Mirror, Mirror 2021: Reflecting Poorly
Health Care in the U.S. Compared to Other High-Income Countries
The Commonwealth Fund
August 4, 2021
By Eric C. Schneider et al.

Issue: No two countries are alike when it comes to organizing and delivering health care for their people, creating an opportunity to learn about alternative approaches.

Goal: To compare the performance of health care systems of 11 high-income countries.

Methods: Analysis of 71 performance measures across five domains — access to care, care process, administrative efficiency, equity, and health care outcomes — drawn from Commonwealth Fund international surveys conducted in each country and administrative data from the Organisation for Economic Co-operation and Development and the World Health Organization.

Key Findings: The top-performing countries overall are Norway, the Netherlands, and Australia. The United States ranks last overall, despite spending far more of its gross domestic product on health care. The U.S. ranks last on access to care, administrative efficiency, equity, and health care outcomes, but second on measures of care process.

Conclusion: Four features distinguish top performing countries from the United States: 1) they provide for universal coverage and remove cost barriers; 2) they invest in primary care systems to ensure that high-value services are equitably available in all communities to all people; 3) they reduce administrative burdens that divert time, efforts, and spending from health improvement efforts; and 4) they invest in social services, especially for children and working-age adults.

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Comment by: Isabel Ostrer

The Commonwealth Fund compared health systems in 11 high-income countries to identify what policies and practices are associated with better performance. The countries were Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

The overall health care system ranking is striking: the U.S. ranks last in every domain except care process. (This includes preventive care, e.g., rates of mammography and influenza vaccination.)

In access to care, which includes affordability and timeliness, we’re last because individuals here are most likely to experience insurance denials, high out of pocket costs, difficulty paying medical bills, and delays in seeing a provider.

To add insult to injury, health care spending in the U.S is uniquely high. In 2019, the U.S. spent 16.8% of its GDP on health care. The next highest spender, Germany, clocked in at 11.7% .

What do we get for all this spending? The U.S. is dead last in health care outcomes. We have the highest infant mortality rate, the highest rate of maternal mortality, and the highest rate of preventable mortality.

So what can we learn from our peer countries? For starters, they all have universal health coverage and no cost barriers. The U.S. has 30 million uninsured … and 40 million underinsured.

The evidence speaks loudly. Sinking more money into a multi-payer health care system serves only to inflate U.S. health care costs without improving access or outcomes. A truly patient-centered system is one that provides universal coverage and shields patients from unnecessary cost-sharing.

Executive Order on Promoting Competition in the American Economy
The White House
July 9, 2021

Stop Playing Health Care Antitrust Whack-A-Mole
Bill of Health
May 17, 2021
By Jaime S. King

The Sleeper Health Cost Policy
KFF
July 22, 2021
By Drew Altman

Comment by: Allison K. Hoffman and Hannah Leibson

In early July, the Biden Administration issued this high-level executive order focused on promoting competition in the American economy. The order urged the FTC and DOJ to significantly ramp up antitrust enforcement to prohibit future mergers and divest existing anti-competitive arrangements.

The order states in part, “whereas decades of industry consolidation have often led to excessive market concentration, this order reaffirms that the United States retains the authority to challenge transactions” in violation of the antitrust laws.

The problem is that it’s likely too little too late for health care.  For the past few decades, health care consolidation has been on the rise. 

Jaime S. King points out that the rate of consolidation has increased so dramatically that up to 95 percent of metropolitan areas have highly concentrated hospital markets. Private equity investment has driven much of this trend.

As Drew Altman explains, consolidation is negatively impacting quality of care and significantly driving up health care costs for consumers—as much as 50 percent in some hospital systems. When one or two large hospital systems are running the show in a city or region, insurers don’t have any leverage to negotiate lower prices. Consumers have no choice but to pay the higher prices or travel far distances to seek care.

Things like choices of insurance plans or transparency, both mentioned in the Biden Executive Order, will not solve these structural problems on their own. In the months ahead, the impact of COVID-19 will likely accelerate consolidation in many economically disadvantaged regions where hospitals are already deep in the red.

Amped up antitrust enforcement will only go so far in health care, especially considering thin government resources. It could prevent further consolidation. More aggressively, the administration could review merged entities and unravel those that have proven anticompetitive.

All of these measures could be beneficial, but ultimately, comprehensive price regulation is the only way to control the rising health care costs associated with provider consolidation. As Altman highlights, drugs comprise just 10% of health care spending while hospitals represent a whopping 34%. More and more, physician groups are also merging or are affiliating with hospitals and will benefit from their hefty negotiating power to command higher prices.

One option is a federal all-payer system to set price caps or limits on total hospital spending. It could eliminate the large gap between Medicare rates and those commercial insurers are forced to accept in highly consolidated hospital markets. Medicare for All is another means to set rates federally, in one fell swoop, and it would also eliminate the administrative costs associated with having many different payors.

Another option is rate setting at the state level, but this approach would be more difficult to enact and less coordinated. The state of Maryland already has such a model in place, and has seen positive outcomes since it was launched by CMS as a pilot program in 2014. From 2014 to 2019, Medicare spending in Maryland fell 2.8 percent and the state has seen a 4.1 percent decrease in total health care costs. Alongside these cost savings, quality benchmarks across several dimensions have surpassed expectations. This model could inform policy design at the federal level, just as Massachusetts’s reform informed the design of the Affordable Care Act.

Antitrust enforcement is but one piece of the puzzle of controlling health care price inflation, and, unless the FTC and DOJ aggressively unwind the consolidation of the past decades, it is only a very small piece.

Newsletter Opinion
The New York Times
August 3, 2021
By Paul Krugman

When you’re a wonk trying to be a pundit — or for that matter any kind of technocrat who wants to have real-world influence — it’s usually not helpful to push for policies that you believe would be right in principle but have no political chance of becoming reality.

The prime example for me has been health insurance. If our goal is to make sure that everyone has adequate, affordable health care, why not just pay for everyone’s care? On policy grounds, I’ve never disagreed with the proposition that we should have Medicare for all; there’s even a pretty good case for direct provision of medical care along the lines of Britain’s National Health Service. Why bother with a Rube Goldberg device like Obamacare, which uses regulations and subsidies to nudge private insurers into covering most people?

But the politics are impossible, and not just because of special interests: You’d have to persuade the 170 million Americans with private insurance to accept something completely different. Even though most of them would probably be better off, that’s too heavy a lift. So incremental reform, possibly evolving over time into single-payer, is how it’s going to have to be.

Virchow at 200 and Lown at 100 — Physicians as Activists
By Salvatore Mangione, M.D., and Mark L. Tykocinski, M.D.
New England Journal of Medicine
July 22, 2021

Current Surgeon General Vivek Murthy wrote in 2019 about the need for physicians to be guardians of integrity: “People will accuse us of being political, but if people accuse you of being political because you’re standing up for people who can’t stand up for themselves, then you should do it anyway, because that is at the heart of our profession.”

Comment by: Don McCanne

Anyone who has studied the subject realizes that a well-designed single payer system would provide equitable, high quality health care for everyone at a price that each of us could afford, paid for with progressive taxes. In principle, the concept is the moral imperative, but it does not mesh with the politics.

So what do we do? Like Paul Krugman, who represents the intellectuals who do understand, do we say that it is too heavy a lift? And then do we move on to insufficient and unsatisfactory tinkering? No, that is not right. The only right course is the one that accomplishes our goal of health care justice for all.

If the policy is right and the politics are wrong, you change the politics, not the policy. That would move us into the realm of politics, but, as Vivek Murthy said, since we’ll be standing up for people who can’t stand up for themselves, we should do it anyway. It’s simply the right thing to do.

Medicare and Dental Coverage
KFF
July 28, 2021
By Meredith Freed et al

Key Findings:

• Nearly half of Medicare beneficiaries (47%), or 24 million people, do not have dental coverage, as of 2019.
•  Almost half of all Medicare beneficiaries did not have a dental visit within the past year (47%), with higher rates among those who are Black (68%) or Hispanic (61%), have low incomes (73%), or who are in fair or poor health (63%), as of 2018.
• Average out-of-pocket spending on dental services among Medicare beneficiaries who had any dental service was $874 in 2018. One in five Medicare beneficiaries (20%) who used dental services spent more than $1,000 out-of-pocket on dental care.

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Comment by Isabel Ostrer

The Medicare website explicitly reads, “Medicare doesn’t cover most dental care, dental procedures, or supplies, like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices,” so it’s no wonder that a recent analysis by the Kaiser Family Foundation (KFF) found that 24 million Medicare beneficiaries lacked dental coverage in 2019. These disparities in access to dental care are even greater for non-white and low-income Medicare beneficiaries.

As Dr. Sanjeev Sriram said during a rally on July 30th marking the 56th anniversary of the Medicare program, “Your eyes, your ears, and your teeth are connected to your body… These things are not luxury items. Your teeth are not luxury items.” Why, then, in the richest country in the world, do we separate dental care from health care?

The simple answer boils down to an historical anomaly: dentistry has its roots in the barber profession – until the 1800s barbers routinely pulled painful teeth after they finished trimming a patron’s hair – and was consequently shunned by the medical profession. When the first medical schools were created dentistry was not recognized. Subsequently, when Medicare was enacted in 1965 dental services were not covered.

This history ignores that oral health is intimately tied to overall health and well-being. Dental pain is a leading reason for emergency department visits. Poor oral health is associated with numerous medical conditions, including cardiovascular disease and rheumatoid arthritis.

As Congress works towards passing a trillion dollar infrastructure bill that includes Medicare reform, adding vision, hearing, and dental benefits should be a top priority. But while we’re at it, we should push for sweeping health reform. Medicare for All would ensure that all Americans – not just seniors – have access to comprehensive benefits including dental coverage.

The Increasing Role of Physician Practices as Bill Collectors Destined for Failure
JAMA
July 30, 2021
By A. Jay Holmgren et al

Through increasing deductibles, coinsurance, and co-payments, the privately insured population in the US is responsible for a larger share of health care out-of-pocket costs. Although many studies have examined the effects on patients, the implications for physicians have received less attention. The increase in cost sharing is forcing many physicians and health systems to take on the role of bill collectors. It is a task for which physician practices are unsuited. The result is a system with substantial administrative burden, frustrated patients struggling with confusing bills, and physicians receiving less compensation.

Moving away from deductibles and toward fixed-dollar co-payments as a cost-sharing mechanism could simplify the billing experience for patients and the collection process for physicians while retaining the ability of payers to steer patients to lower-cost care with financial incentives.

Conclusion

The growth of cost sharing and HDHPs has resulted in patients’ taking on more of the cost of their own care and in physicians’ holding the risk and responsibility of collecting large dollar amounts. Physician offices are poorly suited to the task, exacerbating a complex and confusing system for patients and clinicians alike. New private firms have developed products to simplify, consolidate, and improve billing. However, these private-sector solutions may help ameliorate the problem but will not solve it. Only larger shifts in how out-of-pocket costs are envisioned will meaningfully address the burden of high out-of-pocket spending on both patients and physicians.

Comment by Don McCanne

This JAMA Viewpoint article explains the burden of out-of-pocket cost sharing on both the patient and the physician – financial barriers for the patient, and a costly administrative burden for the physician.

Cost sharing can interfere with the delivery of care. High cost sharing may cause individuals to forgo beneficial health care. Even modest cost sharing can cause individuals with limited resources to forgo essential care. Also cost sharing has been a significant contributor to the expansion of medical debt with its associated bankruptcies. Cost sharing is detrimental to the goal of health care justice for all.

The purported reason is that the financial disincentives of cost sharing steer patients to lower-cost care. But do patients really shop cost-sharing prices? And would any modest differences have a significant impact on the total cost of care?

If we are trying to control health care spending, wouldn’t it be much more effective and efficient to institute administered pricing with a public plan? We should be able to get pricing right when the public administrators take into consideration both the legitimate costs and fair compensation for physicians, and the interests of the potential patients subjected to progressive taxes.

The authors acknowledge that physician offices are “poorly suited” to the task of collecting cost sharing payments, but the solution is not more of the same by moving from deductibles to co-payments. The solution is to dispense with patient cost sharing and move to universal, first dollar coverage, which would also eliminate the scourge of medical debt and save lives.

Medical Debt in the US, 2009-2020.
JAMA
July 20, 2021
By Raymond Kluender et al.  

Data … were obtained from a nationally representative 10% panel of consumer credit reports between January 2009 and June 2020 (reflecting care provided prior to the COVID-19 pandemic). . . 

An estimated 17.8% of individuals had medical debt (13.0% accrued during the prior year), and the mean amount was $429 ($311 accrued during the prior year). The mean medical debt was highest in the South and lowest in the Northeast ($616 vs $167; difference, $448) and higher in poor than in rich zip codes ($677 vs $126). Between 2013 and 2020, states that expanded Medicaid in 2014 experienced a decline in the mean medical debt that was 34.0 percentage points greater (from $330 to $175) than the states that did not expand Medicaid (from $613 to $550).

Association of Wealth With Longevity in US Adults at Midlife.
JAMA Health Forum
July 23, 2021
By Eric D. Finegood et al.

Higher net worth was associated with lower mortality risk (hazard ratio, 0.95). Among siblings and twin pairs specifically, a similar within-family association was observed between higher net worth and lower mortality (HR, 0.94), suggesting that the sibling or twin with more wealth tended to live longer than their co-sibling or co-twin with less wealth.

Comment by David Himmelstein and Steffie Woolhandler

In a series of studies dating back 16 years (see: here, here and here), we and our colleagues found that illness and medical bills are a leading cause of bankruptcy.  Those findings, based on court records and surveys of debtors, have been derided by scholars funded by the health insurance industry (see our response to them here), and by leading health economists.  Those critics have claimed that debtors can’t accurately identify the causes of their financial ruin, and have turned instead to statistical analyses that rest on unwarranted assumptions about who incurs medical debts and when those debts begin to accrue.

Kluender et al document the extraordinary frequency and size of medical debts.  Even prior to the COVID-19 pandemic, more than one out of six Americans with a credit record had a medical bill in collection, with medical debts totaling about $140 billion – more than the total amount of all other debts in collection.  As the authors acknowledge, that figure surely understates the magnitude of medical debts, e.g. it excludes medical bills charged to credit cards.

Kluender et al find that states that implemented the ACA’s Medicaid expansion reduced medical debts relative to non-expansion states.  Yet even in expansion states Medical debts accounted for the majority of all debts in collection.

Finegood et al’s study suggests that debts have health as well as financial consequences.  Even among genetically identical twins, lower net worth (assets minus debts) is a predictor of earlier death.

When journalist TR Reid asked policy leaders in other developed nations about the frequency of medical bankruptcy in their country he was generally met by blank stares; medical bankruptcy was virtually unknown.  It’s high time that the US join the civilized world and abolish medical debt by implementing universal, first dollar health coverage.

Medicare Advantage: Beneficiary Disenrollments to Fee-for-Service in Last Year of Life Increase Medicare Spending
U.S. Government Accountability Office (GAO)
June 28, 2021

Medicare Advantage (MA) beneficiaries in the last year of life disenrolled to join Medicare fee-for-service (FFS) at more than twice the rate of all other MA beneficiaries, GAO’s analysis found. MA plans are prohibited from limiting coverage based on beneficiary health status, and disproportionate disenrollment by MA beneficiaries in the last year of life may indicate potential issues with their care. Stakeholders told GAO that, among other reasons, beneficiaries in the last year of life may disenroll because of potential limitations accessing specialized care under MA.

Beneficiaries in the last year of life who disenrolled from MA to join FFS increased Medicare costs as they moved from MA’s fixed payment arrangement to FFS, where payments are based on the amount and cost of services provided. GAO’s analysis shows that FFS payments for such beneficiaries who disenrolled in 2016 were $422 million higher than their estimated MA payments had they remained in MA, and were $490 million higher for those that disenrolled in 2017.

Prior GAO and other studies have shown that beneficiaries in poorer health are more likely to disenroll from MA to join FFS, which may indicate that they encountered issues with their care under MA. Beneficiaries in the last year of life are generally in poorer health and often require high-cost care.

Comment by Eagan Kemp

This report is a bombshell — even when delivered in GAO’s typically understated style. Having been a senior analyst at GAO for more than a decade before coming to Public Citizen, I can tell you that it takes an overwhelming amount of substantiated evidence to state things as strongly as they do in this report.

The implications couldn’t be more clear and the profit motive more transparent. Medicare Advantage plans — as they also do with other high-cost patients in poor health — are finding ways to avoid paying the high costs of end-of-life care. They often do this through limiting access to specialized care through narrow networks or other unscrupulous means.

These vulture Medicare Advantage companies will stop at nothing to keep their profits high — including forcing beneficiaries and their families to jump through numerous hoops to disenroll from predatory Medicare Advantage plans and enroll back into traditional Medicare at the worst possible time. And all so that traditional Medicare is left to pay the bills instead of Medicare Advantage plans. I am not sure how these people sleep at night.

It should be no surprise that insurers do everything in their power to evade the one thing they are supposed to do: pay for the care their enrollees need. It is exactly why insurers were insanely profitable during the COVID-19 pandemic — by NOT paying for care.

If it wasn’t already clear by now, these findings drive home the point that insurers add nothing but misery and administrative hurdles for patients while raising the overall cost of the health care in America through massive waste, fraud, and abuse.

It is time to end their ability to hurt patients and reap insane profits. It is time for Medicare for All.

Changes in Racial and Ethnic Disparities in Access to Care and Health Among US Adults at Age 65 Years
JAMA Internal Medicine
July 26, 2021
By Jacob Wallace et al.

Question:  Is Medicare eligibility associated with reductions in racial and ethnic disparities in access to care and health?

Findings:  In this cross-sectional study using a regression discontinuity design, eligibility for Medicare at age 65 years was associated with reductions in racial and ethnic disparities in insurance coverage, access to care, and self-reported health across the US.

Meaning:  Expanding eligibility for Medicare may be a viable means to reduce racial and ethnic disparities and advance health equity by closing gaps in insurance coverage.

JAMA Int Med Editorial
By Robert Steinbrook, MD

As we have observed before, it is a national disgrace that despite the trillions of dollars spent on health care, the US is alone among developed nations in not providing health care to all its citizens.

The study by Wallace et al provides additional evidence that providing health care for all may reduce disparities in health and improve access and equity in the health care system.


Comment by Don McCanne

Advocates of single payer Medicare for All certainly understand that such a program would provide health care coverage for everyone in a system that would make it affordable for each of us, simply by funding a universal risk pool with progressive taxes.

What has been a major concern for those of us supporting health care justice for all is that racial and ethnic disparities, with their inherent injustices, currently permeate our health care system. This very important study demonstrates that such disparities would be almost completely eliminated by adopting a universal program based on Medicare.

It is time to bring an end to the ridiculous discussions about there being many ways to expand health care coverage. It is time to enact and implement the program that we know would work well for all of us in America: single payer, improved Medicare for all.

Racial and Ethnic Disparities in Outpatient Visit Rates Across 29 Specialties.
JAMA Internal Medicine Online First
July 19, 2021
By Christopher Cai et al. 

[Using nationally representative data from the Medical Expenditure Panel Survey] We tabulated office and outpatient department visits to each physician specialty and calculated adjusted rate ratios (ARRs) for each racial/ethnic minority group (compared with the White population).

Black individuals had low visit rates (vs White individuals) to most specialties (23 of 29 [79.3%]. Among specialties with many visits, Black:White disparities were particularly marked for dermatology (ARR 0.27; 95% CI, 0.21-0.34), otolaryngology (0.38; 95% CI, 0.32-0.46), plastic surgery (0.41; 95% CI, 0.23-0.75), general surgery (0.55; 95% CI, 0.44-0.69), orthopedics (0.59; 95% CI, 0.51-0.69), urology (0.62; 95% CI, 0.50-0.78), and pulmonology (0.63; 95% CI, 0.48-0.81). Black individuals had higher visit rates to nephrologists (2.78; 95% CI, 1.37-5.62) and hematologists (1.65; 95% CI, 1.0-2.70) and similar visit rates to internists, geriatricians, and oncologists.

For Hispanic and Asian/Pacific Islander individuals, visit ratios (compared with White individuals) were … significantly lower for 20 of 29 (69.0%) and 21 of 27 specialties (74.1%), respectively. Similar patterns were present for Native American individuals, although the 95% CIs were wide.

The study findings demonstrate a consistent pattern of racial and ethnic disparities in outpatient care, implicating systemic defects that are best characterized as structural racism.

Figure (partial, to fit):

Comment by David Himmelstein and Steffie Woolhandler

This study (disclosure: we’re co-authors) provides yet more evidence of the pervasive effects of white supremacy in medical care.  Black, Hispanic, Asian and Native American people get far less care from virtually every medical and surgical specialty than non-Hispanic White individuals.

The inferior insurance coverage (and hence reimbursement to physicians) of Black, Hispanic and Native Americans probably drives much of the disparities for those groups, but people of color had somewhat lower visit rates even after controlling for insurance coverage.

Fixing these inequities in care will require erasing financial distinctions among patients by assuring that everyone’s insurance pays the same fees, and that co-payments and deductibles are banned.  Only a comprehensive single payer reform can achieve that.  But additional measures will also be needed: e.g. greatly increasing the ranks of minority physicians; offering grants to practices to locate in minority neighborhoods; and changing the racist culture that permeates many medical institutions.          

UnitedHealth Group Earnings: What They Suggest about Patient Access to Care
American Hospital Association
July 15, 2021
By Rick Pollack, AHA President and CEO

Today UnitedHealth Group announced a jaw-dropping $6 billion in earnings in a single quarter. But not enough has been said about a big contributor to these profits: not paying for health care services. During the same quarter last year the company noted its $9.2 billion in profit was due in part to “broad-based deferral of care.” What that means in real-life: profit was earned off missed childhood vaccinations, reduced access to opioid misuse treatment and avoided emergency care for cardiac arrest. But even this isn’t the full story.

Throughout the course of the pandemic, United pursued a number of changes to its policies to further restrict patients’ coverage. United didn’t just profit from avoided care, it actively sought to scale back what care it would pay for at the same time.

*  Specialty Pharmacy Services: In many parts of the country, United has been rolling out coverage restrictions that no longer permit patients to access specialty pharmacy therapies in a hospital outpatient department even if that is where their doctors practice.

*  Surgeries: United will no longer cover a large number of surgical procedures performed in hospital outpatient departments.

*  Lab and Radiology Services: United has announced plans to restrict coverage for many lab and radiology services provided by hospitals and outpatient departments.

*  Primary Care and Specialty Services:  United, the nation’s largest employer of physicians, says it will begin restricting coverage for most physician evaluation and management services provided in hospital outpatient departments, including provider-based clinics.

United routinely rolls out these coverage restrictions throughout the year, meaning that enrollees purchase their health plans under one set of rules only to later learn that their providers and cost-sharing responsibilities have changed.

Our top private health insurer is rolling in cash. And it’s reducing coverage
Los Angeles Times
July 20, 2021
By David Lazarus, Business Correspondent

UnitedHealth Group, parent of UnitedHealthcare, the country’s largest private health insurer, earned $15.4 billion in profit last year. It took in more than $9 billion in profit during the first half of this year.

So what does a well-heeled insurer do amid such a windfall? It seeks to reduce people’s coverage, of course.

…

The insurer won’t cover nonemergency treatment at non-network facilities outside a policyholder’s service area, which is defined as your state of residence and adjoining states.

This change mainly affects UnitedHealthcare members who want to travel to residential treatment facilities, rehabilitation clinics and other nonhospital healthcare providers.

Which is to say, if you’re a UnitedHealthcare member and you need rehab for any reason, you’d better stay in network and you’d better stick close to home. Otherwise, you’ll be footing the bill yourself.

…

Coverage networks might save insurers a few bucks, but they’re not in the best interest of patients, who should be free to seek the best possible care from the best-qualified doctor or hospital.

Nor, for that matter, should people’s coverage be tethered to their jobs. Lose your job, lose your health insurance — what the hell kind of system is that?

We know from the experience of other developed countries that [insurance risk management] is done most effectively by creating a single risk pool comprising the entire population, and then having a single government program handle all claims consistently, fairly and transparently.

Studies have shown that the taxes paid into such a single-payer system — Medicare for all, say — would be less than the premiums, copays and deductibles that now constitute most out-of-pocket medical expenses for Americans.

Comment by Don McCanne

UnitedHealth Group has demonstrated that it has mastered its ability to increase profits by not paying for health care services. They are serving their corporate shareholders at a cost to their customers, aka patients.

Contrast this private insurer function to what the role of a publicly financed and publicly administered insurer would be. Passive insurer shareholders and profits would play no role. The goal would be to pay for necessary health care services, not avoid them.

Even David Lazarus – the Business Correspondent for the LA Times – sees what UnitedHealth Group does and in response sings the praises of single payer.

Based on Rick Pollack’s comments, the American Hospital Association should be a valuable team member in our efforts to achieve health care justice for all.