Friday, February 21, 2020

Bernie's Medicare-for-all study

A new analysis published in the journal Lancet adds some empirical heft to an argument many progressives have been making for years: A national single-payer health-care system would save tens of thousands of lives each year — and hundreds of billions of dollars.

If you watched last night’s Democratic debate in Nevada you might have heard Sen. Bernie Sanders (I-Vt.) cite “a major study [that] came out from Yale epidemiologist[s] in Lancet, one of the leading medical publications in the world” in support of his Medicare-for-all plan. He was talking about this study, which was just published last week.

The study’s lead author, Alison Galvani, is the director of Yale University’s Center for Infectious Disease Modeling and Analysis. The paper discloses that Galvani served as an “informal, unpaid advisor” to Sanders’s Senate office as it developed the Medicare For All Act. None of the other authors disclosed any outside or competing interests.

All told, the study concludes, a single-payer system akin to Sanders’s plan would slash the nation’s health-care expenditures by 13 percent, or more than $450 billion, each year. Not only that, “ensuring health-care access for all Americans would save more than 68,000 lives.”

In their breakdown of the numbers, researchers applied the existing Medicare fee structure across the entire health-care system and found it would save about $100 billion annually. Keep in mind that this basically represents less money going to doctors and hospitals, a major sticking point for medical groups that oppose Medicare-for-all. But those declines would be more than offset by several hundred billions in savings from reduced administrative and billing costs, Galvani and her colleagues estimate. The lack of patient billing under a Medicare-for-all system would also eliminate the roughly $35 billion a year that hospitals now pay to chase down unpaid bills.

The authors estimate an additional $219 billion in savings from reduced “administrative overhead” that the current decentralized system creates, including “the elimination of redundant corporate functions and the truncation of the top-heavy salary architecture of health insurance corporations.”

For instance, the plan would replace dozens of health insurance executives, many of whom make well over $20 million a year, with one administrator paid the same salary as the current Secretary of Health and Human Services.

Finally, letting the national Medicare system negotiate pharmaceutical prices would save about $180 billion, according to the analysis.

Add it all up and here’s what you get: a new system that would cost about $3 trillion a year, instead of the $3.5 trillion that is being spent now.

Galvani and her colleagues estimate that to fully fund Medicare-for-all, the federal government would have to bring in an additional $773 billion a year relative to current revenue levels. They estimate this could be paid for, in part, by a 10 percent payroll tax that would bring in $436 billion annually. Given that current employer contributions to health care work out to about 12 percent of payrolls, this would still be about $100 billion less than what employers currently pay.

The remaining funding could be paid via a 5 percent tax on household income, yielding $375 billion a year. Again, with the elimination of employee contributions to existing health insurance premiums, the average household could expect to save well over $2,000 a year — and have no co-pays or deductibles to worry about.

Galvani’s $3 trillion estimate is somewhat lower than the annual spending estimates produced by other observers, including the libertarian Mercatus Center ($3.3 trillion per year) and the more centrist-oriented Urban Institute ($3.4 trillion per year) and RAND Corporation ($3.9 trillion).
All of these estimates — Galvani’s included — are built on various assumptions about how costs and payments and patient behaviors would work in the real world with a Medicare-for-all plan in place: How much would doctors and hospitals actually save on administrative overhead? How many people would increase their use of medical services once they’re paid for? Would a single-payer system make it easier to detect medical fraud?

Experts answer those questions differently, which is reflected in their final cost estimates. And though we can’t predict the future, we do have plenty of data on what’s happening in the American health-care system right now. Relative to people in other wealthy nations, Americans are less likely to be in good health and more likely to die of preventable causes. Our babies and mothers are more likely to die after child birth, and our lives are shorter overall.

Lack of a universal health-care system means that regular medical care is unaffordable for many Americans: Fully one-quarter of us have put off needed care because of cost. More than 8 million Americans have started a crowdfunding campaign to pay for medical care, with approximately 1 in 5 Americans contributing to somebody else’s medical crowdfunding campaign. Ninety percent of those campaigns will fail to raise the necessary funds.

By addressing these and other problems, Galvani and her colleagues estimate that regardless of cost, Medicare-for-all would save about 69,000 lives each year. They end their paper by calling on the medical community to answer “the moral imperative to provide health care as a human right, not dependent on employment or affluence.”

Friday, February 14, 2020

$32 trillion for Medicare for All?

Democrats have done a miserable job selling “Medicare for all” to the American people.

They’re adept at highlighting the myriad problems with our healthcare system — the high costs, the millions uninsured, the financial devastation of getting sick.

But when it comes to solutions, most of the Democratic presidential candidates offer vague policy proposals and sidestep pointed questions about how much healthcare reform would cost.

This is simply foolish. On both counts — policy and price — the Dems have a winning political issue.

They can point to other developed countries in making the case for the economics and effectiveness of public health plans, whether we’re talking Medicare for all or a similar “public option.”

And they can point to current healthcare spending to make a case for why their proposals would cost less than the status quo that conservatives are determined to defend.

Gerald Kominski, a professor of health policy and management at UCLA, tells me the problem with communicating these ideas is that the scope of the problem is so large, and the underlying components so complex, many people can’t get their heads around such difficult policy matters.

“This easily slips into Nerd Land,” he said.

But once you clear away all the policy brush, Kominski observed, there’s a fairly simple message to be conveyed about Medicare for all or any other single-payer system.

“Most families would be better off,” he said.

There it is.

Yes, this is all very complicated. And, yes, there would be nothing easy about transforming the U.S. healthcare system into one more in line with our economic peers.

But let’s emphasize Kominski’s point: Most families would be better off.

Related video: Where the 2020 candidates stand on health care (provided by ABC News)

That’s the case Democrats should be making, again and again, to the American people.

More than a third of Democratic voters who turned out for New Hampshire’s first-in-the-nation primary this week said healthcare was the most important issue in this presidential election.

Even Republicans say healthcare is one of their most pressing concerns, according to a recent Gallup poll.

Yet critics of Medicare for all say the idea is a non-starter because of its astronomical cost.

They cite a study published last year showing that if Vermont Sen. Bernie Sanders’ proposal for a comprehensive single-payer system were enacted, it would cost about $32 trillion in new federal revenue over 10 years.

Thirty-two trillion! Many Americans couldn’t even tell you how many zeroes are in a number that grotesquely huge.

What Democrats have done a terrible job communicating is that we’re currently spending $3.6 trillion a year on healthcare. That translates to $36 trillion over the next decade.

But the status quo is actually way worse than that.

The federal government estimates that national healthcare spending will total about $48 trillion over the next 10 years as costs keep going up.

By 2027, according to the Centers for Medicare and Medicaid Services, we’ll be spending about $6 trillion annually on healthcare. Total spending over the subsequent 10 years likely will reach a staggering $60 trillion — at least.

That’s the cost of doing nothing. It’s what opponents of healthcare reform are saying is our best option.

And that, of course, is insane.

“We’ve gotten ourselves into a big hole by letting expenditures get out of hand,” said Vivian Ho, a healthcare economist at Rice University. “It’s happening right before our eyes, and we’re not doing anything about it.”

The American people already spend more for healthcare than citizens of any other developed country. Again, this is a message that Democrats fail to get across.

The average American represents more than $10,500 a year in healthcare spending, according to the Organization for Economic Cooperation and Development. (The U.S. government has an even higher figure: $11,172 per person.)

That compares with less than $6,000 per person in Germany, less than $5,000 in France and Canada, and about $4,000 in Britain, according to OECD statistics.

Are we at least getting a proportionally bigger bang for our healthcare buck? Apparently not.

Americans have shorter average lifespans and a higher infant-mortality rate than people in these other countries — two key metrics of healthcare efficacy.

How do other nations do it? Simple. Each of these countries has a variation of single-payer insurance systems that use economies of scale to make healthcare more accessible and affordable.

That’s the entire case for Medicare for all right there: It costs less and works better.

Here’s where opponents of healthcare reform raise their hands and say, “But higher taxes!”

And again, Democrats have failed spectacularly in explaining how these higher taxes would be offset by reductions in insurance premiums, copays and deductibles.

Yes, taxes would rise under a Medicare-for-all system. The system would be funded almost entirely by tax dollars, as is the case in other developed countries.

But when you take most insurance premiums, copays and deductibles out of the equation, guess what happens. Total out-of-pocket costs for most people go down.

Rand Corp. analysts studied a single-payer proposal for the state of New York. They found that “the majority of New Yorkers would pay less” under such a system, “while the highest-income residents would pay more.”

Researchers at the University of Massachusetts Amherst concluded that a nationwide Medicare-for-all system would result in about $5 trillion in savings over 10 years.

“There would also be broader macroeconomic benefits through operating the U.S. healthcare system under Medicare for all,” they noted.

“Among these are that improved health outcomes will raise productivity; Medicare for all will support greater income equality; and that Medicare for all should support net job creation, especially through lowering operating costs for small- and medium-sized businesses.”

This is the message single-payer advocates need to be conveying: Solutions are available, and they’ve already been battle tested in other countries.

Personally, I disagree with Sanders’ plan, which would eliminate private health insurers and place responsibility for coverage solely on the government.

A more practical (and politically feasible) approach would be to emulate the healthcare systems of Germany, France and Japan, which rely on payroll deductions to fund nonprofit private insurers.

Under such systems — known in healthcare circles as the Bismarck model — the government plays an active role in determining what must be covered and how much can be charged for treatment. No one is excluded, regardless of preexisting conditions.

Yet the market still benefits from having private insurers compete for business, which leaves room for more comprehensive coverage for anyone willing to pay more, as well as cheaper plans for younger people who may want to pay less.

Problems abound, of course. How much should doctors and hospitals be reimbursed for treatment? Who determines fair prices for prescription drugs?

Moreover, would having more people insured drive up doctor visits, placing an even greater strain on healthcare resources? These questions need to be answered and addressed.

Some experts say the cost-savings argument isn’t the pitch Medicare-for-all proponents should be making.

“What single-payer advocates should do, in my own opinion, is not make an argument about lowering costs or make an argument that this will not be an expensive endeavor,” said Anupam B. Jena, an associate professor of healthcare policy and management at Harvard University.

“The argument must be made on humanitarian grounds,” such as expanded coverage and accessible treatment, he said.

At least we wouldn’t be starting from scratch. We’d have the luxury of picking and choosing what works best from other countries’ decades of experience.

And if we do things right, Americans would enjoy the same savings as our counterparts abroad and, with hope, the same improvements in health outcomes.

That’s the story Democrats need to be telling.

And when opponents of reform put up a fight, the reply is, “So you like paying more for worse results?”

That’s a hard position to defend.

David Lazarus is an award-winning business columnist for the Los Angeles Times. He also appears daily on KTLA Channel 5. His work runs in newspapers across the country and has resulted in a variety of laws protecting consumers.

Thursday, February 13, 2020

Blangiardi for mayor

[2/13/20] Surrounded by various downtown notables, Rick Blangiardi formally announced his candidacy for Honolulu mayor Wednesday.

The newly retired HNN television general manager joins a field that includes Honolulu businessman Keith Amemiya, former state Sen. John Carroll, former U.S. Rep. Colleen Hanabusa, activist and Realtor Choon James and City Councilwoman Kym Pine.

Running under the slogan “It’s About You,” Blangiardi acknowledged that he is a political novice making his first foray into government. He rattled off a series of priority issues facing Honolulu Hale, including the ongoing headaches with the $9.2 billion rail project, the fight against homelessness, the need to beef up the Honolulu Police Department and other public safety agencies, and getting more help for seniors.

Told that those are largely the same priorities for the current mayor and asked what he would do differently, Blangiardi made it clear he didn’t know the answers but that he is willing to listen to Oahu voters and form his opinions based on what he learns.

“I’m not a politician, I’m just a person who loves our island home and wants the chance to use my leadership and management experience to serve our community and make life better for all of us,” he said.

[1/3/20] Television executive Rick Blangiardi surprised his staff and simultaneously shook up Oahu’s political community Thursday when he announced he is retiring from his job and intends to join the race for Honolulu mayor.

Blangiardi told the Honolulu Star- Advertiser that he expects to finish up as president and general manager of Hawaii News Now by the middle of the month and then make a formal announcement about his political plans in the ensuing weeks.

“I’ve always been a believer that you should leave on top, and while I leave Hawaii News Now in a great place … I still feel like I still have a lot in me to give,” Blangiardi said. “We’re not quite there yet … but I can tell you I am definitely doing this.”

Blangiardi, 73, has not previously run for political office, but has served on a number of community boards. Viewers of what’s generally regarded as the state’s largest TV news outlet are likely already familiar with Blangiardi because of his frequent on-air “Local Connection” commentaries on timely news issues including politics in the middle of newscasts.

Among his favorite topics is homelessness, the cost of living in Hawaii and government’s inability to tackle those issues successfully. Blangiardi said Thursday he’ll have more to say about the issues after he makes his announcement.

He would be entering what’s already a crowded field for mayor that could grow even longer in the coming months. Candidates already announced or holding fundraisers for the mayor’s office are former U.S. Rep. Colleen Hanabusa, incumbent City Council members Ron Menor and Kymberly Pine, Honolulu businessman Keith Ame­miya and former state Sen. John Carroll. Also considering the nonpartisan race are former Mayor Mufi Hanne­mann and former U.S. Rep. Charles Djou.

A term-limit law bars current Mayor Kirk Caldwell from running for a third, consecutive term when his current term ends at the end this year.

Friday, February 07, 2020

the impeachment inquiry

2/9/20 - Four Republican Senators reportedly warned Trump about firing Sondland
2/7/20 - Trump ousts Vindman and Sondland
2/5/20 - Trump is acquitted along party lines
2/5/20 - Romney to vote guilty
2/4/20 - Rand Paul reads alleged whistleblower's name on Senate floor
1/31/20 - Senate rejects witnesses 51-49
1/31/20 - Murkowski to vote no on witnesses
1/27/20 - Bolton's bombshell book / Republicans under pressure
1/27/20 - Hunter Biden and Burisma
1/25/20 - Trump defense fact check
1/24/20 - Schiff, "Right matters."
1/23/20 - Graham tells Schiff good job
1/22/20 - Why Trump doesn't want Bolton to testify
1/22/20 - Justice Roberts warns of pettifogging
1/21/20 - Giulani says Parnas lied stupidly
1/16/20 - GAO finds Trump administration's hold on military aid to Ukraine was illegal
1/16/20 - Lev Parnas says Trump is lying / big ratings for Maddow
12/22/19 - Trump gives Gabbard respect
12/20/19 - Trump attacks Christianity Today for their editorial
12/19/19 - Tulsi Gabbard votes 'present'
12/19/19 - House of Representatives impeaches President Trump
12/18/19: WSJ: This impeachment folly
12/18/19: Republicans compare Trump to Jesus
12/18/19 - Fact checking Trump's letter to Pelosi
12/15/19 - It's now time to impeach Trump (Star Advertiser editiorial)
12/14/19 - Jeff Van Drew to switch parties over impeachment
12/12/19 - Five takeaways
12/10/19 - House announces impeachment charges
12/9/19 - As Democrats close in on impeachment charges, Republicans cry foul
12/5/18 - Pelosi proceeding with articles of impeachment

11/23/19 - Devin Nunes might face an ethics investigation
11/23/19 - Trump making it hard for GOP defenders
11/22/19 - Trump calls FoxFriends (CNN, George Conway)
11/19/19 - AP fact check on GOP claims
11/13/19 - Trump impeachment hearings: 5 key takeaways from the first day

10/30/19 - Trump adviser for Russian and European affairs, Tim Morrison, resigns ahead of impeachment inquiry testimony
10/10/19 - Fox News poll shows 51% want Trump impeached and removed
10/9/19 - White House says it will not participate in impeachment inquiry
10/9/19 - Biden says Trump should be impeached
10/7/19 - where we are now and how we got here

Monday, February 03, 2020

China arrested doctors who warned that SARS coming back

HONG KONG—The new coronavirus that has spread consternation around the world over the last few weeks has now killed more people in China than the SARS epidemic of 2002-2003. China’s health commission reported Sunday that there were 361 deaths nationwide. During the SARS outbreak, 349 people died in mainland China and 774 altogether around the world. The Chinese stock markets took major hits Monday, and the whole nation feels its growing isolation.

Three New Cases of Coronavirus Confirmed in California

Yet last December—before people all over China began falling sick with pneumonia-like symptoms, before people around the world grew alarmed about a disease leaping from captured wild animals to human shoppers in dense Chinese food markets, and before the coronavirus reached new shores after being carried onto planes by human hosts, forcing the World Health Organization to declare a global emergency—eight people discussed how several patients in Wuhan were experiencing severe, rapid breakdowns in their respiratory systems.

They were part of a medical school’s alumni group on WeChat, a popular social network in China, and they were concerned that SARS, Severe Acute Respiratory Syndrome, was back.

It wasn’t long before police detained them. The authorities said these eight doctors and medical technicians were “misinforming” the public, that there was no SARS, that the information was obviously wrong, and that everyone in the city must remain calm. On the first day of 2020, Wuhan police said they had “taken legal measures” against the eight individuals who had “spread rumors.”

Since then, the phenomenal spread of the virus has created cracks even within the normally united front of the Chinese Communist Party. “It might have been fortunate if the public had believed the ‘rumor’ and started to wear masks, carry out sanitization measures, and avoid the wild animal market,” a judge of China’s Supreme People’s Court wrote online last Tuesday.