Saturday Soother – June 18, 2022

The Daily Escape:

Rainy morning, with Vista House at Crown Point in right foreground, Columbia River Gorge, WA – June 2022 photo by David Leahy Photography

Wrongo has written before about the crushing burden of consumer debt in the US. Medical debt is an American disgrace, and Noam Levey, Kaiser Health News (KHN) Senior Correspondent has written an excellent piece about it. He says that 100 million people in America, some 41% of adults, owe some level of debt to healthcare providers.

But most studies don’t reveal the actual extent of the debt because much of it appears as credit card balances, loans from family, or payment plans arranged with hospitals and other medical providers. To calculate the true extent and burden of this debt, KHN partnered with NPR, and the Kaiser Family Foundation (KFF) to conduct a nationwide poll designed to capture not just bills patients couldn’t afford, but other forms of borrowing used to pay for health care.

The results are contained in the KFF Health Care Debt Survey. The KFF poll found that half of US adults don’t have the cash to cover an unexpected $500 health care bill. As a result, many simply don’t pay their medical bills. The flood of unpaid bills has made medical debt the most common form of consumer debt in America.

Over the past five years, more than half of US adults report they’ve gone into debt because of medical or dental bills. Moreover, a quarter of adults with health care debt owe more than $5,000, and about 20% with any amount of debt said they don’t expect to ever pay it off.

Debt incurred for health care is forcing many families to cut spending on food and other essentials. The poll also found that millions are being driven from their homes or into bankruptcy:

So, if 100 million people were in debt and 17% declared bankruptcy or lost their home, that’s 17 million people! The KFF poll found that the debt is also preventing Americans from saving for retirement, investing in their children’s educations, or buying a home. And debt from health care is nearly twice as common for adults under 30 as for those 65 and older. And that age cohort is supposed to be much healthier than the elderly.

Perversely, about 1 in 7 people with medical debt said they’ve been denied access to a hospital, doctor, or other provider because of unpaid bills. An even greater share (two-thirds) have put off care that they, or a family member need because of the cost.

Hospitals are among the culprits. They are capitalizing on their patients’ inability to pay. Hospitals and other medical providers are pushing millions of patients who can’t afford to pay into credit cards and other loans. These are high interest rate loans, carrying rates that top 29%, according to research firm IBISWorld.

This collections business is fed by hospitals, including public university systems and nonprofits granted tax breaks to serve their communities, who sell the outstanding debt to collections companies.

Welcome to the best country on earth, (maybe) one that doesn’t have the best health care system (and certainly one without  health insurance for all). We have a system which shackles 100 million people to medical debt while at the click of a computer mouse, we send $billions in armaments overseas before those same dollars are recycled into the coffers of our Military-Industrial complex.

That’s all for this week. It’s time for our Saturday Soother, when we take a break from the J6 public hearings and whether Ginni Thomas was another Trumpist plotter. Let’s focus on calming ourselves for whatever insults are coming next week.

Here at the Mansion of Wrong, we’re engaged in an air conditioning project, adding more central air to our home. Hey, we’re aware of the crummy stock market, and the rampant inflation, but consume we must.

To help you clear your head on this warm weekend, grab a seat outdoors and brew up a cup of Supernatural coffee ($18.45/12 oz.) by Lee, MA’s own Barrington Coffee Roasting Company. This espresso is said to have flavors of Concord grape, dark chocolate, plum and tangle berry pie!

Wrongo has no idea what tangle berries look like, much less what they taste like.

Now, put on your wireless headphones and listen to the “Adagio for Oboe, Cello, Organ and Strings”, also known as “Elevazione” or “All’Elevazione” by Domenico Zipoli.

Zipoli was an Italian Jesuit priest who lived much of his life in what is now Argentina. He studied with Scarlatti, became a Jesuit, worked as a missionary, and died in 1726 in Argentina at age 38. If fate had granted Zipoli another 20 to 25 years, he might be regarded today as a major composer. Here it’s performed in 2015 by the Collegia Musica Chiemgau conducted by Elke Burkert :

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Monday Wake Up Call – January 31, 2022

The Daily Escape:

Mount Saint Nicholas, Glacier NP, MT – January 2022 photo by Jack Bell Photography

Anyone else thinking that our national party bus is about to stall out in the slow lane on America’s Boulevard of Broken Dreams?

Here’s an under-the-radar story: In 2020, the Trump administration hatched a plan to gradually transition traditional Medicare over to private firms. It’s called Direct Contracting (DC) and is operated by Direct Contracting Entities (DCEs). Currently, there are 53 of them in Phase One of an experimental program operated by the Centers for Medicare and Medicaid Services (CMS).

Under the program, the DCEs receive a fixed amount of money annually to cover care for each traditional Medicare enrollee whose primary care doctor (or group) has signed up with that DCE. The DCEs must pay for all of the care of those people assigned to them. To date, the CMS has auto-assigned hundreds of thousands of people to DCEs.

Since no one on Medicare has voluntarily signed up to work with a DCE, it’s unlikely they know of, nor understand what’s happening. And the CMS doesn’t require DCEs to tell people that they have the right to opt-out.

The idea behind DCEs is to shift a portion of the financial risk of the elderly’s medical care away from traditional Medicare by capping the payments to a third party that’s responsible to pay for it. This is the latest in many efforts by CMS and Congress to control the rising costs of healthcare.

Wrongo and Ms. Right have recently noticed a blizzard of direct mail offers to convert our traditional Medicare to an all-in insurance program. It’s probable that some of these are from DCEs.

The anticipated advantage of the DCE experiment is that Medicare’s out-of-pocket costs will be capped. The DCEs contract with CMS is for an agreed-upon annual payment. They have to pay for care and also make a profit based on that fixed revenue amount from the government. In addition to the normal profits from providing services, DCEs can keep as much as 40% of the money they don’t spend on care.

But there’s no such thing as a free lunch, and it seems to Wrongo that this creates yet another financial incentive to deny otherwise necessary treatments. It’s possible that the DCEs could pay doctors to steer patients away from specialty care. This means that someone enrolled in a DCE has reason to worry that their primary care doctor might limit their access to more costly care.

Direct contracting is supposed to be a pilot program, yet Medicare has no plans to limit the number of people it enrolls in these new plans. Instead, Medicare has announced plans to enroll 100% of traditional Medicare members into DCE-like programs by 2030.

Congress did not authorize the wholesale overhaul of traditional Medicare, so why is this happening? And so far, the Biden administration appears to be willing to continue playing Trump’s cards.

Many of the DCEs are owned by Private Equity (PE) firms. It doesn’t take a chess master to see that the PE firms will ultimately sell out to the insurance industry. And it wouldn’t be a big leap from that to fully privatize Medicare.

Time to wake up America! Did we elect Biden to privatize Medicare? The word “privatize” should scare the hell out of Americans. But unfortunately they’ve been fooled into believing that by some magic miracle of economics, it’s to their benefit.

To help you wake up, today we spend a few minutes with Neil Young. Wrongo appreciates Neil Young saying he wanted his music removed from Spotify if Joe Rogan is allowed to continue spewing his anti-Vaxx trash there.

This was an easy business decision for Spotify. They picked the popular podcaster Rogan with the $100 million-plus exclusive deal, over the cranky 76-year-old rocker whose last gold album was nearly two decades ago. Someone who hasn’t been on the Billboard charts since 1982.

Joni Mitchell and Dave Grohl have now said they will follow Young in leaving Spotify.

Let’s watch and listen to Neil Young playing “Hey Hey, My My” at Farm Aid in Champaign, Illinois on September, 1985. Young is a co-founder and board member of Farm Aid, along with Willie Nelson and John Mellencamp:

Neil won’t burn out or fade away.

Sample Lyric:
Out of the blue
and into the black
You pay for this,
but they give you that
And once you’re gone,
you can’t come back
When you’re out of the blue
and into the black.

“You pay for this, and they give you that”. Listen up Medicare!

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Warren’s Mistake on Single Payer

The Daily Escape:

Mount Shasta, CA – November 2019 photo by pkeller001

Wrongo wonders if Elizabeth Warren has made a big mistake in her policy for Medicare for All. She started out running to reform capitalism, but through the debate process, she’s evolved towards single payer health insurance as a main policy. Months ago, she was an increasingly skilled campaigner whose laundry list of policy proposals made her stand out from the pack. Now she’s for nationalizing health insurance, which doesn’t seem to be on brand.

Two of her main rivals, Biden and Buttigieg, essentially want to extend Obamacare while leaving the 170 million Americans covered by private insurance with their current plans. While on her left, her other main opponent, Bernie Sanders, also wants to nationalize health insurance.

The latest New York Times/Siena College poll of Iowa Democrats shows Warren, Sanders, Buttigieg, and Biden bunched within a 5-point range. And while Warren leads, the poll found more sentiment among primary voters for improving the private health insurance system than for scrapping it in favor of single-payer.

Worse for Warren, she and Sanders are both sufficiently well-funded and popular that neither can easily emerge from Iowa or beyond as the candidate on the left. It’s similar on the moderate side: Neither Biden nor Buttigieg are going away after Iowa either.

Buttigieg is a gifted politician. He’s correctly discerned that the path to marginalizing Biden lies not in attacking him, but in confronting Warren on single payer, which he did in the last debate. He would rather that Sanders was the front-running lefty heading into Super Tuesday, than have to confront Warren.

A few more debates, and Mayor Pete may be the last standing moderate alternative to Warren and Sanders, assuming Bloomberg doesn’t get traction along the way.

Sanders is a much better candidate than he was in 2016. He’s making inroads among African-Americans and Hispanics. AOC, a very popular symbol of youth and progressivism, supports him. Sanders is doing well enough with young progressives to keep Warren from now moving closer to the center on single payer.

She went from cautious on single payer to all-in. First, she allowed that there were multiple paths to universal coverage. In an attempt to simplify during one of the debates, she said: “I’m with Bernie”, without having a firm plan.

When pressed by Biden and Buttigieg to specify how she would pay for her vague plan without raising taxes on the middle class, she dodged the question, saying that overall health insurance costs to the middle class would go down. She finally produced a white paper that described a 10-year $20.5 trillion plan to fund Medicare for All without raising taxes on the middle class.

Her opponents are using her proposal to define Warren to their own advantage: Biden and Buttigieg say it’s too radical and too expensive; Sanders says it’s inferior to his plan. While single-payer is popular among Democratic primary voters, several polls of swing state voters suggest that the majority favor a more moderate health insurance plan.

That would seem to be an invitation to embrace positions most Democrats actually prefer.

Warren’s problem is that she seems married to a health insurance program which leaks votes and positions her in a fight for the left of the primary electorate. However, we’re in a time when a coalition of minorities, suburban swing voters, and persuadable blue-collar whites are what’s needed to win states like Pennsylvania, Michigan, and Wisconsin.

Warren should return to her roots of tax and capitalism reform. These are popular policies with Democrats, even with those who are against mandatory single payer health insurance. The continuing rise in inequality requires us to do something to narrow it.

And Warren’s wealth tax could do just that, and finance more robust social programs and spending on infrastructure. The US mostly taxes individuals on the income earned from their jobs and investments, while a wealth tax would levy taxes on assets like stocks, yachts, artworks and vacation homes.

Both Sanders and Warren have an asset tax plan. In Warren’s plan, all net worth under $50 million is exempted, compared to $32 million for the Sanders plan. Business Insider says the Sanders plan would bring in $4 trillion in government tax dollars over a decade. And, Warren’s version would total $500 billion less in the same period.

During this primary season, moderates and progressives will have to understand clearly why they are Democrats, and how they will bridge their differences by November 2020 and deliver massive turnout.

Both wings need to remember that it isn’t enough to win the White House. Legislative gridlock must end.

It wouldn’t hurt if Warren did some thinking about her single payer plan, too.

 

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