F. Douglas Stephenson – Informed Comment https://www.juancole.com Thoughts on the Middle East, History and Religion Mon, 30 Nov 2020 06:35:30 +0000 en-US hourly 1 https://wordpress.org/?v=4.9.16 Trump’s Health Insurance Plan benefits the 1% and Harms all the Rest of Us https://www.juancole.com/2020/10/trumps-insurance-benefits.html Wed, 21 Oct 2020 04:01:34 +0000 https://www.juancole.com/?p=193962 Gainesville, Florida (Special to Informed Comment) –Considered a serious danger to the wealth of private corporations and individuals, the highly class-conscious corporate-run, profiteering U.S. business community seeks to contain and reduce the political power of the 99%. Toward this goal, President Trump and the GOP are attempting to terminate Obamacare (ACA) including health plan subsidies and elimination of individual and employer mandates authorized by the Affordable Care Act .

With proposed Trump/Republican style ACA replacement programs, there will be huge benefits for corporations and the very rich. Respected economics correspondent of the Financial Times (UK) , Martin Wolf, writes that, “The (Republican) tax proposals would shower huge benefits on already rich Americans such as Mr Trump, while leaving others in the lurch, including, of course, his constituency. The immediate reaction of the business world reveals that Big Insurance, Big Pharma, Wall Street, the military industry, energy industries and other such “wonderful” institutions expect a very bright future”.

Former Secretary of Labor, Robert Reich, writes that by repealing ACA an average of $33,000 of tax cuts would be given to the richest 1 percent this year alone, and a whopping $197,000 of tax cuts given to the top 0.1 percent. The 400 highest-income taxpayers (with incomes averaging more than $300 million each) will each receive an average annual tax cut of about $7 million.It would also increase the taxes of families earning between $10,000 and $75,000 – including just about all of Trump’s working class voters.

Secretary Reich lists what we end up with if Republicans repeal Obamacare-ACA:

– 32 million people losing their health insurance,
– tens of thousands of Americans dying because they don’t get the medical care they need,
– Medicare in worse shape,
– And the rich becoming far richer.

To maintain corporate control of U.S. health care insurance, our system is privatized and unregulated. Private, Big Insurance companies are in the business of making money, not providing health care, and when they undertake the latter, it is likely not to be in the best interests of patients or to be efficient. Administrative costs (and immense profiteering ) are greater in the private health care insurance system, and even Medicare itself is weakened by having to work through the private system.

A major figure in academic family medicine and social-health policy, John Geyman, M.D., distinguished professor emeritus of family medicine at the University of Washington School of Medicine, anticipates that GOP principles and approaches will make an imploding ACA system even worse, with a possible huge backlash from the public and even the private insurance industry when it doesn’t get all that it wants.

Dr. Geyman writes that we already know much about what to expect in any Trump-Republican post-ACA replacement plan. First, the GOP principles upon which it will be based:

1). States, not the federal government, should have primary responsibility for health policy;
Patients and doctors should be in control;
2). There should be more competition among health plans to give patients more choices; and
Small business should have more discretion and flexibility to configure health benefits for their employees.
3). A 37-page GOP white paper, “A Better Way”, includes continuation of consumer-directed health care (CDHC) (with patients having “more skin in the game”), health savings accounts, high-risk pools, selling insurance across state lines, association health plans among businesses, and further privatization of Medicare and Medicaid.
4). Tom Price (R-GA) and other GOP’ers, proposed the complete repeal of the ACA, as well as privatization of Medicare, sharp cuts in Medicaid funding, and defunding of Planned Parenthood.

Dr.Geyman notes that the problem with all of these proposals is—they won’t work. Each of these directions has been used for years, and have all failed to assure Americans with better access to affordable health care. They have been discredited by long experience.

JOHN GUYMAN’S LIST OF FLAWS IN TRUMP/GOP PROPOSALS:

1. MARKET FAILURE: Like the ACA, any of their replacement plans are still based mainly on the private for-profit market place. Insurers, the drug industry, and other parts of the medical-industrial complex, including their shareholders, have enjoyed bonanza years on Wall Street under the ACA without any significant cost containment. Most people are unaware of how extremely privatized and for-profit the current health care system is, as these examples show: free-standing laboratory and imaging centers (100 %), surgical-centers (95 %), dialysis centers (90 %), home care (76 %), nursing homes (65 %), and hospice (63 %) , (2016 Annual Survey by the Commerce Department or most recent available data for share of establishments.) Instead of increased competition, we have seen increasing consolidation and less competition under the ACA.

2. FAILURE TO LEARN FROM PAST FAILED HEALTH CARE POLICIES: Republicans conveniently forget that the ACA was modeled on a health plan brought forward by the Heritage Foundation and enacted as the Massachusetts Health Plan by Governor Romney in 2006. Three years later, a study comparing safety net hospitals with non-safety net hospitals found that the former played a disproportionately large role in caring for disadvantaged patients and were hurting financially. There are many reasons for the ACA’s failure including its reliance on a failing multi-payer financing system with some 1,300 private insurers, mostly dedicated to profits rather than coverage of patients’ health needs. How they continue to discriminate against the sick, profiteer, and inflate their overhead is well known and shows that the industry is not sustainable without taxpayer support.

3. FURTHER PRIVATIZATION: Contrary to experience, evidence and GOP ideology, privatization is less competitive, less efficient, and more expensive for patients than the public sector, as already demonstrated by private Medicare and Medicaid plans. Privatized plans offer less choice, are more volatile and less accountable than their public counterparts. They game the system and demand ongoing overpayments (e.g. more than $173 billion to Medicare Advantage between 2008 and 2016 . All that amounts to corporate welfare at taxpayer expense.

4. DEPENDENCE ON LARGER ROLE OF STATES: There are already wide variations in states’ definitions of eligibility and coverage, which are likely to increase further as more restrictive federal block grants to states become widespread. Safety net resources will be hit hard, seriously impacting the most vulnerable among us.

5). THE GOP IS TAKING US OVER A CLIFF: while seemingly not realizing it may well be political suicide for the party. Dr.Geyman says to expect that any GOP replacement plan will cost patients, families, and taxpayers more, and that we will all get less. This is all so foolish since there is a real solution in plain sight—single-payer national health insurance (Medicare for All-M4A). Republicans have been blinded by ideology and are unaware of the failed policies already proven by the last 25-plus years’ experience, including those of the ACA, much of which are still baked into their supposed “better way.” They also seem to be unaware of the most recent public polls strongly favoring M4A, regardless of political party. As just one example, a Gallup poll as far back as May 2016 found that 41 percent of Republicans and leaners favored replacing the ACA with M4A.

Of the OECD nations, the United States ranks near the bottom in health care justice. And yet Trump and the
GOP is moving forward with legislative action that likely would not only reduce costs for the wealthy, but also further diminish justice within our health care and health insurance system. We need a not-for-profit, one-tier public system of universal coverage, Medicare for All, based on medical need, not ability to pay. Martin Luther King Jr, said, “Of all the forms of inequality, injustice in health is the most shocking and inhuman.”

Medicare for All is the 2020/2021 solution. The majority of Americans support improved Medicare for all. Legislation now filed in Congress, in the House (H.R. 1384) and Senate (S. 1129), would establish this badly needed reform. Contact your legislator asking them to support this critical legislation.

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Bonus Video added by Informed Comment:

Yahoo Finance: “President Trump lays out his plans for health care”

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Can Trump’s Plan to Steal your Social Security, Medicare be Stopped? https://www.juancole.com/2020/10/security-medicare-stopped.html Tue, 13 Oct 2020 04:02:06 +0000 https://www.juancole.com/?p=193822 Gainesville, Florida (Special to Informed Comment) – President Donald Trump, Senate Majority Leader Mitch McConnell and other Republicans promoting the backlash against the federal government seek to return to an earlier, supposedly golden era in American history. By privatizing Social Security, Medicare and Medicaid while further lowering taxes on the top 1 percent income bracket, Freedom Caucus members and other House and Senate Republicans’ plan to solve the GOP manufactured debt crisis by shrinking the government and base its size on the 1950s level of U.S. population, effectively repealing Franklin D. Roosevelt’s New Deal while simultaneously opposing efforts to establish the new 2020 “Green New Deal”.

The New Deal of President Roosevelt, using the creative and humanitarian work of Roosevelt’s “Brain Trust”committee, developed the program of a federal safety net which included Social Security in the 1930s, and also inspired Lyndon B. Johnson’s Great Society and Medicare health insurance program of the 1960s. FDR and LBJ asked all working adults to care for American seniors and the poor.

Before the New Deal, retired people could not turn to the government for income or medical care. That responsibility fell directly to their children, if they had them. That’s why the Republicans’ proposed cuts to Medicare and Social Security are so shocking and inhumane — they shift these costs from the federal budget back to low state and/or non-existent family budgets wracked by the COVID-19 pandemic with huge job and income losses.

Without the programs of the New Deal, you’ll get something like the 19th century which had often mpassable country roads and unpaved city streets; fetid rivers, lakes, and beaches reeking of sewage and industrial waste; no public health programs, cruel ill-health and hunger in all age groups, no mental health,substance abuse or public health programs; epidemics of cholera, typhoid, polio and other scourges; massive illiteracy; indigent old age; few urban, state or national parks; vastly reduced productivity; urban riots and frequent bank failures that periodically wipe out depositors.

New Deal federal agencies such as the Works Progress Administration (WPA), Public Works Administration, Civil Works Administration and Civilian Conservation Corps (CCC) kick-started the construction industry back to health, creating companies like Kaiser and Bechtel. New Deal sewage systems and public hospitals almost immediately improved the health of virtually all Americans. Tennessee Valley Authority (TVA) assisted and improved many communities electrical power needs.

Many people today are unaware that they use federal infrastructure every day, yet insist they want less government in their lives. They are getting their wish as much of the cultural and physical infrastructure the New Deal created is degrading for lack of maintenance, encroachment and repression by those blinded ideologically to shrinking the federal government. The failure to maintain, let alone update, the infrastructure we inherited led the American Society of Civil Engineers to give a “D” grade to U.S. infrastructure, including dams.

Roosevelt’s New Deal programs give us a true picture of what government at its most enlightened can accomplish for all of its citizens, not just the few 1 percent. Let’s stop a return to the 19th century from the 21st. Fairness and democracy of the New Deal are its most important legacy. If DJT, Republicans and their wealthy donors and supporters have their way, we may be stranded in a world without it.

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Bonus Video added by Informed Comment:

The Humanist Report: “Trump Plans to Destroy Social Security if He’s Reelected”

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America’s New Peculiar Institution: Health Care only for those who Can Afford it https://www.juancole.com/2020/10/americas-peculiar-institution.html Sun, 11 Oct 2020 04:01:12 +0000 https://www.juancole.com/?p=193786 Gainesville, Florida (Special to Informed Comment) – The highly respected British medical journal, “The Lancet”, recently summarized the health insurance situation in the USA:

    “Although health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care. Efforts are ongoing to repeal the Affordable Care Act which would exacerbate health-care inequities. By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services. Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US $450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations. This shift to single-payer health care would provide the greatest relief to lower-income households. Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68 000 lives and 1·73 million life-years every year compared with the status quo.”

Other independent analyses by the U.S. Congressional Budget Office, the General Accountability Office, the Lewin Group, and Mathematica Policy Research Group have found that the administrative savings and other efficiencies of a M4A program would provide more than enough resources to provide first-dollar coverage to everyone in the country with no increase in overall U.S. health spending.

Even with the dangerous and burgeoning coronavirus(Covid-19) pandemic, big insurance and big pharma still oppose legislation for the new Medicare for All (HR-1384/S-1129). These resistant, self-serving industries have the most to lose if their huge profits are redirected to direct patient care for all. Individual and corporate predators regard democracy, government, community as obstacles to their greed and avarice, always placing profits over individual patients, families and public health. It’s no wonder so many beholden members of Congress want to protect the interests of big insurance and big pharma, industries who spent $371 million on lobbying in 2017 alone.

These industries always seek to lock us into an obsolete private insurance-based model that holds everyones health hostage to profiteering HMOs and unaccountable big insurance companies for years to come. For proponents of political expediency, the question remains, who will be lost while profiteering continues and basic principles of public health are rejected. Every year, well over 18,000 unnecessary deaths, the equivalent of six times the number who died in the September 11 attacks, are linked to lack of health insurance coverage. Pandemics like COVID-19 are quickly increasing these numbers.

The COVID-19 pandemic and its economic consequences have caused the greatest losses in health insurance enrollment in U.S. history: 5.4 million laid-off workers have become uninsured. Also important to remember that all was not well before the pandemic. Nearly 28 million people were already uninsured and tens of millions more were underinsured – unable to afford the out-of-pocket costs that were not covered by insurance.

We have tens of millions of individuals without insurance, many more who are underinsured, many who have impaired access to their physicians because of insurer network restrictions, many who face financial hardship when health needs arise, and an outrageously expensive system due to the profound administrative waste of the insurers and the burden they place on the health care delivery system when immense profit is required. With millions losing their jobs due to Covid-19, the dangers of connecting health insurance to employment are painfully clear. Health insurance must be tied to citizenship, not employment.

Almost none of these problems would exist if the government, instead of the private insurers, served us as the health insurance financing authority. It is inhumane to allow consumer-directed, moral-hazard based private health policies to erect barriers to health care for millions of citizens with minimal or modest resources.

The real boogeymen opposing M4A are the private health insurance and pharmaceutical industries who have the most to lose if their profits are redirected to direct patient care. Beholden members of Congress want to protect the interest of insurance and Pharma — these two industries spent $371 million on lobbying in 2017 alone. Big Pharma & Big Insurance industries have literally bought most of our legislators (both Democrat and Republican). A massive disinformation/fear campaign has promoted the myth that Medicare for All would limit choice of doctors and hospitals, create unsustainable costs, and expansive, uncontrolled bureaucracy. These myths better describe the reality of our present system based on the private insurance industry.

If we are a society that cares enough to see that everyone receive the health care they need, the basic point of Medicare for All, then it’s important that citizens reject catastrophic expectations and predictions, false fear and scare tactics of the M4A opposition. Citizens now better understand that the real cause of high US health insurance costs is the private insurance industry’s need for high profit. A record number of Americans reject our fractured, profit-based health insurance system and support programs like House Bill H.R. 1384 or Senate Bill S.1129, which improve Medicare’s benefits by adding in previously uncovered services such as dental, hearing, vision, and long-term care while eliminating cumbersome out-of-pocket fees with prepaid health insurance.

Although Medicare for All supporters are often derided as unrealistic, in fact it’s not realistic to expect that Americans will continue passively accepting ‘how much money is in the bank account’ as the most significant factor in their mortality. Sooner or later the GOP/Trump will realize that they cannot lie their way past biology. Because viruses are immune to propaganda and nonsense, Covid-19 will advance regardless of the GOP’s/DJT’s denial and avarice. By seeking to weaken Social Security, Medicaid and Medicare to fund tax cuts for the rich during a time of the Covid-19 public health crisis, DJT and the GOP one percenters have elevated self-interest even further above life itself for the ninety-nine percent.

The USA is a country where health insurance for medical and mental health care is a function of socio-economic status. Everyone knows that this inhumane system should have been corrected long ago, but the ravages of the pandemic crisis makes it impossible to any longer avoid reality. We must immediately end our moral crime of having the greatest health system in the world, but only for those who can afford it. In addition to strickly following the basic principles of public health and epidemiology, the very best way to cope with the vast dangers of COVID-19 to everyone is to immediately implement improved Medicare for All legislation now filed in Congress, H.R. 1384/S.1129.

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Bonus Video added by Informed Comment:

America’s Healthcare Nightmare May Surprise You (w/ Dr. Sam Metz)

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Is it Time to end Profiteering on Public Health and Nationalize Big Pharma? https://www.juancole.com/2020/10/profiteering-public-nationalize.html Thu, 01 Oct 2020 04:01:01 +0000 https://www.juancole.com/?p=193562 Gainesville, Florida (Special to Informed Comment) — Over forty years of profiteering by Big Pharma and oligarch control of our economy has left the public totally exposed and ill-prepared to face the public health crisis of COVID-19. Because Big Pharma rarely invests in prevention, it has very little motivation to invest in preparedness for a public health crisis. Drugs for prevention do not contribute to share-holder value and profit. Instead, cures are designed once a public health crisis strikes. The sicker we are the more profit they earn.

Big business, Big Insurance and Big Pharma industries dominate our government with public health taking a back seat to the need for large private profit. Many government leaders from both political parties share the same ‘profits over public health’ ideology, even though the Covid-19 pandemic clearly shows how our economic system has failed to serve our citizens by allowing these groups to privatize, sabotage, fragment and cripple our health, public health and other social services. No greater disconnect exists between the public good and private interests than in the U.S. system of for-profit Big Pharma. Just like large health insurance corporations,

Big Pharma has the inherent tendency to invent new needs, disregard all boundaries and turn everything into an object for sale and big profit. To make governments less willing and able to respond to public health /environmental crises such as Covid-19, these companies fund right-wing think tanks to attack public health policy. By presenting government as a threat to freedom, the distinguished writer for The Guardian(U.K.),George Monbiot, described how right wing groups and big business create a narrative by reframing responsible government as the “nanny state”, the “health police” and “elf ‘n’ safety zealots”. They dismiss scientific findings and predictions as “unfounded fears”, “risk aversion” and “scaremongering”. Public protections are recast as “red tape”, “interference” and “state control”.
Gerald Posner, author of “Pharma: Greed, Lies, and the Poisoning of America”, said, “Pharmaceutical companies view Covid-19 as a once-in-a-lifetime business opportunity”.

The world needs pharmaceutical products, of course. For the new coronavirus outbreak, in particular, we need treatments and vaccines and, in the U.S., tests. Dozens of companies are now vying to make them. “They’re all in that race,” said Posner, who described the potential payoffs for winning the race as huge. The global crisis “will potentially be a blockbuster for the industry in terms of sales and profits,” he said, adding that “the worse the pandemic gets, the higher their eventual profit.” The ability to make money off of pharmaceuticals is already uniquely large in the U.S., which lacks the basic price controls other countries have, giving drug companies more freedom over setting prices for their products than anywhere else in the world. During the current crisis, pharmaceutical makers may have even more leeway than usual because of language industry lobbyists inserted into an $8.3 billion coronavirus spending package, passed last week, to maximize their profits from the pandemic.”

The antidote is nationalization of the pharmaceutical industry, large increases in production of non-patent medications and ending monopolization by the Big Pharma industry. Drug companies should be converted to non-profit public service corporations that serve the public interest rather than being used by the 1 percent and oligarchs for unlimited profit. Additionally, we need comprehensive reform in the way we produce new drugs including a public program for producing needed drugs and clinical trials that would produce new non-patent medications that stay in the public domain.

Drugs would function as real social service items, not huge profit producing goods for a tiny group of oligarchs. With this new, fundamental reorientation of drug manufacture, drugs become more affordable for patients and society, promote innovation, strengthen efforts to assure safety and effectiveness, and upgrade the evidence available to prescribers and the public. Because drugs developed and manufactured through new public pathways remain in the public domain, they could be economically produced generically throughout the world, benefiting many nations.

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Bonus Video added by Informed Comment:

Rep. Pressley: “Rep. Pressley Grills Big Pharma CEO on Devastating Impact of Skyrocketing Drug Costs”

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Stop Profiteering on Misery: Private Prisons must be ended Now https://www.juancole.com/2020/09/profiteering-private-prisons.html Mon, 21 Sep 2020 04:01:46 +0000 https://www.juancole.com/?p=193360 Gainesville, Florida (Special to Informed Comment) – Every state should follow California’s outstanding example by ending the obscene system of private prisons and privately-run immigration detention facilities. California will phase out the use of these for-profit, private detention facilities by 2028. The state prohibited renewing contracts or signing new contracts with a private prison company after January 1, 2020. By ending the use of for-profit private prisons and detention facilities, California sends a powerful message that it vehemently opposes the practice of profiteering off the backs of immigrants and prisoners, and will stand up for the health, safety and welfare of all citizens, and is committed to humane treatment for everyone.

In a for-profit prison, jail or immigrant detention facility, people are imprisoned by a private third party that contracts with a government agency. Contractual agreements between governments and private entities commit prisoners to privatized facilities and are paid a per diem or monthly rate, either for each immigrant or prisoner in the facility, or for each place available, whether occupied or not. Such contracts may be for the operation only of a facility, or for design, construction and operation.

Private profit prison corporations have become the best example of a private capitalist enterprise that profits on the misery of man while trying to ensure that nothing is done to decrease that misery. Profiteering private prison corporations are cashing in on the misery and desperation of U.S. citizens as many county jail and state prison systems privatize throughout the nation. Private companies house about 9 percent of the nation’s total prison population, with privatization/profiteering madness now extending to well over 6 million people under correctional supervision, more than ever were in Stalin’s gulags. Misery and desperation has been compounded by the underfunding and deterioration of community mental health services. Accordingly, the often privatized county jail has become the largest mental health facility in most American communities.

Most alarming, the private prison industry also incarcerates about 73 percent of all immigrant children, adolescents and adults . A spokesman for the Immigration and Customs Enforcement Service (ICE), Alonzo Pena, acknowledged that the private companies have all too often fallen short, noting that “It wasn’t their priority to ensure that the highest standards were being met”. ICE deserves some blame/responsibility. “We set up this partnership with the private industry in a way that was supposed to make things much more effective, much more economical, but unfortunately, it was in the execution and the monitoring and the auditing we fell behind, we fell short.”

Next to private health insurance corporations, there is no greater disconnect between the public good and private interests than the rise of corporate owned and operated jails. The interest of private jails lies not in the obvious social good of having the minimum necessary number of inmates, but instead having as many immigrants and prisoners as possible housed as cheaply as possible.

The chilling 2005 annual report of the Corrections Corporation of America cautioned its investors about the financial risk if the number of convicted prisoners were ever to be reduced:

“Our growth is generally dependent upon our ability to obtain new contracts to develop and manage new correctional and detention facilities. … The demand for our facilities and services could be adversely affected by the relaxation of enforcement efforts, leniency in conviction and sentencing practices or through the decriminalization of certain activities that are currently proscribed by our criminal laws. For instance, any changes with respect to drugs and controlled substances or illegal immigration could affect the number of persons arrested, convicted, and sentenced, thereby potentially reducing demand for correctional facilities to house them.”

Without evidence, private prison corporations always claim that their program will save the county and state millions annually. Private companies, such as CCA/CoreCivic and GEO Group dominant, tout their virtues by saying they build and operate prisons more cheaply than governments can, due to the public sector’s many mandates. Their day-to-day operations are similarly more efficient and less costly, they assert, and they do it all without compromising public safety. The bottom line, they say, is that they allow governments to free up public funds for pursuits that mean more to most taxpayers than how felons or immigrants are jailed.

“Privately operated facilities are better equipped to handle changes in the flow of illegal immigration because they can open or close new facilities as needed,” said Rodney E. King, CoreCivic’s public affairs manager.
Critics tell a different story. They cite moments like a 2015 riot to protest poor conditions at a prison in Arizona run by another major private player, Management and Training Corporation. Earlier at that same institution, three inmates had escaped and murdered two people.

Many case examples show scrimping by prison and immigrant detention facility operators, with bad food and shabby health care for inmates, low pay and inadequate training for guards and hiring shortages. At immigrant detention centers, operators see little need to offer extensive educational programs for children or job training since people held there are mostly destined for deportation. “To maximize profit, you minimize your expenditures,” said Rachel Steinback, a lawyer for hunger strikers.

Despite many promises that jail and prison privatization will lead to big cost savings, such savings, as a comprehensive study by the Bureau of Justice Assistance, part of the U.S. Department of Justice concluded, “have simply not materialized.” To the extent that private prison and jail operators do manage to save money, they do so through “reductions in trained staff, fringe benefits and other labor-related costs.”

The standard technique of privatization: defund government services to make sure things don’t work and people get angry, then hand it over to private capital. By continuing to defund mental health services, local publically funded jail and state prison services, county commissions and state government allows the for-profit, private prison corporations to appear to “rescue” the county jail or state service via self-serving profit-driven programs.

It’s not long until privatization falls short in quality service; the private jail program saves money by employing fewer, less trained guards and other workers and pays them badly, with horror stories often accompanying how these jails are run. In addition to Department of Justice studies and experience showing that governments save little money, if any, by turning over prison functions to private outfits, the DoJ also concluded that private prisons were in general more violent than government-operated institutions, and ordered a phaseout under the Obama administration of their use at the federal level. Regrettably, reversing that order was one of the first things that President Trump’s attorney general, Jeff Sessions, did on taking office.

The Trump administration leaves no doubt that it will detain as many undocumented immigrants as it can and send them to for-profit centers. And to help make sure that happens, private prisons companies spend millions on campaigns and congressional lobbying efforts, just like businesses that sell cars, real estate, hamburgers or toothpaste.

To fix this problem, we should demand that private corporations be removed from the administration of our local, state and federal public prison programs. Privatization of jail services increases costs without any corresponding increase in quality or care. Economist Paul Krugman notes that “as more and more government functions get privatized, states become ‘pay-to-play paradises in which both political contributions and contracts for friends and relatives become quid pro quo for getting government busines.”

The corrupt nexus of privatization and patronage by the 1 percent is undermining local and state levels of government across the USA. Since treatment, counseling and rehabilitation programs are not profitable and therefore discouraged or rejected, longer-term institutionalization by for-profit corporations is promoted via harsh sentencing guidelines and other means for keeping inmates doing lengthy, and very profitable for the corporation, sentences. As long as the general population remains passive, apathetic and seemingly unable to advocate for its best interests, the powerful in county, state and federal government, along with their corporate oligarch partners, will continue privatizing and profiteering as they please, while laughing all the way to the bank.

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Bonus Video added by Informed Comment:

CNBC: “Who Makes Money From Private Prisons?”

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De-Privatize and Expand Medicaid, NOW! https://www.juancole.com/2020/09/privatize-expand-medicaid.html Thu, 10 Sep 2020 04:01:26 +0000 https://www.juancole.com/?p=193047 Gainesville, Florida– (Special to Informed Comment) – The COVID-19 pandemic shows the urgent need for expansion of the Medicaid health insurance program. In too many states, political decisions by state legislators to deny health insurance to thousands of their citizens has resulted in an almost non-existent social and health safety net. Decisions in 2016/2017 by 25 states to reject the expansion of Medicaid coverage under the Affordable Care Act resulted in an estimated 7,115 and 17,104 more deaths than had all states opted in, according to researchers at Harvard Medical School and the City University of New York. The researchers found that because of the states’ “opting out” of the Medicaid expansion, 7.78 million people who would have gained coverage remained uninsured.

To worsen the situation, many states have over the last decade privatized administration of their Medicaid program into a managed care program administered by the private profit health insurance industry. The companies are paid by state government, and their profit depends on spending as little as possible on Medicaid patients. It’s hard to imagine any greater disconnect between public good and private profit: the interest of private health insurance companies lies not in the obvious social good of delivering quality health care to patients but in having as few as possible treated as cheaply as possible. No better example exists of a private capitalist enterprise that feeds on the misery of man.

You might think that we learned the lesson of discredited managed care in the 1990s. The term “managed care” is confusing to many, but really amounts to managed reimbursement rather than managed care. A set prospective annual payment is made by federal/state governments, as in the case of state Medicaid managed care, to cover whatever services patients will receive over the coming year. There is therefore a built-in incentive for managed care organizations to skimp on care and pocket more profits.

Unfortunately, privatized Medicaid managed care was facilitated further by the Affordable Care Act. More than one-half of Medicaid beneficiaries are now in privatized plans, which have been enacted in many states based on the unproven theory that private plans can enable access to better coordinated care and still save money.
That theory is not just unproven, it is patently wrong as the state of Florida discovered. In 2016, Medicaid ate up 45.9 percent of growth in general revenue , ballooned by approval of a 7.7 percent increase in payment to private managed care plans. Privatized programs have high administrative costs, built-in profits, and do not save money or improve care. Their route to financial success is by finding more ways to limit care and deny services.

Without evidence or disclosure by the private Medicaid plans business/profit interests, private HMOs claim they save the state millions annually. Shockingly, we let many state administrations get away with this illusion by forgetting that adding a “profiteering middleman” to manage health care delivery always adds cost, and does not lower them. The Florida and other state GOPs, for example, lobbied hard for Medicaid managed care. Using scare tactics, they claimed that more than 3 million recipients (Fla.) would receive better care and also save the state money, sternly warning the roughly $23 billion a year Medicaid bill was consuming the state budget.

John P. Geyman, M.D., former chair of the University of Washington Department of Family Medicine and one of the most published family physicians in the U.S., asks, “Why do we still worship at the altar of privatization in U.S. health care, especially for the poor and most vulnerable among us?”

Four answers stand out:

(1) there is a lot of money to be made by insurers operating health programs subsidized by state governments;

(2) exploitive privatized programs are perpetuated by well-funded “free market” think tanks, their followers in Big Business, and compliant politicians responding to industry lobbyists;

(3) regulations are inadequate to prevent gaming by insurers at patients’ expense;

(4) as a society, we still don’t seem to care when people have bad health outcomes and die because of failed health care policies.”

US citizens should demand that private corporate HMOs be removed and banned from the administration of our public health insurance programs in all states. Privatization of Medicaid increases costs, without any corresponding increase in quality or access to care. Private insurers maximize profits by mainly limiting benefits or by not covering people with health problems. The greed of casual inhumanity is built in the business model and the common good of citizens is ignored. Excluding the poor, aged, disabled and mentally ill is sound business policy, since it maximizes profit. As long as health care remains so lucrative for private insurers, patients’ needs and the public interest are disregarded by health insurance profiteers.

After we expand Medicaid to meet today’s immediate COVID-19 challenge, tomorrow we need to insist that the federal government finance a nationwide, not-for-profit, Medicare for All system of universal, single-payer coverage, based on medical need and not ability to pay. This would resolve persistent problems of failed market policies, and would resolve what Martin Luther King, Jr. once described: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

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Bonus Video added by Informed Comment:

Healthwatch Wisconsin: “People of Missouri Vote to Expand Medicaid”

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How Trump’s Expansion of Junk Short-Term Health Insurance Plans Puts Americans at Risk https://www.juancole.com/2020/08/expansion-insurance-americans.html Sat, 15 Aug 2020 04:01:39 +0000 https://www.juancole.com/?p=192587 Gainesville, Florida (Special to Informed Comment) – The U.S. House of Representatives Committee on Energy and Commerce, Subcommittee on Health, and Subcommittee on Oversight and Investigations, recently concluded that the latest GOP/Trump Short Term Limited Duration Insurance (STLDI) plans present a significant threat to the health and financial well-being of American families. STLDI plans involve very limited protection for both catastrophic medical costs and routine medical care, and it is unclear what kind of value consumers are getting for their premium dollars, other than a false sense of security. The Committee staff recommended that federal legislation subject STLDI plans to the all of the Affordable Care Act’s (ACA) interlocking consumer protections, including guaranteed issue and renewability, the ban on pre-existing condition exclusions, coverage of the essential health benefits, the medical loss ratio, and the prohibition on rescissions. Subjecting STLDI plans to all of the ACA’s consumer protections at a federal level will ensure adequate protection for consumers.

Building on other efforts to further sabotage and undermine quality health care insurance for all, President Donald Trump and the GOP had previously proposed very similar “association health insurance plans” that let small businesses band together and insure themselves or buy insurance as a group. Association health plans have a bad track record over the past 10 years, with dozens of court cases and enforcement actions by federal and state officials. Many turned into criminal cases involving fraud, embezzlement, diversion of premiums and mismanagement, leaving employers and employees with millions of dollars in unpaid medical bills.

Just like the latest proposed “STLDI” plans, Trump’s previous association health plans were not required to provide essential health benefits like mental health, substance abuse treatment and drug coverage, and claim they are exempt from all state insurance laws under Trump’s executive order. When toxic plans like this are approved, it’s clear that our health-insurance system is broken. Like a cracked pipe, money gushes into our health-care system but steadily leaks out. Money is siphoned into the advertising budgets of private-profit insurance companies and the army of corporate bureaucrats working to deny claims. Even more dollars are soaked up by the pockets of insurance CEOs who have collectively earned $9.8 billion since the Affordable Care Act was passed in 2010. Nearly a third of all of our health-care dollars go to something other than health care.

Another example is the deceptive appeal of Trump’s profitable “copper catastrophic” plans. They are stunningly inadequate plans that have very low premiums because their actuarial value is only a pathetic 50 percent, giving the illusion of health insurance coverage. They cover an average of about half of health-care costs. In 2017, the deductible for these plans was $7,150. These plans will work great if you never get sick or have an accident.

Offering only deteriorating financial protection, especially those with larger deductibles, this downward trend can produce severe adverse consequences for the physical, mental and financial health of the insured. Because of the spartan nature of the newly proposed STLDI catastrophic plans, the adverse consequences can be anticipated to be even more severe.

The House of Representatives Committee on Energy and Commerce concluded that these latest Trump/GOP plans are simply a very bad deal for consumers. They list six concerns about the Trump Administration’s policy of expanding these dangerous, unregulated plans that presents a threat to the health and financial well-being of American families, particularly in light of the current COVID-19 public health emergency:

1). STLDI plans systematically discriminate against individuals with pre-existing conditions, and against women.

2). These plans offer bare bones coverage, including major coverage limitations that are not always clear in marketing materials, making it difficult for consumers to know what they are buying.

3). STLDI plans offer wholly inadequate protection against catastrophic medical costs.

4). Some STLDI plans impose draconian coverage limitations even for illnesses, injuries, and conditions arising after a consumer purchases a policy.

5). On average, less than half of the premium dollars collected from consumers are spent on medical care.

6). STLDI plans engage in heavy-handed back end tactics to avoid paying medical claims that do arise.

The GOP/Trump latest absurd plan shows once again the fallacy that we can take beneficial policies and detrimental policies and combine them into a reasonable compromise. Good policy for big insurance companies means bad policies for hapless patients and families. What’s good for the shark is bad for the minnow!

Bad policies cannot be neutralized by political accommodations. Under a well-designed, improved Medicare for All national insurance program, catastrophic plans like these would not exist. The sooner we get to single-payer health insurance program, Medicare for All, the better it will be for all of us — meanwhile, caveat emptor, buyer beware!

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Bonus Video added by Informed Comment:

Kaiser Health News: “Let’s Talk About Trump’s Health Care Policies”

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Medicare Turns 55: Let’s Celebrate by Covering Everyone! https://www.juancole.com/2020/08/medicare-celebrate-covering.html Sat, 01 Aug 2020 04:01:48 +0000 https://www.juancole.com/?p=192319 Gainesville, Florida (Special to Informed Comment) — Congress enacted Medicare in July,1965, to provide health insurance for people ages 65 and older and the disabled regardless of income or medical history. In the 55 years since, Medicare has become living proof that public, universal health insurance is superior to private insurance in every way. Medicare is more efficient than private health insurance and is administered at a cost of 3 percent to 4 percent, as opposed to private, for-profit health insurance, which has administrative costs above 15 percent. In light of the burgeoning, severe losses of jobs/employment/health insurances caused by the ravages of the COVID-19 pandemic, it’s very Important to remember that Medicare is still providing stable coverage for everyone 65 and older. If the new and improved Medicare for All, as outlined below, were in place today, everyones health insurance, in spite of the COVID-19 pandemic, would continue uninterrupted because the Medicare insurance system is based on citizenship, not employment.

Medicare’s costs over 55 years have risen more slowly than those of private health insurance industry. Medicare provides better access to care, better financial protection and higher patient satisfaction. Although some have negative feelings toward government, and examples of government inefficiency and incompetence exist, the record of private health insurers is far worse. Dozens of financial profiteering scandals have wracked private insurers and HMOs in recent years.

To continue our 55 years of progress, it’s time to upgrade Medicare by establishing a 21st century “Medicare for All” health insurance system that covers all age groups, cradle to grave. Newborns will leave the hospital with their new Medicare card, and drop it off years later at life’s end. Two comprehensive M4A bills now filed in Congress, H.R. 1384 and S.1129, propose to insure/cover all medically necessary services. Patients have their choice of physicians, mental health professionals, other health care professionals, hospitals and clinics.

M4A insured health services include:
1). primary care
2). medically approved diet and nutrition services
3). inpatient care
4). outpatient care
5). emergency care
6). prescription drugs
7). long-term care and palliative care
8). mental health services
9). dentistry
10). eye care
11). substance abuse treatment

Because our government, instead of private profit health insurance companies, serves us as the health insurance financing authority, co-pays and deductibles paid at health professionals offices are ended because payment for health insurance is fully prepaid directly into Medicare, much like Social Security, and covered at first dollar amounts. This means the obsolete 80 percent/20 percent payment split between private health insurance companies and Medicare is eliminated, with Medicare for All covering 100 percent.

With M4A, citizens are guaranteed access to health care while achieving significant overall savings compared to our existing obsolete system. This is accomplished by lowering administrative and eliminating profiteering costs, controlling Big Pharma prices of prescription drugs, fees for physicians and other health-care professionals and hospitals, reducing unnecessary treatments and expanding preventive care.

Good health care would be established as a basic human right, as in almost all other advanced countries. Nobody would have to forego needed treatments because they didn’t have insurance or they couldn’t afford high insurance premiums and co-pays. Nobody would have to fear a financial disaster because they faced a health care crisis in their family. Virtually all families would end up financially better off and most businesses would also experience cost savings compared to what they pay now to cover their employees.

We finance our new and improved Medicare for All system by eliminating profiteering by the private health insurance industry and slashing the system-wide administrative waste they generate, with a single streamlined, nonprofit public payer health insurance system. Such savings, estimated in 2017 to be about $500 billion annually, would be redirected to patient care.

Existing tax revenue would fund much of the system. According to a 2016 study in the American Journal of Public Health, tax-funded expenditures already account for about two-thirds of U.S. health spending. That revenue would be retained and supplemented by modest progressive taxes based on ability to pay, taxes that would typically be fully offset by ending today’s very high premiums paid to the for-profit private insurance industry and out-of-pocket expenses for care. The vast majority of U.S. households — one study says 95 percent —would come out financially ahead. The system would reap savings by dealing with drug and medical supply companies for lower prices.

More than two dozen independent analyses of federal and state single-payer legislation by agencies such as the Congressional Budget Office, the General Accountability Office, the Lewin Group and Mathematica Policy Research Group have found that the administrative savings and other efficiencies of a single-payer program would provide more than enough resources to provide first-dollar coverage to everyone in the country with no increase in overall U.S. health spending.

M4A is a solid investment in our country because it promotes a social service for universal access to affordable health insurance for everyone. A majority of Americans support Medicare and want expansion of this program to provide health insurance for all. Write to your senators and representatives and let them know how you feel about expanding Medicare. The very best way to cope with the vast dangers of COVID-19 to everyone is to immediately implement improved Medicare for All with H.R.1384/S.1129. By making health insurance available to all age groups, we can enjoy and celebrate Medicare’s 55th birthday with the assurance that this life-saving health insurance program will continue.

Featured Photo: Flicker.

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Can we afford Medicare for All? The Truth is, we can’t afford not to have it https://www.juancole.com/2020/07/afford-medicare-truth.html Wed, 22 Jul 2020 04:03:16 +0000 https://www.juancole.com/?p=192163 Gainesville, Florida — In the US, 30 million people have no health insurance, and the per capita cost of health care is far higher than it is in other countries. On top of this, the recent COVID-19 pandemic and its economic consequences have caused the greatest losses in health insurance enrollment in U.S. history: 5.4 million laid-off workers have become uninsured. However, it is important to understand that all was not well before the pandemic with tens of millions more underinsured – unable to afford the out-of-pocket costs that were not covered by insurance. Of major significance, these are nonelderly adults. Medicare – for those over 65 – continued to provide stable coverage after the onset of the pandemic. There would be no uninsured now had we had in place a single payer Medicare for All program.

To address these problems, many have advocated establishing Medicare-for-All (M4A). University of Minnesota professor Gordon Mosser,(in “A Review of the Reports on the Cost and Funding of Medicare for All”), reviewed seven reports on the costs of M4A that were written by scholars of health economics in universities or private foundations that study health care. Two of these reports also describe in detail how the program might be funded. Senators Bernie Sanders and Elizabeth Warren have also made suggestions for funding.

When someone asks, “How are we going to pay for Medicare for All?”, Mosser’s answer is, “We’re already paying enough, but we’re going to pay for it more fairly through equitable tax policies. For all but the very wealthy, average health care spending will decrease.” Prof. Gordon Mosser, in an analyses of general M4A concepts by Thorpe, Blahaus, PERI, Friedman, Urban Institute, RAND, has compiled “golden mean” estimates on what the major features of spending on single payer Medicare for All might be.

Prof. MOSSER BRIEF SUMMARY:

1). Our current national health expenditures are already more than enough to pay for comprehensive health care for everyone through a well designed single payer model of an improved Medicare for All. Our total national health expenditures may actually decrease under such a model.

2). Medicare benefits would be improved, providing more comprehensive coverage.

3). Medicare eligibility would be expanded to include everyone.

4). The efficiency of the single payer model of Medicare would dramatically reduce administrative waste, plus efficiencies in purchasing would recover enough funds to pay for much of the improved benefits and expanded coverage of Medicare for All.

5). Since the system would be funded through the tax system, taxes will increase, but the additional amount paid in taxes by most individuals will be more than offset by the elimination of private spending for health care. On average, only the wealthy will pay more than they currently do.

6). Since the taxes will be progressive, funding of health care will be more equitable, based on ability to pay, and thus affordable for each of us.

7). What will the system cost? Nothing, since we are already spending enough to pay for it. To claim that the tax increases are increases in costs is either naive or outright dishonest.

The seven reports reviewed by Mosser concludes that M4A would result in a net decrease in overall US healthcare costs of 5.7% on average. Under M4A, US health care would cost approximately $46,000 billion over 10 years. Over the same period, approximately $23,500 billion in new federal revenue would be needed in place of present-day payments from other sources. It would not be necessary to impose a federal sales tax or any new taxes directly on low or middle income households, but high income households and wealthy Americans would likely pay higher taxes.

Further supporting Mosser’s conclusions, another publication,(PLOS Medicine,January 15, 2020) published “Projected costs of single-payer healthcare financing in the United States: A systematic review of economic analyses,” by Christopher Cai, James Kahn, et al , surveyed an even greater number of single payer cost analyses, and their results were essentially the same as Mosser’s:

“There is near-consensus in these analyses that single-payer would reduce health expenditures while providing high-quality insurance to all US residents.”

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Bonus video added by Informed Comment:

Bernie Sanders: “Debunking a Huge Medicare for All Myth”


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