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Medicare for All
46 minutes | Sep 19, 2021
Are There “Multiple Pathways” to Universal Healthcare? Evidence from Europe
Are the German and Dutch health insurance systems really private? What would it actually take to transition to a social insurance model? Once and for all, we debunk the myth that we can “build on the current public-private healthcare system” to achieve universal coverage. Show Notes Ben and Stephanie discuss Healthcare-NOW’s recently-completed comprehensive comparison of public healthcare systems in the European Union. Much to the chagrin of the establishment – Medicare for All is the campaign that won’t die. First in 2016, back when Bernie Sanders dared to run on the policy, the media tried to cancel M4A “puppies and rainbows.” That did not work. This argument, beloved by wonks, pundits and moderates alike, claims that most EU countries achieve universal coverage without single payer. They accomplish this with competing private health insurance, along with tight regulation and government subsidies that make premiums affordable for everyone. Is this true? So now instead of arguing against M4A, they’re saying that we don’t have to “blow up” the whole healthcare system to get to universal healthcare, there are “other pathways” that look shockingly like the system we already have: one in which some people have really comprehensive private healthcare, some have an ACA plan with a $15k deductible, some have their healthcare plan as an employee of Hobby Lobby, some have Medicaid, Medicare, whatever. Nope. Depending on how you count them, there are between 30 and 35 countries in Europe. 27 of those countries have a fully public health insurance system. Either one single fund that’s run by the national government (England, all of Scandinavia, Italy, Spain, Portugal, Cyprus, etc.) or there could be several administrators of the one public plan, like in France or Austria, where you’ve got one government-defined package that is delivered for historical reasons by 4 or 5 big quasi public insurance funds, depending on your occupation. They’re noncompetitive, you don’t choose which system you get in, etc. A sort of corollary to this is Canada. Because of the way the system was developed, it isn’t actually one single national plan but are separate plans administered by the provinces. But we still call it single payer. 6 countries use a hybrid model, where “sickness funds” or quasi-public, third-party entities provide primary healthcare coverage. In this option, the government assumes the risk, the government pools healthcare taxes and premiums, profits are illegal, and the sickness funds are heavily regulated by a nationally-set benefits package. Only 1 country (Slovakia) runs on a for-profit, private insurer network. (And this is actually in violation of EU law). As the movement for Medicare for All has heated up since 2017, and increasing pressure placed on Democrats to support it, centrist/corporate Dems have started fetishizing these 6 countries, portraying them as “the ACA on steroids” and potential models for achieving universal healthcare WITHOUT having to take on the health insurance industry. Even more troubling, almost every healthcare reporter at every major “liberal” newspaper, radio outlet, and major news blog, has taken the same position – and they’ve been pumping out extraordinarily inaccurate coverage. Respected healthcare journalists like Margot Sanger-Katz, Julie Rovner, Dylan Scott, and Paul Krugman have written multiple inaccurate articles mischaracterizing European healthcare as private, premium-based and universal healthcare system (while in fact they are publicly funded through taxes). Ben and Stephanie bust myths that are well-loved by moderate Democrats, who claim that Medicare for All is too politically difficult to pass, and we could arrive at our goal with Euro-style private system. These narratives tend to gloss over elements of European plans that are essentially like Medicare for all: Mostly or entirely publicly financed No one profits off of health insurance Publicly-set provider rates Money that’s saved is invested back into the healthcare system, not into profits The notion that European plans feature private, competing insurance companies similar to the ACA is a total sham. The way that European countries have managed to cover everyone and control costs was by eliminating most market-based, market-driven dynamics in their systems. Oddly, the only time these narratives came up was when support for Medicare for All makes gains. There is no actual legislation or movement to transition the US to a European-style so-called hybrid system. They’re all anti-Medicare for All talking points, and nothing more. Please read Healthcare-NOW’s recently published report on European healthcare for much more information, and use it as a resource when you’re talking to your own elected officials. Bust those myths! Follow & Support the Pod! You can listen to Medicare for All on Apple Podcasts, Google Podcasts, or visit our website here. Please donate to the Healthcare-NOW Education Fund to support the podcast!
28 minutes | Sep 5, 2021
Drug Advertising: How to Make a Killing
With the Pfizer/BioNTech vaccine receiving full approval from the FDA, and Moderna shortly behind, prepare for an unprecedented wave of drug advertising! This could have a positive impact with regards to vaccination rates, but drug advertising in the U.S. has a dark, deadly history. Joined by guest co-host Gillian Mason, we cover the surprising reasons our airwaves and social media are saturated with drug ads, and the lethal consequences we saw in the opioid epidemic, which was manufactured by the exact same pharmaceutical companies now marketing the COVID-19 vaccines. Show Notes Direct-to-Consumer advertising is illegal in every country except the United States and New Zealand. Even in the U.S., you never saw drug ads until the 1980s and very few until the 2000s, since drug makers had to list ALL of the drug’s potential risks and side effects in the ad – just like they did in magazine and newspaper advertisements. So the decade that gave us “Wake Me Up (Before You Go Go)” (one of the finest pop songs of the 80s) also gave us the start of “loophole ads” that didn’t mention their drugs’ risks and side-effects, but ALSO didn’t mention the disease the drug treats – just pure branding. Finally in 1997 the FDA started allowing pharmaceutical companies to only list the MAJOR risks of their drugs – not all risks. If you’ve ever listened to the risk section of a drug ad, it’s terrifying to imagine that we’re actually not even getting the full risk statement. This is why they say “see our ad in some completely bizarre magazine” – they’re actually referring you to their full risk statement. Back the money: direct to consumer advertising of prescription drugs hit $6.58 billion in 2020. This doesn’t even include social media or online advertising, which generally wasn’t allowed prior to 2016 – because it’s hard to list the “side effects” of drugs on social media – but the FDA has been allowing it, and pharma has been hitting social media hard now. Facebook pharma advertising hit about $1 billion in 2019. Drug advertising is not only the wrong venue to learn the pros and cons of a medication (your doctor’s office is the best place for that), it’s dangerous. The opioid epidemic was manufactured using marketing and advertising. Right now Pfizer and Johnson & Johnson are being sued by every state and many cities and counties for their role in the epidemic. Opioid litigation started with a seminal 2019 court ruling against J&J for over $500 million for its role in the Oklahoma opioid crisis: “The Defendants, acting in concert with others, embarked on a major campaign in which they used branded and unbranded marketing to disseminate the messages that pain was under-treated and ‘there was a low risk of abuse and a low danger’ of prescribing opioids.” Stay tuned for news about the national opioid settlement and various state, city, and county lawsuits against opioid manufacturers. Follow & Support the Pod! You can listen to Medicare for All on Apple Podcasts, Google Podcasts, or visit our website here. Please donate to the Healthcare-NOW Education Fund to support the podcast!
34 minutes | Aug 13, 2021
Denials at the ER: A Profit-Making Precedent
United Healthcare, the largest insurer in the US, announced this May that they may start denying claims from the ER if it turned out the visits were not actual emergencies. Like almost everything in our healthcare system, this policy doesn’t actually make sense on a moral or even a financial level. We discuss the surprisingly long history of this “new” policy, its implications and impact, and the pushback from doctors and patients. Show Notes Ben and Stephanie break down the latest evil plot of the insurance industry. United Healthcare, the largest insurer in the US, announced this May – during the pandemic – a policy to hold down health care costs: the insurer would review claims for emergency department care to determine whether or not the visit was for an actual emergency. If the paper-pushers decided you didn’t actually require emergency care, the insurer could deny the claim. After outcry from doctors and patients, and United Healthcare said it would delay implementation until the COVID-19 pandemic has passed — but it still plans to institute the policy eventually. ER visits have actually been down during the pandemic, as people are avoiding the hospital for fear of risking a COVID-19 exposure. With ER visits down, private health insurance profits are up. United Healthcare took in $257 billion in revenue last year. It also reported more than $15 billion in profit — an 11% increase from the previous year. This quarter, it took in $4.37 billion in profit and increased its earnings outlook after beating expectations for profit and revenue. Anthem reported $1.8 billion in profit and said COVID-19 variants and slowing vaccination rates added uncertainty to the second half of the year, but still raised its earnings forecast. Ben and Stephanie discuss other efforts by the insurance industry to punish people for using the ER. In addition, many states have been implementing this policy for Medicaid beneficiaries for years, part of a pattern of targeting and terrorizing Medicaid beneficiaries. Medicaid programs that have implemented copays for “nonemergency” visits. Unsurprisingly, people are still going to the ER when they need care, and these policies are having no impact on the Medicaid recipient ER utilization rate. A 2018 study by Boston area researchers looked at what would happen if these policies were adopted nation-wide. This research showed that retroactively reviewing ER visits is wrong in principle: “The main limitation of retrospectively judging the necessity of ED care is that the determination is based on information not available to patients prior to the medical evaluation. When patients become acutely ill, they must decide whether to seek care (and, if so, when and where) based not on a diagnosis but on the symptoms they are experiencing.” Health insurance companies prime us to be afraid of using our healthcare benefits, of avoiding the healthcare system whenever possible, because if you’re hassled with bills and denials every time you use care, obviously they will succeed in getting you to avoid care. This is exactly that they’re doing here – conditioning us to think twice. Their business model literally depends on people not getting care. An insurance company CEO, allegedly. (Image description: Dr. Evil from Austin Powers films.) According to a Journal of Public Health and Emergency study, women use the emergency department 25% more often than males. Black Americans under the age of 65 use the emergency department 10-19% more often than White Americans. So United Healthcare’s policy would affect women of color at an extremely disproportionate rate. Last year, California health care regulators fined health insurer Aetna for wrongfully denying members’ ER claims 93% of the time, in violation of state laws protecting ER patients. (The department’s sample of ER claims denied by Aetna in 2019 found that a stunning 93% were wrongly denied.) The fine, at $500k, is pocket change. “Avoidance of urgent or emergency care was more prevalent among unpaid caregivers for adults, persons with underlying medical conditions, Black adults, Hispanic adults, young adults, and persons with disabilities,” the researchers wrote. If United Healthcare still goes ahead with the change later on, the policy would apply to millions of people in United’s fully insured plans in 35 states, including New York, Ohio, Texas, and Washington. Next, Ben and Stephanie dig into the narrative that people overuse the ER, which drives up costs for everyone. But ER visits have been stable for years. Its costs have been going up – driven by prices. Shifting care from the ER to outpatient settings may have real clinical benefits for patients — the evidence is robust that early medical interventions, in primary and specialist care, lead to better outcomes — but it won’t necessarily save money. People might get more outpatient care and, on top of that, hospitals will charge what they must to cover the cost of operating an emergency department. More resources Health Affairs article, “The Uninsured Do Not Use The Emergency Department More—They Use Other Care Less” Amy Vilela’s daughter Shalynne was denied emergency care, and later died. List of cost-sharing for ER (and other services) for Medicaid enrollees. Report from former Senator Claire McCaskill’s office focused on the impact of denial of ER claims in Missouri alone. Jacobin article “Health Insurers Shouldn’t Be Incentivized to Deny Patients’ Emergency Room Visits“ Follow & Support the Pod! You can listen to Medicare for All on Apple Podcasts, Google Podcasts, or visit our website here. Please donate to the Healthcare-NOW Education Fund to support the podcast!
29 minutes | Aug 2, 2021
Medicare Expansion Gains Momentum & Victories!
Last podcast, we discussed expanding and improving Medicare, and since then there are a couple of major updates on the budget moving through Congress, with implications for the M4A movement! We also discuss the history of expanding and improving Medicare (or degrading, in the case of privatization). Show Notes Last podcast, we discussed expanding and improving Medicare – way back 2 weeks ago – it was really an uphill fight, with the Biden administration focused only on expanded subsidies for the ACA. Thanks to a lot of grassroots pressure, it’s a whole new world now since even just two weeks ago. Ben and Stephanie update us on how the ground has really shifted, and share a couple of MAJOR updates on the budget moving through Congress, with implications for the M4A movement. Another thing we started thinking about since the last podcast is – when WAS the last major expansion of Medicare? How would these reforms fit in the history of expanding Medicare since it was passed in 1965? We did a little research on that, learned a lot of interesting things, and so we’ll also quickly take a tour of Medicare through the years and try to figure out where this moment is in all that historical context. The first major development is on the House side: the House Appropriations Committee for the first time in 45 years passed a budget WITHOUT the Hyde Amendment included. It’s unlikely to make it through the Senate, but we are getting closer and closer to eliminating the ban on public funding of abortion services. https://www.dailykos.com/stories/2021/7/16/2040229/-House-Democrats-advance-spending-bill-to-overturn-the-Hyde-Amendment The second major development is on the Senate side: Senate Dems & Biden have agreed to a $3.5 trillion number for the budget, not as much as Senator Sanders had wanted. But Chuck Schumer publicly announced that he will push to include dental, vision, and hearing in traditional Medicare – he’s crediting Bernie Sanders and the M4A movement with the proposal. This wasn’t even on the table a couple of weeks ago. https://www.commondreams.org/news/2021/06/21/schumer-backs-sanders-proposal-include-dental-hearing-and-vision-care-medicare We don’t know the details of how extensive the dental, hearing and vision benefits will be, so we need to keep pushing to make sure the benefits are generous enough to undercut the privatized Medicare Advantage plans. The better the benefits, the fewer reasons there are to buy a private plan, putting more folks in the public pool, increasing efficiencies and lowering costs for patients. The other thing very likely to be included in the budget is SOME FORM of Medicare negotiation of prescription drugs, but there is a fight shaping up within the Democratic caucus in the Senate about whether Medicare will be given real power to negotiate drug prices. HOW MANY drugs will Medicare be allowed to negotiate prices for? How will Medicare set prices for those drugs – particularly whether Medicare can use what’s called “international reference pricing”? The political barriers to Medicare drug negotiations are actually NOT primarily the centrist Democrats who you’ve been hearing so much about during this budget process – Joe Manchin (WV) and Kyrsten Sinema (AZ). The real dangers are the Senators who we in the M4A movement call the “Pharma darlings”: primarily Bob Menendez (NJ), but we’re also worried about Tom Carper (DE), and Catherine Cortez Masto (NV). We really need activists in those three states to step up their pressure. (Sidenote to some M4A activists: instead of blasting champions like Rep. Cori Bush and Rep. Alexandria Ocasio-Cortez and other progressive women of color, could you focus on the Pharma darlings instead?) The third proposal we’ve been advocating for is lowering the eligibility age for Medicare to 60, which we thought would be the hardest provision to win. But there is still a real chance to win within this budget, because of the way the budget process works. Our allies in Congress who have been part of the process believe we could win lowering the age of Medicare, and they’ve asked the grassroots to push hard on this particular demand, so that’s what we’ve been doing. In particular if you are age 50-65, telling your story about how you’d be impacted by lowering the age of Medicare is really important. Consider writing a letter to the editor of your local paper, or recording a selfie video of your story and tagging your Senators and Member of Congress on social media. The last Medicare expansion we’ve been fighting for is to set an out-of-pocket maximum for seniors who have Medicare. Stephanie puts these proposals in historical context, with a rundown of all the expansions and reforms since Medicare was established in 1965: the addition of some people under 65 with specific conditions, the addition of some services, an ill-fated out-of-pocket cost cap (that was paid for with increased premiums and was quickly repealed). When we talk about an out of pocket cap now, we’re not talking about paying for it through increased premiums! How about we tax the people who are sending rockets into space, for instance? (Image description: Jeff Bezos’s rocket blasting off, caption reading “This is why we can’t have nice things like healthcare. Tax the rich.”) In 2003, we had an expansion that was entirely private – Medicare Part D, the optional prescription drug benefit offered only by private insurers. This created the dreaded “Donut Hole,” which was finally eliminated in 2010 by the ACA. https://www.medicareresources.org/basic-medicare-information/brief-history-of-medicare/ Action steps! Petition: Strengthen and Expand Medicare Now! Write a Letter to the Editor of your local paper. Healthcare-NOW has a whole training on how to do this! Post your healthcare story on social media and tag your Senators. Work with your local Medicare for All group to have a meeting with your Senators. Follow & Support the Pod! You can listen to Medicare for All on Apple Podcasts, Google Podcasts, or visit our website here. Please donate to the Healthcare-NOW Education Fund to support the podcast!
29 minutes | Jul 16, 2021
Week of Action: Expand Medicare!
Congress has an opportunity to make real steps towards Medicare for All this week. We go over the 4 proposed reforms that would expand Medicare, what’s at play and what’s at stake, the opposition to Medicare Expansion – if you can believe it – there IS opposition to giving seniors dental care – and what you can do to help pressure our legislators to fight! Show Notes Ben in Boston and international correspondent Stephanie in Denmark discuss the proposal to substantially expand and improve Medicare that’s moving through Congress right now. As part of the negotiations around the American Families Plan, there are four demands: Lower the eligibility age for Medicare from 65 to 60, which would add 23 million people to Medicare coverage. (Lowering to 50 would add 60 million people, and lowering it to zero would be even better, but reducing it by just five years would be a huge victory, lowering overall healthcare spending in the U.S. and lowering employer healthcare spending by almost 15%. This will be the hardest of the four demands to achieve, but the one that would affect the most Americans. Add hearing, dental, and vision to Medicare, improving the program for existing Medicare beneficiaries, a huge number of whom are going without needed care. Of Medicare recipients, 75% who need a hearing aid don’t have one, 70% haven’t gone to the dentist in the last year, and 50% didn’t get an eye exam. Create a cap on out-of-pocket costs. Most health insurance has a cap on out-of-pocket expenses, but traditional Medicare doesn’t. This is wonky and less exciting for politicians because while it will save a lot of people a lot of money, it’s not as tangible a benefit as adding hearing, dental, and vision. Allow Medicare to negotiate drug prices. Medicare has been prohibited by law from negotiating drug prices for decades, forcing Americans to pay up to triple what other nations pay for the same pharmaceuticals. Negotiating with the pharmaceutical industry would save Medicare up to $450 billion over ten years, paying for all of the above expansions. Calls for expansion are building not just from the grassroots from within Congress. Letters from members of the House and the Senate (signed by many Democrats including centrists who aren’t traditional Medicare for All supporters) have already been sent to President Biden, pressuring him to include expansion in the American Families Plan. Calls for expansion are coming from inside Congress! (Image description: surprised looking cat, with caption “the call is coming from inside the house!!!”) We have some (very cynical) theories about these odd bedfellows: The centrist Democrats who signed on aren’t deeply in the pocket of the healthcare industry, but they are avoiding Medicare for All because they perceive it as a liability in their district. They are in the pocket of one particular branch of the healthcare industry (but not pharma); they think it could help hospitals or insurance companies. They are signing the letter but don’t think it will pass, and are happy to throw these provisions under the bus behind closed doors. All of the Above These expansion reforms both bring us closer to Medicare for All, and help us divide and conquer the healthcare industry; this proposal takes on Big Pharma, but mostly leaves the insurance and hospital industries alone. But is it working? Currently the opposition to expanding and improving Medicare is coming from the usual suspects, under the umbrella of the Partnership for America’s Health Care Future, the evil transformer of insurers, pharma giants, and hospitals. They’ve even managed to find (some really bad) ways to argue against giving dental care to seniors. Dental coverage wasn’t even a thing in 1965 when Medicare was passed, so seniors don’t need it! 38% of Medicare beneficiaries already receive dental coverage through (privately administered, for-profit) Medicare Advantage, so the rest don’t really need it! (Turns out that coverage isn’t very good; according to a New York Times article 43% of those with Medicare Advantage dental plans have annual caps on coverage of only around $1,000.) Call to Action: Most of the fight for these proposals will be in the Senate. There are only 50 Democrats in the Senate, so all the opposition has to do is knock off one Democrat who is in the pocket of Big Pharma. So the call to action is to contact your Senators. Call your U.S. Senators: 202-224-3121 (Capitol switchboard will be put you through to your Senators) If you are between the ages of 50 and 65, write a letter to the editor or OpEd of your local paper about what it would mean to you to have these benefits, and asking your Senators to sign on. Those closest to Medicare age are the most affected and the most in need of these reforms. Your voice is particularly powerful if you’re in this age range. Follow & Support the Pod! You can listen to Medicare for All on Apple Podcasts, Google Podcasts, or visit our website here. Please donate to the Healthcare-NOW Education Fund to support the podcast!
43 minutes | Jul 2, 2021
Do Marches and Rallies Work?
We’re joined by L.A. Kauffman, author of How to Read a Protest: the Art of Organizing and Resistance. L.A. Kauffman was the mobilizing coordinator for some of the largest demonstrations in U.S. history — the massive Iraq antiwar protests of 2003 and 2004 — and has played key roles in many other movements and campaigns. Her book is about the role of marches and rallies in social movements, particularly large-scale mass demonstrations. Show Notes Today we talk tactics, and in particular, do rallies and marches work? This is a timely topic as we start to re-enter society after over a year of pandemic lockdown, and we’re finally starting to plan in-person collective actions again. We’re joined by L.A. Kauffman, the mobilizing coordinator for some of the largest demonstrations in U.S. history — the massive Iraq antiwar protests of 2003 and 2004 — and a key player in many other movements and campaigns. L.A. is the author of a 2018 book that we love here at Healthcare-NOW, called How to Read a Protest: the Art of Organizing and Resistance, which is specifically about the role of marches and rallies in social movements, particularly large-scale mass demonstrations. L.A. tells us she wrote How to Read a Protest after her experience of the single largest day of protest in world history, against the rush to war in Iraq, on February 15, 2003. Despite the record-breaking numbers of people on the streets in countries on every continent, the protest failed, resulting in little more than a shrug from the White House. L.A. tells us she wrote the book to try to figure out why. Why do we march? Where do protests come from? What do they accomplish, and are they even worth doing? Spoiler alert: we don’t typically achieve policy objectives from mass mobilizations. Most of us think of the legendary 1963 March on Washington as a success: “MLK had a dream, people marched, and civil rights legislation passed,” but it was much more complicated than that. Mass mobilization just doesn’t work as a short-term pressure tactic. L.A. shares that the 2003 global anti-war protests failed because, in the wake of America’s defeat in the Vietnam war, it was imperative for the U.S. government to prove that an empire can wage war at will. The administration shrugged off the massive public opposition, daring the mass mobilizations to continue. They did not. Ben fondly recalls meeting with former Congressman Barney Frank, who once told activists calling for a million-person protest to win Medicare for All, “the only thing that Marches on Washington apply pressure to is the grass in Washington, DC.” If marches aren’t accompanied by calls from and meetings with constituents, they won’t have the desired impact on lawmakers. The 1963 March on Washington was the first major march in DC. Since then, it’s become almost routine for movements to hold marches on Washington, many of which have been very forgettable. But at the time it was very novel, and — motivated in large part by racism — feared by the powers that be. The predictions that hundreds of thousands of Black people marching in DC would cause riots and violence never came to be, though. We contrast the stately 1963 March which was centrally planned from the top down (entirely by men), and very tightly policed — all the way down to prohibiting all but pre-printed protest signs — with the 2017 Women’s March, which mobilized 4.2 million people across the country with improvisational and decentralized leadership and a diverse spectrum of messages. They were very different mobilizations with very different outcomes. The book reveals that the 1963 March actually drew energy away from smaller, local civil rights actions, while the 2017 Women’s March resulted in countless local organizing efforts around progressive issues. All of the time, money, and energy spent on the 1963 March left the movement depleted afterward, limiting the amount of follow up organizing. Due to the decentralized organization of the 2017 Women’s Marches (650 communities held marches in 2017), people continued working together, forming lasting groups like Indivisible and establishing the single largest era of protest in American history – in both numbers and geographical locations. L.A. reminds us that pressure works best when it’s targeted, and tactics depend on the target; protests won’t work in every instance. Protests work better at changing popular opinion and building the movement, especially if the mobilizations are repeated (such as LGBTQ+ rights marches in DC.) Often the biggest impact of mass mobilizations is not how they affect decision makers, but how they affect participants. When people feel energized, they’ll continue the work. This is intangible, hard to measure and hard to plan for. Protests are crucial to building social change, but we don’t usually sit down and plan for morale building. Our time and energy would be well spent on our greatest asset, our participants; this is how we create sustained engagement that it will take to win. Our big takeaway from our conversation with L.A. is that we’ll never win a big fight with one single tactic; it will take a variety of tactics on multiple fronts, repeated over time. But there’s so much more in her book that we didn’t get to cover. If you’re an organizing nerd like we are, seriously, go read How to Read a Protest: the Art of Organizing and Resistance! Sign up for the Healthcare-NOW email list at healthcare-now.org to get involved. Follow & Support the Pod! You can listen to Medicare for All on Apple Podcasts, Google Podcasts, or visit our website here. Please donate to the Healthcare-NOW Education Fund to support the podcast!
34 minutes | Jun 18, 2021
Did Big Pharma or Governments Invent the COVID Vaccines?
Stephanie and Ben discuss who developed the vaccine; who is profiting from it; and the fight for global vaccine equity on this episode with guests David Mitchell of Patients for Affordable Drugs and Andrew Goldstein, a public hospital primary care doctor, assistant professor of medicine at NYU, activist, and organizer with the Free the Vaccine and People’s Vaccine campaigns. Show Notes Who paid to develop the COVID-19 vaccines? Primarily taxpayers. David gives us a history lesson: before the COVID-19 pandemic, the Federal government invested $17 billion in vaccine technology because drug companies weren’t investing in this high-risk, low-return research. When the COVID-19 pandemic hit, these vaccine technologies were ready to be tested. Taxpayers invested another $20 billion in clinical trials, creating production capability, and pre-ordering the product. We took the risk out of the endeavor for the pharmaceutical companies. (We socialize the risk, and privatize the profit.) Are there strings attached to taxpayer dollars for pharmaceutical development? Not really. David explains that the National Institutes of Health contributed to every new drug approved by the FDA in the US between 2010-2019. NIH is the single largest medical research agency in the world. When the drugs are ready for commercialization, they turn the intellectual property (IP) over to pharmaceutical companies with no strings attached. The drug companies can set any prices they want. (For an example, see the new Alzheimers drug from Biogen, that will cost $56,000 a year.) In the case of the COVID-19 vaccines, the US government did negotiate, showing that it is possible to have life-saving innovation at reasonable prices for patients. The Pfizer vaccine is currently $19.50/dose. Pfizer has told their shareholders recently that they want to raise the price of a dose to $150-$175. Many Americans may still need a booster in the future, which will be an opportunity for the drug companies to raise prices if the government doesn’t negotiate. What is standing in the way of developing nations purchasing enough vaccine to inoculate their entire population? Andrew shares that so much of our response to this global pandemic has been approached differently nation-by-nation. Rich nations who gobble up all the available doses are also preventing maximum production of doses, creating false scarcity and “vaccine apartheid.” Trade deals with wealthy nations result in forced austerity for developing nations, keeping them impoverished. Most of them have a tiered healthcare system, with very frail public health mechanisms. Some might have a universal public system, but they tend to be low quality. A secondary private system exists for wealthy people who pay full price out of pocket. Even if wealthy countries donate vaccines, those countries may be selling them to cash-paying patients. Patent rights are preventing developing nations from producing generic vaccines to save their own populations. In the fall of 2020, South Africa and India called on the World Trade Organization for a Trade Related Intellectual Property Rights (TRIPS) waiver, an emergency public health authority to waive patents on vaccines and the technology to produce them. Unfortunately, there are also a lot of trade secrets that aren’t patented that companies are unwilling to share. The TRIPS waiver is a necessary but insufficient solution to free the vaccines. Will the donations of vaccines from G7 countries be enough to meet global need? There are about 6 billion vaccine eligible people on earth who will need two doses = 12 billion doses. G7 countries are announcing a total of about 1 billion doses, but they’re already backing away from that amount and they haven’t tied them to a timeline. Philanthro-capitalism won’t be enough to get 10 billion doses in the next year to meet the global need. Every other developed country bargains for pharmaceutical prices. We don’t, and we pay four times more as a result. H.R. 3 – the Elijah E. Cummings Lower Drug Costs Now Act would let Medicare negotiate for all drugs, including vaccines. The bill would extend those lower prices to the private sector, cap annual price increases at no more than inflation, lower out-of-pocket maximums down to $2000, and would direct savings to NIH to ensure new drug innovation. We expect the bill will pass the House. The Senate Finance Committee is working on a similar bill, and we expect to see it in July. President Biden supports the bill and it can pass through reconciliation. Get involved to help win vaccines for all: Share your story at PatientsForAffordableDrugs.org Partners in Health https://www.pih.org/learning-collaborative/pihs-strategy-achieving-equity-covid-19-vaccination Doctors Without Borders: https://www.doctorswithoutborders.org/what-we-do/news-stories/story/pushing-peoples-vaccine-covid-19 Justice is Global action sign up: https://actionnetwork.org/forms/take-action-to-end-the-pandemic-everywhere-2/ Read more: Policy case by NYT op-ed board: https://www.nytimes.com/2021/04/24/opinion/covid-vaccines-poor-countries.html Policy deep dive: https://www.bu.edu/gdp/files/2021/04/GEGI_WP_Baker_FIN.pdf Follow & Support the Pod! You can listen to Medicare for All on Apple Podcasts, Google Podcasts, or visit our website here. Please donate to the Healthcare-NOW Education Fund to support the podcast!
33 minutes | Jun 7, 2021
Pharma’s Image Gets a Boost from COVID-19
62% of people now have a positive opinion of drug companies, up from 32% in 2020. What’s responsible for the sudden shift, and do pharmaceutical companies deserve this newfound adoration? We’re joined by Shannon Rotolo, co-founder of Pharmacists for Single Payer and a clinical pharmacy specialist at the University of Chicago Medicine, to debunk industry lies about research and development, innovation, the market, and more. Show Notes Public opinion seems to be driven by the belief that pharmaceutical companies mainly function to discover and manufacture important new drugs. While the big pharma companies do do some research and development, they primarily buy the intellectual property of smaller biotech research companies, and then mostly act as marketing and sales reps for the product. They actually spend a lot less on research and development, and much more on marketing and profits for shareholders. Image description: Congresswoman Katie Porter, holding a whiteboard at a House Oversight Committee hearing about drug prices. The smallest circle on the whiteboard is labeled Litigation and Settlements, the next circle is labeled R&D, the next largest is labeled Marketing and Advertising. The largest circle, Stock Buybacks and Dividends, is more than 10 times the size of the next largest circle. https://www.businessinsider.com/video-katie-porter-tears-into-pharma-ceo-whose-company-inflated-its-prices-for-two-major-drugs-2021-5 The vast majority of breakthrough innovative pharmaceuticals are actually funded by taxpayers through the National Institute of Health. Some studies are funded through the Veteran’s Administration. There are countless examples of pharmaceutical companies profiting off of publicly-funded research, making billions and denying any royalties to the government. Those royalties could be used to provide lower cost drugs to patients, but the pharmaceutical companies instead have driven prices up, making life-saving drugs unavailable to people who need them. A recent example is the drug Truvada, marketed by Gilead. Shannon explains some of the games pharma plays to make more money regardless of patient needs. Patent extensions, me-too drugs and changes to delivery methods all allow drug companies to maximize profits and minimize research costs and risks, ultimately driving up costs for patients. While drug companies argue that lowering prices will stifle innovation, the profit motive actually works against the innovation motive. If you can tweak a drug and profit from it, the incentive isn’t there to take the risk and put in the work to develop something new. (Socialize the risk, privatize the profit, as they say.) If you’ve always wondered what Pharmacy Benefit Managers (PBMs) add to healthcare, Shannon breaks it down. Insurance companies, large employers and Medicare Part D contract with PBMs to facilitate prescription drug benefits. They negotiate rebates with drug companies, ultimately setting the price the payer will pay for the prescription. Essentially, PBMs are yet another corporate middleman that skims profits off the system without adding any actual care for patients. What would single payer mean for pharmaceutical prices? Removing insurance companies and PBMs, and negotiating prices would all help bring down costs. But the key benefit of single payer would be simplifying the process and eliminating out-of-pocket costs for drugs that patients need to live. We sometimes hear concerns about a single payer system limiting the drugs that are covered. Shannon explains that there would be a formulary in the system, which would limit coverage of some of the duplicative me-too drugs; but that’s already the case with the insurance plans that most Americans have now. The benefit of a single national formulary is that it’s transparent. Your provider will know what’s covered and you’ll get it. There would be an exception process for patients with rare conditions, allergies to certain drugs, and so forth. But it will be the same process for every patient everywhere, that patients and pharmacists can count on, rather than a patchwork of processes for each and every insurance plan. Long story short, it’s very rarely Big Pharma that comes up with breakthrough, lifesaving drugs. It’s Big Pharma marketing them to us. For more: follow Pharmacists for Single Payer on Twitter @PharM4A. The documentary Big Pharma Market Failure (from the people who brought you Fixit: Healthcare at the Tipping Point) is a great introduction to how we got extreme drug prices and profit-driven pharmaceuticals. Follow & Support the Pod! You can listen to Medicare for All on Apple Podcasts, Google Podcasts, or visit our website here. Please donate to the Healthcare-NOW Education Fund to support the podcast!
44 minutes | May 22, 2021
Mailbag Episode: Listeners interview us
In our inaugural mailbag episode, Rose Roach – Executive Director of the Minnesota Nurses – joins us to answer your questions about how Medicare for All would save money and impact rural hospitals, how to answer to pushback on cost, talking to conservatives about Medicare for All, the political landscape, petitions as a base-building tool, and more! Show Notes Ben and Stephanie are joined by Rose Roach, the Executive Director of the Minnesota Nurses Association (MNA), and answer questions from listeners. First, we celebrate that Congresswoman Betty McCollum (D, MN-4), Rose’s own representative, signed on as a co-sponsor of HR 1976 after a conversation with MNA nurses during Nurses Week (and years of advocacy by healthcare activists in her district). On to the mailbag questions! Q: Jordan asked: How does insurance work for the Indian Health Service? A: The Indian Health Service (IHS) is independent but not well funded. Earlier versions of Medicare for All absorbed IHS into the system, which concerned advocates for tribal sovereignty. Under HR 1976, though, IHS will stay independent of the Medicare for All system, but will be treated as a provider, so will receive financing like any other provider. Q: Laurie asked: Why is it taking so long for Medicare for All? A: For one, our political system and elected officials are influenced by money. The for-profit health insurance industry has deep pockets and is willing to spend big to maintain the status quo. Until we have campaign finance reform, we will have to fight this fight against monied special interests. Another issue is that we haven’t quite achieved the working class solidarity that it will take to create the grassroots demand that will force elected officials to pass Medicare for All. Q: Heather asked: How would Medicare for All affect hospitals? How will they stay up and running, especially rural hospitals?A: Medicare for All would actually be transformative for hospitals, despite the misperception generated by the industry that it would hurt them. Medicare for All would fund hospitals equitably and fairly, based on their value to the community rather than their profitability. In a market-based system, hospitals that don’t generate profits, like small rural and safety net hospitals, can go under, regardless of the benefit they provide for the community. Under the Medicare for All system, hospitals will be funded based on the care needed by people in the community. Medicare for All is actually what could save rural healthcare from closures and consolidation. Q: Steve asked: How do we educate conservative rural communities at risk of losing their hospitals about the benefits of Medicare for All? A: We have to meet people where they are. Ask them how the system works for them now? Do you have to travel far for your routine care? For some it’s an ideological difference and we’ll never convince them, but there are conservatives who can be engaged about the care they and their community need. Q: Many asked: How would we pay for Medicare for All? A: The two Medicare for All bills don’t have financing language yet. The plan is to build the financing through the committee process. Several studies over the years have shown ways to pay for the program and generate savings, including the Political Economy Research Institute (PERI) Economic Analysis of Medicare for All. The PERI study found the whole system would cost about $3 trillion, which is less than we’re currently paying. We already pay for about two thirds of the healthcare in the US through tax dollars. The other third is currently coming out of people’s pockets in the form of employer and employee premiums, deductibles, and co-payments that generate insurance company profits. Under Medicare for all, those dollars would go to a public system that would guarantee your healthcare. Some proposals also include taxes on the extremely wealthy. Most individuals and employers would pay less under Medicare for All, and would have their healthcare guaranteed. Q: Phillip asked: Would Medicare for All be modeled after traditional Medicare? Or Medicare Advantage? A: Traditional Medicare! Medicare Advantage is the private option of our current Medicare system, part of the problem. Medicare Advantage covers healthier seniors who cost less to insure, skimming healthcare dollars out of the system for profit, leaving sicker seniors needing more care for the publicly-funded traditional Medicare system to cover. M4A would be modeled after traditional Medicare, but improved, with better coverage and more services (dental, vision, hearing, etc.) Q: Carol asked: Is extending Medicare benefits to include all necessary care and eliminating out of pocket costs doable under the Biden administration? A: It wouldn’t get us the cost savings of putting everyone in the program and eliminating the profit grabbing, but improving Medicare and making private insurers redundant is an important step toward the bigger goal of achieving M4A. Unfortunately this probably isn’t doable under the current Congress without a lot more organizing. However, a group of senators and representatives – including many who have never signed on to M4A – recently signed a letter to President Biden proposing expanded and improved Medicare, which gives us a new group of elected officials to start educating and lobbying! Q: Paul asks: Are you going to conduct a grassroots petition drive? A: Basebuilding is a constant process; we need more people to get involved in our movement in order to pressure elected officials. Petitions themselves have very little impact on legislators, but are a good way to build the base and engage with people who can become active in the movement. National Nurses United is currently doing on-the-ground organizing. Forums and town halls are going on all the time, often sponsored by elected officials and local single payer groups. Follow & Support the Pod! You can listen to Medicare for All on Apple Podcasts, Google Podcasts, or visit our website here. Please donate to the Healthcare-NOW Education Fund to support the podcast!
33 minutes | May 7, 2021
Biden’s 1st 100 Days on Healthcare
We discuss Biden’s American Families Plan proposal, which Biden unveiled in his first State of the Union address last week (spoiler: it’s rather underwhelming) and the industry lobbying that made it happen. Then we discuss the proposal to expand Medicare that came from Reps and Senators – both progressives and moderates – and what it may signify in the fight for Medicare for All. Show Notes Today we celebrate Stephanie’s first dose of vaccine and Biden’s first 100 days. (Spoiler alert: #underwhelming) While Ben and Stephanie liked the President’s non-healthcare progressive priorities like paid family and medical leave, subsidized childcare for low income families, and increasing taxes on the very wealthy, they’re disappointed in the healthcare vision Biden laid out. Ben and Stephanie first review the healthcare components of the American Rescue Plan, passed on March 10. This plan included $1,400 payments as well as 100% subsidy of COBRA (the very expensive program that allows employees who have lost their jobs to pay for their past employer’s health insurance plan) premiums. It also removed the income limit on ACA premium subsidies for anyone whose health insurance premium costs more than 8.5% of their income, and increases subsidies for low income households. All of these policies will sunset, or die off later this year or in a few years. During the State of the Union, President Biden also talked about proposals that aren’t actually in the American Families Plan: a public option, lowering the Medicare eligibility age to 60, extending subsidies to low income people in states without Medicaid expansion, and letting Medicare negotiate drug prices. The actual American Families Plan only has one healthcare proposal: the ACA subsidies from the Rescue Plan will be made permanent. This will affect about 9 million people, less than 3% of the population, at a time when 30 million have no insurance, and more than 60 million are seriously underinsured. While this expansion will help this small group, it sends more tax dollars to a private, profit-driven insurance industry. Not the big bold reform those of us who believe healthcare is a human right and a public good hoped for. Coincidentally, back in December America’s Health Insurance Plans (AHIP – the industry lobbying organization) and Blue Cross called on Congress to fully subsidize COBRA and expand subsidies for private ACA plans, as a response to the COVID-19 pandemic. Interesting that this is the exact proposal made by President Biden in the Rescue Plan and Families Plan. Hmm. Ben and Stephanie also discuss the alternative proposal sent to Biden by members of Congress (Seventeen Democratic Senators and 80 Democratic Representatives), calling for the American Families Plan to include an expansion of Medicare eligibility to age 60, cover hearing, dental, and vision, and introduce a cap on out of pocket expenses. Interestingly, the letter signers include a lot of centerist leadership, not just the typical Medicare for All supporters. This plan isn’t a clear win for us: we assume Medicare Advantage, the private insurance alternative to traditional Medicare, will continue to siphon taxpayer dollars into private coffers. Also, bringing in 60-65 year olds, we won’t get the cost savings we would get by bringing all Americans in. But bringing more people and some additional benefits into Medicare would help build confidence in public healthcare, potentially making it easier to build a case for Medicare for All. Ben does some coalition math on this alternative plan: the insurance industry would probably like this plan, because it would take the most expensive people (those 60-65 years of age) out of the private employment-based insurance pool, leaving younger and cheaper policy holders for insurance companies to profit off of. The opposition will come from hospitals and providers, because Medicare pays them less than private insurance does. On the other hand, to win Medicare for All, we want the support of doctors, and the opposition of the insurance industry. Our next episode will be a M4A mailbag: we’ll take question from listeners, so make sure you’re on the Healthcare-Now email list to submit your question! Follow & Support the Pod! You can listen to Medicare for All on Apple Podcasts, Google Podcasts, or visit our website here. Please donate to the Healthcare-NOW Education Fund to support the podcast!
29 minutes | Apr 23, 2021
The Koch Brothers: Behind New Strategy Against M4A?
We talk with Ben Palmquist from Partners for Dignity & Rights about a new anti-single payer bill in the Florida state legislature that would require a two-thirds supermajority to pass a single payer bill in the state. We segue into a larger conversation about the various opposition groups that have sprung up against Medicare for All and how the Florida bill is part of a trend of attacks on both healthcare and democracy. Show Notes Ben and Stephanie speak with guest Ben Palmquist, Program Director, Health Care and Economic Democracy, at Partners for Dignity and Rights (aka NESRI) to discuss the Koch Brothers' entry into the M4A debate at the state level. Healthcare advocates are watching an anti-M4A bill working its way through the Florida State Senate which, if passed by the legislature and voters, would require a two-thirds supermajority to pass a state single payer bill. If this bill passes in the Florida legislature, it would go on the next statewide election ballot and would require 60% of the vote to pass and amend the state constitution. It appears that Americans for Prosperity (the libertarian/conservative think tank funded by the Koch brothers) may be behind this bill, and are considering pushing it through other Republican-controlled legislatures if they're successful in Florida. A single payer bill has not actually been introduced in Florida, so this anti-M4A bill is in anticipation of the introduction of one, should the state continue to trend purple and swing to the left. Ben P sketches out broader right-wing policy campaigns, including attacks on voting rights and democracy. Healthcare industries are highly organized against M4A (and any legislation that changes the status quo). He notes that typically the insurance industry is in competition with hospitals and pharmaceutical companies because they bargain with each other over prices. But now we're seeing coalitions (Partnership for America's HealthCare Future, Realities of Single Payer, Affordable Coverage Coalition) bringing them together to attack any shift away from privatized insurance. Stephanie puts the Florida bill singling out M4A for a two-thirds majority into the context of a larger attack on democracy. Ben P notes it's part of a strategy that the right-wing has used for decades, dating back to the California tax revolt in the 1970s. In California, Proposition 13 is still state law, requiring any tax hike to be passed by a two-thirds majority, making it hard to raise revenue, decimating public education and other public services. Conservatives are now using this model for a systematic attack on voting rights and democracy: even if the citizens of Florida elect a majority of legislators who want to pass single payer, they will preemptively prohibit the will of the people from being enacted. They discuss the way conservatives have also dominated the framing of the healthcare debate in the media. Conservative groups of all stripes have found common cause in attacking government at all levels and sectors, most recently in a coordinated campaign to frame M4A as "government-run". On the other hand, rather than talking about the current system as "corporate-run," the conservative frame refers to it as "private," erasing corporate profiteers from the discussion about the system. Mainstream media has picked up this frame to discuss any attempts at healthcare reform. Stephanie notes the recent effort by liberal philanthropy and think tanks to focus on countries with universal coverage with private insurance. Media stories have held up countries like Singapore and Switzerland to justify the role of private insurance in a universal healthcare system. These stories downplay the fact that these countries have different regulations on private insurance than we have: in some, their hospitals are public, or the government sets prices, and workers have seats on boards that govern the economy.
32 minutes | Apr 11, 2021
New York: Majority Support in House and Senate for M4A
In January, the Campaign for New York Health made single payer history in the United States: the bill secured the support of a majority of co-sponsors in both chambers of the New York State legislature. Campaign organizers Ursula Rozum and YuLing Koh Hsu join us to discuss how NY got here and the very real chance to win Medicare for all at the state level! Show Notes The Campaign for New York Health recently achieved a huge majority of cosponsors of the New York Health Act in the State Assembly and a narrow majority in the State Senate, so this week Ben and Stephanie speak with co-directors YuLing Koh Hsu and Ursula Rozum about their work over the last several years leading to this milestone. They discuss the early days of the work, the broad coalition they’ve assembled, and the story-based organizing and lobbying that has been key to their success. In New York, the people who are impacted by the healthcare system the most are leading the movement, including patients, families, and small business owners who can’t afford healthcare coverage. Everyone is an expert on their own experience with the healthcare system, and New York’s story-driven strategy focuses on real people to build the grassroots demand that’s necessary to pass major legislation. Predictably, the insurance industry is actively opposed to the New York Health Act, relying on the usual arguments that the legislation will raise their taxes. It’s important to remember that they are making billions on the status quo, and their arguments all need to be viewed through the lens that they will say anything – true or false – to maintain their control over care and ability to make profits. Even with a majority in the Assembly and Senate, the last step of passing the New York Health Act is going to be the hardest. The next step for New York is to organize legislative co-sponsors to become vocal supporters of the bill. The new legislators elected in 2020 are bringing a bold, progressive approach to the work, and the campaign will focus on moving more legislators from being passive co-sponsors to active champions of the bill who will demand a vote from the Speaker of the Assembly and Leader of the Senate. YuLing discusses their campaign’s theory of change: to build a long term, mass movement that can not only pass legislation, including financing, but will also do the hard work to make sure the Act works for the people it was built for. Ursula stresses the importance of understanding that the American failure to pass a national health system has roots in systemic racism; white supremacist opposition to a desegregated health system killed early attempts to pass national healthcare, and compromises in the creation of Medicare and Medicaid allowed Southern states to discriminate against patients of color. Our current profit-driven healthcare system continues to reinforce racial hierarchies. The lesson today is that programs and policies intended to marginalize people of color end up hurting everyone, and a multi-racial, anti-racist healthcare movement is necessary to move the United States toward a just healthcare system. (For more, see Healthcare NOW’s video, “The Politics of Race and Medicare for All: https://www.youtube.com/watch?v=_eN0KhJ3BoI.) Ursula and YuLing urge other state healthcare movements to focus on the long-term fight, building leaders, and using stories as the foundation of the work. There are no shortcuts to organizing; building a base and a strong leadership has to happen before a bill can pass. Follow & Support the Pod! You can listen to Medicare for All on Apple Podcasts, Google Podcasts, or visit our website here. Please donate to the Healthcare-NOW Education Fund to support the podcast!
32 minutes | Mar 30, 2021
Record-Breaking Launch of the Medicare for All Act
Rep. Pramila Jayapal re-introduced the Medicare for All bill last week with a record 112 original cosponsors - up now to 114. We talk about surprise sign-ons, powerful stories from the cosponsoring Reps, the first national endorsement of a hospital CEO, and the epic organizing effort that got us to this stage! Show Notes Representative Pramila Jayapal introduced H.R.1976 on March 17th, with a record number of original co-sponsors on the bill: 112. That represents a majority of the Democratic members of the House. Ben and Stephanie discuss how far our movement has come in just a few years, evidenced by the largest ever co-sponsor list. Thanks to the hard work of advocates, we have gained two committee chairs as co-sponsors: Rep. Frank Pallone (D-NJ-6), the chair of Energy and Commerce, and Rep. Ted Deutch (D-FL-22), chair of the Ethics Committee. Other new sign-ons include Rep. Mike Quigley (D-IL-5), Del. Gregorio Sablan (non-voting member, D-North Mariana Islands), and Rep. Tony Cardenas (D-CA-29). A number of freshman members of Congress also signed on: Rep. Jamaal Bowman (D-NY-16), Rep. Mondaire Jones (D-NY-17), Rep. Ritchie Torres (D-NY-15), Rep. Cori Bush (D-MO-1), Rep. Teresa Leger Fernandez (D-NM-3), Rep. Nikema Williams (D-GA-5), Rep. Marie Newman (D-IL-3), and Rep. Sara Jacobs (D-CA-53). The bill launch event, held virtually, wasn’t business as usual. Some representatives spoke about their own experiences living without health insurance. A business owner from Pennsylvania spoke about how hard it was to run a business and administer health insurance for his employees. The bill received its first endorsement from a hospital system CEO, Dr. Eric Dixon of UMass Memorial Hospital System. Also, for the first time, a leader for racial justice, Patrice Cullors, co-founder of Black Lives Matter, addressed healthcare as a racial justice issue. Thanks to the work of constituents on the ground and allied organizations across the country, there has been extensive organizing in every district represented by those 112 co-sponsors. Follow & Support the Pod! You can listen to Medicare for All on Apple Podcasts, Google Podcasts, or visit our website here. Please donate to the Healthcare-NOW Education Fund to support the podcast!
32 minutes | Mar 23, 2021
The 2021 Medicare for All Bill
We’re joined by Stephanie Kang, Rep. Pramila Jayapal’s Health Policy Director, to discuss the upcoming 2021 Medicare for All bill, which will be shortly reintroduced in Congress. Kang also discusses changes made to the membership rules of the Progressive Caucus, and the most effective way to lobby your legislator during COVID! Show Notes We are excited to speak with Stephanie Kang, DrPH, MS, the Health Policy Director from the office of Representative Pramila Jayapal. Kang is one of the nation’s leading experts on Medicare for All and has been instrumental in Representative Jayapal’s work as chief author to reintroduce the Medicare for All Act. The upcoming Medicare for All Act is the most comprehensive healthcare program proposed in decades. With the principles of the late Representative John Conyers’s H.R.676 as a foundation, Representative Jayapal’s bill does away with the unfair, fragmented, and inefficient system we have now and makes sure that every American resident has guaranteed access to full healthcare, with all medically necessary services covered, while lowering costs by eliminating all the waste from a profit-driven, inefficient system. The current Medicare system has some major gaps. The upcoming Medicare for All Act would expand and improve coverage; eliminate out of pocket costs; and add dental, vision, reproductive care, and long-term care support for the elderly and disabled people. Medicare would be allowed to negotiate drug prices. Kang stated that the bill is “battle ready,” a comprehensive, 125 blueprint ready for implementation. While offering comprehensive benefits to every American resident, countless studies show that Medicare for All will actually cost less, by cutting administrative waste, profits to shareholders, and lobbying and marketing expenses; allowing negotiation of drug prices; and streamlining the inefficiencies of our current system. Nearly 90% of Democrats polled in April 2020 supported Medicare for All, but currently only about half of the Democratic members in the House support the bill. Kang discussed some of the objections she has heard from Democratic lawmakers who are reluctant to sign on to the bill, including the issues of choice and finance. Choice in our current system usually means having the choice to keep your employer-provided plan if you would prefer. While opponents often claim that Americans like their employer-provided coverage and would not want it to change, that argument seems to be losing steam as millions of Americans lose their jobs and insurance in the pandemic-related downturn. The choice that actually matters – choice of healthcare providers, clinics, and hospitals – is hampered by insurance companies’ narrow networks, a cost cutting measure that prevents countless Americans from getting the care they need from the provider they want. Medicare for All is the only system that has no networks and allows patients to choose their providers. With no out-of-pocket costs, Medicare for All also allows patients to choose to seek medical care when they need it, not when they can afford it. Kang also discussed what the transition to Medicare for All would look like. First, no American would go without coverage during the transition period. In the first year of the program, all Americans under 18 and over 55 would be transitioned into coverage under Medicare for All. In the second year, all other age groups would follow. In the meantime, there would be a public option available for the second group, in case private insurance companies decide to stop offering plans or collapse. Kang explained that because everyone would be eligible, the administrative setup of the new system will be much simpler than the current system, and should be able to be phased in quickly. The Medicare for All Act will be re-introduced this spring, and Rep. Jayapal is already collecting an impressive list of co-authors for the legislation.
34 minutes | Mar 4, 2021
The Road to a Floor Vote on Medicare for All
In the House, we have about half of the cosponsors we need to pass Medicare for All. Democrats who are not currently cosponsors (and constitute the other half we need to win) represent districts that are whiter and wealthier than the districts we’ve already won. What does this mean for our movement and how do we organize in this next phase?
54 minutes | Dec 30, 2020
Healthcare in the Netherlands: Public or Private?
Is the supposedly “private" Netherlands healthcare system a model for the US? And what would it take, politically and in terms of concrete policy, to transition to this system? Dr. Kieke Okma, an expert on healthcare systems around the world, joins us to discuss how exactly the Dutch healthcare system works (to start: its 80% publicly financed), the nature and extent of the privatization reforms made over the past 15 years, and the effect those reforms have had on the healthcare system. We discuss more broadly the role of government in any healthcare system and what the private sector can and can not deliver in the health insurance sphere. You can find a copy of her upcoming book, Health Reforms Across the World: The Experience of Twelve Small and Medium-Sized Nations with Changing Their Healthcare Systems, by clicking the title. Follow & Support the Pod! You can listen to Medicare for All on Apple Podcasts, Google Podcasts, or visit our website here. Please donate to the Healthcare-NOW Education Fund to support the podcast!
45 minutes | Dec 1, 2020
Racial Justice and Medicare for All
This week we chat with Dr. Bita Amani, an epidemiologist and Associate Professor for Charles R. Drew University of Medicine and Science and Lead Co-Chair of the COVID-19 Taskforce on Racism and Equity which is housed in the UCLA Center for the Study of Racism, Social Justice, and Health. We talk about how health played a role in the invention of race, and what structural racism in our healthcare system looks like right now. We also talk about health inequities and what Medicare for All will fix (and also what it won’t fix!) Show Notes We start with the basics: Dr. Amani is an epidemiologist. What IS epidemiology? It's the study of the distribution and patterns of disease - meaning: who gets sick, and what causes some groups to get sick while others don't? Specifically, she's a "social epidemiologist," which focuses on how major structures - like housing, the workplace, and HEALTH CARE - impact the distribution of disease. She is exactly the expert you'd want to ask about the COVID-19 epidemic, and it turns out that race and racism plays a major role in who gets sick and who doesn't. To understand how racism impacts health, it's important to understand that we're talking primarily about "structural racism" - such as the systems of mass incarceration and policing in the United States, systems where you'll be treated differently based on your race. This is different from defining racism as the things that bigoted, racist people say and do. Although there are plenty of bigots, and people with explicitly racist ideas out there, a system of structural racism doesn't need them to create different outcomes based on your race (in criminal justice, in housing, in healthcare, etc). As it turns out, medicine played a crucial role in creating the concept of "race" - which has no biological basis - and convincing the U.S. population that people belonged to different races characterized by fundamentally different bodies and mental facilities. This role of early medicine was particularly important for maintaining slavery, and formed the basis of white supremacy. So how has this legacy of our healthcare system supporting structural racism carried over into the present day? The geography has carried over for one, leaving communities of color in "medical deserts" - areas without enough access to care. This problem has been getting worse with the closing of hospitals that serve communities of color, which is even happening during the pandemic. Or look at health insurance coverage - which is linked to employment and the racial inequities in access to good jobs - where black people are twice as likely to be uninsured as white people. If we won Medicare for All in the United States - which would guarantee at least universal access to health insurance - what impact would that have on racial inequities in healthcare? It would obviously de-link your healthcare from your job, which would be a major victory for insulating healthcare from one major system of structural racism. A victory like this in healthcare coverage could also be a real tipping point for addressing broader systems of structural racism, if we don't have to worry about our healthcare. However, Medicare for All would not end - or even possibly make a big dent - in racial inequities in health outcomes. That's because our health outcomes (whether and how often we get sick, how long we live, etc) are impacted not just by our access to healthcare, but by housing, education, our access to social supports, etc. M4A wouldn't even necessarily end racial inequities at hospitals and physicians offices themselves, where we know that people of color are treated differently (worse). So Medicare for All can't be an end-goal for a movement for health equity, it has to be just a beginning. What about the intersection of COVID-19 and structural racism? Sadly, Dr. Amani knew right away that there would be vast inequities in how communities of color were impacted by the pa...
32 minutes | Oct 29, 2020
Should we support the individual mandate?
Public Citizen’s Eagan Kemp joins us as we dive into the history of the individual mandate (spoiler: it’s a conservative idea), why it disproportionately punishes low-income people, and how progressive taxation under a single payer plan would be much more equitable than our current flat premium system. We look back at how such a regressive idea came to be championed by Democrats, and then forward at the continuing legal challenges to the ACA that center around the controversial mandate. If the ACA survives this latest attack, will a Biden administration try to reinstate the tax? Show Notes Why are we talking about the "individual mandate" in healthcare? Two reason! 1) The mandate is at the center of a lawsuit challenging the Affordable Care Act, which many are worried may succeed after Amy Coney Barrett tilts the Supreme Court to the right; and 2) Republicans essentially eliminated the mandate back in 2017, and if Democrats retake Congress and the Presidency in 2021, this raises the question of whether Dems will - or should - reinstate the mandate. We start off by asking Eagan the hard questions: like what the hell is an individual mandate?? It is a requirement that you obtain health insurance, or you face a fine (usually when you do your taxes). At this moment in our country's political history, the individual mandate is generally supported by Democrats (as personal responsibility and a way to get healthy people to pay into the healthcare system) and opposed by Republicans (as an infringement on personal liberty and the right to choose whether you buy insurance or not). But it was not always so! The individual mandate was originally a conservative proposal - championed by the Heritage Foundation and offered by Senate Republicans as an alternative to Hillary Clinton's health reform plan, which was based on an employer mandate. How on earth did this conservative alternative to "Hillary Care" become a central plank of the Affordable Care Act (ACA)? First, as Eagan points out, the mandate is beloved by the health insurance industry - it's basically a law that compels people to buy their products, and it's great for profits. The insurers give a lot to both parties, so it's not a shock that both have championed the idea at different times. The shift from a Republican to a Democratic policy really began in the Massachusetts Health Reform law of 2006 - which became the model for the ACA - and included an individual mandate as a compromise between a Democratic state legislature and Republican Governor Mitt Romney. Ironically, in the election that followed, Hillary Clinton and John Edwards both supported the individual mandate during the 2007 Democratic Presidential primaries, while Barack Obama opposed a mandate. But it was included in the Affordable Care Act anyway - probably to placate the health insurance industry - at which point Republicans decided it was the devil's work. It's also important to understand that the individual mandate is a regressive way to pay for expanding health insurance coverage, when compared to creating a new tax and then expanding public insurance coverage. When you pay your Medicare payroll tax, for example, you pay 2.9% of your wages - which will be a high amount for really rich people, and a low number for someone being paid a minimum wage. The individual mandate requires everyone to pay a flat premium, regardless of whether you're a billionaire or just scraping by on a lower income. This is why studies find that Medicare for All would create huge savings for working class and middle class people. Beyond being a regressive way to pay for healthcare coverage, the mandate is also different from using taxes because what you pay - a health insurance premium - is decided by a private corporation, whereas the healthcare taxes like the Medicare payroll tax is set by Congress. This is why the Medicare payroll tax has barely been changed at all in 20+ years,
30 minutes | Oct 15, 2020
US Mail Not for Sale: The Fight for the USPS
This is how intertwined the Medicare for All and public mail movements are: if we had a national single payer system in place for the last decade, the USPS would be running a surplus. Steve DeMatteo of the American Postal Workers Union joins us to discuss the surprising connections between the postal service and our healthcare system, the political and financial obstacles that the USPS has faced under the Trump administration, and also how you can fight to protect this vital public service. Show Notes This week we welcome to the podcast Steve DeMatteo from the American Postal Workers Union (APWU)! The postal service has become crucial for our democracy during the COVID pandemic, as many voters shift to using mail ballots for safety concerns. TOTALLY COINCIDENTALLY, the Trump administration has also attempted to undermine and privatize the postal service in the run-up to the November elections. We invited Steve on to talk about the important and, for most people, surprising ways in which protecting our public postal service and establishing healthcare as a right are intertwined. The APWU and its President Mark Dimondstein are among the leading advocates for Medicare for All in the labor movement. Why? As Steve says, postal workers are in a similar position to many workers. Although the APWU has won fairly good health benefits for their members, the rapidly rising costs of healthcare are brought to the table by their employers (the postal service) every contract, and used as a counterweight for winning decent wages and other important benefits for postal workers. What is the scale of the United States Postal Service (USPS), and how is it different from private mail companies like UPS or FedEx? The postal service employs more than 600,000 workers across the country (second only to Amazon as a national employer!), at 30,000+ post offices around the country. The USPS is also the largest civilian employer of veterans in the country. It is the only service explicitly mentioned in the U.S. Constitution, and the USPS actually predates the Constitution - in 1775, Benjamin Franklin served as the first Postmaster General. In contrast to this history, in which the USPS has served as an integral part of American life since the country's founding, for-profit mailing companies like UPS or FedEx operate on a very different model. USPS service is universal, and does not charge discriminatory rates depending on whether you're rich or poor, or whether you live in an urban or rural area. For-profit mailing companies, like healthcare corporations, will not mail to unprofitable areas, and will charge every consumer as much as they can. In fact, about 25% of mail sent by UPS and FedEx are dropped off to a public post office for the final leg of your delivery - since for-profit mailing companies won't service the final address! (See this IPS study on how 70 million Americans are up-charged by UPS and FedEx because they don't live in a major city.) Now that we understand what the postal service is, how do we explain the fact that the USPS has struggled financially in recent years - even before coronavirus? Most people will never hear about it, but almost all of the USPS's losses stem from a 2006 law called the "Postal Accountability and Enhancement Act," which required the postal service to pre-fund retiree health benefits 75 years in advance (!!!). That means the USPS has to pay, right now, for the health benefits of future USPS retirees who haven't even been born yet. No other government agency, and certainly no private corporation, has to pre-fund their healthcare benefits three generations in advance, and it created an impossible financial situation. If you read or watch mainstream news on why the postal service has struggled financially, though, you will never hear about this 2006 law. The reason the press overlooks the reality of the postal service's struggles is due to a concerted effort to demonize the USPS...
28 minutes | Sep 23, 2020
Canada’s Single Payer Prevails Against Privatization Attempt
This week we host Dr. Monika Dutt, Board member of Canadian Doctors for Medicare and a public health and family physician in Nova Scotia. She fills us in on the historic legal challenge to the Medicare program that was just decided by the Supreme Court of British Columbia. The plaintiff, a for-profit surgery clinic, sought to allow patients to pay more for quicker treatment; it would have opened the door to a two-tiered health care system that would draw resources away from the public system and disproportionately affect the most vulnerable patients. Dr. Dutt talks about the ramifications of this victory for Canada’s single payer system and what’s next in the fight for a better Medicare. Show Notes Canadian Doctors for Medicare, which Dr. Dutt sits on the Board of, was founded about 10 years ago to defend Canada's single-payer healthcare system, and also to improve and expand upon it. It may be confusing for some in the United States, but "Medicare" in Canada refers to their entire universal healthcare system, whereas here in the U.S. "Medicare" is a healthcare program only for seniors age 65 and older. Although the entire system in Canada is referred to as "Medicare," in reality each province and territory runs their own single-payer health insurance plan. They all have to meet the requirements of the Canada Health Act, though, which outlines the core principles of Medicare, including universality. While you can buy private health insurance in Canada for services not covered by the public single-payer system (like dental care, some medications, and other specialty services depending on the province), private insurers are not allowed to compete with Medicare by covering the same care that Medicare already covers. This principle, and what happens when you allow a "two-tier" system of public insurance competing with private insurance, is exactly what was at stake in a major lawsuit that was just ruled on - Cambie Surgeries vs. British Columbia. This case started in 2016, when Cambie Surgeries sued British Columbia's single-payer system, trying to win the right to do three things: "Extra billing" (called "balance billing" in the United States), or allowing providers to charge their patients above and beyond the rates they receive from Medicare, which would open the door to preferential treatment for patients able to pay more;The ability to bill private insurers for basic healthcare that is covered by Canada's Medicare program, which would allow the creation of a two-tier system where people willing to pay more for private insurance could gain access to better and faster care; andAllow providers to be reimbursed by both private and public insurance. Providers in BC who participate in Medicare currently cannot accept private duplicative insurance or be paid out-of-pocket for any services covered by Medicare. BC physicians are free to not enroll in Medicare, in which case they can bill patients out-of-pocket, but they cannot also bill the public plan. If the lawsuit was successful, it would have allowed those who are healthier and wealthier to buy preferential treatment, and to get treated first - exactly as they are allowed to in the United States. However, just this past week British Columbia's Supreme Court ruled against Cambie Surgeries, relying on a mountain of evidence submitted by experts around the globe showing that allowing two-tier systems undermines care in the public system and... does not improve wait times. (More on this shortly!) Expert witnesses were brought in from Canada and other countries with single-payer healthcare systems. The Judge's final ruling, which considered all of that testimony, is 880 pages long (!!), but Canadian Doctors for Medicare has helpfully compiled a 40 page summary of the ruling. The Judge found that, if the court ruled in favor of the plaintiffs, it would make Canada's healthcare system more inequitable, and would likely increase waiting times instead of...
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