A Patient Advocate's View

Medicare for All, is it time?

I haven’t wanted to comment on the proposals from the politicians because it was clear to me that they were getting their marching orders from the policy wonks who only rehash the same mis-disinformation and lies told about the problems in the US Health System.

In the article below, the focus groups tell me that I was right. That only by changing the health delivery system, and not just the payment of premiums system, can we get the quality and access data we need to improve the system. Government’s role is to collect taxes and spend the money to reach certain goals. They do not create programs, they simply fund programs that are brought to the table.

Just because those over 65 get Medicare, if they contributed the required amount, doesn’t mean that Government has anything to do with designing the health delivery system.  They simply fund it. There are still out of pocket costs with Medicare, which encourages people to choose to forego straight Medicare and to have their Medicare premiums sent to an Advantage Plan run by an insurance company. What difference will it make in the system if all health care dollars are funneled through insurance companies?  We will still have the insurance company’s favorite managed care tool to contend with, cost shifting.

In 1989, Communications Workers of America went on-strike because NYNEX wanted the employees to pay for their health benefit premiums. The slogan was “Fight Against Cost Shifting.” Up to this point, the workers were given a Medicare for All type plan, where the employer paid into a fund to cover the cost of claims. The strike led to the creation of the health reform movement, that culminated in the proposed Clinton Health Plan. The idea was to take health care decisions out of the hands of employers, who at that time were funding most health insurance coverage, so that people would not lose their coverage if they changed jobs.  The plan described how premiums would be paid, either by employers of individuals into a Federal plan, similar to what we have under the ACA. When the Clinton Plan failed to pass, mostly because of the insurance industry’s mis-disinformation campaigns, the movement took up the slogan, Medicare for All to try to simplify the funding mechanism to the public. But, this was before Managed Care and Advantage Plans. This was also before Medicaid and Medicare funding were combined, so that funding was no longer based on who contributed.

This is why the hopes for an accountable plan design is not coming to fruition through the ACA. The system remains fragmented with out universal quality measures. When we talk about agreeing with Bernie or any of the possible candidates, we need to be sure of their understanding of the problem or we may vote them in only to find out they they use the same tired excuses as we found with the ACA.



June 3, 2019

Voters are tuning out the health care debates

By Drew Altman

There’s a big disconnect between the health care debates that dominate Washington, the campaigns and the politically active — where all of the talk is about sweeping changes like Medicare for All or health care block grants — and what the voters are actually thinking about.

The big picture:  In our focus groups with independent, Republican, and Democratic voters in several swing states and districts, the voters were only dimly aware of candidates’ and elected officials’ health proposals. They did not see them as relevant to their own struggles paying their medical bills or navigating the health system.

Details:  We conducted six focus groups in three states (Texas, Florida, and Pennsylvania), facilitated by Liz Hamel, the Kaiser Family Foundation’s Director of Polling and Survey Research. Each one had eight to 10 people who vote regularly and said health care will be important in their presidential vote in 2020.

The highlights:

*  These voters are not tuned into the details — or even the broad outlines — of the health policy debates going on in Washington and the campaign, even though they say health care will be at least somewhat important to their vote.

*  Many had never heard the term “Medicare for all,” and very few had heard about Medicare or Medicaid buy-in proposals, or Medicaid and Affordable Care Act state block grant plans like the one included in President Trump’s proposed budget.

*  When asked what they knew about Medicare for all, few offered any description beyond “everyone gets Medicare,” and almost no one associated the term with a single-payer system or national health plan.

*  When asked about ACA repeal, participants almost universally felt that Republicans did not have a plan to replace the law.

*  When voters in the groups were read even basic descriptions of some proposals to expand government coverage, many thought they sounded complicated and like a lot of red tape.

*  They also worried about how such plans might strain the current system and threaten their own ability to keep seeing providers they like and trust.

Between the lines:  Most voters in these groups don’t seem to see the current health reform proposals on either side of the aisle as solutions to their top problems: paying for care or navigating the health insurance system and red tape.

*  That, combined with a general distrust of politicians, can make these voters wary of any plan that sounds just a little too good to be true to them.

The bottom line:  For most voters, the debate will be more meaningful when they see stark differences on health between the Democratic nominee and President Trump in the general election. Then they may be able to focus more on what differences on health reform mean for the country and their daily lives.



June 4, 2019 - Posted by | Uncategorized

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