Protests for Gun Safety … & Health Care Justice

Interview of former Gov. John Kasich (R, Ohio) after tragic school shooting in Nashville
MSNBC
March 28, 2023
Andrea Mitchell Reports

If Americans don’t protest gun violence, politicians will continue to ‘look the other way’

Gov. Kasich:

Until people go into the streets and protest, we’re not going to see changes. In my state, had I been able to get five thousand, ten thousand people on the lawns of the state house, politicians would have passed what we wanted. I couldn’t get them mobilized. I was reading this morning about the Montgomery bus boycott. You realize that took over one year for the Supreme Court ultimately to act to end discrimination on transportation. If you don’t have the people rising up, like they did with civil rights, like they did to end the Vietnam war, if you don’t have that, the politicians are going to keep passing the buck. They’re going to listen to one group of people, and, frankly, if in fact we can have the kind of massive outpourings that we have seen in this country consistent about saving our children at this point and so many other tragic accidents then you put the real pressure on the politicians to do things that we all know that we can do while still preserving the right of the second amendment. Things can be done that can provide a safer environment for all of us in this country and most particularly our children. Without the protest, Andrea, I think we’re going to keep doing… 19 incidents, 19 incidents in school shootings this year! This is sick! I heard the lady talking about all the people she visited, God bless her, she along with all of the other people who have experienced this tragedy personally has to figure out a way to mobilize all of us to stand up and say. “Enough!”

Now what I said about those women down in Montgomery, they just kept marching. They just kept doing everything they could, and that’s what it’s going to take here. If we don’t have people to begin to get into the streets and say, “Enough of this!”… the women who were so worried about all the children… the men who say this is my family… we all have to mobilize. Without it, the politicians are going to look the other way. And it’s not going to happen in a week or two. It has to be ongoing in order to get this changed. That’s my opinion on it because I sat there trying to get things done, and I was frustrated the whole time. I did what I could with executive orders, as the president has done, but there’s a limit to it. We have to get legislative action with common sense proposals that can really make a difference.

Comment by: Don McCanne

Now that guns have replaced auto accidents as the number one cause of deaths in children, isn’t it about time we really did something about it? We haven’t acted, with Democrats blaming Republicans for inaction and Republicans blaming Democrats for attacking their second amendment rights. But here we have one of the more prominent Republicans in the nation saying , “Enough!”

Mr. Kasich makes it clear that we cannot expect a responsible response to these tragedies from the politicians, as our nation’s political history has demonstrated. But he has much more faith in us, the people. All we have to do is to go into the streets, in mass, and protest. We need to march, and keep on marching. The politicians who are looking the other way will no longer be able to do so if we stay in their faces.

Our children….
    are being slaughtered by gun violence….
    and the politicians have failed us
To the streets everyone!

But wait….

We are spending more on health care than any other nation, yet we tolerate more suffering in children and others through mediocrity in health care and through the profound prevalence of poverty. While we’re demonstrating against violence in our children, shouldn’t we be simultaneously protesting this form of violence as well, violence that is quantitatively much greater and often just as tragic.

Yes. To the streets….  “No More Guns” at the top of our placards, but “Health Care Justice for All” below that.

Saturday! National Day of Action for Single Payer

Heal This Sick Country: ‘Hands Up’ for the National Day of Action for Single Payer
Common Dreams
Apr 27, 2025
By Judy Albert, Ed Grystar, Ana Malinow, Kay Tillow, Claire M. Cohen

Event details provided HERE
Scroll down a little to “Find an Action” or click here

Today, we call on people across the country to gather on May 31, 2025, to put their “Hands Up” for:

> The recognition by our government that healthcare is a human right;

> The elimination of private health insurance and the banning of for-profit delivery of care;

> The enactment of a publicly financed, national single-payer program that would provide comprehensive coverage to everyone; and

> The transformation of care delivery from profit-seeking ventures into services organized to serve the people of our country, a system in which all caregivers are freed from corporate control.

President Donald Trump’s inauguration has introduced the prospect of severe hardships to working class and low-income people, people with disabilities, the elderly, and children with proposed cuts to Medicaid, Medicare, and Social Security necessary to fund tax cuts for the wealthy. This moment demands more than the protection of our public programs; it demands a national, single-payer healthcare program, free from profit, for everyone. One people, one plan. 

The complicity of our government in the profit-making enterprise of health insurance has been exposed once again when, on Monday April 7, the Trump administration raised payment rates for Medicare Advantage insurers by 5.1%, significantly more than the Biden administration’s proposed increase of 2.2%, which was bad enough. This rate increase has the potential to increase payments to MA by $25 billion next year.

[see article for more examples of how our insurance approach increasingly places profits over health care]

Comment by: Jim Kahn

This imminent national event is exciting!

Popular demand is an essential element of achieving single payer – the desperately needed transformation of how we pay for health care. Single payer / Medicare for All places people over profits, annually saving hundreds of thousands of lives and tens of billions of dollars (as HJM has often reported). What decreases is hassle, administrative waste, and profits for payer intermediaries.

The path to single pay is, we have found over decades, very difficult. We must redouble our efforts.

Express your demands for health care justice on Saturday! Spread the word!

See links above to find out more.

Veterans Care Under Attack

VA Secretary Collins: Indifferent to Public’s and Congressional Opposition to His Gutting Veterans’ Care
The American Prospect
May 23, 2025
By Suzanne Gordon & Russell Lemle

When Doug Collins first appeared before the Senate Committee on Veterans’ Affairs (SVAC) for his confirmation hearing, his comforting bromides about his commitment to the VA and veterans lulled Democratic members, who, with only a few exceptions, voted to confirm Collins as President Trump’s new secretary of the Department of Veterans Affairs. As one Capitol Hill insider told the Prospect, many believed that, unlike Pete Hegseth or RFK Jr., Collins was “a man they could work with.” …

Fast-forward four and a half months to May 6th, when Collins appeared for the second time in front of the Senate Committee, and May 15th, when he made his first appearance before the HVAC. Assessing his first months on the job, Democrats now clearly viewed Collins as someone working not with, but against, them—and against the nation’s veterans. They expressed anger at his firing of 1,000 probationary employees, his cancelation of hundreds of contracts with vendors that supply VA with critical resources, and his termination of VA researchers, thus interrupting clinical trials that could benefit veterans. And, of course, there was Collins’s vow to lay off 83,000 VA employees. …

As one VA observer who chose to remain anonymous observed, “Some VISN staff reductions could occur without loss of functional capability if such were done in a systematic and thoughtful manner. In doing so, however, it would be important to work with the Congress on what programmatic, reporting, and other requirements they are going to insist upon going forward.”

As for all those supposed underperforming doctors and nurses Collins wants to reassign or fire, some are chiefs of medicine, chiefs of staff, chiefs of nursing, or nurse managers who provide the kind of clinical leadership without which no hospital or health system can function. These administrative positions also require the very clinical background that Collins seems to dismiss. …

At the end of the House hearing, ranking member Takano displayed a spreadsheet in which Collins’s team had calculated the cost savings that would result from a 15 percent reduction in every VA classification. The spreadsheet, Takano said, estimated that cutting 4,000 nurses would save $1 billion, while cutting 400 psychologists would save $110 million. Why, Takano asked the secretary, had Collins requested that his team conduct this kind of analysis given that he’d promised not to cut direct-care staff?

Instead of responding to the question, Collins began yelling at the ranking member …

On the afternoon after the Senate hearing, a group of 60 members of Common Defense, a progressive veterans’ organization that has launched a nationwide campaign called “VA: Not For Sale,” joined nurses and congressmembers on the steps of the U.S. Capitol to protest Collins’s plans. Common Defense’s executive director, Army veteran Jose Vasquez … told the Prospect that Common Defense is adamantly opposed to arbitrary mass layoffs at the VA. “VA shouldn’t be firing 8, or 80, or 8,000, much less 83,000 employees. The VA needs to hire, not fire.” More importantly, Vasquez added, “instead of attacking VA doctors and nurses who contribute to our care in all kinds of ways, VA leaders should be supporting the dedicated caregivers who themselves sacrifice to support veterans like me.”

Call To Action May 31, 2025: Demand Health Not Profit!
Search “Action Sites” on the webpage for a US map – will update all week as new sites are added!

We call on communities across the country to join in a National Day of Action on Saturday, May 31, 2025, to put National Single Payer Healthcare on the nation’s agenda.

Our health care system is broken beyond repair. Insurance companies and for-profit middlemen create barriers to care and massive administrative waste. These result in unnecessary suffering and deaths. For over 60 years, piecemeal reforms have resulted in higher costs and the worst health outcomes among comparable nations.

We demand the recognition by our government that health care is a human right.

We demand the elimination of private health insurance and the banning of for-profit delivery of care.

We demand the enactment of a publicly financed, national single payer program that would provide comprehensive coverage to everyone.

We demand that health care delivery be transformed from profit-seeking ventures into services organized to serve the people of our country, a system in which all caregivers are freed from corporate control.

The National Day of Action will bring people together locally and nationally from neighborhoods, unions, faith groups, businesses, and all types of civic organizations to join the demand to remove profit from health care. We must focus our collective anger towards corporate health insurers to bring real reform: put National Single Payer on the nation’s agenda!

 

Comment by: Jim Kahn

On Memorial Day, of course our attention turns to the health care of military veterans. Only to find, sadly, that this group – which voted 65% for Trump – is being mistreated by his administration. Unlike other nominees requiring Senate confirmation, Doug Collins seemed competent and committed to the VA role, to the welfare of veterans. But, as it turns out, he’s committed most of all to cutting budgets, regardless of consequences. And when questioned on this anti-veteran approach, he bristles. Thus we find that even this highly valued group of Americans suffers from being a lower priority than the billionaires whose tax cuts are the payment due for supporting the current president’s campaign.

Single payer – with everyone served by the same public system – is the way to assure adequate funding. Indeed, it is the path to combining efficiency with generosity, by eliminating administrative complexity and intermediary (insurer) profit-taking.

An exciting national day of action for single payer is just 5 days away! Join the event nearest you. Raise our voices — demand health care justice. Louder and louder every day!

GOP Medicaid Cuts: Multifaceted, Severe, Deadly, Machiavellian

Tracking the Medicaid Provisions in the 2025 Reconciliation Bill
Kaiser Family Foundation (KFF)
Updated: May 19, 2025

Requires states to impose cost sharing of up to $35 per service on expansion adults with incomes 100-138% FPL; maintains existing exemptions of certain services from cost sharing and limits cost sharing for prescription drugs to nominal amounts. Maintains the 5% of family income cap on out-of-pocket costs. Effective Date: October 1, 2028

Reduces the expansion match rate from 90% to 80% for states that use their own funds to provide or support health coverage … for individuals who are not lawfully residing in the US. Effective Date: October 1, 2027

Requires states to condition Medicaid eligibility for individuals ages 19-64 applying for coverage or enrolled through the ACA expansion group on working or participating in qualifying activities for at least 80 hours per month. Effective Date: January 1, 2029

Limits retroactive coverage to one month prior to application for coverage. Effective Date: October 1, 2026

Delays $8 billion annual reductions in subsidies for hospitals with high uninsured and Medicaid rates to September 30, 2028. 

Blocks implementation of long term care nurse staffing requirements.

Blocks Medicaid participation for large not-for-profits providing primarily reproductive health care, i.e., Planned Parenthood.

House Republicans’ Medicaid Cuts and Associated Lives Lost
Center for American Priorities
May 15, 2025

House Republicans’ radical new budget plan proposes requiring states to implement Medicaid work reporting requirements for adults enrolled through the Affordable Care Act’s (ACA) Medicaid expansion. Under this proposal, nonpregnant, nondisabled, noncaregiver adults ages 19 to 64 would be required to document at least 80 hours per month of work or qualifying activities (such as volunteering) in order to maintain their Medicaid coverage. Otherwise, they would need to seek approval for a qualifying exemption.

Evidence from prior state-level implementations show that bureaucratic paperwork requirements do not increase employment but do result in large-scale coverage losses—even among those who are working or should be exempt from the requirements.

The consequences of such coverage losses, however, are not just administrative: For thousands of Americans, they would be deadly. New estimates from the Center for American Progress show that 6.9 million people losing coverage by 2034 as a result of congressional Republicans’ proposed paperwork requirements would lead to more than 21,600 avoidable deaths nationally each year. [Provides table of avoidable deaths for selected Congressional districts.]

 

Comment by: Jim Kahn

Medicaid cuts in the House budget reconciliation bill just passed out of committee are a marvel of multidimensionality, severity, lethality, and politically adroitness. One by one:

Multifaceted: As inventoried by KFF, the changes are far-reaching in type, including enrollee cost-sharing, lower federal payments for states supporting undocumented immigrants, a work requirement, limited retroactivity, blocking minimum nursing staffing levels finalized under Biden, and proscribing participation by Planned Parenthood.

Severe: These are huge changes, with outsized increases in state costs; impaired affordability of care for enrollees with tenuous finances; millions of eligible individuals excluded from coverage by onerous (and ineffective) work requirements; dangerous nursing levels; and loss of a highly regarded provider organization. These shifts will massively impair access to care, with millions losing coverage and millions more facing new financial barriers. It will buffet state budgets, particularly in blue states that help the undocumented get coverage.

Deadly: As excerpted above, CAP estimates 21,600 added annual deaths, based on a 2017 study of Medicaid-associated reductions in mortality. Other research supports the substantial life-saving effects of Medicaid, including a comprehensive 2021 study using national surveys and datasets, and a just-published article in Lancet. There’s no question: cutting health insurance kills.

Machiavellian: The political chatter around these expected Medicaid cuts was that they would hurt the GOP in the 2026 midterms and 2028 presidential election. We underestimated the GOP political acumen / deviousness. Note that the most obviously hurtful provisions (e.g., cost-sharing and work requirements) go into effect only in late 2028 / early 2029 – thus minimizing pain to voters and electoral harm to the GOP in the interim. Guess who’ll be blamed by the voters for late 2028 and early 2029 Medicaid cuts? The Dems, if they win. Of course the Dems can cancel the cuts, but not in time to avoid significant political damage. And with GOP tax cuts (for the rich) and the Trump-tariffs-induced economic downturn, the federal budget won’t exactly be flush with funds to restore the program.

It’s truly astounding how complex Medicaid rules, funding, and politics have become. Take an apparently good idea – provide health insurance for the poor – and ultimately what you get is a major political distraction, with the immediate losers being the poor, and the long-term losers being the country. If only, if only … we could figure out a way to pay for health care simply, efficiently, generously … whereby we could remove our medical care from the dirty domain of party politics.

Health Insurance in South Korea

Query:
Please tell me about health insurance in South Korea. What financing approach is used for the primary coverage — e.g., all private insurers (and of those, a role for profit)? all public? a mix? Is separate supplemental insurance? What % of the population is uninsured? Does everyone have the same coverage (benefits + cost-sharing obligations)? How high are deductibles? How common is medical bankruptcy / debt? How common are access to care problems for financial reasons? What is annual health care spending per capita? (Feel free to compare to the US)

ChatGPT 4o:
South Korea’s healthcare system is primarily a publicly financed, single-payer model known as the National Health Insurance Service (NHIS). It offers universal coverage with a standardized benefits package, supplemented by private insurance options. Here’s an overview comparing key aspects with the U.S. system: 

1. Financing and Structure

• Primary Coverage: Administered by the NHIS, a government-run entity under the Ministry of Health and Welfare.
• Funding:
  • Payroll Contributions: Shared equally between employers and employees.
  • Government Subsidies: Support for low-income and self-employed.
  • Out-of-Pocket: Patients contribute through co-payments and services not covered by NHIS.
• Private Insurer Role: supplemental benefits and services.

2. Universal Coverage and Enrollment

• Coverage: ~97% of population enrolled in NHIS.
• Medical Aid Program: Covers the remaining 3% (low-income unable to pay in).

3. Benefits and Cost-Sharing

• Standardized Benefits: NHIS provides a uniform benefits package, ensuring equitable access to healthcare services.
• Deductibles: No deductible system akin to the US.
• Co-Payments:
  • Inpatient Care: Usually 20%.
  • Outpatient Care: 30-60%, depending on care level & facility type.
  • Exemptions: Low-income, age <6 and >65, cancer / rare diseases, disabled.

4. Supplemental Private Insurance

• Purpose: To cover services not included in NHIS, such as certain advanced diagnostics, private hospital rooms, and alternative treatments.
• Enrollment: Many individuals opt for PHI to reduce out-of-pocket expenses and access a broader range of services.

5. Financial Protection and Access

• Medical Bankruptcy: Rare due to the comprehensive coverage provided by NHIS and Medical Aid Program.
• Access Issues: While the system provides broad access, some individuals may experience financial strain due to services not covered by NHIS or high co-payments.

6. Health Expenditure

• $4,570 per capita (2022).
• US: $13,432 per capita (2023)

Comparative Snapshot

Aspect	South Korea	United States
Coverage Model	Public single-payer (NHIS)	Mixed: Private & public
Coverage Rate	~100% (NHIS + Medical Aid)	~91% (recent)
Standardized Benefits	Yes	No; varies by insurer and plan
Co-Payments	20-60% depending on service; many exemptions	Varies; often includes deductibles & co-pays
Medical Bankruptcy	Rare	Common; significant cause of personal bankruptcy
Longevity	83.6 years	76.4 years

 

Comment by: Jim Kahn

My wife and I are in Seoul, the capital of South Korea, on holiday. Our first three days have been wonderful, in this vibrant, easy-to-navigate, safe, and friendly city. We’ve had terrific conversations with quite a few people, despite our nearly non-existent Korean. Many locals manage well in English, and love to discuss their country and ours. They seem pleased to discover that we know a bit about Korean history and culture, gleaned from reading and Korean TV dramas. As far as we can tell, the culture combines diligence about work and family obligations with a sense of calm. We see consistent evidence of high trust, with valuable items (even a vendor’s cash box) left unguarded.

Of course, I’m no sociologist, and our impressions are preliminary and tentative. Still, we like what we’ve seen so far. Of note, South Korea has a thriving, free-market economy. And a thriving democracy –a popular uprising suppressed an attempted military coup by the president in December 2024.

So, naturally, I had to inquire about how health insurance works here. I know some people are skeptical about ChatGPT and other AI large language models. However, the latest versions are, based on my scrutiny, reliable sources of nuanced information. A carefully phrased query yields a highly edifying response.

As you see in the excerpt, South Korea relies on single payer. The result is high access, low costs, and impressive longevity. I can’t prove it, but I believe that universal public insurance also contributes to the high level of friendliness, calm, and trust that we’ve seen so far. Certainly, there are no significant downsides to providing universal insurance. When, oh when, will the US learn from the myriad exemplary insurance practices around the world?

Private Equity Endangers Patients

Private equity in health care puts patients’ lives in danger, studies show
U.S. RIGHT TO KNOW
April 28, 2025
By Pamela Ferdinand

Private equity firms claim their investments in U.S. health care modernize operations and improve efficiency, helping to rescue failing healthcare systems and support practitioners. But recent studies build on mounting evidence that suggest these for-profit deals lead to more patient deaths and complications, among other adverse health outcomes.

Recent studies show private equity (PE) ownership across a wide range of medical sectors leads to: 

Poorer medical outcomes, including increased deaths, higher rates of complications, more hospital-acquired infections, and higher readmission rates.

Staffing problems, with frequent turnover and cuts to nursing staff or experienced physicians that can lead to shorter clinical visits and longer wait times, misdiagnoses, unnecessary care, and treatment delays.

Less access to care and higher prices, including the withdrawal of health care providers from rural and low-income areas, and the closure of unprofitable but essential services such as labor and delivery, psychiatric care, and trauma units.

Dr, Stephanie Woolhandler, a distinguished professor of public health at Hunter College and co-founder of Physicians for a National Health Program, isn’t surprised by the findings. 

“Private equity’s track record in health care is so consistently bad that regulators should ban new private equity purchases in the health sector and impose stringent oversight on the health resources private equity already owns,” she says.

A landmark review in The BMJ analyzed 55 studies across eight countries, primarily in the U.S. It detailed how PE ownership in health care was most often associated with higher costs to patient or payers and “mixed to harmful” impacts on quality of care.

Now, new peer-reviewed research reinforces these findings and reveals a troubling pattern, especially in the absence of effective regulation and oversight: Patients treated at PE-owned facilities, whose numbers have skyrocketed, continue to experience worse or mixed outcomes – from higher mortality rates to lower satisfaction – compared to those treated elsewhere.

In fact, no study to date has found significant improvements to health care quality, efficiency, costs, or access as a result of private equity’s entrance into health care, according to a March 2024 report from Stanford Law Review.

“The drive for quick revenue generation threatens to increase costs, lower health care quality and contribute to physician burnout and moral distress,” they say.

Another study, published last year (July 2024) in JAMA, found hospital assets decreased by 24% in the two years after private equity purchases, leaving facilities less equipped to care for patients. The loss of land, buildings, major hospital equipment, and information technology – equivalent to $28 million in total assets per hospital – means fewer resources for effective patient care, experts say. 

“It’s a very striking finding and should change the way people think about private equity in hospitals. The PE firms say, ‘We bring new capital into hospitals.’ It turns out that’s not quite true,” Woolhandler, a co-author of the study, told NBC News. “There are real dangers to the health care that people get if you deplete all of the capital from a hospital.”

 

Comment by: Don McCanne

To achieve affordable, high quality health care for everyone, the need for single payer has been recognized for decades. Our failure to act has resulted in an intolerable expansion of wasteful expenses without solving the problems of impaired access and individual financial hardship.

In recent years, the menace of private equity has crept into our health care system, greatly compounding its high costs and dysfunction. The “U.S. RIGHT TO KNOW” article convincingly demonstrates this.

Three years ago we wrote an article in The Nation explaining that mere enactment and implementation of a single payer Medicare for All program would no longer be satisfactory because entrepreneurial interests had gained too much control through provider ownership: insurance reform would no longer be enough to ensure that everyone would have access to affordable, comprehensive, high quality health care. We still need single payer, but we must also address ownership of the health care delivery system. We must agree that the system belongs to all of us — community-ownership of hospitals, clinics, and other health care resources.

What have we accomplished in the last three years? Incremental changes have had a negligible impact, allowing the status of our health care system to deteriorate even more. If we continue with our inertia, things can only get worse since private equity is a one-way street in the wrong direction.

You saw the images of the Medicare for All signs at the huge Sanders-AOC rallies. It’s time! Citizen action now!

Medicare for All Act Reintroduced in Congress

Progressive Democrats Join Sen. Bernie Sanders’s Reintroduction of Medicare for All Act
Democracy Now!
Headline
Apr 30, 2025

Democratic Congress members Pramila Jayapal and Debbie Dingell joined Vermont independent Senator Bernie Sanders on Tuesday in reintroducing the Medicare for All Act, which would provide universal single-payer healthcare based on patient needs, not industry profits. 

Sen. Bernie Sanders: “Our legislation would provide comprehensive care to all Americans — rich, poor, young or old — with zero out-of-pocket expense. It would provide full freedom of choice regarding healthcare providers: You go to the doctor or the nurse that you want to. No more insurance premiums, no more deductibles, no more copayments, no more filling out endless forms!”

Sanders, Jayapal, And Dingell Press Conference About Reintroducing Medicare For All
Forbes Breaking News
Video (47 min)
April 29, 2025

 

Comment by: Jim Kahn

Amidst the current oligarchic turn of national politics, with cynical performative gestures toward efficiency obscuring the billionaire pursuit of government largesse, it is critical to reassert our quest for Medicare for All — the powerfully synergistic combination of efficiency and generosity designed to help everyone.

M4A, aka single payer, is the magical yet real and practical strategy that would trim away hundreds of billions of dollars in profits and administrative burden, facilitating directing our massive spending on health care to … health care! (instead of executives and shareholders). Families will save money, and hundreds of thousands of deaths will be averted.

Many thanks to our progressive Congressional leaders, for again promoting this admirable vision in legislative form.

To learn more, and to urge your elected officials to co-sponsor the bills, consult the PNHP website.

And stay the course. We will, eventually, guide US policy to the commonsense solution used around the world: simple and comprehensive health insurance for everyone.

US Mortality High & Strongly Linked to Wealth

Association between Wealth and Mortality in the United States and Europe
New England Journal of Medicine
April 2, 2025
By Sara Machado et al

In the United States, there has been a massive transfer of wealth from the middle class to the wealthy in the past 60 years, which has increased wealth inequality. Other high-income countries have seen concurrent growth in wealth inequality, but these have been less pronounced than in the United States. Life expectancy in the United States is also lower than in other high-income countries, and it is decreasing. These are of key concern, particularly because increases in mortality are most pronounced among the poorest people.

[Interpretation: Survival over time among adults 50-85 years old is lower in the US than in Northern / Western Europe, with more spread by wealth level.]

From the Discussion

We found that wealth was associated with mortality across the United States and Europe and that the difference in mortality between the top and bottom quartiles of wealth appeared to be larger in the United States than in Europe. Mortality in the United States was higher than in Europe, even at higher wealth levels.

Comment by: Don McCanne & Jim Kahn

We have reported often that the US can greatly increase the access and affordability of health care by enacting and implementing a well-designed, single payer, improved version of Medicare that is provided to all.

However, as this study indicates, our health is also broadly linked with economic disparities. The well recognized problem of wealth inequality in the US is associated with reduced life expectancy, especially afflicting lower-wealth individuals, far more than in European nations. At the same time, when compared to those nations – with comprehensive universal health care systems – all US wealth levels have higher mortality, even at the top tier. So the wealthy should understand that they will gain life expectancy if the system is fixed overall. Single payer is not about trade-offs, it’s about improvements for everyone.

What does this tell us? Clearly, as we have said for decades, our nation’s overall health would improve with an improved system of Medicare for All. But it also demonstrates that we need a more equitable distribution of wealth which would be more likely if we also had an equitable system of income distribution. The study showed that life expectancy was related to wealth. However, it is very difficult to see how wealth could be made more equitable without ensuring adequate income for everyone. We also really need a progressive wealth tax if we are going to correct the profound inequities created by today’s preoccupation with the accumulation of mega-wealth.

This is not the same as calling for equal income and wealth. Instead, it is a plea for fairness and justice in income and wealth distribution instead of the creation of centi-billionaires made possible by denying middle- and lower-income workers their fair share of society’s productivity. This, of course, requires effective government oversight, unlike the inhumane, slash-and-burn administration we have today.

What can we do? In just 100 days, extensive damage has been initiated to our socioeconomic and legal systems, and much more is threatened. So reversing the current politics and policy is an emergency. Once we have control of the situation, we can move forward with changes that will let us function like our European friends, perhaps even better. Solving our major challenges would enhance our nation’s well-being and return us to a place of leadership and admiration in the world. Our progress will increase global well-being! But it’s up to the people to act.

Stand-Up for Simple Health Insurance

“Oh my God, like what is going on with the healthcare system?”
Or on YouTube
Video, 1.5 minutes
April 15, 2025
By Darlene Bereznicki

 

 

Comment by: Jim Kahn

Ms. Bereznicki starts her riff with “When the Luigi Mangione thing went down, my Canadian friends asked … OMG what is going on with the healthcare system?” That’s the question we’re all asking ourselves, all the time. Leave it to a professional comedian to answer to that question so well and amusingly, in just a minute and a half. Maybe she should delivery my health policy talks!

Deductibles, copays, out of pocket maximums, etc – she quickly covers the gamut. This routine even alerted me to the fundamental difference between HSAs (health savings accounts, which roll over tax-free to retirement*) and FSAs (flexible spending accounts, use them or lose them).

Note the massive attention to the Instagram video in just five days, and all the supportive comments. (The YouTube video was just uploaded by Ms. Bereznicki, as a favor to HJM readers.)

Why did this resonate so widely? Because we’re all fed up with a laughably convoluted and inefficient – plus unfair and harmful – set of clunky mechanisms to pay for health care. Ms. Bereznicki and her Canadian friends would agree I’m sure: the US needs a single public payer, with minimal or no cost sharing.

____

* HSAs are a major gift to the healthy and wealthy, and undercut insurance markets …

MA Insurers Reap $60 Billion from Premium Boost & Inflated Diagnoses

Trump’s CMS dramatically raises payments to Medicare Advantage plans
Healthcare Dive
April 8, 2025
By Rebecca Pifer

     > The Trump administration handed Medicare Advantage plans a massive gift on Monday, finalizing payment rates for 2026 significantly higher than what regulators in the Biden administration sketched out. 

     > The 5.1% benchmark increase should accelerate margin recovery for the privatized Medicare plans … Insurer stocks soared [up to 16%] after the payment notice was announced.

The 5.1% rate increase for MA plans is the largest rate increase in the past decade, and is up significantly from the 2.2% increase proposed by the Biden administration in January.

Overall, it should result in more than $25 billion in additional payments going to MA plans next year, according to the CMS.

However, the real sum will be higher, given the CMS’ estimate doesn’t include the impact of plans’ coding practices. The expected change in revenue for MA plans jumps from 5.1% to 7.2% including the impact of risk scoring.

“This reads very positive” for insurers, Mayo said.

“Overall, we view the [2026] Final notice as a best-case scenario,” Ryan Langston, analyst with TD Cowen, wrote in a Monday note.

 

Insurer-Level Estimates of Revenue from Differential Coding in Medicare Advantage
Annals of Internal Medicine
April 2025
By Richard Kronick et al.

Background: Medicare Advantage (MA) plans report diagnoses more intensely than providers in traditional Medicare (TM), and there is wide variation in coding intensity across MA plans.

Participants: 697 MA contracts offered by 193 insurers.

Results: In 2021, the average risk score was 1.26 in MA vs 1.07 in TM. … The risk score at UnitedHealth Group was 0.28 higher than it would have been if its plans had coded identically to TM. … Kaiser Permanente coded only slightly more intensely than TM. Due to differential coding, MA plans received an estimated $33 billion in additional payment in 2021, 42% of which went to UnitedHealth.

 

Comment by: Jim Kahn & Don McCanne

We linked these two stories because they reveal a common theme: regulatory capture to add profits and shareholder value for the private insurers that operate Medicare Advantage. The big premium hike reflects MA lobbying power, especially in a GOP administration; the diagnostic upcoding suggests confidence that CMS will never clamp down on this misbehavior (recent efforts were beaten back, see here and here),

The overpayments are huge. The $60 B total annual cost of generous premium-setting plus over-diagnosis is 6-30 times higher than all DOGE cuts, according to estimates of true DOGE efficiencies from the American Enterprise Institute ($10 billion) and the Financial Times ($2 billion). Thus, while the Trump administration pretends to find efficiencies, it overpays insurers many times more. They don’t really care about efficiency, they care about enriching wealthy companies and individuals. (Of course, looming Medicaid cuts may reach $90 billion per year … but that’s not an “efficiency” instead a reduction in medical access and care.)

What is alarming for the future is that the Trump administration appears to be injecting new life into Medicare Advantage private insurers as a prelude to fully displacing traditional Medicare. Privatizing Medicare would have the adverse consequences of handing even more tax funds to private insurers, while increasing care costs for patients. We would lose choice of providers, forced into narrow networks and declining access to specialized services for complex medical conditions, as is frequent in MA. The model favored by current CMS leadership (Mehmet Oz) will encourage private insurers to tailor their plans for a competitive marketplace by adding benefits of limited value such as current dental, vision, and hearing care – thus appearing to offer generous benefits when, in fact, they shift costs to patients via stricter prior authorization requirements and increased claim denials. They’ll also shorten the list of medical benefits, claiming that many legitimate treatments are still experimental and lack sufficient scientific support to be covered.

Geek Notes: In the graph, appreciate the strikingly high jump from “advance” (under Biden) to “final” (under Trump) for 2026. Kronick’s estimate of $33 B due to diagnostic coding intensity is up from the $20 B previously discussed in HJM, despite being for 2021, several years out of date. In theory CMS is revising diagnostic coding practices, to reduce the overage, but such efforts have been dismally unsuccessful in the past.

Poll Shows Rising Health Cost Insecurity

In U.S., Inability to Pay for Care, Medicine Hits New High
Gallup
April 2, 2025
By Dan Winters and Ellyn Masse

The percentage of U.S. adults who have recently been unable to afford or access quality healthcare has reached 11% — equivalent to nearly 29 million people — its highest level since 2021, according to new findings from the West Health-Gallup Healthcare Indices Study, which classifies these individuals as “Cost Desperate.” 

The most notable increases since 2021 have occurred among Hispanic adults (up eight percentage points to 18%), Black adults (up five points to 14%,) and the lowest-income households, earning under $24,000 per year (up 11 points to 25%). Meanwhile, there has been no meaningful change in the proportion of White adults or middle- to high-income earners facing the same level of struggle. As a result, disparities in access to healthcare based on race, ethnicity and income are also at their highest point since surveying began.

“Cost Desperate” individuals lack access to quality, affordable care and have recently been unable to pay for needed care and medicine.
“Cost Insecure” individuals lack access to quality, affordable care or have recently been unable to pay for either needed care or medicine.
“Cost Secure” individuals have access to quality, affordable care and can pay for needed care and medicine.

The percentage of adults [who are “Cost Secure”] has reached its lowest level, with only about half of Americans (51%) falling into this category. The demographic groups who saw the biggest drops are Hispanic adults (down 17 points to 34%) and Black adults (down 13 points to 41%).

While households earning under $48,000 annually have always reported more difficulty accessing affordable healthcare, the difficulty has worsened considerably in the past year, climbing by 11 points (to 64%) among those in households earning under $24,000 and 12 points (to 57%) among those in households earning $24,000 to less than $48,000. 

Implications

The erosion of cost security in healthcare comes with serious practical implications for the American public. Recent research from West Health and Gallup shows that 12% of U.S. adults report borrowing money to pay for healthcare last year, amounting to an estimated $74 billion borrowed, and nearly 60% of U.S. adults report feeling “somewhat” or “very” concerned about going into debt due to a major medical event. Other common effects of care unaffordability include significant stress for household members, having to cut spending on basic items such as food, transportation and utilities to pay for care, and staying in an unwanted job solely for the health benefits.

 

Comment by: Don McCanne

In spite of the fact that the United States spends more than any other nation on health care, our financing system leaves more people exposed to unaffordable costs, and this study shows that it is getting worse.

What is the outlook? The current administration wants to reduce government spending in order to provide large tax cuts for the wealthy. Medicare is likely to be further privatized, shifting more profits and administrative expenses to the private insurers which would be paid through increased premiums, cost sharing, and taxes. Many states are electing to reduce spending on the Medicaid program, leaving patients responsible for more of the costs. The Republicans have made repeated efforts to reduce government spending on the Affordable Care Act and are likely to continue in their efforts. These measures would further reduce the affordability of health care for those enrolled in these programs.

This is so unnecessary. We have a plethora of studies that show that we can provide affordable health care to everyone and pay for the increases in care with the efficiencies inherent in a well-designed single payer system – an improved Medicare for All.

We’ve been saying this for years. Isn’t it about time that we actually do it?