New York Daily News, Chris Sommerfeldt, September 14, 2023

Reps. Malliotakis, Torres introduce bipartisan bill blocking Mayor Adams’ Medicare Advantage switch for NYC retirees.

New York City retirees protest outside City Hall Friday, March 31, 2023 in Manhattan, New York in response to his signing a Medicare Advantage Plan contract for retired city employees.

A bipartisan legislative push is afoot on Capitol Hill to prohibit all U.S. employers from forcing their retired workers into Medicare Advantage coverage — a proposal that could spell trouble for Mayor Adams, who’s trying to mandate the privatized health insurance program for New York City’s 250,000 municipal retirees.

The anti-Advantage effort is expected to formally get underway Thursday, when Reps. Nicole Malliotakis and Ritchie Torres, both of whom represent parts of New York City, plan to co-introduce a bill that would amend U.S. social security law so that it’d become illegal for “public and private employers” to “involuntarily” shift Medicare-aged retirees into Advantage plans.

Under the legislation, a copy of which was exclusively shared with the Daily News ahead of its introduction, the only way an employer could legally force a senior into an Advantage plan is if it secures consent from the person to do so.

Malliotakis, a Republican who represents Staten Island and parts of southern Brooklyn, said the bill is directly aimed at blocking a long-running bid by Adams to switch the city’s municipal retirees into an Advantage plan on the auspice that it’d save the city money on health care costs.

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COMMON DREAMS, Jake Johnson, September 9, 2023

Largest Concentration of Health Insurance Loss in US History

States across the U.S. have stripped nearly 6 million people of Medicaid coverage over just the past several months, creating what one healthcare activist and researcher described as “the largest concentration of health insurance loss in American history.”

“This is happening in red states like Texas, Utah, or Idaho, where we expect this brutal Medicaid retrenchment,” Beatrice Adler-Bolton, co-author of ” Health Communism” and co-host of the popular “Death Panel” podcast, said in a statement on Friday.

“But there are huge amounts of procedural disenrollments happening in California. It’s happening in Rhode Island and California and New Mexico,” noted Adler-Bolton. “This is a year-long process, and it’s just getting started. It’s moving slowly, and it’s more dangerous this way. This process is rolling, so the data is slow. We’re not going to have a full picture of how to compare states against each other for months and months.”

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The latest data compiled by KFF—which includes publicly reported figures from 48 states and Washington, D.C.—shows that at least 5.7 million people have lost Medicaid coverage since April, when states began eligibility checks and disenrollments that were paused during the coronavirus pandemic.

A bipartisan deal reached by Congress and approved by President Joe Biden late last year lifted the pandemic-era continuous coverage requirements that prevented states from kicking people off Medicaid during the public health emergency. The policy led to record Medicaid enrollment, and its termination could cause upwards of 15 million people—including millions of children—to lose coverage under the program.

According to KFF, 73% of the people disenrolled from Medicaid so far have lost coverage for procedural reasons—such as a failure to return paperwork on time or jump through other, often confusing, bureaucratic hoops—not because they were deemed ineligible due to their income or other factors.

“High procedural disenrollment rates are concerning because many people who are disenrolled for these paperwork reasons may still be eligible for Medicaid coverage,” KFF explained earlier this week. “Some states, such as Maine, have temporarily paused procedural terminations for some enrollees while the states address problems in the renewal process that lead to increased procedural disenrollments.”

“Many of these individuals did not receive any notice of denial, leaving them unaware of their coverage termination.”

Texas has removed more people from Medicaid than any other state, disenrolling around 617,000 in just a few months.

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JACOBIN, LUKE MESSAC MAX JORDAN NGUEMENI, August 27, 2023

Hospitals portray unions as opposed to the interests of patients. The opposite is true: health care unions have been the strongest advocates for safer conditions and patients who can’t pay debts.

At the nation’s largest academic medical centers, resident physicians have rekindled a long-standing debate over health care worker unionization. According to the Committee of Interns and Residents, the number of unionization wins increased from one in 2020 to two in 2021 to five in 2022. This year alone, residents have voted in favor of unionization in landslide elections at Penn Medicine in Philadelphia (88 percent), Mass General Brigham in Boston (75 percent), Montefiore Medical Center in New York (82 percent), and George Washington University Hospital in Washington, DC (94 percent).

As unionization efforts have spread, they have renewed debate over the role of resident labor in hospitals, the rights of trainee-workers, the ethics of health care worker strike actions, and the financial priorities of C-suite executives in the modern hospital.

One of the major points of contention is what effect unionization will have on the most important people in any hospital: the patients. In this debate, supporters and detractors alike have tried to draw lessons from other health care worker unions. Opponents of unionization, on the other hand, accuse nursing unions of seeking to impose inflexible mandates that frustrates efforts to provide care in unavoidably fluid circumstances.

Advocates of unionization point to unsafe conditions when hospital executives pursue their priorities without effective worker input, as well as the very real threats of termination that hospital employees face when they speak out about these conditions without the protection of a union. Pro-union voices also cite econometric analyses that demonstrate a causal link between nursing unionization and improved patient outcomes.

There is, however, a longer history that we can draw from to understand how unions can advocate for patients. Hospitals have often painted themselves in this debate as the protectors of patient care against self-seeking workers, but when the decisions of hospital executives cause patients harm, unions have been a crucial countervailing force. The example of the Service Employees International Union (SEIU) at Yale New Haven Hospital (YNHH) provides such a case study.

In May 2001, the New Haven Advocate, an independent weekly magazine, published a story titled “Predator on the Hill” written by Paul Bass. The story detailed the hospital’s practice of foreclosing on the homes of patients, some of whom worked low-paying jobs at the hospital, over unpaid debts. When asked for comment, hospital executive Marna Borgstrom claimed the hospital only sued patients with the ability to pay and blamed debtors for their lax spending habits: “I’m always amazed at what people pay for discretionary items.”

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Washington Monthly, Thom Walsh, June 19, 2023

For decades, hospitals have insisted that they charge the privately insured more to offset losses from Medicare patients. A health care regulator blows the whistle on that myth.

Medicare’s hospital insurance trust fund is officially projected to be exhausted within five years. To close the gap, President Joe Biden has proposed a tax on families earning more than $400,000, while also calling for large cuts in how much the government reimburses Medicare Advantage plans. Meanwhile, Republicans, from Paul Ryan to Ron DeSantis, have a long history of efforts to defund the program. But what if both sides are missing the point? America does face a big-time health care financing crisis. But Medicare is not the reason.

Yes, Medicare faces a shortfall, but it’s modest. The cost of the main hospital insurance trust fund, which currently comes to just 1.6 percent of GDP, is expected to rise by only half a percentage point by 2045 before flattening out and even falling thereafter with the passing of the Baby Boom generation. By contrast, the continuing cost of the tax cuts implemented under George W. Bush and Donald Trump is more than seven times as large as a percent of GDP. Or to take another measure, according to the “intermediate” range projections by the system’s actuaries, gradually increasing payroll taxes by less than one percentage point before 2045 would keep the trust fund solvent indefinitely. 

But even if Medicare is basically fine, the outlook for private health care plans, which cover the majority of working-age Americans, is not. The biggest reason is that the prices these plans and their members pay to doctors and hospitals are out of control. According to researchers at RAND, the prices paid by private payers for hospital care are nearly two and a half times higher on average than the prices paid by Medicare for the same treatments in the same hospitals. And the gap keeps increasing. According to a 2020 study by the Congressional Budget Office (CBO), the cost per enrollee for hospital and physician services under traditional “fee-for-service” Medicare rose by just 0.2 percent more than the rate of general inflation from 2013 to 2018. By contrast, the per-person costs in private plans rose by nearly double the rate of general inflation. 

Because of those high and rising prices, the cost of health care consumed by a typical middle-class family of four with a typical employer-sponsored preferred provider organization (PPO) plan reached $30,260 in 2022, according to the Millman Medical Index. This cost is borne almost entirely by the families themselves because, as any economist will tell you, even when the employers nominally cover the premiums, they do so by paying less in wages and other benefits. It’s a burden on middle-class families that is rising far faster than their ability to pay, increasing by nearly $9,000 for the typical family of four between 2010 and 2018 and by another $5,000 in just the past two years. Commercial health insurance doesn’t have a trust fund, but if we accounted for it the same way we do for Medicare, it would show a huge, unsustainable long-term deficit. 

Why aren’t we talking about this? The biggest reason is the power of a myth, promoted by monopolistic hospitals, other health care providers, and private insurers, that continues to pervert the thinking of both Republicans and Democrats when it comes to health care finance. It’s time to unpack that myth and show how it obscures what’s really driving up health care prices. 

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July 27, 2023 F. Douglas Stephenson  INFORMED COMMENT

The most successful health insurance program, Medicare, was enacted in July,1965 to provide health insurance for people ages 65 and older and disabled regardless of income or medical history. Medicare is more efficient than private health insurance

The most successful U. S. health insurance program, Medicare, was enacted ln July,1965, to provide health insurance for people ages 65 and older and the disabled regardless of income or medical history. In the 58 years since, Medicare has become living proof that public, universal health insurance is superior to private insurance in every way. Medicare is more efficient than private health insurance and is administered at a cost of 3 percent to 4 percent, as opposed to private, for-profit health insurance, which has for-profit/administrative costs above 15 percent.

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

‘ MEDICARE FOR ALL’ STALLED FOR 58 YEARS

Following the successful 1965 grassroots campaign to enact Medicare, many believed that the dream of a full national health insurance system that included all age groups, “Medicare for All”, was right around the corner. Unfortunately five decades later, Medicare still has not been expanded. Most of the changes have been contractions with higher out-of-pocket costs for beneficiaries and repeated attempts at privatization by Big Pharma, Big health insurance industry companies/oligarchs and their champions in the White House and Congress.

Because the for- profit, private insurance industry so thoroughly dominates our national health insurance system, the basic concept and purpose of health insurance is defined by them. The U.S. subscribes to a private business model of health insurance that defines insurers as commercial entities. Private insurers maximize profits by mainly limiting benefits, maximizing health policy premiums or by not covering people with health problems. Like all businesses, their goal is to make money. Under the business model, the greed of casual inhumanity is built in and the common good of the citizens and nation is ignored; excluding the poor, the aged, the disabled and the mentally ill is sound business policy, since it maximizes profit .

WEALTH ADDICTION AT THE ROOT OF BIG HEALTH INSURANCE/BIG PHARMA PROFITEERING:

“Money is like salt water. The more you drink, the thirstier you get”. Roman proverbs say that the more money a rich man has, the more driven he is to accumulate more. Limitless greed for money the Greek dramatists said, becomes a disease of the psyche. In the 388 B.C. play, “Ploutos”, Aristophanes writes that a person may become over-saturated with food….but no one ever has enough wealth. Wealth addiction is a greedy compulsion to obtain more and more wealth, and specifically obtain what belongs to others. The effect is to injure others because it is adversarial/harmful to society as a whole. The related condition of “affluenza” reflects an inability of wealthy/oligarchs to understand the consequences of their behavior because of financial privilege.

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Gothamist, Jaclyn Jeffrey-Wilensky, July 15, 2023

New York City could soon have to perform more thorough lead paint inspections and report on landlords who try to contest their results.

On Thursday, the City Council passed a pair of bills intended to close gaps in the city’s existing lead poisoning prevention policy. Those measures now head to Mayor Eric Adams for his approval or veto.

Federal officials also announced this week that they’re proposing tighter standards for how much lead is considered hazardous in older buildings and child care facilities. The threshold for lead treatment would drop to anything above 0 micrograms of lead per square foot of space on high-touch surfaces like floors and window sills. The change could protect as many as half a million children per year nationwide, the Environmental Protection Agency said in a statement.

Experts and advocates praised the changes and called for more investment in the city’s health and housing departments to reflect their increased workloads.

“We’re applauding this,” said Lonnie Portis of the advocacy group WE ACT for Environmental Justice. “It’s an acknowledgement that there is no safe level of exposure to the dangerous toxin that is lead.”

Lead, a common ingredient in paint up until the late 1970s, is especially dangerous for children. Exposure can lead to irreversible brain damageand lifelong learning problems. Dust from deteriorating lead paint can collect on floors and window sills, where it can be easily ingested by crawling or curious children.

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(The Bullet) Erica Cirino, July 17, 2023

Clearly, micro- and nanoplastics are getting into us, with at least some escaping through our digestive tracts. We seem to be drinking, eating, and breathing it in.

The air is plasticized, and we are no better protected from it outdoors than indoors. Minuscule plastic fibers, fragments, foam, and films are shed from plastic stuff and are perpetually floating into and free-falling down on us from the atmosphere. Rain flushes micro- and nanoplastics out of the sky back to Earth. Plastic-filled snow is accumulating in urban areas like Bremen, Germany, and remote regions like the Arctic and Swiss Alps.

Wind and storms carry particles shed from plastic items and debris through the air for dozens, even hundreds, of miles before depositing them back on Earth. Dongguan, Paris, London, and other metropolises around the world are enveloped in air that is perpetually permeated by tiny plastic particles small enough to lodge themselves in human lungs.

Toxic Tires

Urban regions are especially full of what scientists believe is one of the most hazardous particulate pollution varieties: synthetic tire debris. As a result of the normal friction caused by brake pads and asphalt roads, and of weathering and wear, these tires shed plastic fragments, metals, and other toxic materials. Like the plastic used to manufacture consumer items and packaging, synthetic tires contain a manufacturer’s proprietary blend of poisons meant to improve a plastic product’s appearance and performance.

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Chelsea Community News, John Mudd, July 1, 2023

On Monday, January 9th, 2023, The New York City Council held a hearing to consider legislation amending the administrative code to preserve health care choice for retirees. But amending the code does nothing to preserve choice. The groans and rebuttals from city workers and retirees filling the main floor and balcony said as much (to view the hearing, click here).

My name is John Mudd. I’m with the Midtown South Community Council (MSCC). We’ve been serving the public for 38 years by taking issue with deplorable health, hunger, homelessness, and housing conditions. MSCC joins City workers and retirees in the fight to stop Administrative Code 12-126 from being amended. Doing otherwise will be a threat to their health.

Union leaders gave plenty of reasons for the need to cover rising hospital and drug costs—using words like “ensure,” “preserve,” and “protect” while accusing the retirees of lying; riling the crowd while twisting reality and defending their sinister intent.

Daniel Pollock, The First Deputy Commissioner at The City of New York Office of Labor Relations, was particularly worrisome, declaring, “This isn’t about whether the Advantage plan proceeds, we are planning on moving forward with that plan. We think this amendment is necessary to provide the choices for the retirees.”

UFT President Michael Mulgrew said it’s about a fight for health care costs. Henry Gorrido, Executive Director of District Council 37 (with 150,000 members and nearly 89,000 retirees) and other union representatives said the bill provides choice. An agreeable bunch, they assured us they’ve done everything in their power to work within a system to hold down costs. Gorrido asserted the cost is outpacing the budget, and with no “stabilization” funds available, we’re short $1.8 billion ($600 million annually) to cover the costs of health care. And “We’re going to do everything in our power to serve our members. We’ve got 75% of care given without the need for prior authorization.”

I believe they are earnest in their efforts, but not in prioritizing their retiree’s health. I wouldn’t want to be the 25% having to get an authorization during some medical emergency, and I don’t believe insurers should dictate how doctors should care for the public.

When questioning the union representatives as to why there was so much resistance to changing this code, they gave a host of answers, including: They weren’t allowed to explain the truth of it because former NYC Mayor Bill de Blasio wanted to push it through; Change is hard; Change has to be made; Nobody likes change—and my favorite: They were up against a “cottage industry” focused on how to stop the Medicare Advantage Plan.

NYC Council Member Lincoln Restler said the Union is “doing the best they can in an earnest heartfelt way and we have people who are truly fearful of what this means for their health care,” and what “We’re all struggling with is the inability to communicate to them, that it is not as devastating as they think it is. The crux of the challenge…how can we compromise and work toward a path to negotiate the interests” of the health care industry and force “the compromises necessary to move forward.”

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THE LEVER, Andrew Perez, Nick Byron Campbell, June 25, 2023

Now that Biden and Congress have ended pandemic protections, nearly a million have lost Medicaid coverage for procedural reasons so far — and many more will.

As states have begun clearing out their Medicaid rolls for the first time since the start of the COVID-19 pandemic, nearly three quarters of the Americans who’ve lost coverage have been terminated not because they’re ineligible for the low-income health insurance program, but due to administrative reasons, such as failing to quickly respond to a piece of mail.

In February, President Joe Biden bragged in his State of the Union speech that “more Americans have health insurance now than ever in history.” Biden made that comment six weeks after he set the stage to massively increase the United States’ uninsured population, when he signed legislation from Congress ending the pandemic-era requirement that states maintain Medicaid beneficiaries’ coverage in exchange for extra federal funding.

The measure, passed as part of a year-end spending bill, allowed states to begin mass disenrollments starting in April — a policy decision that is naturally a boon for government contractors that states pay to identify beneficiaries they could potentially remove from the program.

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Now that states have resumed annual Medicaid eligibility reviews, an estimated 17 million people, and potentially up to 24 million, could lose Medicaid coverage. According to early data from the Kaiser Family Foundation, more than 1.5 million Americans have already lost coverage, and 1.1 million have lost their health insurance for arbitrary reasons, not because they aren’t eligible.

The Biden Health and Human Services Department (HHS) estimated last year that roughly 45 percent of people who would lose Medicaid coverage once states could begin disenrollments would have their insurance canceled for procedural reasons despite being eligible for the program. The actual proportion of Americans being terminated for such procedural reasons appears to be far higher — 73 percent — according to the latest Kaiser data.

At a health insurance industry conference last week, one lobbyist admitted that the country is witnessing “distressing levels of administrative procedural disenrollments.” A top official from an organization representing state Medicaid directors downplayed those numbers, arguing that it’s too soon to jump to any conclusions.

“In terms of the data we’re starting to see, I think we need to proceed with caution,” Dianne Hasselman, deputy executive director of the National Association of Medicaid Directors, said at a health insurance industry conference last week. “It is very early. We can’t make huge assumptions about the data.”

Read More: THE LEVER

NY TIMES, Eyal Press, June 15, 2023

The corporatization of health care has changed the practice of medicine, causing many physicians to feel alienated from their work.

Some years ago, a psychiatrist named Wendy Dean read an article about a physician who died by suicide. Such deaths were distressingly common, she discovered. The suicide rate among doctors appeared to be even higher than the rate among active military members, a notion that startled Dean, who was then working as an administrator at a U.S. Army medical research center in Maryland. Dean started asking the physicians she knew how they felt about their jobs, and many of them confided that they were struggling. Some complained that they didn’t have enough time to talk to their patients because they were too busy filling out electronic medical records. Others bemoaned having to fight with insurers about whether a person with a serious illness would be preapproved for medication. The doctors Dean surveyed were deeply committed to the medical profession. But many of them were frustrated and unhappy, she sensed, not because they were burned out from working too hard but because the health care system made it so difficult to care for their patients.

In July 2018, Dean published an essay with Simon G. Talbot, a plastic and reconstructive surgeon, that argued that many physicians were suffering from a condition known as moral injury.Military psychiatrists use the term to describe an emotional wound sustained when, in the course of fulfilling their duties, soldiers witnessed or committed acts — raiding a home, killing a noncombatant — that transgressed their core values. Doctors on the front lines of America’s profit-driven health care system were also susceptible to such wounds, Dean and Talbot submitted, as the demands of administrators, hospital executives and insurers forced them to stray from the ethical principles that were supposed to govern their profession. The pull of these forces left many doctors anguished and distraught, caught between the Hippocratic oath and “the realities of making a profit from people at their sickest and most vulnerable.”

The article was published on Stat, a medical-news website with a modest readership. To Dean’s surprise, it quickly went viral. Doctors and nurses started reaching out to Dean to tell her how much the article spoke to them. “It went everywhere,” Dean told me when I visited her last March in Carlisle, Pa., where she now lives. By the time we met, the distress among medical professionals had reached alarming levels: One survey found that nearly one in five health care workers had quit their job since the start of the pandemic and that an additional 31 percent had considered leaving. Professional organizations like National Nurses United, the largest group of registered nurses in the country, had begun referring to “moral injury” and “moral distress” in pamphlets and news releases. Mona Masood, a psychiatrist who established a support line for doctors shortly after the pandemic began, recalls being struck by how clinicians reacted when she mentioned the term. “I remember all these physicians were like, Wow, that is what I was looking for,” she says. “This is it.”

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