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HJM AI-Assisted 2023 Review

2023 was another year of deteriorating US health insurance performance, especially as post-COVID protections lapsed, and continued modest gains toward single payer. For the annual summary, we set up a ChatGPT-based artificial intelligence bot on the HJM website to allow natural language interaction with HJM content – called HJM Ai-Chat. Check it out! Let us know what you like about it and any suggestions. Below are sample queries and responses. (The new HJM website is beta, we’re refining visual presentation and adding content … official launch in early 2024.)

January 1, 2024

How did the US health care system perform in 2023?

In 2023, the US healthcare system faced significant challenges and shortcomings, as highlighted by the provided information. Here’s a summary of its performance in 2023:

  • Financial Barriers to Care: A survey by the Commonwealth Fund revealed that US health insurance, across all types, posed widespread financial barriers to care, leaving a large percentage of insured working-age adults struggling to afford healthcare. This underscores the financial burdens and difficulties faced by individuals and families in accessing essential medical services, indicating a systemic issue within the healthcare system.
  • Privatization Challenges: The founders of Physicians for a National Health Program emphasized the growing hold of giant for-profit corporations on the healthcare system, including banks and for-profit ownership of health providers. This increasing involvement of for-profit entities has made it harder to address the systemic dysfunctions and challenges within the healthcare system, contributing to growing dissatisfaction among doctors and the public.
  • Dysfunctional System: The healthcare system continued to face significant dysfunctions, leading to massive medical bills, unaffordable lifesaving treatments, and growing dissatisfaction among healthcare professionals. This dysfunction has created a strong interest and constituency for fundamental health reform, reflecting the urgent need for comprehensive healthcare financing reform to address the systemic issues and dysfunctions within the US healthcare system.

These insights collectively indicate that the US healthcare system faced significant challenges and dysfunctions in 2023, highlighting the pressing need for comprehensive and equitable healthcare financing reform.


  1. healthjusticemonitor.org/2023/09/14/us-health-care-is-pretty-good-if-you-own-an-insurance-company/
  2. healthjusticemonitor.org/2023/10/27/survey-confirms-again-that-us-health-insurance-makes-us-sicker-poorer/
  3. healthjusticemonitor.org/2023/05/04/call-for-a-national-health-system/


What were the problems with job-based insurance in 2023?

In 2023, job-based insurance faced several significant problems, as highlighted by the provided information. Here’s a summary of the key issues with job-based insurance in 2023:

  • Biased Reporting: The Chamber of Commerce’s online poll claimed overwhelming worker support for job-based health benefits. However, the methods and reporting were biased, leading to a skewed representation of worker sentiments. This biased reporting obscured the true challenges and concerns faced by workers regarding job-based insurance.
  • Erosion of Benefits: The traditional appeal of employer-sponsored plans has diminished due to skyrocketing deductibles, which have obscured the lower wage effect. This erosion of benefits has undermined the attractiveness of job-based insurance as a reliable and comprehensive healthcare option for workers and their families.
  • Lack of Solidarity: Relying on decent job-based insurance has undermined the principle of solidarity, which is a fundamental value in ensuring healthcare for everyone. The Affordable Care Act (ACA) aimed to enhance solidarity while preserving employer-sponsored plans, but the rapid growth of high deductible plans and the failure to provide decent coverage for everyone have led to an erosion of solidarity in healthcare coverage.

These problems with job-based insurance in 2023 underscore the need for comprehensive healthcare financing reform to address the evolving challenges and ensure equitable access to high-quality healthcare for all individuals and families.


  1. healthjusticemonitor.org/2023/01/05/the-problems-with-job-based-insurance/
  2. healthjusticemonitor.org/2023/10/01/denied-medical-claims-most-likely-with-private-insurance-rarely-resolved/


What happened with Medicaid post-COVID disenrollment in 2023?

In 2023, the post-COVID disenrollment from Medicaid led to significant challenges and disruptions in healthcare coverage for many individuals. Here’s a summary of the key developments related to Medicaid disenrollment post-COVID in 2023:

  • Disenrollment Estimates: In 20 reporting states, it was estimated that approximately 13% of Medicaid enrollees would be disenrolled when the continuous enrollment requirement ended. However, the estimates varied widely across states, ranging from about 8% to over 30% of total enrollees. The primary reasons for disenrollment included an increase in income and incomplete renewals or missing documentation.
  • Impact on Coverage: The potential disenrollment of millions of people from Medicaid coverage following the end of the public health emergency (PHE) posed a significant risk of leaving many individuals uninsured. However, it was noted that many children would likely be eligible for CHIP, and adults would likely be eligible for Marketplace or other coverage. Successfully transitioning these individuals into alternative coverage options could help reduce the number of individuals who lose coverage altogether.

These developments underscore the complexities and potential consequences of the post-COVID disenrollment from Medicaid, emphasizing the need for ongoing efforts to ensure access to comprehensive and equitable healthcare coverage for all individuals.


  1. healthjusticemonitor.org/2023/07/26/round-up-pause-for-reflection-makeover/
  2. healthjusticemonitor.org/2022/03/17/medicaid-coverage-turmoil-as-covid-pandemic-eases/


What did new evidence from 2023 reveal about the prevalence and severity of medical debt in the US?

New evidence from 2023 revealed alarming insights into the prevalence and severity of medical debt in the US, shedding light on the significant financial burdens faced by individuals and families. Here’s a summary of the key findings:

  • The prevalence of medical debt: A multi-year survey of US adults found that medical debt affected 18% of households, indicating a substantial portion of the population grappling with healthcare-related financial challenges.
  • Risk factors for medical debt: The survey highlighted that individuals with no insurance, high deductible private insurance, or Medicare Advantage faced a higher risk of accumulating medical debt. This underscores the vulnerability of certain segments of the population to healthcare-related financial burdens.
  • Impact on social determinants of health: Medical debt was found to exacerbate social determinants of health, leading to increased food insecurity, the inability to pay for housing and utilities, and heightened risk of eviction or foreclosure. These consequences underscore the far-reaching impact of medical debt on overall well-being and stability.

The new evidence from 2023 underscores the urgent need for comprehensive healthcare financing reform to address the pervasive and detrimental effects of medical debt on individuals and families across the US.


  1. healthjusticemonitor.org/2023/10/31/history-of-us-medical-debt-collection/
  2. healthjusticemonitor.org/2022/06/17/medical-debt-in-the-us-pervasive-harmful-unnecessary/
  3. healthjusticemonitor.org/2022/09/19/medical-debt-prevalence-risk-factors-effects-on-social-determinants-of-health/


In 2023, what percentage of US families skipped or delayed medical care for financial reasons?

  • In 2023, the percentage of US families who skipped or delayed medical care due to financial reasons was alarmingly high. According to the provided information, the data from Gallup in January 2023 revealed that 38% of Americans reported postponing medical treatment in 2022 due to cost, marking a significant 12-point increase from the previous year. This trend indicates a growing financial barrier to accessing necessary healthcare services.
  • Furthermore, the data highlighted that insured adults also faced challenges, with 29-42% of them or their family members delaying or skipping needed healthcare or prescription drugs due to unaffordability over the past 12 months. This percentage varied across different types of insurance coverage, with the highest rates observed among those enrolled in Medicaid (39%) and individuals with Medicare (42%).
  • These findings underscore the widespread impact of financial barriers on healthcare access, affecting a significant portion of US families across different insurance categories. The high percentage of families experiencing cost-driven delays in obtaining care or missing care, coupled with the prevalence of medical debt, paints a concerning picture of the challenges individuals and families face in accessing essential medical services.

The data from 2023 emphasizes the urgent need for comprehensive healthcare financing reform to address the pervasive financial barriers that hinder access to healthcare for a substantial portion of the US population.


  1. healthjusticemonitor.org/2023/01/21/galluping-in-the-wrong-direction-higher-cost-barriers-lower-quality/
  2. healthjusticemonitor.org/2023/10/27/survey-confirms-again-that-us-health-insurance-makes-us-sicker-poorer/
  3. healthjusticemonitor.org/2022/09/29/the-dismal-state-of-us-health-insurance/


How are other wealthy countries doing with health insurance in 2023?

In 2023, other wealthy countries have continued to demonstrate more efficient and equitable approaches to health insurance compared to the United States. Here’s a summary of the key insights from the provided information:

  • Automatic Enrollment and Comprehensive Coverage: Dr. Danielle Ofri’s experience highlighted the inefficiencies of the US health insurance system, where an email glitch led to her automatic enrollment in a basic plan, excluding her family. This contrasts with the streamlined and comprehensive coverage provided in other wealthy nations, where individuals and families are not subjected to the bureaucratic hurdles and uncertainties associated with annual re-enrollment.
  • Lessons from Other Countries: An op-ed in the New York Times emphasized the importance of learning from other wealthy nations, underscoring that single payer is the only plausible path to achieving efficient and equitable healthcare financing in the US. This suggests that other countries have established successful models that prioritize accessibility and fairness in healthcare coverage.
  • Comparative Health Outcomes and Expenditure: The data from John Abramson’s publication highlighted the stark disparities in health outcomes and healthcare expenditure between the US and other comparable countries. Despite the US spending significantly more on healthcare per person, the health outcomes remain inferior, indicating the need for a reevaluation of the US healthcare system in comparison to those of other wealthy nations.

These insights collectively indicate that other wealthy countries have continued to prioritize efficient, comprehensive, and equitable health insurance systems, providing valuable lessons for addressing the shortcomings of the US healthcare system.


  1. healthjusticemonitor.org/2023/10/25/how-to-get-health-insurance-in-other-countries-be-born/
  2. healthjusticemonitor.org/2023/06/15/learning-from-other-countries/
  3. healthjusticemonitor.org/2023/05/30/de-sickening-america/


What were the major developments with single payer reform in 2023?

In 2023, there were significant developments and discussions surrounding single payer reform, reflecting the ongoing push for comprehensive healthcare financing reform. Here’s a summary of the major developments:

  • The issue of corporate takeover of primary care emerged as a significant challenge for single payer reform. The large-scale corporate appropriation of primary care was highlighted as enabling profiteering that dominates the US healthcare system, potentially jeopardizing the doctor-patient relationship and the viability of single payer financing. This underscores the need to address corporate dominance in healthcare to ensure the success of single payer reform.
  • Discussions emphasized the typical features of single payer systems, highlighting key elements necessary to achieve universal, equitable, efficient, and affordable access to care. These features include universal coverage, identical comprehensive benefits for everyone, standardized payment rates, minimal cost-sharing, centralized capital spending decisions, negotiated drug and medical equipment prices, and inclusion of long-term care as an essential need. These features underscore the fundamental principles and goals of single payer reform.
  • Legislative efforts led by Bernie Sanders in the Senate and Pramila Jayapal in the House were highlighted as providing the basis for comprehensive single payer reform. The focus was on the need for a system that brings health care justice to all individuals, emphasizing the importance of understanding the principles that underpin an ethically superior healthcare system and selecting politicians with the moral fortitude to enact such a system.

These developments in 2023 underscore the ongoing efforts to address the challenges and principles of single payer reform, reflecting the continued push for a more just and equitable healthcare system.


  1. healthjusticemonitor.org/2023/05/09/primary-care-corporate-takeover-a-challenge-for-single-payer/
  2. healthjusticemonitor.org/2022/06/04/what-is-single-payer/
  3. healthjusticemonitor.org/2023/11/27/saving-lives-in-the-middle-east-via-political-solution-the-us-via-health-reform/


What were key health reform developments in California in 2023?

In 2023, California saw several key health reform developments, reflecting the ongoing efforts to address healthcare access, equity, and financing. Here’s a summary of the significant developments:

  • The 2023 CHCF California Health Policy Survey revealed concerning findings related to healthcare costs and medical debt. Half of Californians reported skipping or delaying healthcare due to cost, with half of them experiencing worsened conditions as a result. Additionally, more than one-third of respondents reported having medical debt, with disparities in debt rates among different income and racial groups. These findings underscore the urgent need for comprehensive healthcare reform to address access limitations and financial burdens.
  • A proposed law in the California Senate aimed to advance the state’s single payer process by instructing state officials to engage with the federal government on approvals and coordination for a state single payer bill. This legislative effort highlighted the ongoing push for a government-run health system in California, reflecting the state’s commitment to exploring avenues for comprehensive healthcare financing reform.
  • California enacted SB 770, establishing a formal process to explore federal waivers necessary for state-level “unified financing,” such as a single-payer health care system, building on the findings of the Healthy California for All Commission. This legislation marked a potent mechanism to advance single payer, emphasizing the state’s commitment to pursuing unified financing and high-quality healthcare for all Californians.

These developments in 2023 underscore the ongoing efforts to address healthcare access, equity, and financing in California, reflecting the state’s commitment to comprehensive healthcare reform.


  1. healthjusticemonitor.org/2023/02/23/california-survey-on-health-care-access-debt-equity/
  2. healthjusticemonitor.org/2023/03/27/legislation-to-advance-california-single-payer-process/
  3. healthjusticemonitor.org/2023/11/11/california-seeks-federal-waivers-for-unified-health-care-financing/


Will single payer save money for families?

Yes, single payer healthcare has the potential to save money for families, as evidenced by comprehensive research and analysis. Here’s a summary of the key findings:

  • Research conducted by academic teams at Yale University and the University of California, San Francisco (UCSF) concluded that single payer healthcare, such as Medicare for All, will save money overall. These findings are based on rigorous, peer-reviewed scientific papers, which have undergone close examination by experts in the field for validity and reliability.
  • The evidence indicates that single payer healthcare will generate substantial savings by eliminating unnecessary paperwork and insurance company profits, reducing drug costs, and other cost-saving factors. These savings are projected to more than offset the cost of improving coverage and expanding it to everyone.
  • A specific example from California’s context revealed that nearly 9 out of 10 individuals who used a cost calculator for single payer found that they would save money. The average savings were reported to be more than $5000 per year, demonstrating the potential financial benefits for households.

These findings provide strong support for the assertion that single payer healthcare has the capacity to save money for families, offering a more cost-effective and equitable approach to healthcare financing.


  1. healthjusticemonitor.org/2023/01/29/single-payer-savings-for-households-calculator-results/
  2. healthjusticemonitor.org/2022/01/10/california-single-payer-lower-net-cost-to-families/
  3. healthjusticemonitor.org/2023/05/18/medicare-for-all-legislation-in-the-senate-house/


What are some amusing & informative videos about health care from 2023

In 2023, there were several amusing and informative videos about healthcare that effectively conveyed the complexities of the US healthcare system and the need for reform. Here are some noteworthy videos from 2023:

  • Dr. Glaucomflecken’s 30 Days of US Healthcare Series: This series of 2-minute videos covered a wide range of crucial topics, including job benefits, deductibles, co-insurance, surprise billing, pharmacy benefit managers, insurance kickbacks, hospital price transparency, and more. Dr. Glaucomflecken’s amusing skits, in which he plays all roles, provided a master class on concisely conveying the issues with US health insurance in a biting and entertaining manner.
  • John Stewart’s Insightful Video: John Stewart’s video effectively highlighted how the government-funded healthcare system benefits private for-profit corporations, particularly insurers, at the expense of the public. This video provided valuable insights into the dynamics of the US healthcare system and its impact on individuals and private corporations.

These videos offered engaging and informative content, distilling complex healthcare policy discussions into entertaining and insightful snippets. They effectively conveyed the fundamental issues plaguing the US health insurance system in an accessible and engaging manner.


  1. healthjusticemonitor.org/2023/09/25/health-reform-essentials-in-entertaining-2-minute-videos/
  2. healthjusticemonitor.org/2023/09/20/understanding-fighting-investor-ownership-of-health-care/
  3. healthjusticemonitor.org/2023/01/16/martin-luther-king-and-health-justice/


Are there arguments for single payer that might resonate with my politically conservative uncle?

It’s great to see the engagement and discussions around healthcare reform and the potential for single payer. Here are some compelling arguments for single payer that might resonate with politically conservative individuals, such as your uncle:

  • Efficiency and Cost Savings: Single payer healthcare systems have been shown to be more efficient in terms of administrative costs. For example, a study by the Political Economy Research Institute at the University of Massachusetts Amherst found that a single payer system could result in approximately $600 billion in annual savings on administrative costs. This aligns with conservative principles of fiscal responsibility and reducing government waste.
  • Market Competition and Freedom of Choice: Contrary to common misconceptions, a single payer system can actually enhance market competition by leveling the playing field for healthcare providers. It allows individuals the freedom to choose their healthcare providers without being restricted by narrow networks or in-network requirements, fostering a more competitive and consumer-driven healthcare market.
  • Simplicity and Streamlined Access: A single payer system simplifies the complex web of insurance plans and billing processes, providing streamlined access to healthcare services. This aligns with conservative values of reducing bureaucracy and promoting individual autonomy.
  • Protection from Financial Burdens: Single payer systems provide comprehensive coverage and protection from financial burdens, ensuring that individuals and families are not overwhelmed by medical expenses. This resonates with the conservative principle of personal responsibility and financial stability.

These arguments emphasize the potential benefits of single payer healthcare in terms of efficiency, market competition, simplicity, and financial protection, aligning with principles that may resonate with politically conservative individuals.


  1. healthjusticemonitor.org/2023/11/15/excessive-corporate-control-in-medicine/
  2. healthjusticemonitor.org/2023/11/11/california-seeks-federal-waivers-for-unified-health-care-financing/
  3. healthjusticemonitor.org/2021/09/16/crowdsource-ideas-on-government-role-in-single-payer/


About the Commentator, Jim Kahn

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Jim (James G.) Kahn, MD, MPH (editor) is an Emeritus Professor of Health Policy, Epidemiology, and Global Health at the University of California, San Francisco. His work focuses on the cost and effectiveness of prevention and treatment interventions in low and middle income countries, and on single payer economics in the U.S. He has studied, advocated, and educated on single payer since the 1994 campaign for Prop 186 in California, including two years as chair of Physicians for a National Health Program California.

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