Capitol Pressroom Thursday, November 15, 2018 Governor Cuomo’s view regarding signing NYH

November 15, 2018

Governor Cuomo was on before this segment.  First segment.

 

Ex-UN chief Ban Ki-moon says US healthcare system is ‘morally wrong’

September 26, 2018

https://www.theguardian.com/us-news/2018/sep/25/ex-un-chief-ban-kioon-says-us-healthcare-system-is-morally-wrong

 

Ex-UN chief Ban Ki-moon says US healthcare system is ‘morally wrong’

Exclusive: Former UN secretary general accuses ‘powerful’ health interests in the US of blocking universal healthcare

Ban said: ‘It’s not easy to understand why such a country like the United States, the most resourceful and richest country in the world, does not introduce universal health coverage.’
Ban Ki-moon: ‘It’s not easy to understand why such a country like the United States, the most resourceful and richest country in the world, does not introduce universal health coverage.’ Photograph: Ali Smith for the Guardian

The former United Nations secretary general Ban Ki-moon has denounced the United States’ healthcare system as politically and morally wrong, and urged American leaders to enact publicly financed healthcare as a “human right”.

Ban made the comments in an exclusive interview with the Guardian in New York, as part of his work with The Elders, a group founded by Nelson Mandela to work on issues of global importance, including universal health coverage.

The US has the world’s most expensive health system, accounting for nearly one-fifth of American gross domestic product and costing more than $10,348 per American. The United Kingdom, by comparison, spends a little under 10% of GDP according to the latest available statistics, and healthcare is free at the point of delivery.

“It’s not easy to understand why such a country like the United States, the most resourceful and richest country in the world, does not introduce universal health coverage,” said Ban. “Nobody would understand why almost 30 million people are not covered by insurance.”

Failing to provide health coverage, he said, was “unethical” and “politically wrong, morally wrong”. He accused the “powerful” interests of pharmaceutical companies, hospitals and doctors that “inhibit the American government” of having prevented the US from moving towards universal healthcare.

“This is for the people. Leaders are elected because they vowed that they would work for the people,” said Ban. “They are abandoning people because they are poor, then these poor people cannot find a proper medical support.”

Despite astronomical spending on health, millions in the US live entirely outside the health system, uninsured and unable to go to the doctor without incurring hundreds or thousands in debt. Since President Trump was elected, an additional 4 million people have lost health coverage, according to a recent survey by the Commonwealth Fund.

“It seems with Trump just undoing Obamacare, people were not happy first of all,” said Ban, about health reforms enacted to weaken elements of the Affordable Care Act, former President Barack Obama’s signature healthcare law. “Ironically, it might have motivated people to think other ways, and influence their senators and their congressmen to think the other way.”

Ban revealed he had his own run-ins with the American healthcare system. While he was secretary general between January 2007 and December 2016, the UN provided him with American health insurance. About three years ago, he set out to pick up a prescription at a pharmacy, but forgot his insurance card. A worker at the pharmacy told him that without insurance, his prescription would cost $200. If he came back with his insurance card, it would be $20.

“It was totally unfair,” said Ban. “People like myself can afford [this]. But poor people cannot afford it. They do not have any support.”

“While swearing in as secretary general, I pledged I would make this world better for all,” he said. “Nobody would imagine that there should be so many people – 30 million people – who would be left behind” in the US.

Health coverage has become a major issue ahead of the congressional midterm elections in November, which are widely seen as a referendum on Trump’s America.

Progressive Democrats have called for Congress to enact “Medicare-for-all”, a proposal to expand the public health program which covers all Americans older than 65. Establishment Democrats have argued for expansions of Obamacare.

As well, four conservative states are attempting to expand Medicaid, the public health insurance program for the poor and disabled, through a ballot referendum.

Trump and Republicans have worked to make health coverage more exclusive. The Trump administration has allowed states to add work requirements to public health programs for the poor and disabled, and Republicans ended a requirement for Americans to buy private health insurance when they cut taxes.

Ban blamed the “sectoral interests” of pharmaceutical companies, hospitals and doctors, “which inhibit the American government” for hindering moves towards a universal health coverage plan.

“Here, the political interest groups are so, so powerful,” Ban said. “Even president, Congress, senators and representatives of the House, they cannot do much so they are easily influenced by these special interest groups.”

Ban said he hopes states, including California and New York, will pass universal health coverage and spark a national call for public financing of health.

“It will be either California or New York who will introduce this system,” said Ban. “Then I think there will be many more states who will try to follow suit. I think that’s an encouraging phenomenon we see.”

 

 

The Lancet EDITORIAL The 2018 US midterm elections—health in the middle

August 26, 2018

Midterm elections in the USA are so called because they refer to the elections for federal offices that typically demarcate the middle of a presidential term. Historically, these elections draw lower voter turnout than presidential elections, but can serve as powerful referendum votes on a sitting president’s performance. Despite receiving nearly 3 million fewer votes than his opponent Hillary Clinton and with more than half of Americans rating him negatively, President Trump’s numbers are stable, but reflect deeply polarised political views. Both parties hope to take advantage of the partisan divide by aggressively campaigning and mobilising voters in the most contested state midterm elections—with congressional control at stake. Recent polls and media coverage indicate that health care is emerging as the key determining issue in many races. Other health-related issues, including gun control, immigration, and the environment, will feature prominently.
The midterm elections, taking place on Nov 6, 2018, will encompass 435 seats of the US House of Representatives, about a third of full-term US Senate seats, 34 of the 50 states’ gubernatorial races, and several pivotal special elections and ballot measures across the country. This year’s midterm elections will put a wide range of health policy proposals to voters. Florida, Maine, Idaho, and Utah will decide whether to expand Medicaid. Other notable votes will take place on a policy amendment in Alabama that would eliminate any state funding or provision of abortion, a sales tax exemption on feminine hygiene products in Nevada, and, in Massachusetts, an anti-discrimination veto that would roll back transgender equality legislation passed in 2016.
Within the present political gridlock, state-level ballot measures have taken on increasing importance during midterm elections. Even with a congressional majority, Republicans have been unable to achieve much of their agenda through congressional legislation, with the exception of a sweeping tax overhaul. Previous attempts during 2017 to dismantle the Patient Protection and Affordable Care Act (ACA) faced unanimous rejection from Democrats and failed to get sufficient Republican traction in Congress. As a result, opponents of the ACA have shifted tactics to undermine some of the health law’s signature provisions. Using strategically placed lawsuits in district courts, the Trump administration has attempted to challenge the constitutionality of the individual mandate (ie, requirement that all Americans must have basic health insurance) and pre-existing condition coverage. With two Supreme Court openings in the past 2 years, the administration has also had the opportunity to appoint conservative Neil Gorsuch to the country’s highest legal jurisdiction and will likely confirm a second, Brett Kavanaugh, prior to the midterm elections. A right-leaning US Supreme Court could have profound implications for legislation stemming from ACA challenges to the potential revisit of Roe v Wade, the landmark 1973 decision to disallow federal restrictions on abortion.
Lawmakers who prevail after the midterm elections will immediately be faced with other urgent health-related issues affecting the nation. Candidates in both parties have been pressed by voters on where they stand on critical issues including the rising cost of health care, especially insurance premiums, drug pricing, and efforts to curtail the opioid epidemic. Preliminary data from the US Centers for Disease Control and Prevention indicate that the number of deaths has edged upward, with nearly 72 000 owing to overdoses in 2017. While there have been modest bipartisan efforts, including a flurry of bills targeting opioid abuse, proposed legislation has largely neglected how to provide more treatment without dramatically increasing federal spending, an unlikely scenario given Republican opposition to Medicaid expansion or alternative funding. Similarly, bipartisan-sponsored plans to rein in drug price hikes, such as the FAIR Drug Pricing Act, which would require notification of price increases over 10%, will face strong resistance from drug makers, the largest lobbying group in the USA.
As the country anticipates the results of the 2018 midterm elections, the media have argued whether a “blue wave” or a Democratic surge will dominate local and special elections in response to dissatisfaction with the Trump administration and Congress. Over 500 women candidates have registered for congressional races, a record number, and two-thirds are Democrats. 80% of women candidates are campaigning around core issues of health care, education, and reproductive health. With engagement on both ends of the political spectrum escalating, in the lead up to November, the debate around American health will surely continue to be front and centre.
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An unlikely winner in the long-running bull market: Health insurers

August 25, 2018

 

Richard Gottfried <gottfried@nyassembly.gov>

Aug 24, 2018, 11:32 PM (9 hours ago)

This Quote of the Day is stunning. This refers to the post from yesterday An unlikely winner in the long-running bull market: Health insurers by Bertha Coombs

At last week’s annual conference of the National Academy for State Health Policy, one of the speakers was Ana Gupte, from the Wall Street firm Leerink Partners, talking about Wall Street’s view of health care.  The room, filled with many state Medicaid directors and other state officials and a few state legislators, was pretty stunned to hear her say that for Wall Street, “Medicaid managed care is a gold mine.”

 

This Quote of the Day lays that out in more detail.

The key thing about Medicaid managed care and “Medicare Advantage” is that they run public health coverage through the wasteful machinery of insurance companies.

Think of the billions of dollars that go to feeding insurance company administrative operations, marketing and profit, and the billions that doctors, hospitals and other providers spend on administrative costs to fight with insurance companies.  Think of the health care that money could pay for.  Or the food, clothing, housing, vacations, and other things that money could pay for if it was in people’s pockets instead of being taken by insurance companies.

Thinking of this, I was reminded of the speech by President Eisenhower (Republican and the general who led the Allied victory in World War II) in 1953:

Every gun that is made, every warship launched, every rocket fired signifies, in the final

sense, a theft from those who hunger and are not fed, those who are cold and are not clothed. This world in arms is not spending money alone.

It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children.

The cost of one modern heavy bomber is this: a modern brick school in more than 30 cities.

It is two electric power plants, each serving a town of 60,000 population.

It is two fine, fully equipped hospitals. It is some 50 miles of concrete highway.

We pay for a single fighter plane with a half million bushels of wheat.

We pay for a single destroyer with new homes that could have housed more than 8,000 people.

This, I repeat, is the best way of life to be found on the road the world has been taking.

This is not a way of life at all, in any true sense. Under the cloud of threatening war, it is humanity hanging from a cross of iron.

Here’s a link to a nice article about it: https://www.usnews.com/opinion/blogs/robert-schlesinger/2011/09/30/the-origins-of-that-eisenhower-every-gun-that-is-made-quote

(When I was a child, it was common for people to make fun of Eisenhower for being inarticulate.  But that passage is poetry.)

I’m not suggesting we mix up discussion of the NY Health Act with a discussion about military spending — we’ve got enough on our plate.  But I like the idea of talking about what we could be doing with all that money spent on feeding and fighting insurance companies.  E.g., people have been saying that commercial health coverage for a family of 4 costs about $20,000 a year — and that’s like buying a new car every year.  (And don’t forget the deductible — you can’t drive it until you buy tires and an engine.)

Richard N. Gottfried
“Free yourself.  Free others.  Serve every day.” –Nelson Mandela

 

An unlikely winner in the long-running bull market: Health insurers

August 24, 2018

CNBC
August 19, 2018
An unlikely winner in the long-running bull market: Health insurers
By Bertha Coombs
The bull market, which is about to become the longest running in recent history, has produced healthy returns for investors. The S&P 500 is up well over 300 percent over the last nine years, but health insurance stocks have logged even more impressive gains.
The S&P Managed Care sector, made up of the largest insurers, has gained more than 1,100 percent during the market’s bull run. That’s more than twice as much as the gains in the biotech sector.
Nine years later, two of the biggest health-care winners have seen large growth in part because of Obamacare.
The Medicaid boom
Medicaid expansion under the ACA has resulted in nearly 15 million people gaining coverage under the government health program for the poor and disabled. At the same time, over the last decade, states have increasingly turned to insurers to manage their Medicaid programs.
Medicaid insurer WellCare Health Plan’s shares have gained more than 4,000 percent since March 2009, and its annual revenues have nearly tripled from $6.9 billion to an estimated $18.7 billion this year.
Rival Centene’s shares have gained nearly 1,800 percent over the last nine years. Annual revenues have ballooned from $3.4 billion to an estimated $59.8 billion this year. Centene is up 42 percent year to date, trading near record highs.
At the same time that the Medicaid business has expanded, Medicare has seen big growth over the last decade as more baby boomers have aged into the government health plan for seniors.
For the major health insurers that has meant that their government business has grown faster than the commercial employer and individual insurance plan business. Government plans now account for more than 50 percent of the industry’s insurance revenues.
More diverse businesses
Government plans have been one of the growth drivers for the nation’s largest insurer, UnitedHealth Group, which is up 19 percent year to date, and has seen shares gain nearly 1400 percent over the last nine years.
United’s health plan membership has grown from 32 million to nearly 50 million over the last nine years; its Medicaid and Medicare membership has more than doubled, during the period.
But new business segments outside of health insurance have played a big role in growing the health-care giant’s annual revenues from $87 billion in 2009 to an estimated $225 billion this year. The health services and products under the Optum division have become a key driver of top-line growth.
United’s Optum unit now accounts for 20 percent of revenues, and includes data analytic services, pharmacy benefit management, physician practices and outpatient surgical centers.
Revenues from the services businesses are not subject to the ACA regulatory caps, which require insurers to spend at least 80 percent of premium revenues on medical care. That makes them more profitable.
United’s success has been part of the impetus behind the increasing number of vertical health insurer deals. More health plans have acquired health-care providers and services in order to have greater control over medical costs in their health plans.
Pharmacy benefit giant CVS Health’s $69 billion deal for Aetna and Cigna’s $54 billion deal to buy pharmacy benefit firm Express Scripts are both predicated on trying to driving cost efficiencies by having greater control over a wider range of members’ care.
Meantime, Democrats have revived the health reform debate over single-payer Medicare For All, nine years after investors were rattled by the prospect of single-payer health care under the ACA.
If either side gains traction, analysts say the major insurers have positioned themselves to adjust more readily to the shifting landscape over the last decade.
“Even if it’s Medicare for all, it would probably be Medicare Advantage for All,” with the government funding private Medicare plans, said Deep Banerjee, health-care credit analyst at Standard & Poor’s.
“Health care today is a public-private partnership … it’s very hard to see a system without a private player meaningfully involved,” he said.
===
Comment by Don McCanne
Since enactment and implementation of the Affordable Care Act (ACA) we have heard stories about how tough it has been for the insurance industry. Congress and both the Obama and Trump administrations have responded with measures to ensure the viability of this industry (in spite of blowhard repeal activity of the Republicans that had essentially no detrimental impact on the insurers – they just raised their premiums). You really need to read this very brief summary of the past nine years to understand what a godsend this has been for the health insurance industry.
Much of the clamor has been over the ACA exchange plans. Yet in the overall picture that has been a very small part of what has really happened in the past decade. In fact, it has been such a small part that some of the largest insurers have pared back their involvement in the exchanges since they have been an insignificant contributor to their business successes.
So what has been the source of their success? The two government programs, Medicare and Medicaid, and the expansion and diversification of their industry.
The largest expansion as a result of ACA has been in the Medicaid program, and that has coincided with a massive shift into the private Medicaid managed care programs. The behavior of the Medicaid managed care stocks has demonstrated what a phenomenal business success this has been (even if it appears that this success has been made possible by the implementation of their business model that simply prevents their Medicaid patients from receiving much of the care that they should have). Since the private Medicaid managers have been successful in barely providing health care to huge numbers of Medicaid beneficiaries at a very low cost to the government, it its likely that this program is locked in place for the indeterminate future. The political process will be very resistant to any proposals that would increase spending on poor people – the low-income population that qualifies for Medicaid.
The success of the private Medicare Advantage plans has not been due to ACA but rather due to other programs that were set up in an effort to privatize Medicare. Again, Congress and the Bush, Obama and Trump administrations have all nurtured this program by providing them with very generous funding (much due to administrative chicanery) while at the same time giving the insurers regulatory backup to pay for health care at rates considerably below the rates paid by standard commercial plans. With high volume, generous funding, and low costs, it is no wonder that these insurance companies have become darlings of Wall Street.
What should be very alarming to us is the success that these insurance companies have had in diversifying their businesses. They are no longer just the insurers and administrators, they have now become an integral part of the health care delivery system with their acquisition of physician practices, outpatient surgery centers, pharmacy benefit managers, data analytic services, and other vertical acquisitions. Profits from these expansions are not limited by the ACA regulatory caps, and if there is anything that the private insurers understand, that is how to make a buck.
So where is the money coming from that has created this phenomenal success for the private insurers? Well, a large amount is from the taxpayers through the Medicaid managed care and private Medicare Advantage plans – part of the silent costs of health care that the taxpayers do not realize they are already paying. Some is coming from a diversion of funds from the health care providers into the coffers of the insurers. Some is coming from the Wall Street customers who are paying excessive amounts for stock purchases plus the cost of churning in this protracted bull market. And some is from the excessive administrative services that the insurers keep selling us. You can probably think of more sources of their enrichment.
We’ve been saying for three decades that it is urgent that we change to a publicly funded and publicly administered, single payer, improved Medicare for All. Not only have we wasted funds on the excesses of our current dysfunctional system, but also far too many have gone without essential health services, and tens of millions have faced unnecessary financial hardship.
But what has snuck up on us is that the insurance industry has taken over. They have planted themselves in a position to capitalize on the Medicare for All movement. Medicare for All has now become the rallying cry for the Medicare public option. Just as the private Medicare Advantage plans are engulfing the traditional Medicare program, the insurance industry is positioned to be sure that the Medicare public option will be a Medicare Advantage public option, and they will do it with the support of our politicians, including many who profess to be progressive or liberal or whatever label assuages their guilt.
The latest Reuters/Ipsos poll shows that 70 percent of Americans support Medicare for All, including half of Republicans. But, with the complicity of the neoliberals, the industry has latched onto the Medicare for All rhetoric and will use it to expand their business successes.
What can we do? Well if the public is really serious about wanting affordable health care for all, it will require massive community action – education, grassroots, coalitions, voter engagement – now! Otherwise, sit back and watch them implement Medicare Advantage for All. It’s almost here.

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