulations that require consumers to purchase certain types or levels of coverage. Consumer price‐​consciousness acts as a check on providers’ ability to amass market power and charge excessive prices. To the extent consumers are price‐​conscious, they respond to excessive prices by switching to lower‐​price providers. Health insurance makes consumers less price‐​sensitive. It “removes the incentive on the part of individuals, patients, and physicians to shop around for better prices for hospitalization and surgical care”15 because the savings go to the insurance company rather than to the consumer. It therefore encourages inefficient consolidation by diminishing the market’s ability to punish it. Health insurance nevertheless increases efficiency on balance. While the moral‐​hazard effect of health insurance inevitably leads to higher medical prices, premium‐​paying consumers balance the marginal costs of moral hazard (including inefficient consolidation) against the marginal benefits of risk protection. To the extent consumers pay the premiums themselves, many will support or tolerate efforts by insurers to steer them toward lower‐​cost providers in exchange for lower premiums. Government policies that encourage excessive levels of coverage upset that balance and lead to inefficient consolidation by making insured consumers less price‐​sensitive. Obamacare’s “essential health benefits” mandate and more than a thousand mandated‐​coverage requirements at the state level require consumers to purchase more coverage than they otherwise would.16 These regulations diminish the market’s ability to punish inefficient consolidation both by blocking entry into health insurance markets and by making consumers even less price‐​conscious when consuming medical care. The tax exclusion for employer‐​sponsored health insurance diminishes price‐​consciousness when consumers purchase both medical care and health insurance.17 The exclusion leads workers to demand excessive coverage in at least two ways. First, it reduces the after‐​tax price of health insurance relative to other goods and services. That price distortion leads workers to demand more coverage than they otherwise would. Second, it creates the illusion that employers, rather than workers themselves, bear most of or all the cost of employee health benefits. That illusion leads workers to demand more coverage than they would if they knew they bear the full cost.18 The exclusion therefore encourages inefficient consolidation in at least two ways. First, encouraging excessive coverage diminishes the market’s ability to punish inefficient consolidation. Second, insulating workers from the price of their health insurance makes workers less likely to tolerate efforts by insurers to punish inefficient consolidation by steering enrollees toward lower‐​price providers. Both of these effects—insurers purchasing a larger share of medical spending and greater enrollee resistance to insurers’ negotiating strategies—increase the rewards for inefficient provider consolidation. They allow providers to demand even higher prices from insurers, who face strong incentives to accede rather than face a backlash from their price‐​insensitive enrollees. Government Purchasing A third category is government purchasing of medical care. The pricing errors that inevitably accompany government price‐​setting and purchasing provide powerful incentives for producers to merge and consolidate. Medicare itself sets the total price it pays doctors and hospitals for each individual service. Medicare often pays more when similar patients receive the same service in a hospital versus a physician’s office. “When a cardiologist in private practice provided a level II echocardiogram without contrast,” for example, “Medicare paid $188. But, when a doctor connected to a hospital performed the same test in an outpatient context, the payment was $452.89. That’s an additional $265 that the hospital and doctor can share—including an additional $212 from taxpayers and $53 from the patient—to their mutual advantage.”19 Such “site of service” pricing errors occur throughout Medicare: In 2012, Medicare paid an average of $1,300 for colonoscopies performed in doctors’ offices, but it shelled out $1,805—39 percent more—when these procedures were delivered at hospitals.… When a hospital gives a lung cancer patient a dose of Alimta, its fee is about $4,300 larger than a doctor with an independent practice would receive. For Herceptin, a drug given to women with breast cancer, the site‐​of‐​service differential is about $2,600. And for Avastin, when used to treat colon cancer, it is $7,500.20 Figure 1 shows Medicare’s site‐​of‐​service price differentials when similar enrollees received identical evaluation and management services in hospitals versus physicians’ offices in 2013. Looking only at evaluation and management services in just eight states, Medicare’s site‐​of‐​service pricing errors cost taxpayers $1.3 billion and Medicare enrollees $334 million from 2010 through 2017.21 Equivalently, just this one category of site‐​of‐​service pricing errors created $1.6 billion in incentives for providers in those states to consolidate. Site‐​of‐​service differentials could be appropriate if hospitals were treating patients who require more services than a physician’s office can provide. In many cases, however, such as evaluation and management (E&M) office visits, patients are similar across settings and generally do not require the more‐​intensive services hospitals offer. Higher payments for hospitals are therefore not appropriate because “hospitals should not need to maintain standby capacity for E&M office visits that are not provided in an emergency department, nor should requirements to stabilize patients presenting at the emergency room affect the costs of furnishing E&M office visits.”22 Indeed, Medicare pays higher prices even when patients continue to receive the same services in the same physician’s office simply because a hospital purchased the physician’s practice.23 Congress and the Centers for Medicare & Medicaid Services have taken steps to reduce site‐​of‐​service pricing errors.24 Even if existing reforms had been in place from 2010 to 2017, however, site‐​of‐​service pricing errors for evaluation and management would still have cost taxpayers and Medicare enrollees $200 million in those eight states.25 Put differently, existing reforms to evaluation and management pricing errors would have left in place $200 million in incentives for providers in those states to consolidate. Not only are existing “site neutrality” reforms inadequate but the federal government has suspended some of them for the duration of the COVID-19 public health emergency.26 Medicare’s persistent pricing errors encourage providers to consolidate to capture and split the benefits of the excessive prices Medicare sets and pays. Once those firms merge, taxpayers pay more for the same services via the Medicare program, enrollees pay more out of pocket, and those firms’ greater market power allows them to increase prices for private payers. Stop Encouraging Inefficient Consolidation Inefficient consolidation is a result of government failure, not market failure. Government therefore is not the solution to inefficient consolidation in health care. Government is the problem. If state and federal lawmakers want to combat inefficient consolidation, they should stop doing so much to encourage it. Don’t Expand Government Most proposals to address inefficient consolidation involve additional government intervention into the health sector. Such proposals gain currency not because they would benefit consumers but because they would benefit special interests. Legislators and bureaucrats gravitate toward and promote additional government interventions out of their own self‐​interest. Additional government power further increases their own power and status. Industry interests gravitate toward and promote proposals that would let them use government to punish their rivals or that would let them benefit at the expense of taxpayers. The health insurance lobby says the solution to inefficient consolidation is to expand antitrust powers and enforcement.27 Incidentally, those proposals would allow health insurers to use government to punish hospitals. Many physicians argue that the solution to inefficient consolidation is to expand Medicare. Specifically, they argue that Medicare should subsidize physician‐​owned hospitals and that doing so would encourage entry in hospital markets.28 Indeed, it might. It would also happen to benefit, at the expense of taxpayers, the physicians who own those hospitals. History instructs that such approaches are likely to backfire. Dozens of government interventions—including government regulation generally, health care regulation, tax policy, and entitlements—have had the unintended consequence of encouraging inefficient consolidation in health care markets. Additional government regulation is more likely to encourage such consolidation or produce other unintended consequences than it is to fix the problem. Reduce Regulatory Burdens across the Board To curb inefficient consolidation, government should outright repeal or drastically curtail regulations that encourage it. Eliminating any government regulation with high fixed costs and low marginal costs would reduce incentives for health care providers, insurers, and other producers to consolidate and would increase competition by removing barriers to market entry. The scope for competition‐​enhancing deregulation is vast.29 Since 1976, federal regulators have issued more than 208,000 final regulations. In 1960, the Code of Federal Regulations comprised fewer than 23,000 pages. By 2020, it contained nearly 186,000 pages.30 The costlier the regulation, the more that eliminating it would remove incentives for inefficient consolidation and encourage competition. Repeal State Laws That Encourage Market Concentration States should repeal regulations including CON, clinician‐​licensing laws, and insurance‐​licensing laws. States should also repeal or drastically curb regulations that impede entry and competition, such as “any willing provider” laws and “network adequacy” regulation. Despite their laudatory ostensible goals, in practice these regulations do little more than protect providers from competition at the expense of consumers. Authorities such as the Federal Trade Commission, the Department of Justice, and antitrust economist Martin Gaynor recommend repealing CON laws entirely.31 Repeal would reduce barriers to entry for more‐​efficient providers, thereby reducing market concentration and health care prices. States should likewise repeal clinician‐​licensing laws. Such laws inhibit innovations including affordable primary care, interstate telehealth, and integrated delivery systems. The anti‐​competitive effects of clinician licensing reduce access to care while adding little if anything to the quality protections that would exist in its absence.32 If repealing clinician‐​licensing laws is politically infeasible, states should overhaul such laws in a manner that prevents them from blocking new categories of health professionals, innovations in medical education, or innovations in health care delivery. “States that have not done so already should adopt licensure reciprocity across states, in order to facilitate entry and the advance of innovative ways of organizing and delivering care.”33 In addition, states should certify multiple private organizations to perform the functions of state licensing boards.34 Gaynor argues that states should further increase competition and curb excessive prices by repealing “any willing provider” regulations and curtailing network‐​adequacy regulation.35 Any‐​willing‐​provider regulations protect high‐​price providers from price competition by preventing insurers from steering enrollees toward more‐​efficient providers. The result is higher prices and premiums. Network‐​adequacy regulations inhibit competition among both insurers and providers and “can also undermine attempts by insurers to promote competition” and lower prices.36 Akin to clinician‐​licensing laws, state insurance‐​licensing laws block entry by health insurance products available in other jurisdictions. They contribute to market concentration and higher premiums by protecting incumbent insurers from competition by new entrants. They further increase premiums by denying consumers the opportunity to escape unwanted regulatory costs. Of particular moment, they block entry by products from U.S. territories, where Obamacare’s costliest regulations do not apply and insurers can therefore offer lower‐​cost, higher‐​quality health plans. If repealing insurance‐​licensing laws is politically infeasible, states can increase competition in their insurance markets by deeming as in compliance with their regulations any health plan that American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, or the U.S. Virgin Islands license for sale. In 2019, just two insurers—Blue Cross Blue Shield and Centene—controlled 92 percent of Florida’s individual health insurance market.37 Freeing Florida consumers to purchase any health plan that U.S. territories license for sale would open the market to competition from additional carriers such as Aetna, UnitedHealthcare, and Humana, each of which already does business in the territories and has provider networks in Florida.38 It would also reduce premiums and improve the quality of health insurance. Plans that are free from Obamacare regulations have premiums that are often 70 percent lower and offer broader provider networks.39 Repeal or Overhaul Federal Policies That Encourage Market Concentration Most government interventions that encourage inefficient consolidation occur at the federal level. Congress therefore has an even larger role to play in removing anti‐​competitive policies than states do. To start, Congress should repeal federal network‐​adequacy regulations and the “community rating” price controls that give rise to them. The purpose of network‐​adequacy regulation is to counteract the unintended consequences of community rating. Through the Medicare Advantage program and Obamacare, Congress prohibits insurers from charging actuarially fair premiums to enrollees. The stated purpose of those price controls is to eliminate discrimination against patients with preexisting conditions. Instead, community rating merely shifts discrimination against the sick to the level of benefit design, where it is even more harmful.40 Eliminating the price controls that give rise to state and federal network‐​adequacy regulations would eliminate the need for those regulations. Most important, Congress should reform the tax code and Medicare to make consumers fully price‐​conscious. Converting the current tax exclusion to an exclusion for contributions to larger, more flexible HSAs would let workers control $1 trillion of their earnings each year that employers currently control. It would also deliver the largest effective tax cut in living memory.41 Reforming Medicare using “public option” principles would transform it into a cash‐​transfer program similar to Social Security.42 Each of these reforms would partly restore the market’s ability to punish inefficient consolidation. If consumers controlled the majority of the $4 trillion that fuel the U.S. health sector, they would punish inefficient consolidation and excessive prices because they personally would reap the benefits of switching to more‐​efficient providers. Patients would not pay hospitals twice as much as what a physician’s office charges for the same service, like Medicare does. “If patients were spending their own dollars, they wouldn’t go to more expensive providers when cheaper ones were available, and just as good.”43 Empirical evidence confirms that price‐​conscious consumers can overcome producers’ market power. In California, market power allows many hospitals to charge excessive prices for hip and knee replacements. Insurers have little choice but to pay those excessive prices; the fact that their enrollees are price‐​insensitive leaves insurers unable to steer them toward lower‐​price hospitals. Why should enrollees go along when they see no benefit? An experiment that made patients who received hip or knee replacements price‐​conscious changed the behavior of both the patients and high‐​price hospitals. Once consumers personally reaped the benefit of shopping for lower prices, one‐​sixth of patients who received hip or knee replacements switched from high‐​price hospitals to low‐​price hospitals. That loss of market share led high‐​price hospitals to cut prices by 37 percent over two years—an average price reduction of $16,000 per procedure.44 Figure 2 shows that prices fell across all hospitals by roughly 20 percent and that in similar experiments, price‐​consciousness reduced prices by up to 32 percent after two years for knee and shoulder arthroscopies, cataract removals, colonoscopies, CT and MRI scans, and laboratory tests.45 These experiments illustrate how excessive health care prices have become, that price‐​unconsciousness is allowing those excessive prices to persist, and that price‐​consciousness can defeat providers’ market power. Conclusion Inefficient consolidation among hospitals and other producers in the health sector is primarily a result not of market forces but of ill‐​advised government interventions into health care markets. Government does not need any new powers to make health care better, more affordable, and more secure for all Americans, including for the most vulnerable. State legislatures and Congress need only stop encouraging inefficient consolidation. Sweeping, wholesale reform is rare. Yet merely tweaking the government interventions that encourage inefficient consolidation would continue to leave consumers in the lurch. Eliminating anti‐​competitive government policies in health care may literally be a matter of life and death.

US health care costs growing and undermine the economy

 

Peter Peterson Foundation, April 27, 2022, Why the American Health Care System Underperforms, https://www.pgpf.org/blog/2022/04/why-the-american-healthcare-system-underperforms

Healthcare in the United States is very expensive — but we don’t get what we pay for. The United States will spend a projected $4.5 trillion — or 18 percent of the national economy — on healthcare in 2022. On a per capita basis, we spend nearly triple the average of other developed countries. Nonetheless, our health outcomes are generally no better than those of our peers, and in some cases are worse, including in areas like life expectancy, infant mortality, and diabetes. Our underperforming healthcare system lacks some of the factors that fuel innovation in other industries and countries: Consumers have not been cost sensitive because their employers and health plans often cover a large share of their costs, and because they lack the information required to assess quality and cost. Providers generally operate under a fee-for-service model in which they are compensated based on the volume of their services, rather than the value of the care they provide. Improvements in technology often make healthcare more expensive. The result is a system in which, without reform, costs will continue to increase. Total healthcare costs — including all private and public spending — are anticipated to rise from $4.5 trillion in 2022 to $6.8 trillion by 2030, growing by an average of 5.1 percent per year, according to the Centers for Medicare and Medicaid Services. Healthcare spending is projected to grow faster than the economy, increasing from 18.2 percent of gross domestic product (GDP) in 2022 to 19.6 percent of GDP in 2030. Such increased costs will be felt by all Americans — for example, in the form of increased prescription drug costs — as well as by the U.S. government in the form of higher spending on major federal health programs like Medicare and Medicaid. A healthcare system with high costs and less favorable outcomes undermines our economy and threatens our long-term fiscal and economic well-being. Fortunately, there are opportunities to transform our healthcare system into one that produces higher-quality care at a lower cost. For more information on potential reforms, visit our solutions page and the Peterson Center on Healthcare.

Economic loss occurs across multiple sectors

 

Ryan Nunn, Jana Parsons, and Jay Shambaugh Tuesday, March 10, 2020, A dozen facts about the economics of the US health-care system, https://www.brookings.edu/research/a-dozen-facts-about-the-economics-of-the-u-s-health-care-system/

The health-care sector is in many ways the most consequential part of the United States economy. It is a fundamental part of people’s lives, supporting their health and well-being. Moreover, it matters because of its economic size and budgetary implications. The health-care sector now employs 11 percent of American workers (Bureau of Labor Statistics [BLS] 1980–2019b and authors’ calculations) and accounts for 24 percent of government spending (Centers for Medicare & Medicaid Services [CMS] 1987–2018; Bureau of Economic Analysis 1987–2018; authors’ calculations).[1] Health insurance is the largest component (26 percent) of nonwage compensation (BLS 2019b) and health care is one of the largest categories of consumer spending (8.1 percent of consumer expenditures; BLS 2019a). A well-functioning health-care sector is therefore a prerequisite for a well-functioning economy. Unfortunately, the problems with U.S. health care are substantial. The United States spends more than other countries without obtaining better health outcomes (Papanicolas, Woskie, and Jha 2018). Health care is growing as a share of the economy and government budgets in ways that appear unsustainable (CMS 1960–2018; Organisation for Economic Co-operation and Development [OECD] 2015). This growth has slowed at times; health spending as a share of GDP was roughly flat in much of the 1990s, and growth has also slowed to some extent in recent years. But even if expenditures as a share of GDP plateaued at their current level, they would still represent a massive expenditure of resources. Sixty years ago, health care was 5 percent of the U.S. economy, as can be seen in figure A; at 17.7 percent in 2018, it was more than three times that. This growth represents a range of factors, from new health-care treatments and services to better coverage, higher utilization, and rising prices. Some of these changes are desirable: As a country gets richer, spending a higher share of income on health may be optimal (Hall and Jones 2007).[2] Countries with a higher level of output per capita tend to have a higher level of health expenditures per capita (Sawyer and Cox 2018). In addition, as the population ages, health deteriorates and health-care spending naturally rises. Finally, if productivity advancements are more rapid in tradable goods like agriculture or manufacturing than in services like health care or education, the latter will tend to rise in relative price and as a share of GDP.[3] But some of the increase in health-care costs is undesirable (Cutler 2018). Rent-seeking, monopoly power, and other flaws in health-care markets sometimes result in unnecessary care or in elevated health-care prices. In several of the facts that follow, we describe these factors and how they are shaping health care. Spending by private and public payers have both increased. The United States has a health-care system that largely consists of private providers and private insurance, but as health care has become a larger part of the economy, a higher share of health-care funding has been provided by government (figure B). As of 2018, 34 percent of Americans received their health care via government insurance or direct public provision (Berchick, Barnett, and Upton 2019). As shown in figure C, health care has doubled as a share of total government expenditures in the last three decades, from 11.9 percent in 1990 to 24.1 percent in 2018. This increase comes from the rising shares of the population enrolled in Medicare, Medicaid, state Children’s Health Insurance Programs, and veterans’ health benefits. Policy changes like the introduction of the Medicare prescription drug benefit (Part D) in 2006 and a major expansion of Medicaid eligibility in 2014 played important roles. At the same time, spending on discretionary programs like education and research and development have decreased as a share of GDP (Congressional Budget Office 2020). If health expenditures continue to increase as a share of government spending, the increase will eventually necessitate either tax increases or reduced spending on other important government functions like public safety, infrastructure, research and development, and education. Of course, health costs are also borne by the private sector. Firms and households in the United States spent 10 percent of GDP on health care in 2018. Despite widespread coverage—as of 2018, 91.5 percent of Americans had either private or government health insurance for all or part of the year (Berchick, Barnett, and Upton 2019)—many people still face large and variable out-of-pocket health-care costs. In 2017, more than 1 in 50 Americans who interact with the health-care system have out-of-pocket costs in excess of $5,000, and 1 in 200 have costs over $10,000.[4] At the other end of the distribution, roughly one in seven have no out-of-pocket costs at all in a given year (figure D).[5] The upper end of the distribution of out-of-pocket costs dwarfs the liquid resources of many U.S. households, meaning that many people faced with a negative health shock may also find themselves in financial trouble. Negative health shocks tend to be associated with loss of income, thereby compounding the problem (Garcia-Gómez et al. 2013). Unexpected health costs can generate bankruptcies and ongoing financial hardship (Gross and Notowidigdo 2011).[6] In this document, we provide 12 facts about the economics of U.S. health-care, focusing largely on the private-payer system. We highlight the surge in health-care expenditures and their current high level. We note the wide variation of expenditures across individuals—something that necessitates insurance. We document that the United States pays higher prices than most countries and that these prices vary widely across and within places. We show that a lack of competition and high administrative costs are especially important contributors to high expenditures, indicating the need for reforms to reduce costs in the United States. To keep the focus on these issues, we do not discuss questions of coverage or of how coverage is provided (publicly or via the market), but instead address the questions of why expenditures, costs, and prices are so high. This analysis aims to promote The Hamilton Project’s mission to support broadly shared economic growth. Removing excess costs from the health-care system is both an economic imperative and a complement to policy efforts to improve health-care access and outcomes. In the following facts we provide context for understanding the landscape of policy options for reducing costs in the health-care system.

 

Discrimination and a lack of access to reproductive health care undermine US soft power and the credibility of the democratic model

Repnikova, July/August 2022, Foreign Affairs, The Balance of Soft Power: The American and Chinese Quests to Win Hearts and Minds, https://www.foreignaffairs.com/articles/china/2022-06-21/soft-power-balance-america-china

Looking ahead, the United States and China will face distinctive challenges in soft-power promotion. Washington’s approach draws scrutiny because of the disconnect between the country’s emphasis on democratic values and its inconsistent adherence to them. Democratic erosion, pervasive racial discrimination, and attacks on reproductive rights at home detract from the United States’ image as an inspirational democracy. In workshops with U.S. State Department officials, I have sensed a growing awareness of the need to address these issues but also a sense of fear that doing so publicly would put the United States at a disadvantage vis-à-vis China. “Wouldn’t it make us look weak?” asked one official when I suggested that U.S. public diplomacy could convey more candor and humility about the challenges facing American democracy.

What is included in, “Medicare for All”/”Single Payer”

Lefkowitz, 2022, Ken Lefkowitz is a former consultant and Senior Director for major corporations, including AstraZeneca and PECO Energy. Ken designed and managed healthcare plans for hundreds of thousands of employees and their dependents. He has negotiated with major health insurers and managed large corporate self-insured plans. A number of his writings about healthcare have been published in the Washington Post, Courier Post/USA Today Network, Philadelphia Inquirer, and the New York Times. Ken earned a BA degree from Brooklyn College, MS degree from City Ken Lefkowitz is a former consultant and Senior Director for major corporations, including AstraZeneca and PECO Energy. Ken designed and managed healthcare plans for hundreds of thousands of employees and their dependents. He has negotiated with major health insurers and managed large corporate self-insured plans. A number of his writings about healthcare have been published in the Washington Post, Courier Post/USA Today Network, Philadelphia Inquirer, and the New York Times. Ken earned a BA degree from Brooklyn College, MS degree from City University of New YorkLefkowitz, Ken. Medicare for All (p. i). Taylor and Francis. Kindle Edition.  Medicare for All: An Economic Rationale

Outline of Medicare For All Before we begin the exploration of our current system’s flaws and shortcomings, it is important to outline the definition of Medicare For All so the reader can gain an understanding of the program’s essentials and parameters. Two Medicare For All bills have been introduced in Congress, one originally in the House by Representative Jayapal, HR 1384 in March 2019, and another in the Senate, S1129, by Senator Sanders in April 2019, who humorously said in a discussion about Medicare For All elements during the Democratic Presidential debates, “I wrote the damn bill.” Quite similar in content, both bills present the key elements of a Medicare For All program, defining it as a single-payer universal healthcare coverage plan. Here are their key elements: Every resident receives a healthcare coverage card; Comprehensive coverage is provided for doctor, hospital, dental, vision, mental health, medical supplies, pharmaceuticals, and long-term care; There are no deductibles or copays; Private duplicate coverage is banned; The plans are exempt from the Hyde Amendment that bans government spending on women’s right to choose. Under each plan, doctors, hospitals, and other medical providers remain independent and operate freely. Patients are free to choose any doctor or hospital since the delivery of care continues to remain in private hands. Continued free choice of each person to select their own doctors and hospitals is assured. Neither plan is a government takeover of healthcare. Only funding and coverage are addressed. Lefkowitz, Ken. Medicare for All (p. 3). Taylor and Francis. Kindle Edition.

US health care spending is double the next highest spender

 

Lefkowitz, 2022, Ken Lefkowitz is a former consultant and Senior Director for major corporations, including AstraZeneca and PECO Energy. Ken designed and managed healthcare plans for hundreds of thousands of employees and their dependents. He has negotiated with major health insurers and managed large corporate self-insured plans. A number of his writings about healthcare have been published in the Washington Post, Courier Post/USA Today Network, Philadelphia Inquirer, and the New York Times. Ken earned a BA degree from Brooklyn College, MS degree from City Ken Lefkowitz is a former consultant and Senior Director for major corporations, including AstraZeneca and PECO Energy. Ken designed and managed healthcare plans for hundreds of thousands of employees and their dependents. He has negotiated with major health insurers and managed large corporate self-insured plans. A number of his writings about healthcare have been published in the Washington Post, Courier Post/USA Today Network, Philadelphia Inquirer, and the New York Times. Ken earned a BA degree from Brooklyn College, MS degree from City University of New YorkLefkowitz, Ken. Medicare for All (p. i). Taylor and Francis. Kindle Edition.  Medicare for All: An Economic Rationale

The UK spends the least at about $4,000 followed by Japan, France, Canada, Holland, and Sweden clustered around $5,000. Germany is next at closer to $6,000. For a broader perspective, we calculated the average of the European Union which is very nearly the same as the UK at $4,000. The most striking amount on the chart is the United States that spends in excess of $11,000, more than twice that of all the other countries except one. That country is Germany against whom the United States falls just short of spending double. Lefkowitz, Ken. Medicare for All (p. 5). Taylor and Francis. Kindle Edition.

Despite the highest healthcare spending in the world, the US ranks low in care’s impact

 

Lefkowitz, 2022, Ken Lefkowitz is a former consultant and Senior Director for major corporations, including AstraZeneca and PECO Energy. Ken designed and managed healthcare plans for hundreds of thousands of employees and their dependents. He has negotiated with major health insurers and managed large corporate self-insured plans. A number of his writings about healthcare have been published in the Washington Post, Courier Post/USA Today Network, Philadelphia Inquirer, and the New York Times. Ken earned a BA degree from Brooklyn College, MS degree from City Ken Lefkowitz is a former consultant and Senior Director for major corporations, including AstraZeneca and PECO Energy. Ken designed and managed healthcare plans for hundreds of thousands of employees and their dependents. He has negotiated with major health insurers and managed large corporate self-insured plans. A number of his writings about healthcare have been published in the Washington Post, Courier Post/USA Today Network, Philadelphia Inquirer, and the New York Times. Ken earned a BA degree from Brooklyn College, MS degree from City University of New YorkLefkowitz, Ken. Medicare for All (p. i). Taylor and Francis. Kindle Edition.  Medicare for All: An Economic Rationale

The rather dramatic difference in spending between the United States and other countries as shown in Figure 2.1 may easily lead us to believe that the quality and performance of healthcare in the United States is at a level far in advance of other nations. However, most alarming is the fact that despite the high cost, the United States was ranked last of 11 developed countries in performance and quality by the Commonwealth Fund Study of Health Quality.3 Such a contrast is not just disturbing from an overall health perspective, it also indicates quite clearly that our country is failing miserably in getting value for its healthcare dollar. An analogy is a person who paid $1,000 for a service they could purchase elsewhere for $512. We all would consider such a person quite foolish. Yet, that’s the situation facing healthcare in America today. The charts on the following pages clearly display categories in which the United States sadly lags behind other countries. First is Life Expectancy, a generally accepted measure of healthcare quality as shown in Figure 2.2. Of course, quite a few other factors are involved in life span, but healthcare is a major determinant. The Life Expectancy Chart clearly demonstrates that the United States trails other industrialized countries at 78.6 years compared with Germany, the UK, Canada, France, Sweden, and Italy in which citizens live between 81 and 83 years.

Another quality measure is Infant Mortality. As Figure 2.3 clearly shows, the United States tragically leads most industrialized nations. The United States has 5.9 deaths in the first year of life per 1,000 births, compared with Canada at 4.5, France at 3.8, Germany and Australia at 3.3, Italy at 2.7, and Sweden at the lowest of 2.4 deaths per 1,000 births in the first year of life.

A third important quality measure is maternal mortality, expressed as deaths per 100,000 births. Here, again, as can be clearly seen on Figure 2.4, the United States has a dismal record when compared with other industrialized countries. The United States leads the pack by far with an appalling 26.4 maternal deaths per 100,000 births compared with France, Canada, the UK, Germany, and Australia which ranged from a low of 1.6 deaths to 8.7 deaths. In addition to these three measures focusing on longevity, a number of studies including those reported by the Commonwealth Fund indicate that the United States also performs poorly in managing chronic disease, which in its many forms is growing in America.3 Chronic disease includes arthritis, asthma, chronic lung disease, diabetes, heart disease, heart attack, hypertension, or high blood pressure. The OECD reports the United States has among the highest rates of hospitalizations from preventable causes like diabetes and hypertension.2 Additionally, the Commonwealth Fund reports that the United States has the highest rate of avoidable deaths overall.3

Another quality indicator, reported in the medical journal Lancet, and outlined in an article in the New York Times, “deaths avoidable through healthcare” is a newer complex measure of mortality. The measure takes into account how well each country examined fares at preventing deaths that could be avoided by applying known medical interventions like successful surgeries, treatment of birth problems, breast, colon, and skin cancer, diabetes, heart disease, and lymphoma. The United States ranked 35th of the nations measured with Switzerland, Sweden, Iceland, Norway, and Australia at the highest ranked. Dr. Christopher Murphy, the report’s chief author and director of the University of Washington’s Institute for Health Metrics and Evaluation, offered his view of the results as quoted in the New York Times, “It’s an embarrassment, embarrassment, especially considering how much the US spends on healthcare per person.”4 Dr. Murphy’s comment sums up the key point of this chapter, compared with other countries, the quality of healthcare in the United States is far from exemplary, especially in light of the fact that America spends more than double what other industrialized countries do on healthcare. For a country that prides itself on efficiency and effectiveness, this is not a pretty picture. Lefkowitz, Ken. Medicare for All (p. 8). Taylor and Francis. Kindle Edition.

Relying on the free market dramatically raises costs

 

Lefkowitz, 2022, Ken Lefkowitz is a former consultant and Senior Director for major corporations, including AstraZeneca and PECO Energy. Ken designed and managed healthcare plans for hundreds of thousands of employees and their dependents. He has negotiated with major health insurers and managed large corporate self-insured plans. A number of his writings about healthcare have been published in the Washington Post, Courier Post/USA Today Network, Philadelphia Inquirer, and the New York Times. Ken earned a BA degree from Brooklyn College, MS degree from City Ken Lefkowitz is a former consultant and Senior Director for major corporations, including AstraZeneca and PECO Energy. Ken designed and managed healthcare plans for hundreds of thousands of employees and their dependents. He has negotiated with major health insurers and managed large corporate self-insured plans. A number of his writings about healthcare have been published in the Washington Post, Courier Post/USA Today Network, Philadelphia Inquirer, and the New York Times. Ken earned a BA degree from Brooklyn College, MS degree from City University of New YorkLefkowitz, Ken. Medicare for All (p. i). Taylor and Francis. Kindle Edition.  Medicare for All: An Economic Rationale

The United States, under its free market system, spends nearly five times in hospital billing and administration per capita, $1,008, than Canada spends, $209, under its single-payer healthcare system. These costs are reflected in the higher prices of healthcare in the United States that we explored in Chapter 2. The huge disparity in these costs is a result of the numerous healthcare insurers, plans, and rate structures in the United States, as we explained previously in this chapter. To illustrate this point, Dr. David Cutler indicated on a PBS news interview, based on data reported in the Journal of the American Medical Association (JAMA), in 2018 the Duke Medical Center, one of America’s premier hospitals employed 1,600 billing clerks for just under 1,000 beds, more than one billing clerk per hospitalized patient!3 An icon in American Healthcare, the Cleveland Clinic, reported the following in Modern Healthcare of September 30, 2019: Compounding the complexity, we have many different payers and multiple different products within each payer. Specifically, we estimate that we have 3,000 contracted rate schedules across the Cleveland Clinic … system. Further, our chargemaster reflects over 70,000 lines …. Thus, the number of data points needed to be posted would exceed 210 million ….4 The Duke Medical Center’s and The Cleveland Clinic’s information are indicative of the waste and duplication in America’s current free market healthcare system. Since the information is focused on hospital settings, it is also important to examine the effect of our free market system on doctor’s administrative costs. Lefkowitz, Ken. Medicare for All (p. 23). Taylor and Francis. Kindle Edition.

High medical costs ruin many economically

 

Lefkowitz, 2022, Ken Lefkowitz is a former consultant and Senior Director for major corporations, including AstraZeneca and PECO Energy. Ken designed and managed healthcare plans for hundreds of thousands of employees and their dependents. He has negotiated with major health insurers and managed large corporate self-insured plans. A number of his writings about healthcare have been published in the Washington Post, Courier Post/USA Today Network, Philadelphia Inquirer, and the New York Times. Ken earned a BA degree from Brooklyn College, MS degree from City Ken Lefkowitz is a former consultant and Senior Director for major corporations, including AstraZeneca and PECO Energy. Ken designed and managed healthcare plans for hundreds of thousands of employees and their dependents. He has negotiated with major health insurers and managed large corporate self-insured plans. A number of his writings about healthcare have been published in the Washington Post, Courier Post/USA Today Network, Philadelphia Inquirer, and the New York Times. Ken earned a BA degree from Brooklyn College, MS degree from City University of New YorkLefkowitz, Ken. Medicare for All (p. i). Taylor and Francis. Kindle Edition.  Medicare for All: An Economic Rationale

In the prior chapters, we have defined the magnitude of the extremely high healthcare costs in America and have examined the underlying causes and reasons for those costs. In this chapter, we will explore the economic burden such costs place on the population as the result of expanding medical debt. We will also consider the pressures these costs place on employers that provide healthcare coverage for between 160 million and 170 million residents of this country. As indicated in Chapter 2, it’s important to understand that no one is immune from escalating healthcare costs. Even for those who are fortunate to be covered by employer plans, a 2020 Kaiser Family Foundation Survey reported that the amount an employee pays for her/his healthcare coverage averages $5,600 a year for family coverage with an average deductible of $1,650 annually.1 In fact, a 2020 US Bureau of Labor Statistics survey of employee healthcare costs shows that family coverage for those covered by employer plans was $6,800 annually.2 This amount is over $1,000 higher than the Kaiser survey probably because of the survey’s participant mix, leaning more heavily toward smaller employers which pay more for coverage. These costs have been raising every year and continue to escalate, representing a significant economic burden for many Americans. Since 2010, these premiums have risen by about 50%, more than double the rise in wages or inflation, and are even affecting many former “Cadillac plans” under which employee contributions have been historically low or nonexistent. Some 30 million Americans are uninsured and without health insurance coverage protection against medical costs.3 And many of those with insurance are dangerously exposed to the high costs of medical care resulting from a number of factors. First, as mentioned above, is the escalating costs of insurance premiums and high deductibles even in the best of coverage plans. Then, because of the high cost of quality coverage, many are driven to less expensive high deductible plans, where the economic exposure is quite substantial before the deductible is met. There is also the issue of many plans that cover only a certain percentage of the cost of care. Even in high-quality plans, 80/20 cost-sharing in which a person is responsible for 20% of the costs is not unusual. With ever increasing healthcare costs, that 20% amount in actual dollars continues to grow each year. Also, there is the issue of surprise billing as explained in Chapter 2, where for reasons beyond a person’s control they are billed by a medical provider or facility outside of the network of their insurance company. Although the Biden Administration is addressing this issue, it still remains problematic. Lastly, recently exacerbated by the COVID-19 pandemic, is the folly of tying healthcare coverage to employment. As people leave a job because of downsizing and layoffs among other reasons, they are exposed to the potential of catastrophic medical costs in between jobs. COBRA, the Consolidated Omnibus Budget Reconciliation Act, gives employees who lose their health benefits the right to continue coverage for a limited period of time, but is frequently too expensive because the employee typically is required to pay the full amount of the insurance without their employer’s contribution. And the benefit can expire before the employee obtains another job. So, for all of the reasons outlined above, Americans bear the weight of the high cost of healthcare in the United States which has become a major contributing factor in many bankruptcies. The Commonwealth Fund reported that many adults in the United States are faced with medical debt problems: 43% had used up all their savings to pay their bills, 43% had received a lower credit rating as a result of their debt, 32% strained credit card debt, and 18% said they had delayed education or career plans.4 A recent survey entitled “The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey” by L. Hamel et al. presented revealing information about the issue of the economic burden of high healthcare costs.5 It reported that nearly one quarter of Americans within the age group of 18–64 experience problems paying medical bills. Among those with medical bill problems, nearly half indicate that the bills have had a major impact on their families. And although those with lower incomes are more likely than higher income people to report problems paying medical bills, among those who had problems paying medical bills, those with higher incomes are just as likely to report that the bills had a major impact. Lefkowitz, Ken. Medicare for All (p. 27). Taylor and Francis. Kindle Edition.

Medicare for All lowers costs

 

Lefkowitz, 2022, Ken Lefkowitz is a former consultant and Senior Director for major corporations, including AstraZeneca and PECO Energy. Ken designed and managed healthcare plans for hundreds of thousands of employees and their dependents. He has negotiated with major health insurers and managed large corporate self-insured plans. A number of his writings about healthcare have been published in the Washington Post, Courier Post/USA Today Network, Philadelphia Inquirer, and the New York Times. Ken earned a BA degree from Brooklyn College, MS degree from City Ken Lefkowitz is a former consultant and Senior Director for major corporations, including AstraZeneca and PECO Energy. Ken designed and managed healthcare plans for hundreds of thousands of employees and their dependents. He has negotiated with major health insurers and managed large corporate self-insured plans. A number of his writings about healthcare have been published in the Washington Post, Courier Post/USA Today Network, Philadelphia Inquirer, and the New York Times. Ken earned a BA degree from Brooklyn College, MS degree from City University of New YorkLefkowitz, Ken. Medicare for All (p. i). Taylor and Francis. Kindle Edition.  Medicare for All: An Economic Rationale

In this chapter, we will explore the cost savings that can be realized from moving away from America’s current free market system to Medicare For All, a single-payer system similar to Canada’s National Health Plan, NHP. We begin with the graph in Figure 6.1 comparing healthcare costs as a percent of gross domestic product (GDP)1 The graph compares the healthcare costs of single-payer system with a free market system, both before its implementation and then afterward over many years. GDP is all the money spent on goods and services in a given period, used as a general measure of a country’s economy. Using costs as a percent of GDP levels the playing field in terms of the size of a country’s economy. The period covered is 1970 to 2019 comparing Canada and the United States. The graph is very revealing. It presents a comparison of the cost of the free market system in the United States to a single-payer system in Canada. The Canadian National Health System (NHP on the graph) is referred to as Medicare by many Canadians. A few very notable observations begin in 1970 prior to Canada adopting its single-payer system. The reader can clearly see that healthcare costs in Canada, as a percent of GDP, were higher than US healthcare costs as a percent of GDP before the implementation of the Canadian single-payer system. Then, when it was fully implemented, costs dropped dramatically and decreased below those of the United States, graphically demonstrating the savings that can be realized from a single-payer system like Medicare For All. Perhaps, even more important, since adopting its plan in 1972, Canada has seen its healthcare costs rise, but at a much lower rate than the United States, as the U.S. and Canada lines diverge over nearly 50 years, demonstrating that a single-payer system not only immediately saves money as against a free market system, but also controls costs much more effectively over time. This contrast is even more pronounced because Canada does not include prescription drugs in its NHP (see Appendix), and if it did, healthcare costs would be even lower. Also, Canada’s lower costs are achieved with higher quality scores than the United States (examples are in Chapter 2) as reported by the Organisation for Economic Co-operation and Development (OECD) and Commonwealth Fund in the studies identified in footnotes 2 and 3 in Chapter 2. Such a comparison clearly illustrates the cost-effectiveness of a single-payer system, like Medicare For All, versus a free market system in the United States. Is the reduction of overhead and other costs associated with a plethora of insurance companies, as we explored in the prior chapter, the only factor in the cost-effectiveness of a single-payer system? Although it is a critical factor in cost reduction, there is another major factor at work, the national negotiating leverage with doctors, hospitals, pharmaceutical companies, and other healthcare providers. Medicare currently pays doctors, hospital, and other providers lower fees because of its negotiating leverage, based on the number of lives it covers and plan consistency, versus that of any single insurance company. The Centers for Medicare and Medicaid Services, CMS, estimates that Medicare pays doctors a much smaller rate than what private insurers

Medicare for All is a single payer system

 

Physicians for National Health Care, 2022, Understanding the Medicare for All Act of 2022, https://pnhp.org/what-is-single-payer/senate-bill/

Sen. Bernie Sanders (I-Vt.) has introduced substantive single-payer legislation in the U.S. Senate. The Medicare for All Act (S.4204), which was filed May 12, 2022, would establish a publicly-funded national health program that would guarantee comprehensive, high-quality care for all residents of the United States.

Medicare for All contains global budgets that promote equity

Physicians for National Health Care, 2022, Understanding the Medicare for All Act of 2022, https://pnhp.org/what-is-single-payer/senate-bill/

Based on our analysis, we find the Medicare For All Act of 2022 to be a significant step forward in the fight for single payer. Taken together with Rep. Pramila Jayapal’s Medicare for All Act (H.R. 1976), it would transform U.S. health care from a market commodity into a full-fledged human right.

The 2022 bill includes some major improvements from the 2019 version, bringing it closer to PNHP’s gold standard as established by the Physicians Proposal.

Global budgeting of hospitals and other institutional providers: Global budgets would fund hospitals with annual lump sum payments which can be used for patient care — not for profits, advertising, or executive bonuses — with separate funding for capital projects. PNHP estimates that global budgets would save $220 billion per year; they would also prevent hospital closures by providing facilities in rural and other underserved communities with stable funding, which can be quickly supplemented during public health emergencies. Global budgets also promote health equity by funding services and capital projects based on community health needs (i.e., mental health, obstetrics, and HIV care), not what’s most profitable for hospitals (i.e., elective surgeries).

Health care is a collection of goods, not a right, and giving it to everybody kills quality and availability

 

Sally Pipes, 6-30, 22, Town Hall, Health Care Is Not a Right, No Matter What the Left Says, https://townhall.com/columnists/sallycpipes/2022/06/30/health-care-is-not-a-right-no-matter-what-the-left-says-n2609544

At the recent unveiling of his latest plan for Medicare for All, Sen. Bernie Sanders, I-Vt., evoked a familiar theme. “Health care,” he said, “is a human right that all Americans, regardless of income, are entitled to.”But health care is neither a right nor a privilege. It’s an aggregate of goods and services. The task of health policy is to ensure timely, affordable access to these goods and services for all who need them — and to do so without sacrificing the quality of care. Medicare for All would outlaw private health insurance and grant everyone a right to public coverage. All Americans would have an insurance card with their name on it. But as real-world evidence from Medicare for All-like systems abroad makes clear, access to coverage is not the same as access to care. That’s because there’s a limited supply of health care, just like any other good or service. Unlimited demand — fueled by Medicare for All’s promise that care will be free at the point of delivery — paired with limited supply is a recipe for shortages, long waits, and suffering far worse than anything Americans see under our current system. Great Britain’s National Health Service, the single-payer system established in 1948, has subjected patients to life-threatening treatment delays and subpar care for generations. And that crisis has only grown more acute in recent years. According to a report released last month, a record-high 6.4 million patients in England were waiting for care. A separate study released May 31 by the Royal College of Emergency Medicine found that a lack of capacity in NHS emergency rooms was causing “real patient harm” and was a “serious patient safety crisis. In Canada, the situation is much the same. The typical wait time for Canadian patients to receive specialist care following referral by a general practitioner is over 25 weeks, according to the Fraser Institute, a Vancouver-based research organization. Median wait times in some provinces now exceed a year. It’s no surprise, then, that more than 200,000 Canadians leave the country to seek care, according to a 2017 analysis from SecondStreet.org, a Canadian think tank. Single-payer absolutists in the United States almost never acknowledge the bleak conditions in these and other government-run health systems. On the contrary, these are the very healthcare schemes Sanders lauds when he laments that America is “the only major country on earth that does not guarantee health care to all of its citizens.” But in what sense does the United Kingdom or Canada “guarantee health care to all its citizens?” Months- or years-long waits for needed care mock such guarantees. As former Chief Justice of the Canadian Supreme Court Beverley McLachlin wrote in a 2005 decision challenging the Canadian system’s ban on private insurance coverage, “Access to a waiting list is not access to health care.”

 

Loss of ACA subsidies will explode the number of uninsured

 

Cynthia Cox, June 30, 2022, Falling off the Subsidy Cliff: How ACA Premiums Would Change for People Losing Rescue Plan Subsidies, https://www.kff.org/policy-watch/falling-off-the-subsidy-cliff-how-aca-premiums-would-change-for-people-losing-rescue-plan-subsidies/

The Affordable Care Act (ACA) offers subsidies to offset the cost of health insurance, capping how much people signing up on the ACA Marketplaces pay at a certain percent of their income. These subsidies work on a sliding scale, with people whose incomes are just above poverty receiving the most generous subsidies while those with incomes of three to four times poverty paying more. For years, people with incomes just over four times the federal poverty level were not eligible for subsidies under the ACA, meaning even a small increase in income could mean they would have to pay full price – what came to be known as the “subsidy cliff.”

That was the case until the American Rescue Plan Act (ARPA) expanded subsidy eligibility, now capping what people with higher incomes pay for a silver plan premium at 8.5% of their income. By doing so, the ARPA temporarily did away with the ACA’s subsidy cliff, in addition to enhancing subsidies for lower-income people who were already eligible for some help with premiums. Congress is considering extending these enhanced subsidies or making them permanent at an estimated cost of about $22 billion per year. If the ARPA subsidies expire, as they are set to at the end of this year, people with incomes over four times the poverty level would no longer qualify for subsidies and would have to pay full price for insurance coverage.

On average across the U.S., a 40-year-old with an income just over four times the poverty level ($51,520 per year for individuals buying coverage in 2022), will see their premium payments increase from 8.5% of their income to about 10% of their income if ARPA subsidies expire. The typical 40-year-old would go from having subsidized monthly payments of $365 to an unsubsidized $438, or an increase in their premium payment of about 20% simply due to the loss of subsidies. That’s before accounting for any increase in the unsubsidized premium from 2022 to 2023.

Because unsubsidized premiums vary so much across the country, Marketplace enrollees living in some states would pay more than those living in other states. For example, a 40-year-old with an income of just over four times the poverty level living in West Virginia or Wyoming would have to pay an average of 18% of his or her income for a silver plan without the ARPA’s subsidies. That’s an increase of over 100% in their premium payments. Meanwhile, the same person living in one of six low-premium states (Colorado, Maryland, Michigan, Minnesota, New Hampshire, and Rhode Island) already pays less than 8.5% of their income for an unsubsidized silver premium.

Older residents of high-premium states would see even steeper increases in premium payments from the loss of ARPA subsidies. Instead of paying 8.5% of their income for a silver plan, as they do under the ARPA, a 64-year-old Marketplace enrollee making just over four times the poverty level in West Virginia or Wyoming would have to pay more than 40% of their income for a silver plan if they lost access to the ARPA subsidies. That would amount to an increase of over 380% in their premium payment. Again, this is all based on 2022 premiums, so it’s not accounting for any additional increase in unsubsidized premiums heading into 2023. Insurers are just now starting to file their 2023 premiums with state regulators, but it’s likely unsubsidized premiums in many states will rise.

If the ARPA subsidies expire, premium payments will increase across the board for all 13 million subsidized Marketplace enrollees. But the approximately one million people with incomes above four times the poverty level will face a double whammy: Not only will many of them lose subsidies, but they will also have to start paying for any increase in the unsubsidized premium beyond that. The reality is that for many people, such an increase in premium payments would be unaffordable, leading them to drop their health coverage.

Single payer costs $3-$4 trillion per year, triggering both inflation and deficit increases

 

Sally Pipes, 6-30, 22, Town Hall, Health Care Is Not a Right, No Matter What the Left Says, https://townhall.com/columnists/sallycpipes/2022/06/30/health-care-is-not-a-right-no-matter-what-the-left-says-n2609544

What’s more, the “free” health care Sanders claims to offer is anything but. The Vermont senator himself has suggested that his proposal will cost taxpayers between $30 trillion and $40 trillion over the next decade — money that would have to be raised in large part through some combination of massive tax increases and enormous inflation-spurring deficits. Single-payer health care is not free elsewhere. In Canada, the average family of four pays more than $15,000 a year in taxes just to support the country’s public health insurance system. Senator Sanders wants to force all American patients into a single, enormously expensive government-run healthcare program — the kind of program which has choked off access to timely, high-quality medical care every place it’s been tried and led to needless pain and death. That’s some view of what constitutes a “human right.

US health care costs highest in the world
31 million uninsured, resulting in 36,000 deaths per year
Poor disproportionately affected
Doctor burnout now
Current system is bad for business

Andy Douglas, 6-24, 22, USA Today, Opinion: A look at the numbers shows how poor the U.S. health care system is, https://www.press-citizen.com/story/opinion/2022/06/24/opinion-statistics-show-how-poor-u-s-health-care-system/7661914001/

Health care costs in the U.S. are the highest in the world. Hospital charges in 2012 were $12,537 per day, compared to France ($883) or Argentina ($479), and this continues to be the case. The U.S. is the only major industrialized country without universal care. There are still 31 million uninsured people in the U.S., with 36,530 deaths in 2016 directly related to noninsurance . These are mostly low-income working families, who can’t afford coverage, many of them living in the several states that didn’t expand Medicaid. Friedman calls it a crisis of the underinsured: high deductibles and co-pays making people reluctant to go to the doctor. This percentage of underinsured adults is growing, while the average deductible rises. A rising number of people make no visit to the doctor in a typical year. U.S. patients skip care more often than in similar nations. For those who do go, medical bills are now the most common reason for debt collection calls. Americans spend more on prescription drugs than other citizens. An average of $1,113, versus $620 in Canada, or $534 in Germany. U.S. renal failure patients are less likely to get transplants than in other countries. A lot of this comes down to the corporatization of care. A shocking graph Friedman shared with me showed the growth of physicians and hospital administrators between 1970-2009. There was a 3,000% growth in the number of administrators. This is compared to about a 100% growth in doctors. It all started to peak in the 1990s. Despite a popular perception, overuse of the health system is not a driver of cost in the U.S. (The biggest drivers are drug costs; devices, at a significant markup; diagnostics; fees, especially for specialists; technology, including computerized medical records; fraud and malpractice; and preventable errors.) Private insurance is central to the problem. Monitoring claims, sales, commissions and marketing, profits and outrageous CEO salaries rack up costs while adding nothing to the quality of care. Just so you know, the CEO of United Health received a salary of $66 million in 2016. Insurance overhead is about $806 per person in the U.S., compared with $141 in Canada, $209 in Holland, $255 in Germany and $286 in Switzerland. The American health field is also becoming notorious for doctor burnout. Doctors are needlessly engaged in record-keeping for insurance companies, while dealing with insurance company meddling in medical decisions. U.S. doctor satisfaction is low compared to Norway, UK, Canada and Australia. In short, Friedman says, the current system is bad for business, both employers and employees. It creates high costs, and distracts from a business’ core focus. It results in lower employee salaries, and prevents new business startups. It also makes it hard to compete internationally. Fifty percent of small business bankruptcies are due to health care crises. Of course, businesses pass their costs on to their customers, so anyone who buys goods or services is paying for all this. What’s to be done? Friedman believes a single-payer system would solve many of these problems, something like Medicare for All. He sees the so-called Public Option, with its Medicare buy-in, as falling short, with premiums growing too high because of a smaller pool of insured. Ongoing attempts to privatize Medicaid and Medicare simply exacerbate the problems. Health care is a basic requirement of life. Why should the U.S. fare so poorly compared to other nations, when there are viable alternatives?

Number of uninsured increasing

 

Arielle Dreher, 6-24, 22, Colorado bets on a public option to grow health coverage, https://www.axios.com/2022/06/24/colorado-public-option-health-insurance-bet

The end of the COVID-19 public health emergency could alter prospects for state-based health plans, as thousands of people who have stayed on Medicaid plans throughout the pandemic might no longer qualify. It remains to be seen whether that population can find affordable coverage on state marketplaces.

Lack of universal health care costs 338,000 lives during the pandemic

Sarah Elbeshbishi, 6-23, 22, USA Today, Lack of universal health care cost 300,000 American lives in pandemic, study shows, https://www.usatoday.com/story/news/health/2022/06/23/universal-healthcare-save-american-lives-pandemic/7652206001/?gnt-cfr=1

More than 330,000 Americans could have been saved during COVID-19 pandemic if the United States operated under a universal health care system – nearly one-third of the total COVID-related deaths – according to a recent study.  The study, published in Proceedings of the National Academy of Sciences USA last week found that universal health care would have helped address underlying and pre-existing conditions that contributed to the COVID-related deaths, ultimately saving over 338,000 lives between the start of the pandemic and mid-March 2022.

 

The health care system itself is racist, expanding access won’t solve

 

Jerald Walker, 6-10, 22, Jerald Walker is a professor of African American literature and creative writing at Emerson College. His latest book, “How to Make a Slave and Other Essays,” was a nonfiction finalist for the 2020 National Book Award, Racism’s ill effects on the health-care system — and the body itself, https://www.washingtonpost.com/outlook/2022/06/10/racisms-ill-effects-health-care-system-body-itself/

In a searing New York Times Magazine article in 2018, headlined “Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis,” Linda Villarosa wrote, “People of color, particularly black people, are treated differently the moment they enter the health care system.” Race, in other words, in terms of health care in this country, is the story. Villarosa, a journalism professor at the City University of New York, reported on studies that show, for example, that Blacks are less likely than Whites to receive kidney dialysis or transplants, coronary bypasses, appropriate cardiac medications, or pain medications, yet they are more frequently given amputations for diabetes.

In her brilliant, illuminating book, “Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation,” Villarosa expands on the theme. She discovers that racial bias within the health-care system is a compounding factor to racial bias in America. Meticulously researched, sweeping in its historical breadth, damning in its clear-eyed assessment of facts and yet hopeful in its outlook, “Under the Skin” is a must-read for all who affirm that Black lives matter. It will be especially eye-opening for anyone who believes that wealth, education and access to quality medical services are the great equalizers, the attainable means by which Black Americans can achieve health-care parity.

Equal treatment within the health-care system, Villarosa argues, regardless of class or social status, remains elusive because of three primary obstacles: long-standing institutional and structural discrimination; implicit biases in the medical profession resulting not only in misdiagnoses but even blame for being unwell; and “weathering,” which, Villarosa writes, refers to the “struggle with anger and grief triggered by everyday racist insults and microaggressions … [which] can, over time, deteriorate the systems of the body.”

The female reproductive system is not immune. Villarosa cites a 2007 American Journal of Public Health study that demonstrates that Black women who reported experiencing racial discrimination had double to triple the rate of low-birth-weight babies compared with Black women who did not report incidents of discrimination. Summing up, Villarosa writes, “The researchers’ conclusion: low birth weights among African American women have more to do with the experience of racism than with race.”

A decade earlier, Villarosa stringently followed all prescribed prenatal care during her own pregnancy but had to ask herself if her “lived experience as a Black woman in America” had resulted in her daughter being born at only 4 pounds, 13 ounces. She recounts that a doctor “hounded” her with questions about her lifestyle, as if she were a habitual user of alcohol and drugs. Villarosa wondered, “Does this doctor think I’m sucking on a crack pipe the second I leave the office?”

 

Health care costs increasing under Obamacare

 

Nina Owcharenko Schaefer is Director of the Center for Health and Welfare Policy at The Heritage Foundation, May 31, 2022, Health Care: Time to Go on Offense, https://www.heritage.org/health-care-reform/report/health-care-time-go-offense

The Biden Record: Since Obamacare’s enactment, average monthly premiums have more than doubled—a 129 percent increase from 2013–2019. (See Chart 1.) Deductibles are also higher, having risen from $5,100 (self-only policy) and $10,300 (family policy) in 2013 to $6,894 (self-only) and $13,949 (family) in 2021.2 Edmund F. Haislmaier and Abigail Slagle, “Premiums, Choices, Deductibles, Care Access, and Government Dependence Under the Affordable Care Act: 2021 State-by-State Review,” Heritage Foundation Backgrounder No. 2668, November 2, 2021, https://www.heritage.org/health-care-reform/report​/premiums-choices-deductibles-care-access-and-government-dependence-under.

Furthermore, the number of insurers offering coverage in the Obamacare exchanges is 25 percent less than the number that offered coverage in the individual market before Obamacare.3

 

 

 

Health care cost explosion due to declining subsidies

 

Karen Tumulty, May 24, 2022, Democrats are facing a ticking time bomb on health-care costs, https://www.washingtonpost.com/opinions/2022/05/24/democrats-affordable-care-act-aca-health-care-costs-premiums-ticking-time-bomb/

 

You might call it a disastrous “October surprise” for Democrats in this year’s crucial midterm campaign — except it wouldn’t be a surprise at all, and it is completely avoidable. The governing party’s inability thus far to reach some kind of agreement on a scaled-back version of President Biden’s Build Back Better legislation is raising a real possibility that millions of middle-class Americans will see their health insurance costs go up by hundreds of dollars per month next year. And if it happens, they will hear the news about it just weeks before Election Day. That’s because the temporary subsidies for people who buy their coverage through the Affordable Care Act exchanges — assistance that was provided in last year’s massive covid-19 relief package — are scheduled to expire at the end of 2022. The stalled BBB legislation would provide an extension of the subsidies. The exchanges were set up for people who do not receive health insurance through their jobs or government programs such as Medicare and Medicaid. They include early retirees, gig workers and others who are self-employed, as well as people employed by small businesses that do not offer group coverage. In its original version, the 2010 health-care law provided premium assistance only to households earning between 100 percent and 400 percent of the poverty level. In 2021, the American Rescue Plan Act made temporary premium assistance available to an estimated 3.7 million additional people, mostly with incomes between four and six times the poverty level, according to the Kaiser Family Foundation. This new help for those whose incomes previously were too high to qualify for assistance is a major reason that a record 14.5 million Americans signed up to get health coverage this year through Obamacare marketplaces, passing the previous peak by nearly 2 million. How much benefit have people been receiving from those subsidies? Again, some figures from Kaiser: They are enough to cover more than half the annual $11,000 premiums for a relatively low-deductible “silver” plan for a 60-year-old making just over $51,000, or about four times the poverty level. Without the assistance, the monthly premium paid this year by a couple over the age of 50 earning $75,000 would go up by close to $700, bringing their plan’s total cost to more than $1,200 a month. So losing those subsidies would be a big hit for people who make a living wage but are far from wealthy. And that is not all they are likely to face when the annual signup for the Obamacare exchanges rolls around. Because hospitals are paying significantly higher labor and other costs, insurance premiums are expected to rise by double digits next year. That kind of sticker shock will force many people to buy plans with lower coverage or higher deductibles and other out-of-pocket costs. They might be priced out of the health insurance market entirely. All of this should add some urgency to the seemingly moribund negotiations between the White House and Democrats on Capitol Hill to figure out which parts of the president’s original multitrillion-dollar proposal to transform the U.S. economy might still be salvageable. (The Congressional Budget Office estimates that extending the temporary subsidies for people who purchase insurance on the health-care exchanges would cost about $210 billion over the next decade.) Time is running out, and Democrats may not get a second chance if they blow this opportunity. Republicans, should they take over one or both chambers after this fall’s elections, are unlikely to shore up the ACA, which they detest. “Members of Congress — particularly Democrats — are not acting like this is a crisis. They can fix this,” Chris Jennings, who was a top health-care adviser in both the Clinton and Obama administrations, told me. Extending the subsidies would require a simple majority under the Senate’s budget reconciliation rules. The frustratingly opaque Sen. Joe Manchin III (D-W.Va.) remains the pivotal vote, but there is reason to believe he would not be an obstacle. He has been a supporter of the Affordable Care Act and generally expressed openness to measures that would lower health-care costs, including by allowing Medicare to negotiate prescription drug prices, which is another provision of the Biden agenda and something Democrats have promised for many years. Democrats, even with their narrow majorities in the House and Senate, can still get a few things over the finish line. Preventing an entirely foreseeable explosion in health-care costs should be one of them.

Massive delays and poor care

 

Sally Pipes, May 23, 2022, Forbes, Bernie And The Single-Payer Beast, https://www.forbes.com/sites/sallypipes/2022/05/23/bernie-and-the-single-payer-beast/?sh=46717c5717a3

 

Earlier this month, Senator Bernie Sanders, I-Vt., reintroduced his signature Medicare for All legislation alongside 14 of his Democratic colleagues at a Senate Budget Committee hearing. With a little perseverance and a touch of political magic, Sanders is hoping his government-run healthcare fairytale, which he has championed for years during his time in the House and Senate, will finally become reality. For patients, that’d be anything but a happy ending. Medicare for All would subject Americans to long waits for subpar care. To see how, look to the inspiration for Sen. Sanders’s single-payer vision—Canada. North of the border, health care is largely free at the point of service. That keeps demand for treatment high. But with a limited supply of physicians—Canada has fewer than three per 1,000 people, one of the lowest ratios among developed countries—the country’s single-payer system is unable to meet people’s needs. Delayed care is the inevitable result of this mismatch. Canadians face a median wait of 25.6 weeks—roughly six months—for treatment from a specialist following referral by a general practitioner last year, according to the Vancouver-based Fraser Institute, a think tank. escapes these waits. Earlier this month, children were waiting up to 16 hours to receive care at a pediatric emergency room in Alberta. Some seniors have been told that they’ll need to wait up to two years for a hip replacement. One woman was in so much pain after waiting a year for a hip replacement that she flew to Lithuania to get the procedure done. A year after she got the surgery abroad, her Canadian doctor still hadn’t called to schedule it. Jets Are A Popular Pick Among Bettors To Exceed Their Woeful Record Of Last Season Stories like this are not uncommon. In Canada, the government has a monopoly on paying for “medically necessary” treatment; private insurance is banned for anything the government asserts the right to cover. So patients can either wait for publicly-provisioned care—or spend their own money to seek treatment abroad. Many opt for the latter. Secondstreet.org, a Canadian think tank, estimated that nearly a quarter of a million patients went abroad for treatment in 2017. Some aren’t so lucky. More than 11,500 patients died waiting in treatment queues between 2020 and 2021, according to Secondstreet.org. Routine cancer care is hard to come by. Just 54% of Canadian women between the ages of 50 and 69 have been screened for breast cancer. That’s compared to 80% of U.S. women in the same age group. This lack of access translates into poor health outcomes. Canadian breast cancer, stomach cancer, lung cancer, and prostate cancer patients have lower survival rates compared to their American counterparts. The human cost of these waits is clear. But there’s also a significant financial cost. According to a new Fraser report, Canadians lost $4.1 billion in wages and productivity during the workday as they waited for care in 2021. With more than 1.4 million people in treatment queues, the cost of waiting is about $3,000 per person. And that’s a conservative estimate. When researchers factored in nights and weekends, the cost of waiting ballooned to nearly $12.4 billion—about $8,700 per person.

 

7 reasons health care costs are increasing

 

Elizabeth Walker, May 16, 2022, Seven reasons for rising healthcare costs, https://www.peoplekeep.com/blog/seven-reasons-for-rising-health-care-costs

 

The average American spends a considerable amount of money on healthcare each year. Premium increases, higher deductibles and copays, and soaring drug prices result from spikes in healthcare costs. According to the Centers for Medicare & Medicaid Services, in 2021, healthcare expenditures skyrocketed to $4.3 trillion. Despite the decrease in health services accessed in 2020 due to the COVID-19 pandemic, national healthcare spending is expected to reach $6.8 trillion by 2030. Total national health care costs, KFF With no end in sight to rising health insurance costs, it’s important to understand what exactly causes these spikes in the first place. Let’s take a look at seven reasons for rising healthcare costs in the U.S and how you can offset your expenses with an HRA from PeopleKeep. Find out how much health insurance costs in your state with our infographic Seven reasons for rising healthcare costs 1. Medical providers are paid for quantity, not quality Most insurers—including Medicare—pay doctors, hospitals, and other medical providers under a fee-for-service system that reimburses each test, procedure, or visit. That means the more services provided, the more fees are paid. This can encourage a high volume of redundant testing and overtreatment, including patients with unlikely potential to improve their health. On top of this, the U.S. medical system is not integrated. The World Health Association defines integrated health services as “the organization and management of health services so that people get the care they need, when they need it, in ways that are user friendly, achieve the desired results and provide value for money.” So what does that have to do with cost? Integrated health means providers, management, and support teams communicate with one another on a patient’s care. On the other hand, in an unintegrated system, the lack of coordination can result in patients receiving duplicate tests and paying for more procedures than they truly need. 2. The U.S. population is growing more unhealthy According to the Center for Disease Control and Prevention (CDC), more than half of the U.S. population has at least one chronic condition, such as asthma, heart disease, or diabetes, which all drive up health insurance costs. A staggering 85% of healthcare costs in the U.S. are for the care of a chronic condition. What’s more, recent data finds that nearly 40% of adults over 20 in the U.S. are either overweight or obese, which can lead to chronic illness and inflated medical spending. As the U.S. population gets sicker and more overweight, the risk of insuring the average American goes up. And in turn, the higher the risk, the higher the cost of annual premiums. Data from the Kaiser Family Foundation (KFF) shows between 2011 and 2021, the average premiums for family coverage rose from $15,073 to $22,221—that’s an increase of 47.4%. Get our guide to employee wellbeing to better support your staff’s health and wellness 3. The newer the tech, the more expensive Medical advances can improve our health and extend our life, but they also add to the cost of health insurance and the overutilization of expensive technology. According to a study by the Journal of the American Medical Association (JAMA), Americans tend to associate more advanced technology and newer procedures with better care, even if there’s little to no evidence to prove that they’re more effective. This assumption leads both patients and doctors to demand the newest, and often most expensive, treatments and technology available. 4. Many Americans don’t choose their own healthcare plan Data from the KFF finds that roughly 49% of the U.S. population gets their insurance through their employer. That means nearly half of Americans don’t make any actual consumer decisions about the cost of their insurance because their employer already determined it. Organizations have an incentive to purchase more expensive health insurance plans because the amount employers pay toward coverage is tax-deductible for the organization and tax-exempt to the employee. In addition, low deductibles or small office co-payments can encourage overuse of care, driving both demand and cost. See how the rise of healthcare consumerism could change this trend 5. There’s a lack of information about medical care and its costs Despite a wealth of information at our fingertips online, there’s no uniform or quick way to understand treatment options and their costs. We would never buy a car without comparing models, features, gas mileage, out-of-pocket cost, and payment options—but yet, this is how we buy healthcare. Kaiser Health News (KHN) reports that even when evidence shows a treatment isn’t effective or is potentially harmful, it takes too long for that information to become readily known, accepted, and change how doctors practice or what patients demand. And in too many cases, even when hospitals make their service prices available, they are challenging to navigate and understand. To mitigate this lack of transparency, Congress passed the No Surprises Act in January 2022. The Act aims to reduce surprise medical bills under group and individual health insurance plans and create better pricing transparency to improve the patient experience. See our infographic to learn more about estimating your medical expenses 6. Hospitals and providers are well-positioned to demand higher prices According to the Center for Studying Health System Change, mergers and partnerships between medical providers and insurers is one of the more prominent trends in America’s current healthcare system. Increased provider consolidation has decreased individual market competition, in which lower prices, improved productivity, and innovation could have occurred. Without this competition, these near-monopolies created in an individual market have both providers and insurers in a position to drive up their prices unopposed. For example, a study done by the American Journal of Managed Care found that hospitals in concentrated markets could charge considerably higher prices for the same procedures offered by hospitals in competitive markets. Price increases often exceed 20% when mergers occur in concentrated markets. However, reviews found these cost increases didn’t improve healthcare quality. 7. Fear of malpractice lawsuits Frequently called “defensive medicine,” some doctors will prescribe unnecessary tests or treatment out of fear of facing a lawsuit. The cost for these treatments add up over time—a study has shown that the average cost of defensive medicine is around $100 to $180 billion each year.

 

Medicare for All costs $31 trillion, requires doubling taxes

J.D. Tuccile, May 18, 2022, Medicare for All Would Be a Terrible Trade, https://reason.com/2022/05/18/medicare-for-all-would-be-a-terrible-trade/

The ten-year price tag of Medicare for All would be close to $31 trillion, Blahous estimated, which is lower than his prediction in 2018. “If $31 trillion were indeed the number, this would again exceed what could be financed by doubling all currently projected individual and corporate income taxes.”

Medicare for All results in worse care; Public option counterplan solvency

BY MICHAEL F. CANNON, Director of Health Policy @ CATO, May 4, 2022,  The Hill, Medicare For All would mean worse care for all, https://thehill.com/opinion/congress-blog/3477455-medicare-for-all-would-mean-worse-care-for-all/

Senate Budget Committee Chairman Bernie Sanders (I-Vt.) has announced that as early as next week, his committee will hold a hearing “on the need to pass a Medicare for All single-payer program.” Sanders gets an “A” for passion, but an “F” in compassion. The non-partisan Congressional Budget Office has cautioned that Sanders’ Medicare for All bill would create “a shortage of providers, longer wait times, and changes in the quality of care.” Indeed, the non-partisan Medicare Payment Advisory Commission has warned since at least 2003 that Medicare’s approach to health care quality “is largely neutral or negative.” Enrolling 330 million people in the program would only make the problem worse. Thankfully, there is a (potentially bipartisan) way to reverse Medicare’s negative impact on quality: Apply “public option” principles not to the private health insurance market but to Medicare, where this traditionally Democratic idea would dramatically increase choice and competition. Since 1965, Medicare has paid providers more for low-quality care than for high-quality care. For example, in 1995, Utah’s Intermountain Health Care reduced mortality by improving how it treated pneumonia. Medicare rewarded those quality improvements by paying Intermountain less. In 1999, Duke University developed a better way to treat congestive heart failure. Medication adherence increased. Hospitalizations fell. Resource use fell by half. Again, Medicare (and private insurers with similar payment rules) responded by reducing payments. Duke eventually had to shutter the program for lack of funds. In 2002, Whatcom County, Washington improved glucose management for diabetics and stabilized congestive heart failure patients, saving $3,000 per patient. The county ended up shuttering the program for the same reason Duke did. Need more evidence? In 2009, Medicare reduced payments to Texas’ Baylor Medical Center after the system cut heart-failure readmissions in half with no increase in mortality. Hospitals can nearly double net revenues if a Medicare patient develops post-operative complications. Medicare pays hospitals nearly $3,000 more per patient when low-quality care leads to more post-acute care and readmissions. Medicare paid a large urban hospital system more when it allowed urinary-tract or bloodstream infections than when it prevented them. It doesn’t have to be this way. In the mid-1990s, Group Health Cooperative of Puget Sound improved diabetes care with an “average cost savings [] of $685-$950 per patient per year.” Group Health’s different payment rules—which markets developed a century before Congress enacted Medicare—allowed it to profit from those quality improvements. What Sen. Sanders doesn’t get is that medicine is so complex, no single payment system can promote all aspects of health care quality. Locking in any single set of payment rules—as a single-payer system by definition must—will always reward low-quality care and penalize progress. Competition drives providers to improve all dimensions of quality—even those their own payment rules discourage. Improving care across the board requires letting all varieties of payment rules compete on a level playing field. Public-option principles demand exactly that: a level playing field where consumers are the ultimate arbiters of quality and efficiency. Public-option supporters want a new government program to be one of the competitors. But there’s no need for a new program. Traditional Medicare is a government-run plan that already competes against private insurers. Economist Mark Pauly explains that Medicare “is essentially a risk-adjusted voucher program” that lets enrollees choose between a public option and private Medicare Advantage plans. That playing field, however, is anything but level. Congress bars certain plans, encourages excessive coverage, and penalizes high-quality coverage. It further violates public-option principles by offering larger subsidies to healthy enrollees if they choose Medicare Advantage, and to sicker enrollees if they choose traditional Medicare. Public-option principles demand eliminating all such distortions. Most important, they require that each enrollee’s subsidy neither rise nor fall depending on which health plan, or how much coverage, he or she chooses. Only one type of subsidy can do that: cash. Public-option principles require that Medicare mirror Social Security, which gives enrollees cash and trusts them to spend it. In 2022, Medicare will spend enough to give each enrollee an average cash subsidy of $12,100. Income- and risk-adjustment would give poorer and sicker enrollees thousands more to ensure they could afford coverage.  Enrollees would spend that money better than government bureaucrats do. Evidence shows that cost-conscious patients force providers to reduce prices and that when seniors control their health decisions, even those with cognitive limitations make good choices. While Medicare for All would condemn generations to low-quality care, applying public-option principles to Medicare would improve health care through choice and competition. It’s a Democratic idea even Republicans can love.  Michael F. Cannon is director of health policy studies at the Cato Institute and coauthor of “Would ‘Medicare for All’ Mean Quality For All?” (with Jacqueline Pohida, AGPCNP-BC, Quinnipiac Health Law Journal, 2022).

 

Private insurers provide higher quality care than Medicare, Public Option solves

 

Michael F. Cannon, MA, JM, is director of health policy studies at the Cato Institute, Jacqueline Pohida, MSN, is a board-certified nurse practitioner, April 8, 2022, Quinnipiac Health Law Journal, April 8, 2022, WOULD “MEDICARE FOR ALL” MEAN QUALITYFOR ALL? HOW PUBLIC-OPTION PRINCIPLES COULD REVERSE MEDICARE’S NEGATIV IMPACT ON QUALITY, https://www.cato.org/sites/cato.org/files/2022-04/cannon-qhlj-v25n2.pdf

Medicare has had a negative impact on health care quality. By the time Congress created Medicare in 1965, research had demonstrated many U.S. physicians and hospitals were providing medical care that was so low-quality as to be dangerous to patients’ health. Congress nonetheless incorporated into the new program features that ensured traditional Medicare would exacerbate existing quality problems. Research accordingly continued to document widespread quality problems, in particular those forms of low-quality care that traditional Medicare rewards with higher payments. Congress and Medicare administrators have resisted correcting these perverse incentives. Only in recent years has Congress attempted to emulate payment rules and quality-improvement tools private insurers have developed, though these efforts have had little if any effect. Congress can reverse Medicare’s negative impact on quality by applying “public option” principles to Medicare, such that traditional Medicare and private insurers compete on as level a playing field as possible.

 

One size fits all single payer encourages the provision of low quality care

 

Michael F. Cannon, MA, JM, is director of health policy studies at the Cato Institute, Jacqueline Pohida, MSN, is a board-certified nurse practitioner, April 8, 2022, Quinnipiac Health Law Journal, April 8, 2022, WOULD “MEDICARE FOR ALL” MEAN QUALITYFOR ALL? HOW PUBLIC-OPTION PRINCIPLES COULD REVERSE MEDICARE’S NEGATIV IMPACT ON QUALITY, https://www.cato.org/sites/cato.org/files/2022-04/cannon-qhlj-v25n2.pdf

Medicare has had a negative impact on health care quality. By the time Congress created Medicare in 1965, research had demonstrated many U.S. physicians and hospitals were providing medical care that was of such low-quality that it was dangerous to patients’ health. Congress nonetheless incorporated into the new program two features that ensured traditional Medicare would exacerbate existing quality problems. The first was that traditional Medicare would directly subsidize health care providers according to a single set of payment rules. As we discuss in detail below, if a provider’s failure to deliver preventive services or to prevent iatrogenic injury leads to a patient needing additional services, traditional Medicare’s fee-for-service payment system often pays the provider more than if the provider had delivered higher-quality care. Purchasing medical care according to a single, one-size-fits-all set of payment rules rewards low-quality care and discourages many quality improvements, regardless of which particular rules the payer chooses. The second feature was an explicit prohibition on government officials working within Medicare’s fee-for-service payment rules to improve quality.

Low quality care causes as many deaths as COVID-19 and a lack of health insurance

 

Michael F. Cannon, MA, JM, is director of health policy studies at the Cato Institute, Jacqueline Pohida, MSN, is a board-certified nurse practitioner, April 8, 2022, Quinnipiac Health Law Journal, April 8, 2022, WOULD “MEDICARE FOR ALL” MEAN QUALITYFOR ALL? HOW PUBLIC-OPTION PRINCIPLES COULD REVERSE MEDICARE’S NEGATIV IMPACT ON QUALITY, https://www.cato.org/sites/cato.org/files/2022-04/cannon-qhlj-v25n2.pdf

As traditional Medicare grew to play a dominant role in the delivery of medical care, so did these perverse incentives. Research accordingly continued to document widespread quality problems, in particular, those forms of low-quality care traditional Medicare rewards with higher payments. For example, conventional estimates. suggest that preventable medical errors: are currently the thirdleading cause of death in the United States;6 cause roughly as many deaths each year as Covid-19 caused in 2020;7 and exceed by an order of magnitude the number of preventable deaths due to uninsurance.8 In addition, non-lethal harm from medical errors “seems to be 10- to 20-fold more common than lethal harm

Fee for Service payment systems encourage poor care

 

Michael F. Cannon, MA, JM, is director of health policy studies at the Cato Institute, Jacqueline Pohida, MSN, is a board-certified nurse practitioner, April 8, 2022, Quinnipiac Health Law Journal, April 8, 2022, WOULD “MEDICARE FOR ALL” MEAN QUALITYFOR ALL? HOW PUBLIC-OPTION PRINCIPLES COULD REVERSE MEDICARE’S NEGATIV IMPACT ON QUALITY, https://www.cato.org/sites/cato.org/files/2022-04/cannon-qhlj-v25n2.pdf

 

One consequence of the mind-boggling complexity of medicine is that no single method of paying providers is capable of rewarding all dimensions of quality. Promoting all dimensions of quality requires open competition on a level playing field between different payment rules. Heavily favoring just one method of payment predictably and persistently rewards certain forms of low-quality care and discourages improvement on those dimensions of quality. Whereas an alternative subsidy structure could have encouraged quality improvement, Congress’ decision to tie traditional Medicare’s subsidies to a single set of payment rules undermined quality improvement. To illustrate how every method of paying health care providers encourages some dimensions of quality while discouraging others, consider fee-for-service payment, which pays providers a separate fee for each additional service. In some respects, fee-forservice payment promotes quality by offering patients a broad choice of providers and creating incentives for providers to offer patients all necessary services. In other respects, fee-for-service promotes low-quality care. Fee-for-service encourages providers to deliver unnecessary services that offer little benefit to the patient and can result in harm.21 When a provider’s failure to deliver preventive services or to prevent iatrogenic injury leads to a patient requiring more services, fee-forservice rewards the provider with additional fees for those additional services. The nonpartisan, congressionally chartered Medicare Payment Advisory Commission (MedPAC) explains that Medicare’s fee-for-service payment systems pay providers more “when complications occur as the result of error” and pay providers less when they prevent medical errors.22 As a result, fee-for-service payment creates disincentives for providers to invest in cost-saving preventive services or in processes that avoid misdiagnoses, iatrogenic injuries, medical errors, and other forms of low-quality care. Under fee-for-service, providers who invest in those quality-improvement measures end up worse off than providers who do not, due to the cost of developing and deploying those measures and to the fact that avoiding additional services means they collect less revenue. Fee-for-service payment thus discourages any quality improvements that reduce the volume or intensity of services. (For concrete examples, see Parts I.C. and I.D.) “The doctor who prevents the patient’s costly medical problem or solves it quickly and inexpensively does not prosper in this model.” 23 Not all methods of paying providers operate this way. More than 100 years before Congress created Medicare,24 markets developed other payment systems that reward quality improvement that fee-for-service payment discourages.25 “Prepayment,” or “capitation,” pays providers a fixed fee per patient. Under this system, when a misdiagnosis, medical error, iatrogenic injury, or another type of low-quality care results in a patient requiring additional services, providers receive no additional payments. Prepayment internalizes those costs to the providers, in that providers themselves bear the cost of those additional services. Prepayment rewards providers who invest in cost-saving preventive services, and in processes that avoid misdiagnoses, medical errors, iatrogenic injuries, and other forms of low-quality care, because providers themselves keep the savings. One result is that integrated, prepaid health systems perform well on dimensions of quality where fee-for-service is weak, and lead other providers to improve quality via competitive pressure and by generating new knowledge that other providers can use. Between 1992 and 1997, the prepaid health system Group Health Cooperative of Puget Sound implemented a blood-sugar-control program that improved the health of Type 2 diabetics and reduced the volume of services they required.26 “During the last 4 years of the study, better glycemic control resulted in average cost savings [] of $685-$950 per patient per year.” 27 Fee-for-service payment would have penalized these quality improvements. 28 Prepayment allowed Group Health to profit from them.29 These incentives partly account for why prepaid health systems have been “the source of considerable research on quality of care, far more so than the . . . fee-for-service system.” 30 Like fee-for-service, prepayment also discourages some dimensions of quality. While fee-for-service payment allows patients a broader choice of providers, prepayment generally limits one’s choices to providers that belong to the system that receives the capitated payment. Prepayment can also reward providers for withholding high-value services. In hypothetically perfect markets, payment rules would not affect quality. Different payment systems would reward different dimensions of quality and each would generate new knowledge about how to meet patient needs. Competitive pressures would push all providers to emulate each other’s quality improvements.31 In even reasonably competitive markets, competition among different payment systems would drive providers to improve all dimensions of quality, even those their own payment rules discourage.32 Where regulation or government subsidies favor or punish particular payment systems, however, those interventions block both the generation of new knowledge about how to improve quality and the competitive pressures that would otherwise push providers to improve quality. In such an environment, the types of low-quality care the dominant payment system rewards persist longer than they would in a competitive market. Such was the state of affairs in 1965, by which point decades of state and federal interventions had already distorted the market to the extent that fee-for-service was the dominant form of payment.33 The result was that health care markets not only failed to eliminate but actively rewarded those forms of low-quality care that fee-forservice payment rewards. Had Congress structured Medicare’s subsidies as cash transfers, as it does with Social Security, Medicare might have had a salutary effect on quality. Such an approach would have created a large market of cost-conscious seniors who could have applied their subsidy to whatever health plans and payment systems they wished. Medicare enrollees would have shopped for coverage (in part) on the basis of quality.34 Demand for prepaid plans would have increased35 and could have mitigated the quality-suppressing effects of prior government interventions that entrenched fee-for-service payment. The resulting competitive pressures could have pushed fee-forservice providers to improve on dimensions of quality where fee-forservice is weak. (In Part IV, we propose a cash-transfer approach could still do so today.) Instead, Congress’ decision to tie traditional Medicare’s subsidies to a single set of fee-for-service payment rules increased the rewards to those forms of low-quality care, discouraged efforts to eradicate them, and caused poor-quality care to persist. The result has been a medical marketplace with drastically sub-optimal incentives to improve quality. One study estimated that hospitals inflict an average of $2,013 in injuries per admission yet bear only $238 (12 percent) of those costs themselves.36 The remaining 88 percent of the financial costs of provider errors fell on “health insurers, disability insurance programs, and injured patients and their families. The second way Medicare undermined quality is by making no serious effort to use the market power it possesses to improve quality. From its inception, Medicare has shown more concern for the needs of the industry that produces low-quality care than for the taxpayers who subsidize such care or the patients who suffer from it. To placate physicians who opposed the legislation, Congress guaranteed the payment system Medicare used would be the one the physician lobby preferred—fee-for-service.38 To placate the industry further, Congress included statutory language prohibiting government officials from exercising “any supervision or control over the practice of medicine or the manner in which [subsidized] medical services are provided.” 39 That prohibition signaled that Medicare would make no serious effort to ensure the medical care it purchased would be a “healing miracle.” What few quality-related provisions Congress included in the original statute proved ineffectual, such that Medicare “did little to improve the quality of care that the newly insured could receive. Economics texts instruct that the inherent complexities of medical care bedevil market forces and “call for government policies to ensure that health care resources are allocated efficiently and equitably.” 41 Medicare provides evidence of government’s incompetence to navigate health care’s complexities. If incentives matter, Medicare is responsible for countless misdiagnoses, medical errors, and iatrogenic injuries. Taking President Johnson’s “healing miracle” pledge42 as the standard of care, Congress and the Medicare program are guilty of gross negligenc

 

More evidence of poor care in Medicare

 

Michael F. Cannon, MA, JM, is director of health policy studies at the Cato Institute, Jacqueline Pohida, MSN, is a board-certified nurse practitioner, April 8, 2022, Quinnipiac Health Law Journal, April 8, 2022, WOULD “MEDICARE FOR ALL” MEAN QUALITYFOR ALL? HOW PUBLIC-OPTION PRINCIPLES COULD REVERSE MEDICARE’S NEGATIV IMPACT ON QUALITY, https://www.cato.org/sites/cato.org/files/2022-04/cannon-qhlj-v25n2.pdf

As evidence of low-quality care in Medicare has grown, researchers have tied these quality problems directly to Medicare favoring a single set of fee-for-service payment rules that inherently discourage many quality improvements. • In 1995, Intermountain Health Care implemented new treatment guidelines that reduced pneumonia severity and mortality.58 Since the guidelines also reduced the number and complexity of admissions, Medicare paid Intermountain less than it would have if Intermountain had allowed more patients to die.59 • In 1998 and 1999, the Duke Heart Failure Program used clinical teams, health coaches, and patient outreach (including regular telephone calls) to emphasize patient education, lifestyle changes, medication adherence, and follow-up visits for congestive heart failure (CHF) patients.60 Clinic visits per patient-year increased from a median of 4.3 to 9.8.61 βBlocker use increased from 52 percent to 76 percent.62 Hospitalizations per patient-year fell from a median of 1.5 to zero.63 The program cut the average cost of treating CHF patients nearly in half, by almost $8,600.64 Duke University nevertheless shuttered the program because delivering higherquality care at a lower cost meant lower payments from Medicare and other fee-for-service payers: “the healthier its patients were, the more money Duke lost. Ultimately, it decided that this program was unsustainable because the hospital was losing too much money by reducing readmissions and therefore opportunities for billable care.” 65 • A 2002 experiment in Bellingham and surrounding Whatcom County, Washington used electronic medical records and care coordinators to emphasize lower-cost preventive care and simplify the patient experience.66 Across 600 participants, including Medicare enrollees, the program “improved or stabilized health status while reducing overall costs by $3,000 per patient.” 67 The program “reduced doctor visits and medical complications. Patients with diabetes have lower glucose levels; those with congestive heart failure have remained stable rather than getting worse.” 68 In a two-month period, “two nurses, seeing 70 patients, reported seven incidents in which they prevented costly options like calls to 911, emergency room visits and emergency visits to a doctor’s office.” 69 One patient reported her care coordinator “saved my life—twice.” 70 Yet participating doctors stood to lose $2,000 a year or more due to the required investment in electronic medical records and because Medicare and other fee-for ervice payers paid them less when higher-quality care avoided unnecessary physician visits.71 The program ultimately shuttered. • In 2009, Baylor Medical Center implemented a new postdischarge care program for heart-failure patients that cut readmissions in half with no increase in mortality.72 As if to punish this quality improvement, Medicare paid Baylor an average of $227 less per heart-failure patient.73 • A 2013 study found that, on average, when a Medicare patient develops post-operative complications, hospitals nearly double their margins (revenue net of variable costs) from $1,880 to $3,629.74 Conversely, investing in processes to reduce complications cuts a hospital’s margin in half. • A 2016 study found that after controlling for patient and hospital characteristics, “patients who had major surgery at high-quality hospitals cost Medicare less than those who had surgery at low-quality institutions.” 75 Medicare paid lowquality hospitals an average of $2,698 more per patient, mostly because patients at low-quality hospitals required more post-acute care and readmissions.76 • A 2018 study found Medicare paid a large urban hospital system less when it prevented urinary-tract and bloodstream infections, and more when it didn’t. The additional payments to hospitals “reduce[d] their incentive to avoid complications.”77 • A 2020 study of “elderly Medicare patients who present at the emergency room with respiratory conditions” found “the marginal hospital admission increases the number of hospital days by seven days and increases charges by $42,240, but has no effect on the risk of death,” suggesting the existence of many profitable but low- or zero-quality admissions.78

 

Medicare hostile to quality improvements

 

Michael F. Cannon, MA, JM, is director of health policy studies at the Cato Institute, Jacqueline Pohida, MSN, is a board-certified nurse practitioner, April 8, 2022, Quinnipiac Health Law Journal, April 8, 2022, WOULD “MEDICARE FOR ALL” MEAN QUALITYFOR ALL? HOW PUBLIC-OPTION PRINCIPLES COULD REVERSE MEDICARE’S NEGATIV IMPACT ON QUALITY, https://www.cato.org/sites/cato.org/files/2022-04/cannon-qhlj-v25n2.pdf

Medicare’s hostility to quality improvement is evident across the entire program, and even in its failure to measure quality in a serious way. Just as Medicare grants quality bonuses to low-quality hospitals, it has awarded quality bonuses to mediocre Medicare Advantage plans. The ACA created a program that offers quality bonuses to high-performing Medicare Advantage plans. Medicare administrators soon thereafter changed the rules to offer such bonuses to mediocre plans nationwide.186 Even as researchers find that Medicare’s five-star rating system for nursing homes can reflect real quality differences,187 an exposé found inspectors cited more than two thirds of 5-star homes for infection-control or patient-abuse violations; nursing homes routinely submit false data; and “government rarely audits the nursing homes’ data.” 188 MedPAC notes that Medicare fails even to measure quality in a comprehensive or serious way.189 Traditional Medicare’s qualitymeasurement programs use process measures that “are burdensome to report,” 190 “are weakly correlated with outcomes of interest such as mortality and readmissions,” 191 and “can lead to biased reporting in response to strong financial incentives.” 192 MedPAC argues “allcondition mortality and readmissions measures are more appropriate to score in pay-for-performance programs than [the current] condition-specific (e.g., acute myocardial infarction) measures” 193 and that Medicare should measure overuse and inappropriate use of services, not just under-use.194 “Overuse is also a quality concern because of the potential for harm to beneficiaries—both directly from the tests and procedures performed on them and indirectly from unnecessary treatments for false-positive diagnoses and for clinically insignificant findings.” 195 Since 2019, MedPAC has recommended eliminating the HRRP, HVBP, and HACRP programs and replacing them with a single “hospital value incentive program (HVIP)” consistent with those principles and that “adjust[s] . . . for social risk factors.” 196 So far, Congress has declined. Medicare’s quality-measurement failures appear in its management of Medicare Advantage, as well.According to MedPAC: The current state of quality reporting in [Medicare Advantage] is such that the Commission can no longer provide an accurate description of the quality of care in [Medicare Advantage] . . . the current quality program is not achieving its intended purposes and is costly to Medicare . . . 197 The quality bonuses Medicare administers for Medicare Advantage plans, like Medicare’s other quality programs, create opportunities to game the scoring rules. “There is evidence that plans have engaged in activities that increase quality scores without increasing underlying quality.” Medicare’s indifference toward careful quality measurement extends even to pilot programs whose purpose is to improve quality. The ACA’s Centers for Medicare and Medicaid Innovation has launched 54 pilot programs to improve quality and/or reduce spending, only five of which “resulted in substantial financial savings . . . with several on pace to lose billions of dollars.” 199 In addition, “the majority of models do not show significant improvements in quality.” 200 Complicating the evaluation of those programs is the fact that CMMI “has data for the control group for only approximately 55% of the quality metrics that are used across its models.” 201 In addition, CMMI typically bases payments to providers on different measures than those it uses to determine whether the program improves quality: [f]or example, across a representative sample of nine models, 71 quality metrics were used to determine performance-based quality payments, but only 39 of those metrics were included in [program] evaluations. In addition, 99 of the 138 quality metrics that were used in the Center’s evaluations were not included in the models’ performance-based quality payments.202 COVID-19 provides further evidence of Medicare’s ongoing hostility to quality. Among other things, the pandemic highlighted that while Medicare has recently begun requiring acute-care hospitals to report infection rates, “[o]utpatient surgery, ambulatory surgery centers, emergency rooms, nursing homes, assisted living and hospice centers have not been required to report infections.” 203 In addition, once the pandemic struck, Medicare quickly suspended many quality-improvement activities, including elements of the HVBP.204 “Never has there been a moment in history when Americans care more about hospital infection rates,” yet Medicare suspended requirements that hospitals track and report infection rates.205 Medicare suspended other quality reporting programs in ways that created additional opportunities for providers to game those programs.206 Medicare officials described these steps as providing “relief for clinicians, providers, hospitals and facilities” from “bureaucratic red tape.” 207 When Medicare administrators refer to qualityimprovement programs as bureaucratic red tape, it suggests either that those programs offer little substantive benefit to enrollees or that Medicare officials have little enthusiasm for them (or, charitably, both). When Medicare officials praise the suspension of qualityimprovement programs for providing relief to providers, it raises questions about whom those officials consider their primary clientele. In sum, MedPAC writes, “Medicare does not consistently measure quality across [Medicare Advantage] plans, [fee-for-service] populations, and providers, so we cannot report trends about the entire Medicare program’s quality of care.” 208 Medicare “does not support sufficient accountability or transparency, such as providing beneficiaries with information that compares the quality of care provided by different models such as [fee-for-service], health plans, or ACOs.” 209 Medicare neither assesses whether the quality metrics it selects advance its quality-measurement objectives, nor tracks all the resources it spends on quality-measurement,210 nor collects data on the cost of complying with its quality-improvement programs, nor makes a serious effort to detect and prevent provider gaming of those programs. More than 50 years after President Johnson requested that Congress give traditional Medicare authority to reward quality, observers still blame the program for continuing to subject enrollees to low-quality care, including iatrogenic illnesses such as avoidable hospital-acquired infections.211 Medicare’s decisions in 2008 and 2009 to cease payments for certain “never events” and hospital acquired infections212 merely highlight how limited those measures are compared to prepayment; how it took Medicare more than 40 years to enact them; and how throughout those four decades, Medicare rewarded low-quality care that a competitive market would not. MedPAC continues to identify ways traditional Medicare undermines quality that the ACA did not address, such as the Commission’s “longstanding concern” that Medicare sets relatively low prices for primary care and pays for primary care on a fee-forservice basis, both of which threaten the quality of care for enrollees with chronic conditions.213 In traditional Medicare’s sixth decade, MedPAC is still urging Congress to “move the Medicare program beyond just blindly paying [fee-for-service] rates.” 214 In 2020, MedPAC wrote that while “the Medicare program has begun to implement quality-based payment policies in a number of sectors . . . the Commission has been increasingly concerned that Medicare’s approach to quality measurement is flawed.”

Private insurers focus on improving quality

 

Michael F. Cannon, MA, JM, is director of health policy studies at the Cato Institute, Jacqueline Pohida, MSN, is a board-certified nurse practitioner, April 8, 2022, Quinnipiac Health Law Journal, April 8, 2022, WOULD “MEDICARE FOR ALL” MEAN QUALITYFOR ALL? HOW PUBLIC-OPTION PRINCIPLES COULD REVERSE MEDICARE’S NEGATIV IMPACT ON QUALITY, https://www.cato.org/sites/cato.org/files/2022-04/cannon-qhlj-v25n2.pdf

Private third-party payers have shown greater interest and initiative in quality improvement by, for example, developing innovative payment systems. The CBO reports that as a share of revenues, private insurers spend at least one third more than traditional Medicare on quality-improvement activities.216 As we note above (Part II.A.), a century before Congress created Medicare, the private sector developed payment systems that reward the dimensions of quality Medicare discourages. The private sector has been more innovative when it comes to reforming fee-for-service payment as well. Private insurers and employers began tying fee-for-service payments to quality at least as early as the early 1990s—two decades before Medicare did.217 After Intermountain Health Care reduced pneumonia mortality in 1995, private fee-for-service insurers worked with Intermountain to address how their payment rules discouraged such innovation.218 In 2003, MedPAC offered a lengthy list of quality-improvement initiativesthat private insurers and employers had deployed and traditional Medicare had not, including “financial and nonfinancial incentives to improve quality.” 219 By that year, “the private sector [wa]s using utilization review, selective contracting, and performance-based compensation to enhance quality of care [while traditional] Medicare [wa]s not really using any of these tools.” 220 A 2017 survey found “valueoriented payments” account for 53 percent of payments private insurers make to health care providers.221 Private Medicare Advantage plans have likewise been more innovative than traditional Medicare. In 2020, MedPAC wrote: [Medicare Advantage] plans have a number of management tools that are not available in [traditional Medicare] but permit plans to improve the quality of care for their enrollees—tools such as selective contracting, care management, information systems shared across providers, and utilization management that can prevent overutilization of potentially harmful care.222 Striking a familiar note, MedPAC continued, “We would therefore expect quality in [Medicare Advantage] to be better than in [fee-forservice], but a lack of sufficient data severely limits any definitive comparisons.” 223 Even so, a systematic review found studies comparing traditional Medicare and Medicare Advantage plans tend to give the latter the edge on quality: [I]n most or all comparisons, [Medicare Advantage] was associated with higher use of preventive care visits, fewer hospital admissions, fewer emergency department visits, shorter hospital and skilled nursing facility lengths-of-stay, and lower health care spending relative to traditional Medicare. Although [Medicare Advantage] plans outperformed traditional Medicare in most studies comparing quality-of-care metrics, their enrollees were more likely to receive care in average-quality hospitals and lower-quality nursing facilities and home health care agencies. The evidence on readmission rates, mortality, experience of care, and racial/ethnic disparities did not show a trend of better performance in [Medicare Advantage] plans than traditional Medicare, despite the higher payments to [Medicare Advantage] plans.224 Echoing MedPAC, the reviewers call for “complete and comparable data” across the two programs.225 Quality is obviously a challenge for private insurers as well. While the study of Florida hospitals above found greater reductions in readmissions among patients with Medicare Advantage and private health plans than among patients in traditional Medicare,226 MedPAC writes that overall, “[e]fforts to promote the use of [value-based purchasing)] in the commercial sector have had relatively modest effects to date.” 227 A potential impediment to private-sector qualityimprovement efforts are government interventions that distort the medical marketplace in favor of fee-for-service payment and deny consumers the opportunity to choose their own health plans. Former Medicare administrator Donald Berwick and his coauthors explain Even if payment schemes were sensitive to quality, and even if consumers could see the difference between better and worse care, [incentives for quality] improvement would be weakened by the distance between the patients and the payment rules. People and payers who might be quite willing to pay a premium for more fully integrated chronic disease care, for the option of a group visit, or for detailed management of their lipid medications do not have the option to do so because of fixed fee schedules and complex payment rules. This is particularly true under Medicare. In effect, people do not have the option to pay for what they want, even if what they want is better than what they have.228 This is also true for workers whom the federal tax code loc ks into generally fee-for-service plans that their employers choose.

 

Public option counterplan

 

Michael F. Cannon, MA, JM, is director of health policy studies at the Cato Institute, Jacqueline Pohida, MSN, is a board-certified nurse practitioner, April 8, 2022, Quinnipiac Health Law Journal, April 8, 2022, WOULD “MEDICARE FOR ALL” MEAN QUALITYFOR ALL? HOW PUBLIC-OPTION PRINCIPLES COULD REVERSE MEDICARE’S NEGATIV IMPACT ON QUALITY, https://www.cato.org/sites/cato.org/files/2022-04/cannon-qhlj-v25n2.pdf

 

A “Public Option” Framework for Medicare Congress can reverse Medicare’s negative impact on quality by reorganizing the program along “public option” principles that President Biden and other policymakers have endorsed.229 Advocates of a public option propose robust competition between a governmentrun health plan and private health insurance plans on a level playing field.230 In the absence of government favoritism toward any market competitor, consumers would act as the ultimate arbiters of quality and efficiency.231 A completely level playing field between a government-run health plan and private insurers is likely unattainable. Government programs can benefit from advantages over private competitors that reflect neither greater quality nor efficiency.232 Traditional Medicare will likely always enjoy such advantages. Regardless, a measure of competition already exists between traditional Medicare and private Medicare Advantage plans, and there are indications that even this limited competition may be improving quality for Medicare enrollees in ways that otherwise would not have occurred (see discussion of Medicare Advantage plans’ quality-improvement tools above). Congress can make the playing field more level by making Medicare enrollees fully cost-conscious and removing distortionsthat push enrollees in the direction of particular plans. At present, various policies can make either traditional Medicare or Medicare Advantage plans seem more attractive for reasons unrelated to efficiency. Such distortions can push enrollees to choose lower-quality plans. Eliminating those distortions would promote quality by leading enrollees to choose (and moving the market toward) higher-quality and/or lower-cost plans. In particular, public-option principles require eliminating favoritism toward fee-for-service payment, or whatever payment rules the government plan happens to employ. Applying that principle to Medicare would increase demand for prepaid group plans and other non-fee-for-service arrangements, promoting dimensions of quality Medicare currently discourages. In a Medicare program that operates under public-option principles, enrollees would make tradeoffs between different payment systems based on their values and without political interference from low-quality providers. Such a framework would, as MedPAC recommends, “giv[e] accountable entities stronger incentives to control costs and improve quality and then rely on those entities to develop the most effective payment arrangements to meet those goals.” 233 As in other markets, competition for the most discerning consumers would improve quality and reduce costs for less-sophisticated consumers as well. While advocates typically propose creating a public option to compete with private insurers in the non-Medicare market, Medicare offers a better opportunity to test public-option principles. Medicare already boasts an established if imperfect public option (traditional Medicare) that competes against private insurers (Medicare Advantage plans) to cover a large population of patients with experience choosing between a government-run plan and private plans. Medicare already offers “what is essentially a risk-adjusted voucher program” where enrollees choose between these options.234 Unlike proposals to create a public option in the non-Medicare market, applying public-option principles to Medicare would not require new government spending 235 and could even reduce government spending.236 The foregoing discussion illustrates that Medicare enrollees are in desperate need of the quality innovations and improvements such competition would generate. Finally, unlike creating a public option to compete in the non-Medicare market applying public-option principles to Medicare could garner support from both major political parties.

 

Medical care costs for employers will increase

 

Janet Young, M.D. | March 31, 2022, Will an avalanche of health care costs hit employers this year?, https://www.benefitspro.com/2022/03/31/will-an-avalanche-of-health-care-costs-hit-employers-this-year/?slreturn=20220530191229

Few things are more certain in American life than the rising cost of health care. In 1969, only 6.4% of the gross domestic product was spent on health care, according to the federal government. In 2019, that figure was 17.7% of GDP. Health care spending in October 2021 (the most recent month for which data is available) reached 23.9% of GDP. And so while it is a likely bet that costs will continue to rise in 2022, nothing is normal during the pandemic. Cost projections are being made under uncertain conditions due to unexpected COVID-19 surges, unknown long-term impacts of the coronavirus on infected individuals, potential downstream effects of delayed and avoided care, and the ongoing labor shortages in the health care sector. As an employer, what do you need to know about rising health care costs and the continuing impact of COVID-19 in 2022 and beyond? Overall spending will increase Employers expect health care costs to rise 4.7% in 2022, according to a survey by asset management and benefits firm Mercer. And while that’s in line with the historical rate of change, it’s still a large number. Among the factors expected to drive the increase are conditions that worsened due to delayed or avoided care and may require more expensive treatment as a consequence. The CDC documented that about 41% of adults delayed or avoided medical care early in the pandemic, and more recent reports suggest that this pattern continued in 2021, albeit to a lesser extent. A survey in April 2021 found that approximately 11% of adults and 9% of children had delayed or decided not to seek care in the previous 30 days due to concerns about coronavirus exposure. Recent studies have also been published on delayed care in elderly adults, delayed childhood vaccinations, and the causes of the delays. While the impact of delayed and avoided care remains to be seen, recent findings from cancer experts provide clues. According to the American Association for Cancer Research, “the pandemic impaired referrals for preliminary cancer diagnoses and led to an 11% increase in patients diagnosed with inoperable or metastatic cancer during March–December 2020 when compared to the same time frame in 2019.” A year into the pandemic, two-thirds of radiation oncologists indicated that new patients were more likely to have advanced-stage cancers than before. Employers may also encounter an increase in individuals developing new chronic conditions, driven by adverse shifts in behavior, including lower rates of exercising, worse diet habits, unintended weight gain, and increased stress and depression. A study of approximately 15 million patients found that almost 40% of patients gained more than 2.5 pounds during the first year of the pandemic, with about 10% gaining more than 12.5 pounds. The increasing number of individuals working from home is likely to result in more members with musculoskeletal issues due to poor ergonomic setups and reduced activity throughout the day without normal breaks, like walking to the coffee machine or meeting room. A study of individuals working from home found that over 40% reported musculoskeletal discomfort related to the back, shoulders, neck, and head, or visual issues. These issues are probably driving the reported 15% increase in average weekly patient visits reported in a survey of chiropractors that examined utilization of services during the pandemic. Psychological needs have increased dramatically Indicators of worsening mental health are easy to find. For instance, a February survey by the American Psychological Association found that 42% of respondents said pandemic stress had brought about significant unwanted weight gain, two-thirds of respondents said their sleep patterns had worsened, and nearly one-quarter said they were drinking more alcohol — behaviors that are costly in and of themselves and can also lead to other conditions. As a literature review in the Psychiatric Times concluded, “in the general population — at least during the first year of the pandemic — there were substantial rises in the rates of anxiety and depression,” which were more pronounced for young people and women.

 

 

Health care costs will increase

Price Waterhouse Coopers, 2022, Medical cost trend: Behind the numbers 2022, https://www.pwc.com/us/en/industries/health-industries/library/behind-the-numbers.html

 

The pandemic has shifted how and where Americans gain access to care, a shift large enough to influence multiple aspects of price and utilization and, thus, medical cost trend. The aftereffects of the pandemic and the health system’s response to changes and failures observed during the pandemic are expected to drive up spending (inflators) in 2022. At the same time, some positive changes in consumer behavior and provider operating models that occurred during the pandemic are expected to drive down spending (deflators) in 2022. Where is the medical cost trend headed in 2022? PwC’s Health Research Institute (HRI) is projecting a 6.5% medical cost trend in 2022, slightly lower than the 7% medical cost trend in 2021 and slightly higher than it was between 2016 and 2020. Healthcare spending is expected to return to pre-pandemic baselines with some adjustments to account for the pandemic’s persistent effects. HRI defines medical cost trend as the projected percentage increase in the cost to treat patients from one year to the next, assuming benefits remain the same. Typically, spending data from the prior year is used as an input in the projection. For 2021 and 2022, the medical cost trend is the projected percentage increase over the prior year’s spending, with the effects of the pandemic removed from the prior year’s spending. Inflator: The COVID-19 hangover leads to increased utilization The pandemic’s long tail may increase utilization and healthcare spending in 2022 thanks to the return of some care deferred during the pandemic, the ongoing costs of COVID-19, increased mental health and substance use issues, and worsening population health. Some care deferred during the pandemic returns – Healthcare spending by employers in 2020 was lower than expected, in large part because of the deferral of care as a result of the pandemic. Some of this care is expected to rebound in 2022, and some of it likely will increase healthcare spending. COVID-19 costs are likely to persist – The costs of testing for COVID-19, treating patients and administering vaccinations for the disease likely will continue into 2022. The mental health and substance use crises show no signs of waning – The pandemic substantially increased demand for mental health services. Increased substance use also likely will increase healthcare spending in 2022. Population health worsened during the pandemic – Poor pandemic-era health behaviors such as lack of exercise, poor nutrition, increased substance use and smoking may lead to deterioration in US population health and increase healthcare spending.

 

 

Single payer defined

 

Mila Araujo, April 5, 2022, https://www.thebalance.com/is-single-payer-health-insurance-a-good-deal-how-does-it-work-4175823, What Is Single-Payer Health Insurance?

What Is Single-Payer Health Insurance?

Mother and child at a doctor’s appointment

Single-payer health insurance is a model in which a single entity (usually the government) pays for health care and extends coverage to all citizens. The details of the system vary by the country implementing it, but in general, citizens in a single-payer system pay little or no out-of-pocket costs for coverage and basic health care treatment. Instead, citizens fund single-payer health care systems through taxes. Definition and Example of Single-Payer Health Insurance Single-payer health insurance is a healthcare system mostly or wholly funded by one entity (like a government agency, using tax dollars). The system takes the place of private health insurance companies and patient co-payments. The networks of doctors, hospitals, and payments in a single-payer system are managed by this single entity. For example, in the U.S., the idea of single-payer healthcare has been coined “Medicare for All.” This name comes from the idea of expanding Medicare. Medicare is the tax-funded single-payer healthcare system designed for older people or those with disabilities. Medicare could expand to provide healthcare coverage for all people in place of private health insurance companies. This expansion would make it the nation’s single-payer health insurance system. How Does Single-Payer Health Insurance Work? While many countries have single-payer systems, they don’t all work in the same way. The systems all work to reduce co-payments and other forms of costs for patients. While reducing costs is the overall goal, the systems don’t always cover the same services. In some countries, patients still pay some out-of-pocket costs. In others, they may need to find supplemental health insurance plans to cover what the system doesn’t. Single-payer systems try to provide low-cost access to: Preventive care Long-term care Mental health treatment Reproductive healthcare Prescription drugs and other medical supplies Not all single-payer systems are national systems. Many large countries rely on the regional governments of states or provinces to administer the healthcare system and pay providers. These governments often get the funds they need from the national government. The regional program leaders decide how to use the funds to meet policy goals. Examples of Single-Payer Systems Around the World Countries that have single-payer health systems (or similar systems) include: Canada uses regional control with national grant programs to fund the system. The United Kingdom has regional flexibility with national funding in its healthcare system. France has a mostly national administration and funding in the system it created. Australia also allows for regional flexibility and uses national funding. Norway gives regional leaders flexibility and uses national funding. Denmark uses national grant programs to give funds to regional leaders for flexibility. Sweden gives regions the flexibility to distribute the funds through mostly regional funding. You may find that countries range from being very complex to simple when you compare their payment systems. For example, the Singapore federal government pays the healthcare providers. England has local clinical commissioning groups that take national funding and distribute the payments. More complex systems in countries like Germany and the Netherlands are often thought to be single-payer. Many private health insurance companies exist in these countries, so they are really multi-payer systems. The funds are disbursed among competing healthcare insurance companies that pay doctors and hospitals. These companies may be nonprofit (like in Germany) or for-profit (like in the Netherlands).

Significant heath inequity in the health care system

Dr. Jamila Michener, Associate Professor of Government and Public Policy Co-director, Cornell Center for Health Equity, March 29, 2022, Hearing: Examining Pathways to Universal Health Coverage, https://oversight.house.gov/sites/democrats.oversight.house.gov/files/Michener%20Testimony.pdf

The Stark Realities of Health Inequity in the United States Health equity has never been a reality for people of color, especially those that identify as Black, Latina/o/x, and Indigenous.1 Notwithstanding significant changes over the long durée of U.S. health policy, racial health inequities have persisted as a continual condition. 2 Consider just a few (among many) examples of striking contemporary patterns in the United States: • Black and American Indian/Alaska Native (AIAN) people live fewer years, on average, than White people.3 • Black and AIAN people more likely to die from treatable conditions than White people. 4 • Black people are at higher risk for chronic health conditions like diabetes and hypertension.5 • Black people are more likely to die from breast and colon cancer, particularly because of later-stage diagnoses and differential treatment.6 • Black and AIAN women are more likely to die during or after pregnancy and to suffer serious pregnancy-related complications; they are also more likely to lose children in infancy.7 • As a result of COVID-19, racial/ethnic disparities in life expectancies grew worse. Average life expectancies for Black, Latina/o, and AIAN people fell more sharply compared to white people.8 These racial disparities are just the tip of a much larger iceberg. Crucially, such inequitable health outcomes are a product of systemic forces, not individual choices.9 In the United States, “systems of racial stratification shape whether you live in a neighborhood that will promote your health, have access to resources to sustain your health, have daily experiences that will threaten your health or make you vulnerable to illnesses that will weaken your health, and they influence the political processes that can be activated to protect your health.”10 These systems are generated through overlapping social, economic, and political processes that together determine racial health disparities. Inequitable health insurance is a key factor that contributes to such disparities. People of color have lower access to health insurance for a wide variety of reasons including more tenuous and disadvantageous positioning in the labor market11 and the racialized geography of public policies like Medicaid.12 As a result, uninsured rates are generally higher for Black, Latina/o/x, and AIAN adults compared to White adults.1\ Unequal, unstable, unaffordable, and constrained access to health insurance, along with a host of related factors, contribute to many people of color experiencing the healthcare system as profoundly discriminatory, difficult to navigate, and racist.14 People of color are more likely to delay care or forgo treatment.15 They struggle to afford prescribed medication and adhere to treatment regimens. 16 Such disparities have only been amplified by the ongoing COVID-19 pandemic.17 As a result, Black, Latina/o/x, and Indigenous Americans had significantly higher rates of COVID-19 infection, hospitalization, and death compared to their White counterparts. The ramifications of such patterns go beyond individuals— extending to communities of color that remain at acute risk because of longstanding patterns of racial residential segregation. 19 The disadvantages generated from being uninsured, underinsured, or otherwise precarious in relation to healthcare, are concentrated in the places where people of color. For example, roughly 60 percent of Black people live in southern states, which have poor health outcomes and attenuated access to health relative to other parts of the country. 20 More generally, heterogeneity in state policy implementation, as saliently demonstrated with the Affordable Care Act, disproportionally affects people of color.21 Looking beyond states, racially unequal access to health insurance persists at the substate level (e.g., in counties and neighborhoods)

Universal health care promotes racial equity

 

Dr. Jamila Michener, Associate Professor of Government and Public Policy Co-director, Cornell Center for Health Equity, March 29, 2022, Hearing: Examining Pathways to Universal Health Coverage, https://oversight.house.gov/sites/democrats.oversight.house.gov/files/Michener%20Testimony.pdf

Universal Health Coverage for a More Racially Equitable Democracy Access to healthcare is an “ethical and human rights principle” that means “everyone has a fair and just opportunity to be as healthy as possible.”23 This principle can only be achieved by reducing health disparities.” 24 Access to high quality health insurance is a critical determinant of racial health disparities.25 For this reason, universal health insurance coverage is a necessary (though not at all sufficient) precondition for giving everyone a fair and just opportunity to be healthy, irrespective of racial classification/identification. Over and above the material and health benefits that such coverage would provide, it would also position people of color as full and equal members of the polity, reinforcing their civic status and strengthening our democracy. Though this connection is too often overlooked, health and health policy have crucial consequences for democratic participation.26 Medicaid is an especially apt example given that a disproportionate share of Medicaid beneficiaries are people of color Medicaid expansion is associated with short-term boosts in voter turnout, whereas Medicaid disenrollment is associated with significant declines in rates of voting.28 More generally, Medicaid beneficiaries’ experiences with the program affect whether and how they participate in politics.29 Access to high quality, affordable health care offered to all in ways that convey dignity and respect, has great potential to amplify the voices of those most who are most economically and racially marginalized in American society, to build their power, and to create a more robust democracy. 30 Such a goal is not in the name of partisan politics or electioneering. Instead, it is about ensuring that those with the most at stake have meaningful influence over the political processes that determine their ability to survive and thrive.

 

Turn: More Medicaid spending means more waste

 

Grace-Marie Turner, President, Galen Institute, March 29, 2022, Hearing: Examining Pathway to Universal Health Coverage, https://oversight.house.gov/sites/democrats.oversight.house.gov/files/Turner%20Testimony.pdf

 

THE HIGH PRICE OF MEDICAID WASTE Pouring more money into Medicaid without reforming the program is reckless. “A recent federal audit examined 2,301 files of people enrolled under ObamaCare’s expansion, and eligibility review errors occurred in 29% of them,” according to a review by Brian Blase.9 The audit found eligibility errors for nearly one third of Medicaid enrollees. What does this cost taxpayers? “The federal government’s improper Medicaid payments now exceed $100 billion a year,” Blase reports. “This means that more than one-in-four dollars flowing out of Medicaid — our nation’s third-largest government program — do not meet program rules. This staggering failure doesn’t just reduce health-care access for the truly eligible, it also harms taxpayers who fund it.” 10 These studies provide further evidence that more government spending is not the answer. STRUGGLING TO ACHIEVE PROMISED GOALS I was in the gallery the night the House passed the Affordable Care Act in March of 2010 and heard Member after Member talk about the importance of passing the bill in order to “finally achieve universal coverage” and guarantee that everyone will be able to access quality, affordable care. Former President Obama promised repeatedly that people would be able to keep their doctors and their plans and that the typical American family’s premiums would drop by $2,500 a year. Many Americans are frustrated that, 12 years later, our nation still is struggling to achieve these goals of access and affordability. They are understandably skeptical of new promises. IF YOU LIKE YOUR PLAN… As members of Congress examine increasing the role of government—either through Medicare for All or derivatives, such as Medicare buy-in or a federal “public option”—we would fall further down the slippery slope where government control of our health sector would make private coverage less and less viable. Former President Obama’s promise that “If you like your plan, you can keep it” and “If you like your doctor, you can keep your doctor” was declared by PolitiFact to be The Lie of the Year in 2013.11 While the promises of Medicare for All sound utopian, what about the large portion of at least 173 million people don’t want to give up their job-based insurance? What if 64 million seniors like their current Medicare and Medicare Advantage plans and don’t want the program abolished and replaced? And what about union members who have made significant sacrifices in wages to earn their rich health benefit packages? Will they and others who like the coverage they have now be forced to pay significant new taxes to finance a government program that is inferior to the one they have no The Big Truth of Medicare for All would be that virtually everyone would lose the plan they have now and there would be no choice but the single, government-run health plan. Employer coverage would end. Medicare as seniors know it would end. Medicaid, the single-largest publicly-supported health program in the country, would end. Medicare Advantage, the Medicare Prescription Drug Program, and the Children’s’ Health Insurance Program all would shut down. “Free” health care would stimulate demand for health care, while threatening its supply. It could well lead to a shortage of doctors and hospital capacity, threatening both access to care and a diminution of quality. Americans could soon find themselves waiting in line for care and paying sharply increased taxes as federal indebtedness soars, putting at even greater risk future prosperity for our children and grandchildren.

 

 Single payer will destroy health care

 

Grace-Marie Turner, President, Galen Institute, March 29, 2022, Hearing: Examining Pathway to Universal Health Coverage, https://oversight.house.gov/sites/democrats.oversight.house.gov/files/Turner%20Testimony.pdf

 

The Congressional Budget Office was asked to evaluate key design elements of a single-payer system and came to sobering conclusions.12 CBO found that establishing such a system would be a “major undertaking” that would be “complicated, challenging, and potentially disruptive” and that the “changes could significantly affect the overall U.S. economy.” CBO says that “Setting payment rates equal to Medicare [feefor-service] rates under a single-payer system would reduce the average payment rates most providers receive—often substantially.” Further, this would likely “reduce the amount of care supplied and could also reduce the quality of care.” It says that “decreases in payment rates lead to a lower supply” and “fewer people might decide to enter the medical profession in the future. The number of hospitals and other health care facilities might also decline as a result of closures, and there might be less investment in new and existing facilities.” According to CBO, the government’s low payment rates “could lead to a shortage of providers, longer wait times, and changes in the quality of care, especially if patient demand increased substantially.” While CBO was not asked to produce budget estimates of a single-payer system, it recognizes the cost risk by imposing global budgets to cap spending for institutional providers through a Medicare for All system. In addition, Washington would assume the task of determining the list of covered benefits and updating it on an annual basis. This would inevitably lead to significant restrictions on access to care, as CBO expects, including the long waiting lines and other barriers to timely care that we see in other countries with government-run health care systems and global budgets. The most vulnerable would be the most severely impacted because they would be forced to navigate a complex, bureaucratic system to get the care they need. WHAT SINGLE-PAYER AND GLOBAL BUDGETS WOULD MEAN TO PATIENTS Disadvantaging the most vulnerable: Because just five percent of the population accounts for more than half of U.S. health care spending, 13 those who are sickest with the greatest health needs are most disadvantaged when the health system is under government control. Political leaders inevitably work to make sure the great majority of their constituents are at least satisfied with the system, even if it means restricting access to services to the smaller minority with the greatest health needs. Provider shortages: Assigning Medicare rates to hospitals would entail payment rates that are roughly 40 percent lower than commercial rates, while physicians would be reimbursed at rates that are 30 percent lower than those paid by private insurers. These payment reductions would gradually grow larger over time for both. Medicare actuaries have warned that if Medicare payment rates contained in current law were put into place, many providers would face negative margins. That could mean that many physician practices and hospitals would be forced to close or significantly cut back on services. Some anticipate the new program would look more like mandatory Medicaid as a result.14 According to the Association of American Medical Colleges, even under our current health system, the U.S. will see a shortage of up to nearly 120,000 physicians by 2030. 15 The demand for physicians is expected to grow faster than the supply, and rural areas will be hit especially hard, according to the report. 16 The payment cuts envisioned under Medicare for All are likely to exacerbate this trend as more physicians close their practices or otherwise withdraw because the payment reductions will force many to close their practices. Disruption of current coverage: I began my testimony talking about the very real problems and frustrations with health care in America, but any policy solution must also take into account what people value about the system and assess the risks of such sweeping changes Today, 64 million people rely on Medicare for their health insurance coverage.17 Seniors value Medicare, and many believe their access would be undermined if 268 million more Americans were competing with them for services from the same underpaid providers. In 2021, 26 million Medicare beneficiaries, or about 42% of those eligible for the program, were enrolled in a Medicare Advantage plan.18 Medicare For All would take away the private coverage that these 26 million seniors have voluntarily chosen under Medicare Advantage, and it would dramatically change the program for seniors in the traditional Medicare program as well, including outlawing private supplementary Medigap policies. Medicare Advantage deploys private insurers to provide better access and better-coordinated care to seniors. The federal government simply is unable to develop creative programs to personalize care to the needs of individual patients—as we see Medicare Advantage and in other private plans today. 19 Dramatic federal spending increases: Using Medicare as a model for health reform risks incomprehensibly large deficit spending well into the future. Dr. Charles Blahous testified before the Rules Committee in an earlier hearing on universal coverage that federal spending would increase by at least $32 trillion over ten years if the United States were to adopt a single-payer health care system.20 He found that even doubling individual and corporate taxes would be insufficient to finance this spending increase. Restricted access to new medicines and other medical technologies also occurs in countries with government-centric health systems. In just one example, my organization published a report surveying access to new drugs in a number of countries with government-dominated health systems. 21 We found the French, for example, have access to only 48% of new drugs introduced between 2011 and 2018. Americans, by contrast, have access to 89% of those innovative medications. Nor is France an exception. The Swiss have access to only 48% of newly-developed drugs, the Belgians 43%, and the Dutch 56%. Thwarting innovation: The United States is a recognized leader in medical innovation. Over the past half century, the United States has been the birthplace of the majority of the world’s biomedical innovations.22 Our hospitals and physicians offer top quality care where Americans have access to the latest medical diagnostics. Americans are accustomed to better quality and access and are unlikely to be satisfied with restrictions and rationing and to stalling the innovation that continues to produce new and better treatments and medicines. Turning the clock backward: In our increasingly complex health care system, many patients are bewildered when faced with a health challenge. Significant progress has been made in developing coordinated care to provide patients with an integrated network of physicians, from primary and specialty care to lab services, pharmaceutical benefits, and hospital services. In addition to improving the quality and effectiveness of health care, providing personalized care is more cost effective and humane. Putting government in charge of our health sector would turn back the clock on the progress we are making to move away from Medicare’s 1965-model feefor-service system. Government rules and payment policies would stifle the movement toward personalized care. Administrative costs: Medicare for All advocates say the administrative savings would help fill the funding gap. But the new single-payer system still would require many of the same administrative functions in any insurance system. Physicians, hospitals, labs and other service providers would have to be approved and payment rates set. The government would need documentation that approved services were actually provided, providers would have to be paid, and there would be an even greater need for safeguards against fraud and abuse. Merrill Matthews of the Institute for Policy Innovation and colleagues analyzed Medicare administrative costs vs those of private insurers.23 He found that an apples to apples comparison showed little administrative savings between Medicare and private payers when, for example, services such as the costs that other government agencies perform, such as collecting premium revenue, are considered.

 

Employer-sponsored health care critical to coverage

 

Grace-Marie Turner, President, Galen Institute, March 29, 2022, Hearing: Examining Pathway to Universal Health Coverage, https://oversight.house.gov/sites/democrats.oversight.house.gov/files/Turner%20Testimony.pdf

 

In our multi-payer health sector, employer-sponsored health insurance (ESI) is the single-largest conveyer of health coverage in America. As such, it is worth taking a deeper dive into this program and its central role in our health sector—including supporting public health programs that can pay less than the cost of providing care. Nearly 175 million Americans receive health coverage through the workplace, either as an employee, retiree, or dependent.24 The great majority highly value their coverage that would be eliminated under Medicare for All. Employers know that high quality health coverage leads to better health outcomes and a healthier workforce. They offered prescription drug coverage for many years before Medicare did. Long before the ACA, they offered preventive and wellness services because they know that addressing health issues before they become a crisis can minimize costs and lead to better outcomes. Employers continue to outpace public programs in the management of chronic illness, price transparency, and the availability of health savings accounts and other innovations to increase health care choices and reduce costs. Employers and employees both have a vested interest in getting the best value for their health care dollars to obtain the highest quality care and coverage at the lowest cost. Most large firms offer coverage to their employees (99 percent of all firms with more than 200 employees offer health coverage). Sixty-seven percent of firms with 10 to 100 employees offer health coverage to their workers, but just 30 percent of employers with fewer than 50 employees offer coverage. These companies want to provide coverage to their workers. According to a July 2021 survey of small businesses:25 • 37% said they felt they couldn’t expand their workforce because of the cost of health coverage for workers. • 47% said they felt their company would lose out on the best workers if they couldn’t offer competitive benefits. • 60% said they limited healthcare benefit options because of high costs. • 59% said they felt they couldn’t compete with the benefit offerings at larger companies. The smaller the firm, the less likely they are to offer coverage. Small businesses need the option to get the economies of scale that larger businesses enjoy by pooling together through Association Health Plans, which I discuss in the Appendix to my testimony.

 

State-based single payer requires a massive tax increase

 

Grace-Marie Turner, President, Galen Institute, March 29, 2022, Hearing: Examining Pathway to Universal Health Coverage, https://oversight.house.gov/sites/democrats.oversight.house.gov/files/Turner%20Testimony.pdf

Single-payer and the States: Some have suggested that the movement to a federal single-payer system can start with state-based single-payer programs. But Colorado, Vermont, and most recently California have failed in their attempts. Colorado voters rejected a single-payer initiative in 2016 by a four to one margin, with residents especially concerned about the high taxes that would be required to finance it and about losing the coverage they have now to the uncertainties of the new system. Vermont officials worked feverishly to design a single-payer system but found that the costs of the program would be prohibitive and that the higher taxes required would seriously damage the economy. And California, which has veto-proof legislative majorities and a willing governor, recently shelved a single-payer bill because costs and tax levies would have been prohibitive.26 AB 1400 would have all but eliminated private health care and replaced it with a centralized state-run financing system known as CalCare. The program was estimated to cost between $314 billion and $391 billion a year, requiring major tax increases in the highly-taxed state.

Medicare for All Buy-In Option Fails

 

Grace-Marie Turner, President, Galen Institute, March 29, 2022, Hearing: Examining Pathway to Universal Health Coverage, https://oversight.house.gov/sites/democrats.oversight.house.gov/files/Turner%20Testimony.pdf

Medicare Buy-In: Still others suggest a Medicare Buy-In approach. It is hard to see what problem Medicare Buy-in would solve. If early retirees were able to buy into the Medicare program and pay their full share, the cost would be an estimated $1,111 per person.28 For many, that would be prohibitively expensive, possibly requiring yet another federal program to provide taxpayer-financed subsidies.

Single payer needed to reduce racial inequity in health care

 

Uché Blackstock, MD, Emergency Physician,. Founder and CEO, Advancing Health and Equity, March 29, 2022, Pathways to Universal HealthCare Coverage: House Oversight Committee Testimony,, https://oversight.house.gov/sites/democrats.oversight.house.gov/files/Blackstock%20Testimony.pdf

 

I’m Dr. Uché Blackstock, an emergency medicine physician with over 17 years of clinical experience, a second-generation Black woman physician who has lived experience with injustice, and the founder of an organization dedicated to advancing health equity. I have worked for years in communities where far too many of my patients were either uninsured or underinsured – mostly Black and brown Americans who have sadly been disregarded by our country. They are not only dealing with mental and physical health issues, but also with systemic afflictions, like bias and racism, housing insecurity, economic instability, and lack of access to reliable transportation. These are what we refer to as the “social determinants of health” – the factors which influence the health and health outcomes of communities and people. Lack of access to health care is one of the primary social determinants of health. -smelling mass protruding from her left breast. It was advanced breast cancer. As Black people and people of color, just living in this country is an act of survival – let alone being able to access quality and culturally-responsive healthcare. Research shows that the long-term, sustained stress of systemic racism clearly has a negative impact on health.1The ‘weathering hypothesis’2 shows that racism and oppression, in ways both large and small, in our surrounding environments, slowly chip away at our physical health in the form of chronic medical problems, like high blood pressure, diabetes, and heart disease. The ongoing COVID-19 pandemic and the country’s presumed “reckoning” with racism has only exposed the deep pre-existing fissures in our healthcare and public health system. Despite significant advances in healthcare innovation and technology over the last 75 years, Black men have the shortest life expectancy. Black women have the highest maternal mortality rate. Black babies have the highest infant mortality rate. Overall, Black Americans have a six-year life expectancy gap compared to white Americans — the widest gap since 1998 and widened even more by the pandemic.3 This pandemic should have been a wake-up call to help us understand the urgency of identifying a path toward making universal healthcare a reality, among other critical strategies to improve health equity. I have had a front row seat to the tragic loss of Black and brown life from COVID-19 and racism. During the height of the pandemic in NYC, I noticed my patients’ demographics quickly shifted from a racially and socio-economically diverse population to mostly Black and brown patients. Many of them were essential and service workers; some already had underlying medical problems. Others were left with no choice but to use public transportation and live in crowded, multi-generational housing.

 

I vividly remember an elderly Black man who came into my urgent care with shortness of breath and a fever. He was in a wheelchair and his oxygen level was shockingly low. He lived alone. I was very worried that he had COVID pneumonia and asked if I could call an ambulance to bring him from urgent care to the closest ER. He refused. He didn’t want to die in the ER. He told me that he didn’t think he would receive good care because he didn’t have insurance. He felt safer at home. For many years, I worked in two ERs: Bellevue Hospital, the oldest public hospital in the country and Tisch Hospital, a private institution that is part of NYU Langone Medical Center – among the wealthiest hospitals in the country that has gotten hundreds of millions of dollars richer after federal bailouts.4 At these two ERs, that literally sit next door to each other, I experienced first-hand deep inequities in our healthcare system – one that is separate and unequal. Patients were divided up based on insurance and race. Nationally, at private academic medical centers, Black patients are two to three times less likely than white patients to receive care, while uninsured patients overall are five times less likely than patients with insurance coverage to be treated.5 In cities across America, the “top-ranked” hospitals do not treat as many patients of color as white patients, even when they are located in a diverse community. This is the definition of systemic racism. People who look like me are living this every day, but it should not fall solely on us to always have to call out when something is wrong. Now is the time to protect our most vulnerable and underserved communities and identify a pathway to ensuring universal healthcare for all Americans. We must work to break the cycles of trauma and injustice to foster generational progress for more people, especially those of color. Because it is cruel to talk about an “American Dream” if only a select few live to see it.

“Universal health care” includes private markets, single payer eliminates them

 

Angela Hart, 3-1, 22, The demise of single-payer in California trips up efforts in other states, https://www.fiercehealthcare.com/payers/demise-single-payer-california-trips-efforts-other-states

Instead, the first-term Democrat, who is running for reelection this November, is pushing for “universal health care,” which aims to provide all Californians with coverage but, unlike single-payer, would keep private health insurance intact

 

Single payer reduces administrative costs and increases productivity

Jaeger Nelson, Congressional Budget Office, February 24, 2022, https://www.cbo.gov/system/files/2022-02/57637-Single-Payer-Systems.pdf

 

The third channel is the single-payer system’s effect on economywide productivity.4 In CBO’s assessment, administrative costs within the health care sector reduce the sector’s productivity. By CBO’s estimate, a single-payer system would reduce administrative costs within the health care sector by approximately 1.8 percent of GDP in 2030 and ultimately boost productivity. A transition to a single-payer health care system would constitute a major change in health care administration. The reduction in the administrative expenses of private insurers and health care providers would reflect efficiency gains as health care utilization increased but fewer resources were used to administer those services. 5 That efficiency gain would increase the productivity level of the economy at large as productive resources were redistributed to other sectors of the economy.

 

Improved health boosts productivity

Jaeger Nelson, Congressional Budget Office, February 24, 2022, https://www.cbo.gov/system/files/2022-02/57637-Single-Payer-Systems.pdf

 

The fifth channel is the single-payer system’s effect on health outcomes. Under each of the single-payer systems that CBO analyzed, almost all U.S. residents would be enrolled, resulting in greater insurance coverage than under current law. 6 Insurance coverage has been shown to improve health outcomes and reduce mortality among people in their prime working years (ages 25 to 54). Those improvements would increase individuals’ longevity, which in turn would increase the size of the labor force over time. Moreover, improved mental and physical health would increase workers’ labor productivity and, ultimately, their earnings

 

People could still choose their own care and pay for it

 

Jaeger Nelson, Congressional Budget Office, February 24, 2022, https://www.cbo.gov/system/files/2022-02/57637-Single-Payer-Systems.pdf

 

Each option would use a fee-for-service approach—similar in many ways to the Medicare FFS program—in which health care providers would be paid for each service or bundle of services they performed. Under that approach, the federal government would set payment rates for health care administratively, including prices for prescription drugs, and would pay providers directly. Providers would not be owned or operated by the single-payer system. Providers would be allowed to furnish covered services outside the single-payer system, and be paid only by patients, if those providers opted not to receive any payment from the system during a given year. Private insurance for such services would not be allowed. (Seeing a provider outside the single-payer system would not preclude patients from receiving care from providers within the system.) CBO estimates that spending on care outside the single-payer system would range from $47 billion to $124 billion in 2030, depending on the policy option being considered.

 

Single payer solves job lock

 

Jaeger Nelson, Congressional Budget Office, February 24, 2022, https://www.cbo.gov/system/files/2022-02/57637-Single-Payer-Systems.pdf

Potential benefits associated with a single-payer system are a reduction in “job lock” and greater job vocational mobility and business dynamism. A persistent concern about the employmentbased insurance system is that workers who rely on that health insurance may choose not to change jobs, switch between full-time and part-time work, leave the labor market, become selfemployed, or retire when eligible, so that they can retain health insurance coverage.31 Conversely, a worker may choose full-time over part-time work, choose large employers over small employers, or switch to a less-rewarding job to obtain health insurance. Even though economists largely agree that job lock exists, evidence about its prevalence and, therefore, its implications for the overall labor market is less clear, because job lock affects different populations in different ways and to varying degrees. Furthermore, a single-payer system that disconnects health insurance access from employment could alleviate job lock for workers and better allow labor turnover to self-employment or other jobs with a higher marginal product, potentially leading to greater productivity and efficiency through increased vocational mobility. A single-payer system effectively lowers the opportunity cost of starting a new business or becoming self-employed. Additionally, untying health insurance and employment removes a relative disadvantage for small businesses, which currently pay a higher percentage of payroll to provide health benefits to employees. It also removes some administrative and labor costs that new businesses currently bear as they navigate a complex system to select and provide health insurance coverage.

 

Single payer means a quick loss of 400,000 jobs

 

Jaeger Nelson, Congressional Budget Office, February 24, 2022, https://www.cbo.gov/system/files/2022-02/57637-Single-Payer-Systems.pdf

The implementation of a single-payer health care system would significantly alter the structure of the health care sector in the United States. How the sector adapts to that new structure is highly uncertain and could alter the economic effects of the program. For example, the implementation of a single-payer health care system would nearly eliminate the health insurance industry, which employed approximately 400,000 people in 2020. Additionally, health care providers’ response to increased demand for care and changes in their payments rates could affect the supply of care and the types of care provided.

 

Single payer frees-up state budget revenue

 

Jaeger Nelson, Congressional Budget Office, February 24, 2022, https://www.cbo.gov/system/files/2022-02/57637-Single-Payer-Systems.pdf

 

The illustrative single-payer systems affect states’ budgets by eliminating a large portion of the Medicaid program, the Children’s Health Insurance Program, and some discretionary grants. Under current law, Medicaid is jointly financed by the federal and state governments. States’ responses to the change would vary and could have broad economic implications that are not included in this analysis. For example, states could respond to the budget surplus by growing their rainy-day funds (at least temporarily), reducing state tax rates, increasing spending on government purchases or public services, or a combination of all three.

 

Health care costs trigger family bankruptcies

 

Jaeger Nelson, Congressional Budget Office, February 24, 2022, https://www.cbo.gov/system/files/2022-02/57637-Single-Payer-Systems.pdf

 

And with roughly 30 million Americans uninsured, two-thirds of all family bankruptcies in America citing medical expenses as the primary reason for their financial ruin, and one in seven Americans reporting that they’d avoid seeking medical attention due to potentially high bills, it’s clear that the current system isn’t working.

 

Answers to Delay

 

No health care kills

 

Paul Constant, February 5, 2022, Business Insider, Employer-based health insurance was a failure during the pandemic. Here’s how single-payer healthcare could do better., https://www.businessinsider.com/single-payer-healthcare-benefits-california-bill-ash-kalra-2022-2

 

Nearly 20% of the United States’ annual GDP is tied up in healthcare costs, which is double what nations with universal healthcare like Great Britain and Spain devote to medical expenses. And it’s not a trade-off. In return for our oversized spending on medical care, Kalra said, Americans receive “the worst outcomes of any wealthy nation by far — it’s not even close.” The United States also ranks dead last in efficiency, equity, and access to care. America’s current healthcare policy is very clearly killing people. “One of the key indicators of whether someone died from COVID was whether they had gaps in their health insurance or not,” Kalra said. Further, the US “saw life expectancy go down for the first year from June 2019 to June 2020, which only takes into account the first few months of COVID,” Kalra said. Taking the whole of 2020 into account, US life expectancy has now dropped by nearly two full years. And Kalra added that the life expectancy numbers are even worse for Black and Latino Americans — supposedly because they have pre-existing conditions that make them more vulnerable “No one asked the next question: ‘Why do they have the pre-existing conditions?’ Because our system is not only socioeconomically disadvantageous to the poor, it’s also racist, and it’s connected to environmental racism and to how care is given to low-income communities as well,” Kalra said.

 

Answers to: Taxes Hurt Businesses

 

Businesses are better off with the taxes than the health care costs

 

Paul Constant, February 5, 2022, Business Insider, Employer-based health insurance was a failure during the pandemic. Here’s how single-payer healthcare could do better., https://www.businessinsider.com/single-payer-healthcare-benefits-california-bill-ash-kalra-2022-2

It’s curious that the California Chamber of Commerce, which claims to be “all about helping California businesses do business,” argued against single-payer healthcare because, as Kalra said, “the average employer pays over $20,000 a year for employees’ family health insurance.”

The tax revenue that would have paid for CalCare — including a 2.3% tax on businesses with more than $2 million annual gross and a 1.25% payroll tax on businesses employing more than 50 people — would almost certainly be a lighter burden on businesses than what they’re paying now for health insurance.

A 2.3% healthcare tax on a business coming in right at the $2 million mark in gross would represent some $46,000 in taxes paid toward healthcare — total, not per employee. And each worker would have to earn $1.6 million per year for the 1.25% payroll tax to equal the $20,000 in average annual per-employee payments that businesses are currently devoting to health insurance.

States can establish single payer systems (and state counterplan fiat is more real world)

 

Michael Lighty, January 27, 2022, MICHAEL LIGHTY is a consultant with the National Union of Healthcare Workers and a Healthy California NOW leader. He previously served as the Director of Public Policy for National Nurses United and the California Nurses Association, States Now Hold the Key to Making Medicare for All a Reality, https://inthesetimes.com/article/medicare-for-all-single-payer-healthcare-california-new-york, States Now Hold the Key to Making Medicare for All a Reality

The Democrats’ omnibus Build Back Better plan, which includes an expansion of healthcare benefits through bolstering the Affordable Care Act, is currently stalled in the Senate. President Biden has so far made no push to enact a public option, as he campaigned on. And Medicare for All — a cornerstone issue in the 2020 Democratic primary — is not on the party’s current congressional agenda. But that doesn’t mean that the movement to achieve universal healthcare is slowing down.

A significant but under-reported story in the field of healthcare reform is the growing effort to establish Medicare for All-type systems at the state level. Across the country, elected officials and movement organizers have joined forces to make single payer a reality. And they’re building momentum.

In New York, after years of conservative control of the state Senate, progressives who campaigned in 2018 in support of the New York Health Act — a bill that would create a Medicare for All-style system — were elected to office. With these victories, a majority of legislators in both the state Assembly and Senate have now co-sponsored the bill. But in May 2021, a combination of privately reluctant legislators and some resistant unions, along with a lack of gubernatorial support, convinced the Democratic leadership not to bring the bill up for a vote in either house of the legislature. In response, the Campaign for New York Health — a coalition organizing for universal coverage — has promoted stories of people denied care because of insurance company practices and costs, conducted canvasses in key legislative districts, and reached out to unions and union members to address their concerns. The bill’s authors are also considering further amendments, and plan to continue their fight to pass the legislation.

In California, a nurse-led campaign has moved the single-payer bill AB 1400 onto the floor of the state Assembly for a vote in late January. A broad labor-community coalition — Healthy California Now — has organized petitions, letter-writing campaigns, and events around the state to urge Gov. Gavin Newsom (D‑CA) to fulfill his campaign promise of enacting single payer, universal healthcare. This month, he proposed to cover all undocumented people through the state’s Medi-Cal program. And in April, Newsom’s universal healthcare commission is expected to recommend a ​“unified financing” (akin to Medicare for All) healthcare system.

Advocates in Washington State, meanwhile, are currently recruiting petition captains for a signature-gathering effort to put a Medicare for All-type healthcare system on the November ballot, in a campaign called ​“Whole Washington.” Also in Washington, the organization-based coalition Healthcare is a Human Right is urging the state’s task force on universal healthcare to adopt a single-payer approach as it advocates for a bill to rein in health entity mergers and acquisitions that restrict access to care and pad the profits of corporate healthcare providers.

In Oregon, Health Care for All, a coalition of advocates, unions and community based organizations, is organizing to move the state’s universal healthcare task force toward a single-payer model. In November, Oregon voters will consider the HOPE amendment, sponsored by the coalition, to establish healthcare as a fundamental right in the state.

Rhode Island activists, working with the Providence chapter of the Democratic Socialists of America, have helped organize testimony in the state legislature, social media campaigns and pressure on state legislators to pass a state single payer bill, and are now building awareness around the effort to reach working people through the institutions they participate in, such as unions and faith organizations. In Minnesota, advocates led by labor union leaders — in particular the Minnesota Nurses Association — are signing up legislative supporters in preparation for favorable majorities in 2023 to move single payer legislation, which was considered this year in a House committee but has since been blocked by the Republican majority in the state Senate.

In Massachusetts, advocates are organizing ahead of the November 2022 ballot, which will ask residents whether they want local officials to back single payer, in districts where state representatives aren’t currently supporting a Medicare for All system. This effort is intended, in part, to inform constituents if their official is not a cosponsor of the current single payer bill in the state, and to help them take action, educate the district about Medicare for All, and demonstrate the wide support for universal healthcare.

Strategy shift

In the context of the stymied efforts to expand Medicare at the national level, these state efforts show where the real action is. If we include the recent successful voter-led efforts in states such as Montana, Missouri and Maine to expand Medicaid, the terrain for winning universal, publicly-financed comprehensive healthcare looks increasingly favorable.

Single payer passage requires the President to spend political capital

 

Michael Lighty, January 27, 2022, MICHAEL LIGHTY is a consultant with the National Union of Healthcare Workers and a Healthy California NOW leader. He previously served as the Director of Public Policy for National Nurses United and the California Nurses Association, States Now Hold the Key to Making Medicare for All a Reality, https://inthesetimes.com/article/medicare-for-all-single-payer-healthcare-california-new-york, States Now Hold the Key to Making Medicare for All a Reality

The current dichotomy between state and federal prospects for Medicare for All style reform reflects a difficult truth that motivated progressives in 2016 and 2020: it takes a president who champions single payer for it to have a chance politically at the national level. In its Build Back Better bill, the Biden administration has not even fought for the modest, incremental promises of the president’s campaign, such as lowering the Medicare eligibility age to 60 and including a public option. Instead of legislative action to expand healthcare as a public good, the administration is allowing private equity and other for-profit entities to have an expanded role within Medicare, continuing a ​“direct contracting” program begun by former President Trump.

In fact, the most popular elements of the House-passed Build Back Better bill are Medicare expansion and prescription drug price negotiations. Medicare for All polls at around 70 percent support among Democrats, majority support among independents, along with a good plurality of Republicans (mostly lower income). Yet not even a deadly pandemic has moved federal lawmakers closer to passing guaranteed healthcare for all. The Covid-19 crisis has revealed long-standing healthcare inequities based on race, exposed inadequate workplace protection and safety measures, made clear that employment-based health insurance is not reliable and shown the need for a more robust public health system. And still, we have the continuing disconnect between the need for a Medicare for All system and the lack of legislative action on it in Congress.

But the problem is not just the lack of strong leadership from the White House or Democratic leadership. The movement for Medicare for All at the federal level has also not yet created sufficient alliances with other movement groups and the electoral leverage and working-class organization necessary to overcome the money and power of the pharmaceutical companies, the insurance industry and the corporate hospital chains. These are the key institutional players that dictate health policy. Private equity has become a major stakeholder in the healthcare industry and a powerful lobbying force, leading to Wall Street control over our access to healthcare.

Current health care approach is neoliberal

 

Michael Lighty, January 27, 2022, MICHAEL LIGHTY is a consultant with the National Union of Healthcare Workers and a Healthy California NOW leader. He previously served as the Director of Public Policy for National Nurses United and the California Nurses Association, States Now Hold the Key to Making Medicare for All a Reality, https://inthesetimes.com/article/medicare-for-all-single-payer-healthcare-california-new-york, States Now Hold the Key to Making Medicare for All a Reality

Historically, the Democratic Party and the organized labor movement championed the social insurance model of Medicare and fought to win it for everybody. But starting in 1993, when the AFL-CIO voted to support then-President Bill Clinton’s modest plan for healthcare reform over demanding Medicare for All from the new administration, much of the mainstream U.S. labor movement followed the lead of the Democrats who largely abandoned their commitment to social insurance. This neoliberal capitulation to the ​“free market” has stayed in place under subsequent Democratic administrations with the passage and institutionalization of the Affordable Care Act, expansion of for-profit entities within Medicare and Medicaid, and the rising costs, restricted access and increasing profits of the healthcare industry.

Labor hasn’t been absent in this fight. The AFL-CIO has passed resolutions in support of social insurance and Medicare for All since 2009, for example, and there was broad labor support for the Medicare for All Act in 2019. Yet the consensus among major labor unions has reverted to the view, expressed by former President Obama and establishment Democrats, that, while single payer would be ideal if we were starting from scratch, Congress will never pass it, so its not a priority.

State action will trickle-up to the federal level

 

Michael Lighty, January 27, 2022, MICHAEL LIGHTY is a consultant with the National Union of Healthcare Workers and a Healthy California NOW leader. He previously served as the Director of Public Policy for National Nurses United and the California Nurses Association, States Now Hold the Key to Making Medicare for All a Reality, https://inthesetimes.com/article/medicare-for-all-single-payer-healthcare-california-new-york, States Now Hold the Key to Making Medicare for All a Reality

Winning single payer in key states like New York and California could help demonstrate that the system works and compel Democrats in Congress to act. This is a political strategy reflecting the reality that Medicare for All advocates face federally. State organizing helps build the base that will be required to ultimately win guaranteed healthcare for all. And, perhaps surprisingly, we now have strong opportunities to do just that.

 

Canada and the UK prove single payer reduces the quality of care

 

Robert E. Moffit, 1-18, 22, Ph.D., Senior Fellow, Center for Health and Welfare Policy, California Nightmare: What to Know About Left’s Next Run at Single-Payer Health Care, https://www.heritage.org/health-care-reform/commentary/california-nightmare-what-know-about-lefts-next-run-single-payer

Single-payer advocates in California and elsewhere routinely promise that their single-payer prescription would guarantee high-quality care for all at lower cost. Nonsense. A rich professional literature shows that such a program delivers delays and denials of care, notably specialty care. Canada, a model “single payer” country, has one of the worst waiting times for care among the world’s economically advanced countries. Likewise, waiting lists in the “single payer” British National Health Service are scandalous. Before the onset of the COVID-19 pandemic in 2019, there were 4.4 million patients (about twice the population of New Mexico) on British hospital waiting lists. With the pandemic, British waiting lists soared to 5.6 million in 2021, and British Health Secretary Sajid Javid is warning that the number could reach yet a jaw-dropping 13 million. So much for “free care” for all.

 

Single payer requires a 21% increase in a payroll tax

 

Robert E. Moffit, 1-18, 22, Ph.D., Senior Fellow, Center for Health and Welfare Policy, California Nightmare: What to Know About Left’s Next Run at Single-Payer Health Care, https://www.heritage.org/health-care-reform/commentary/california-nightmare-what-know-about-lefts-next-run-single-payer

Heritage Foundation analysts, for example, estimated that the federal “Medicare for All” legislation would require an additional tax of 21.1% on earnings, hitting almost two-thirds of all American households—households that would end up paying more than they do today for health care.

 

Bipartisan opposition to single payer

 

Michael Berbenes, 1-19, 22, The fight for single-payer health care moves to the states, https://news.yahoo.com/the-fight-for-single-payer-health-care-moves-to-the-states-160829656.html

Single-payer — so named because a single entity, the government, would pay for all health care — has been promoted by advocates for decades, and public support for a national government-run system has increased over the past few years. But federal action on single-payer is close to unimaginable for the foreseeable future. President Biden, a significant share of congressional Democrats and every Republican member of Congress all oppose the idea.

State single payer will spread to the federal level

 

Michael Berbenes, 1-19, 22, The fight for single-payer health care moves to the states, https://news.yahoo.com/the-fight-for-single-payer-health-care-moves-to-the-states-160829656.html

States could create the pathway for a national single-payer system

 

“In short, small-scale policy innovations can kickstart widespread adoption on a national level. Enacting a single-payer system on the state level could overcome the legislative and political hurdles that currently impede its implementation on a national level.” — Casey Buchholz, Stephanie Attar and Gerald Friedman, Jacobin

State level single payer proposals won’t pass

 

Michael Berbenes, 1-19, 22, The fight for single-payer health care moves to the states, https://news.yahoo.com/the-fight-for-single-payer-health-care-moves-to-the-states-160829656.html

 

States face many of the same barriers that hold back national health care reform

“Even with overwhelming Democratic majorities in both legislative houses, it may be difficult to advance the [single-payer plan], since they will face very stiff opposition from private employer groups … and much, if not most, of the current health care industry. There are, moreover, some serious practical hurdles.” — Dan Walters, CalMatters States face many of the same barriers that hold back national health care reform “Even with overwhelming Democratic majorities in both legislative houses, it may be difficult to advance the [single-payer plan], since they will face very stiff opposition from private employer groups … and much, if not most, of the current health care industry. There are, moreover, some serious practical hurdles.” — Dan Walters, CalMatters