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'We Can Get There': Medicare for All Advocates See Resurgence in National Movement
"More and more people are waking up to realize, we do not want private insurance companies to be in control of our healthcare system," said one advocate who attended the latest Sanders Institute Gathering.
Jun 05, 2024
At The Sanders Institute Gathering in Burlington, Vermont last weekend, U.S. Sen. Bernie Sanders repeated the grim facts and statistics about one of the issues he's most passionate about—healthcare—that were no doubt familiar to many of the progressive advocates at the conference.
Americans spend twice as much per capita as what people in other wealthy countries pay for healthcare, with "significantly lower" life expectancy to show for it.
Medical debt pushes more than half a million people in the U.S. into bankruptcy each year.
More than a third of healthcare expenses go not to actual medical care, but to administrative costs.
Bernie Sanders: It goes without saying that our health care system is broken. I think everybody in America knows that. pic.twitter.com/A2ZiwyoLmT
— Sanders Institute (@TheSandersInst) June 2, 2024
But despite the well-known state of the U.S. healthcare system and a current political climate in which the fight for Medicare for All has been relatively "quiet," as one advocate said, Dr. Deborah Richter believes the Gathering showed a resurgence in the movement for a government-funded healthcare system is on its way.
Growing bipartisan anger over a lack of transparency about healthcare prices, private insurers' denial of claims, and the huge profits raked in by insurance companies while an estimated 98 million American adults skip or delay medical appointments to avoid an unaffordable bill are all pushing people to demand change, according to Richter, who gave a presentation about efforts to bring government-funded healthcare to Vermont.
"Walter Cronkite once said that the U.S. healthcare system is neither healthy nor caring, nor a system," said Richter in the talk, which like the rest of the three-day conference was livestreamed. "And decades later, it's still true. But I think that's the bad news. The good news is that it is possible to cover every single Vermonter, every single American with comprehensive coverage without spending a penny more than we're spending currently."
The system that costs Americans twice the amount which people in other wealthy countries pay for healthcare is spending money not on caring for people, but on administration, said Richter, showing a chart that compared Duke University Hospital Medical Center, a facility with 957 beds and 1,600 billing clerks, with a Canadian hospital with 1,200 beds and just seven billing clerks.
Since 1970, she said, the U.S. has seen more than a 4,000% increase in the number of healthcare administrators, while the number of doctors has risen just 200%.
The discrepancy has helped lead to a system in which insurers are increasingly denying claims to maximize their own profits.
"The good news is that it is possible to cover every single Vermonter, every single American with comprehensive coverage without spending a penny more than we're spending currently."
"I'm hearing from people who were pretty much Republicans and more conservative in their views complaining about Medicare, complaining about the fact that Medicare doesn't cover things," Richter told Common Dreams after her talk, pointing particularly to Medicare Advantage, which is billed as an alternative to traditional Medicare that provides greater benefits, but whose participating private insurers frequently deny claims and overcharge the government, costing taxpayers $140 billion annually.
Richter, a primary care physician who chairs Vermont Health Care for All, said she frequently hears from patients "about having to jump through all kinds of hoops in order to get a procedure or a prescription or whatever. And you're hearing that from pretty much everybody now... Those are all the kindling that we need to get this movement ignited again."
"It's the silver lining to having things just crumbling before your eyes," she added.
In Vermont and across the country, the crumbling healthcare system is one in which primary care doctors are leaving their profession in droves—fed up with the bureaucracy put in place by for-profit insurance companies that force them to get approval to provide certain services.
With insurers placing more value on surgeries and other procedures than on the preventative healthcare management provided by primary care doctors, physicians are spending their days "having to deal with prior authorizations and having to deal with paperwork to justify that you deserve to be paid for the services you render," said Richter. "When you're seeing 16 to 20 patients a day, and each one of those has its own enormous bureaucracy, you can imagine how you end up taking your computer home to do your charts. Medical students are not blind to this and are not choosing [primary care], and that's become a catastrophe."
At a panel discussion on healthcare for senior citizens and the hospital system, Medicare for All advocate Wendell Potter recalled that while he was working in the for-profit health insurance industry, an executive told him the greatest threat to the business was the possibility that employers—who pay for insurance plans for roughly half of insured Americans—would begin to see that the industry does little to ensure people get the healthcare for which they pay an average of $477 per month in premiums.
"Someone asked [the executive], 'What keeps you up at night?' And he said disintermediation," said Potter, who worked in communications for health insurance giants Humana and Cigna before leaving the industry to advocate for Medicare for All. "He said that employers in particular would begin to wake up and question the value proposition of big insurance companies as the middleman. But they as middleman take more and more and more of the dollars that we spend on healthcare."
Another panel focused on price transparency in healthcare, a cause which Sanders (I-Vt.) has championed along with Medicare for All to reduce patients' costs within the current system.
Along with Sen. Mike Braun (R-Ind.) earlier this year, Sanders introduced the Healthcare Prices Revealed and Information to Consumers Explained (PRICE) Transparency Act 2.0 (S. 3548), which would require all negotiated rates and cash prices between healthcare plans and providers to be accessible to patients.
Healthcare price transparency has officially been the law of the land since 2021, explained Cynthia Fisher, founder and chair of Patient Rights Advocate, at the Gathering. But many hospitals refused to comply with the price transparency rule finalized by the Centers for Medicare and Medicaid Services under the Trump administration—even suing to block the rule and appealing when they lost the case.
More than three years later, Fisher's organization still sees medical bills "beyond the negotiated rates that are in place now today," she told Common Dreams. Only 35% of hospitals post all of their pricing data for patients to see online, she said, and "the insurance industry has made the files very difficult for anybody to read and parse through."
Under the for-profit healthcare system, Fisher said, patients become victims of the equivalent of "extortion" as they are forced to arrange medical procedures without knowing how much they'll cost out of pocket or how much another hospital might charge for the same care.
"Every time we get care we have to pay by first signing a blank check," said Fisher. "We're signing away our rights to know those prices upfront... And we're signing away our rights to say... that we are responsible to pay whatever they choose to charge us."
Fisher told the story of one patient in Colorado who was provided only with an estimate of the cost before she got a hysterectomy, with her insurer telling her she was likely to pay a $500 copay and the procedure would cost an estimated $5,000 total.
"What happened in reality was the insurance company denied the claim and the doctor charged $9,000 out-of-network and the hospital had a lien on her home," said Fisher, "because she couldn't pay the $74,000 bill."
"Everybody in this room has a healthcare story, and those stories are about the problems with having a crazy for-profit system with these middlemen that are completely unnecessary, and that raise our cause."
Patient Rights Advocate helped the patient find the hospital pricing file and found that the procedure "was indeed closer to $5,000. And indeed it should have been covered," Fisher explained. "It took us, with her, about four or five months to get that lien off of her house. But [transparent] prices empowered her, they saved her, they protected her, and it's happening across the country."
The group has started a project called Power to the Patients, partnering with famous musicians as well as artists to make sure Americans know they have the right to know how much their healthcare will cost ahead of time.
Artist Shepherd Ferry designed a mural for the group that has now been painted by local artists in nearly 50 cities across the U.S., including Seattle, Los Angeles, and New York.
With 54% of American adults delaying medical care to avoid the cost, said Kevin Morra, co-founder of Power to the Patients, millions of people across the country have come to believe that "healthcare is not for them."
"They can't afford it. They don't want to be in a critical moment where they decide, 'Do I pay my rent or do I pay this medical bill?'" Morra said at the Gathering. "People are making a decision, a deliberate decision to not seek medical care, to not take these nondiscretionary procedures. And when nondiscretionary becomes discretionary, we all have a real infrastructural issue in this country."
During the question and answer session at the panel on healthcare for senior citizens, healthcare providers and patients alike raised their hands and shared personal stories about the "demoralizing" nature of fighting to have medications and procedures covered by insurance companies, with doctors "stripped of [their] professionalism" and patients forced to prove to companies that they're required to cover certain services.
Potter agreed with Richter that Medicare for All advocates are "regrouping," particularly around the issues of improving traditional Medicare by including dental and vision coverage and protecting the program "from creeping, almost galloping, privatization by big insurance companies" through Medicare Advantage.
"More and more people are waking up to realize, we do not want private insurance companies to be in control of our healthcare system," said Potter. "Private companies have grown massively over the last several years and they control so much of their access to care."
From the audience, Ellen Oxfeld of Vermont Health Care for All rallied other attendees of the Gathering.
"The left gets very splintered," said Oxfeld. "And I think Medicare for All is one issue that can unify all of us. I know it's not happening tomorrow, but... everybody in this room has a healthcare story, and those stories are about the problems with having a crazy for-profit system with these middlemen that are completely unnecessary, and that raise our cause."
"We can get there, is what I'm going to say," she added.
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Campaigners Beat 'Greedy' Insurance Giants Exploiting Medicare Advantage
"The private insurance industry is used to getting its way, but this year we out-organized them," said one People's Action leader.
Apr 02, 2024
As insurance companies' stock fell 6-12% on Tuesday in response to the Biden administration's Medicare Advantage announcement, one healthcare campaigner celebrated that the U.S. government didn't cave to the "greedy" industry's pressure.
"The private insurance industry is used to getting its way, but this year we out-organized them," declared Aija Nemer-Aanerud, the People's Action Health Care for All campaign director.
Medicare Advantage (MA) plans are an alternative to traditional coverage under the federal health insurance program for people with disabilities and those age 65 or older. They are administered by private insurance companies known for denying patients necessary care and overcharging the government, which costs taxpayers up to $140 billion extra each year.
"We urge President Biden to do more to rein in abuse of the Medicare program by private corporations."
The Centers for Medicare & Medicaid Services (CMS) announced Monday that "payments from the government to MA plans are expected to increase on average by 3.7%, or over $16 billion, from 2024 to 2025. The federal government is projected to pay between $500 and $600 billion in Medicare Advantage payments to private health plans in 2025."
First unveiled in January, the 3.7% is higher than what campaigners wanted. Last week, Alex Lawson of Social Security Works and Brittany Shannahan of Public Citizen delivered to the White House around 28,000 petition signatures urging President Joe Biden to "reduce MA rates to a level commensurate with traditional Medicare and recoup all overpayments."
However, the rate is also far less than what insurers and industry groups were demanding—and, as Reutersnoted Tuesday, the decision was a departure from the norm, as CMS "typically raises the final reimbursement from the advanced notice."
"Medicare is one of the most popular government programs because it delivers healthcare to people when and where they need it," said Nemer-Aanerud. "Private insurance companies like UnitedHealthcare spent millions in advertising and lobbying in Washington to demand more of our public money for privatized, so-called 'Medicare Advantage' plans."
The People's Action leader pointed out that "we countered their lobbying by helping people share their stories with lawmakers about how Medicare Advantage plans harmed them by denying care when they needed it most."
"We commend the Biden administration for listening to our people and refusing to cave to the insurance lobby's demands," the campaigner added. "We urge President Biden to do more to rein in abuse of the Medicare program by private corporations and reinvest public funds into expanding and strengthening traditional Medicare."
As private insurers have grown their MA businesses, "concerns about the cost of the program have been rising for years from wonkier corners of Washington," Bloomberg's John Tozzi reported Tuesday. According to his newsletter:
"We went years without the advocacy community really paying attention to it," says Wendell Potter, who left a career doing public relations for health insurers to become an outspoken critic of the industry.
That shifted over the last year or two, he said, as a loose group of advocates coalesced around the issue... Potter said advocates now get face-to-face meetings with top Biden administration officials about the issue.
Potter partnered with Congresswoman Pramila Jayapal (D-Wash.)—a leader in the fight for Medicare for All, a single-payer healthcare system that would cover everyone nationwide—for a Newsweek op-ed published just before the CMS announcement.
The pair took aim at the insurance industry's "disinformation campaign" about what they call "Medicare (Dis)Advantage."
"First off, the industry claims that Medicare Advantage plans reduce costs. But this is simply not true," Potter and Jayapal explained. "And it gets worse. While Big Insurance touts the coverage Medicare Advantage plans provide, the reality is Medicare Advantage plans often provide worse coverage than traditional Medicare."
They wrote that "another important characteristic of Medicare Advantage plans is their aggressive use of tools to delay and deny care such as prior authorization, which is seldom used in traditional Medicare, and rarely for services like physician-administered cancer treatments (no one wants chemotherapy if they don't need it)."
"Medicare Advantage plans also drive health inequalities, contrary to Big Insurance claims," they continued. "And the industry's biggest and boldest piece of disinformation is that Medicare Advantage plans will be forced to cut benefits if the government stops massive overpayments that have been padding corporate profits for decades."
"This is wholly false," they stressed. "And you want to know how we know? Because we have reduced overpayments before."
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Fueled by Stock Buybacks, Pay of Top Insurance CEOs Surged to $335 Million Last Year
"These health insurance CEOs have been so successful not because they have improved the health and well-being of Americans, but rather because they have sustained financial returns for Wall Street investors."
Jun 07, 2023
The United States' healthcare system is the worst in the developed world, delivering the highest death rates for treatable conditions, the highest infant and maternal mortality rates, and the lowest life expectancy at birth.
But a system that is failing patients, often in catastrophic ways, has been a massive boon for the executives who run the few private companies that dominate the nation's healthcare sector.
Last year, the CEOs of CVS Health, UnitedHealth Group, Cigna, Elevance Health, Centene, Humana, and Molina Healthcare—the top seven publicly traded health insurance giants in the U.S.—brought in a combined $335 million in compensation, STAT recently reported.
The outlet emphasized that "high-flying stock prices again fueled a vast majority of the gains," which mark a new record. Joseph Zubretsky, the CEO of Molina Healthcare—a company whose revenue comes entirely from taxpayer-funded programs such as Medicaid—took home a staggering $181 million in 2022.
As former Cigna executive Wendell Potter noted Tuesday, "these health insurance CEOs have been so successful not because they have improved the health and well-being of Americans, but rather because they have sustained financial returns for Wall Street investors."
"Not much has changed in how insurer CEOs are compensated since I left Cigna in 2008. Except they're making way more," wrote Potter, who is now the executive director of the Center for Health and Democracy.
In a new analysis of the latest CEO pay figures, Potter observed that "had it not been for their companies' share buybacks"—which help boost the price of their stock by reducing the number of shares outstanding—"they wouldn't have banked nearly that much money."
"My analysis of how much the companies have used our premiums and tax dollars to buy back shares of their own stock showed that combined they spent $141 billion on share repurchases between 2007 and 2022," Potter wrote. "Keep in mind that that is $141 billion that otherwise could have been used to reduce our premiums and deductibles–and keep an untold number of American families out of bankruptcy and away from GoFundMe–but was used instead to increase the wealth of their shareholders and top executives."
\u201c(1/6) LATEST: CEOs from the 7 big health insurance companies pulled in $335 million in just 2022 alone.\n\nHow did they do it?\n\nBy imposing high out-out-pockets requirements and premiums; stock share repurchases; and by gaming the Medicare and drug supply chain.\u201d— Wendell Potter (@Wendell Potter) 1686067073
Potter argued that the CEOs' exorbitant pay packages are "especially alarming when you consider that they are getting more and more of it from us as taxpayers" as tens of millions of Americans go without insurance, struggle to afford their prescription medicines, and drown in medical debt.
In an analysis released earlier this year, Potter estimated that government programs are the source of around 90% of the health plan revenues of Molina, Humana, and Centene.
Centene CEO Sarah London brought in more than $13 million in total compensation last year, and Humana chief Bruce Broussard took home more than $17 million. Both companies are major providers of Medicare Advantage—a privately run, publicly funded, and fraud-ridden program that is a growing source of insurance company revenues.
"Keep all of this in mind the next time you go to the pharmacy counter and are told that even with insurance you'll have to pay a king's ransom for your meds because your insurer—through its pharmacy benefit manager (PBM)—has once again jacked up your out-of-pocket requirement," Potter wrote. "Or the next time you notice how much has been deducted from your paycheck for your health insurance–and Uncle Sam."
Fresh outrage over the pay of insurance industry CEOs, which surged during the coronavirus pandemic as millions lost health coverage and got sick, comes amid a renewed Medicare for All push in Congress.
Last month, Sen. Bernie Sanders (I-Vt.), Rep. Pramila Jayapal (D-Wash.), and others reintroduced Medicare for All legislation in both chambers, with more co-sponsors than ever before—though the bill has no chance of passing the divided Congress.
The legislation would virtually eliminate private health insurance and provide comprehensive care to all for free at the point of service, a transformative change that would likely save tens of thousands of lives and hundreds of billions of dollars each year.
"In America, your health and your longevity should not be dependent on your bank account or your stock portfolio," said Sanders. "After all the lives that we lost to this terrible pandemic, it is clearer now, perhaps more than it has ever been before, that we must act to end the international embarrassment of the United States being the only major country on earth to not guarantee healthcare to all."
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