Benjamin Day and Stephanie Nakajima of Healthcare-NOW break down everything you need to know about the social movement to make healthcare a right in the United States. Medicare for All!
Week of Action: Expand Medicare!
Congress has an opportunity to make real steps towards Medicare for All this week. We go over the 4 proposed reforms that would expand Medicare, what’s at play and what’s at stake, the opposition to Medicare Expansion - if you can believe it - there IS opposition to giving seniors dental care - and what you can do to help pressure our legislators to fight!
Ben in Boston and international correspondent Stephanie in Denmark discuss the proposal to substantially expand and improve Medicare that's moving through Congress right now.
As part of the negotiations around the American Families Plan, there are four demands:
Lower the eligibility age for Medicare from 65 to 60, which would add 23 million people to Medicare coverage. (Lowering to 50 would add 60 million people, and lowering it to zero would be even better, but reducing it by just five years would be a huge victory, lowering overall healthcare spending in the U.S. and lowering employer healthcare spending by almost 15%. This will be the hardest of the four demands to achieve, but the one that would affect the most Americans.Add hearing, dental, and vision to Medicare, improving the program for existing Medicare beneficiaries, a huge number of whom are going without needed care. Of Medicare recipients, 75% who need a hearing aid don't have one, 70% haven't gone to the dentist in the last year, and 50% didn't get an eye exam. Create a cap on out-of-pocket costs. Most health insurance has a cap on out-of-pocket expenses, but traditional Medicare doesn't. This is wonky and less exciting for politicians because while it will save a lot of people a lot of money, it's not as tangible a benefit as adding hearing, dental, and vision. Allow Medicare to negotiate drug prices. Medicare has been prohibited by law from negotiating drug prices for decades, forcing Americans to pay up to triple what other nations pay for the same pharmaceuticals. Negotiating with the pharmaceutical industry would save Medicare up to $450 billion over ten years, paying for all of the above expansions.
Calls for expansion are building not just from the grassroots from within Congress. Letters from members of the House and the Senate (signed by many Democrats including centrists who aren't traditional Medicare for All supporters) have already been sent to President Biden, pressuring him to include expansion in the American Families Plan.
Calls for expansion are coming from inside Congress! (Image description: surprised looking cat, with caption "the call is coming from inside the house!!!")
We have some (very cynical) theories about these odd bedfellows:
The centrist Democrats who signed on aren't deeply in the pocket of the healthcare industry, but they are avoiding Medicare for All because they perceive it as a liability in their district.They are in the pocket of one particular branch of the healthcare industry (but not pharma); they think it could help hospitals or insurance companies. They are signing the letter but don't think it will pass, and are happy to throw these provisions under the bus behind closed doors. All of the Above
These expansion reforms both bring us closer to Medicare for All, and help us divide and conquer the healthcare industry; this proposal takes on Big Pharma, but mostly leaves the insurance and hospital industries alone. But is it working?
Currently the opposition to expanding and improving Medicare is coming from the usual suspects, under the umbrella of the Partnership for America's Health Care Future, the evil transformer of insurers, pharma giants, and hospitals. They've even managed to find (some really bad) ways to argue against giving ...
Do Marches and Rallies Work?
We’re joined by L.A. Kauffman, author of How to Read a Protest: the Art of Organizing and Resistance. L.A. Kauffman was the mobilizing coordinator for some of the largest demonstrations in U.S. history -- the massive Iraq antiwar protests of 2003 and 2004 -- and has played key roles in many other movements and campaigns. Her book is about the role of marches and rallies in social movements, particularly large-scale mass demonstrations.
Today we talk tactics, and in particular, do rallies and marches work? This is a timely topic as we start to re-enter society after over a year of pandemic lockdown, and we’re finally starting to plan in-person collective actions again. We're joined by L.A. Kauffman, the mobilizing coordinator for some of the largest demonstrations in U.S. history -- the massive Iraq antiwar protests of 2003 and 2004 -- and a key player in many other movements and campaigns.
L.A. is the author of a 2018 book that we love here at Healthcare-NOW, called How to Read a Protest: the Art of Organizing and Resistance, which is specifically about the role of marches and rallies in social movements, particularly large-scale mass demonstrations.
L.A. tells us she wrote How to Read a Protest after her experience of the single largest day of protest in world history, against the rush to war in Iraq, on February 15, 2003. Despite the record-breaking numbers of people on the streets in countries on every continent, the protest failed, resulting in little more than a shrug from the White House. L.A. tells us she wrote the book to try to figure out why. Why do we march? Where do protests come from? What do they accomplish, and are they even worth doing?
Spoiler alert: we don't typically achieve policy objectives from mass mobilizations. Most of us think of the legendary 1963 March on Washington as a success: "MLK had a dream, people marched, and civil rights legislation passed," but it was much more complicated than that. Mass mobilization just doesn't work as a short-term pressure tactic.
L.A. shares that the 2003 global anti-war protests failed because, in the wake of America's defeat in the Vietnam war, it was imperative for the U.S. government to prove that an empire can wage war at will. The administration shrugged off the massive public opposition, daring the mass mobilizations to continue. They did not.
Ben fondly recalls meeting with former Congressman Barney Frank, who once told activists calling for a million-person protest to win Medicare for All, "the only thing that Marches on Washington apply pressure to is the grass in Washington, DC." If marches aren't accompanied by calls from and meetings with constituents, they won't have the desired impact on lawmakers.
The 1963 March on Washington was the first major march in DC. Since then, it's become almost routine for movements to hold marches on Washington, many of which have been very forgettable. But at the time it was very novel, and -- motivated in large part by racism -- feared by the powers that be. The predictions that hundreds of thousands of Black people marching in DC would cause riots and violence never came to be, though.
We contrast the stately 1963 March which was centrally planned from the top down (entirely by men), and very tightly policed -- all the way down to prohibiting all but pre-printed protest signs -- with the 2017 Women's March, which mobilized 4.2 million people across the country with improvisational and decentralized leadership and a diverse spectrum of messages. They were very different mobilizations with very different outcomes.
The book reveals that the 1963 March actually drew energy away from smal...
Did Big Pharma or Governments Invent the COVID Vaccines?
Stephanie and Ben discuss who developed the vaccine; who is profiting from it; and the fight for global vaccine equity on this episode with guests David Mitchell of Patients for Affordable Drugs and Andrew Goldstein, a public hospital primary care doctor, assistant professor of medicine at NYU, activist, and organizer with the Free the Vaccine and People's Vaccine campaigns.
Who paid to develop the COVID-19 vaccines? Primarily taxpayers. David gives us a history lesson: before the COVID-19 pandemic, the Federal government invested $17 billion in vaccine technology because drug companies weren't investing in this high-risk, low-return research. When the COVID-19 pandemic hit, these vaccine technologies were ready to be tested. Taxpayers invested another $20 billion in clinical trials, creating production capability, and pre-ordering the product. We took the risk out of the endeavor for the pharmaceutical companies. (We socialize the risk, and privatize the profit.)
Are there strings attached to taxpayer dollars for pharmaceutical development? Not really. David explains that the National Institutes of Health contributed to every new drug approved by the FDA in the US between 2010-2019. NIH is the single largest medical research agency in the world. When the drugs are ready for commercialization, they turn the intellectual property (IP) over to pharmaceutical companies with no strings attached. The drug companies can set any prices they want. (For an example, see the new Alzheimers drug from Biogen, that will cost $56,000 a year.)
In the case of the COVID-19 vaccines, the US government did negotiate, showing that it is possible to have life-saving innovation at reasonable prices for patients. The Pfizer vaccine is currently $19.50/dose. Pfizer has told their shareholders recently that they want to raise the price of a dose to $150-$175. Many Americans may still need a booster in the future, which will be an opportunity for the drug companies to raise prices if the government doesn't negotiate.
What is standing in the way of developing nations purchasing enough vaccine to inoculate their entire population? Andrew shares that so much of our response to this global pandemic has been approached differently nation-by-nation. Rich nations who gobble up all the available doses are also preventing maximum production of doses, creating false scarcity and "vaccine apartheid."
Trade deals with wealthy nations result in forced austerity for developing nations, keeping them impoverished. Most of them have a tiered healthcare system, with very frail public health mechanisms. Some might have a universal public system, but they tend to be low quality. A secondary private system exists for wealthy people who pay full price out of pocket. Even if wealthy countries donate vaccines, those countries may be selling them to cash-paying patients.
Patent rights are preventing developing nations from producing generic vaccines to save their own populations. In the fall of 2020, South Africa and India called on the World Trade Organization for a Trade Related Intellectual Property Rights (TRIPS) waiver, an emergency public health authority to waive patents on vaccines and the technology to produce them. Unfortunately, there are also a lot of trade secrets that aren't patented that companies are unwilling to share. The TRIPS waiver is a necessary but insufficient solution to free the vaccines.
Will the donations of vaccines from G7 countries be enough to meet global need? There are about 6 billion vaccine eligible people on earth who will need two doses = 12 billion doses. G7 countries are announcing a total of about 1 billion doses,
Pharma’s Image Gets a Boost from COVID-19
62% of people now have a positive opinion of drug companies, up from 32% in 2020. What's responsible for the sudden shift, and do pharmaceutical companies deserve this newfound adoration? We're joined by Shannon Rotolo, co-founder of Pharmacists for Single Payer and a clinical pharmacy specialist at the University of Chicago Medicine, to debunk industry lies about research and development, innovation, the market, and more.
Public opinion seems to be driven by the belief that pharmaceutical companies mainly function to discover and manufacture important new drugs. While the big pharma companies do do some research and development, they primarily buy the intellectual property of smaller biotech research companies, and then mostly act as marketing and sales reps for the product. They actually spend a lot less on research and development, and much more on marketing and profits for shareholders.
Image description: Congresswoman Katie Porter, holding a whiteboard at a House Oversight Committee hearing about drug prices. The smallest circle on the whiteboard is labeled Litigation and Settlements, the next circle is labeled R&D, the next largest is labeled Marketing and Advertising. The largest circle, Stock Buybacks and Dividends, is more than 10 times the size of the next largest circle. https://www.businessinsider.com/video-katie-porter-tears-into-pharma-ceo-whose-company-inflated-its-prices-for-two-major-drugs-2021-5
The vast majority of breakthrough innovative pharmaceuticals are actually funded by taxpayers through the National Institute of Health. Some studies are funded through the Veteran's Administration. There are countless examples of pharmaceutical companies profiting off of publicly-funded research, making billions and denying any royalties to the government. Those royalties could be used to provide lower cost drugs to patients, but the pharmaceutical companies instead have driven prices up, making life-saving drugs unavailable to people who need them. A recent example is the drug Truvada, marketed by Gilead.
Shannon explains some of the games pharma plays to make more money regardless of patient needs. Patent extensions, me-too drugs and changes to delivery methods all allow drug companies to maximize profits and minimize research costs and risks, ultimately driving up costs for patients.
While drug companies argue that lowering prices will stifle innovation, the profit motive actually works against the innovation motive. If you can tweak a drug and profit from it, the incentive isn't there to take the risk and put in the work to develop something new. (Socialize the risk, privatize the profit, as they say.)
If you've always wondered what Pharmacy Benefit Managers (PBMs) add to healthcare, Shannon breaks it down. Insurance companies, large employers and Medicare Part D contract with PBMs to facilitate prescription drug benefits. They negotiate rebates with drug companies, ultimately setting the price the payer will pay for the prescription. Essentially, PBMs are yet another corporate middleman that skims profits off the system without adding any actual care for patients.
What would single payer mean for pharmaceutical prices? Removing insurance companies and PBMs, and negotiating prices would all help bring down costs. But the key benefit of single payer would be simplifying the process and eliminating out-of-pocket costs for drugs that patients need to live.
We sometimes hear concerns about a single payer system limiting the drugs that are covered. Shannon explains that there would be a formulary in the system, which would limit coverage of some of the duplicative me-too drugs; but that's already the case ...
Mailbag Episode: Listeners interview us
In our inaugural mailbag episode, Rose Roach - Executive Director of the Minnesota Nurses - joins us to answer your questions about how Medicare for All would save money and impact rural hospitals, how to answer to pushback on cost, talking to conservatives about Medicare for All, the political landscape, petitions as a base-building tool, and more!
Ben and Stephanie are joined by Rose Roach, the Executive Director of the Minnesota Nurses Association (MNA), and answer questions from listeners.
First, we celebrate that Congresswoman Betty McCollum (D, MN-4), Rose's own representative, signed on as a co-sponsor of HR 1976 after a conversation with MNA nurses during Nurses Week (and years of advocacy by healthcare activists in her district).
On to the mailbag questions!
Q: Jordan asked: How does insurance work for the Indian Health Service? A: The Indian Health Service (IHS) is independent but not well funded. Earlier versions of Medicare for All absorbed IHS into the system, which concerned advocates for tribal sovereignty. Under HR 1976, though, IHS will stay independent of the Medicare for All system, but will be treated as a provider, so will receive financing like any other provider.
Q: Laurie asked: Why is it taking so long for Medicare for All? A: For one, our political system and elected officials are influenced by money. The for-profit health insurance industry has deep pockets and is willing to spend big to maintain the status quo. Until we have campaign finance reform, we will have to fight this fight against monied special interests. Another issue is that we haven't quite achieved the working class solidarity that it will take to create the grassroots demand that will force elected officials to pass Medicare for All.
Q: Heather asked: How would Medicare for All affect hospitals? How will they stay up and running, especially rural hospitals?A: Medicare for All would actually be transformative for hospitals, despite the misperception generated by the industry that it would hurt them. Medicare for All would fund hospitals equitably and fairly, based on their value to the community rather than their profitability. In a market-based system, hospitals that don't generate profits, like small rural and safety net hospitals, can go under, regardless of the benefit they provide for the community. Under the Medicare for All system, hospitals will be funded based on the care needed by people in the community. Medicare for All is actually what could save rural healthcare from closures and consolidation.
Q: Steve asked: How do we educate conservative rural communities at risk of losing their hospitals about the benefits of Medicare for All? A: We have to meet people where they are. Ask them how the system works for them now? Do you have to travel far for your routine care? For some it's an ideological difference and we'll never convince them, but there are conservatives who can be engaged about the care they and their community need.
Q: Many asked: How would we pay for Medicare for All? A: The two Medicare for All bills don't have financing language yet. The plan is to build the financing through the committee process. Several studies over the years have shown ways to pay for the program and generate savings, including the Political Economy Research Institute (PERI) Economic Analysis of Medicare for All.
The PERI study found the whole system would cost about $3 trillion, which is less than we're currently paying. We already pay for about two thirds of the healthcare in the US through tax dollars. The other third is currently coming out of people's pockets in the form of employer and employee p...
Biden's 1st 100 Days on Healthcare
We discuss Biden’s American Families Plan proposal, which Biden unveiled in his first State of the Union address last week (spoiler: it’s rather underwhelming) and the industry lobbying that made it happen. Then we discuss the proposal to expand Medicare that came from Reps and Senators - both progressives and moderates - and what it may signify in the fight for Medicare for All.
Today we celebrate Stephanie's first dose of vaccine and Biden's first 100 days.
(Spoiler alert: #underwhelming)
While Ben and Stephanie liked the President's non-healthcare progressive priorities like paid family and medical leave, subsidized childcare for low income families, and increasing taxes on the very wealthy, they're disappointed in the healthcare vision Biden laid out.
Ben and Stephanie first review the healthcare components of the American Rescue Plan, passed on March 10. This plan included $1,400 payments as well as 100% subsidy of COBRA (the very expensive program that allows employees who have lost their jobs to pay for their past employer's health insurance plan) premiums. It also removed the income limit on ACA premium subsidies for anyone whose health insurance premium costs more than 8.5% of their income, and increases subsidies for low income households. All of these policies will sunset, or die off later this year or in a few years.
During the State of the Union, President Biden also talked about proposals that aren't actually in the American Families Plan: a public option, lowering the Medicare eligibility age to 60, extending subsidies to low income people in states without Medicaid expansion, and letting Medicare negotiate drug prices.
The actual American Families Plan only has one healthcare proposal: the ACA subsidies from the Rescue Plan will be made permanent. This will affect about 9 million people, less than 3% of the population, at a time when 30 million have no insurance, and more than 60 million are seriously underinsured. While this expansion will help this small group, it sends more tax dollars to a private, profit-driven insurance industry. Not the big bold reform those of us who believe healthcare is a human right and a public good hoped for.
Coincidentally, back in December America's Health Insurance Plans (AHIP - the industry lobbying organization) and Blue Cross called on Congress to fully subsidize COBRA and expand subsidies for private ACA plans, as a response to the COVID-19 pandemic. Interesting that this is the exact proposal made by President Biden in the Rescue Plan and Families Plan. Hmm.
Ben and Stephanie also discuss the alternative proposal sent to Biden by members of Congress (Seventeen Democratic Senators and 80 Democratic Representatives), calling for the American Families Plan to include an expansion of Medicare eligibility to age 60, cover hearing, dental, and vision, and introduce a cap on out of pocket expenses. Interestingly, the letter signers include a lot of centerist leadership, not just the typical Medicare for All supporters.
This plan isn't a clear win for us: we assume Medicare Advantage, the private insurance alternative to traditional Medicare, will continue to siphon taxpayer dollars into private coffers. Also, bringing in 60-65 year olds, we won't get the cost savings we would get by bringing all Americans in. But bringing more people and some additional benefits into Medicare would help build confidence in public healthcare, potentially making it easier to build a case for Medicare for All.
Ben does some coalition math on this alternative plan: the insurance industry would probably like this plan,
We need to serve our braver angels
This may mean listening to people with divergent opinions. We need to build a bigger circle of inclusion to win health care for all. To be candid I align with Bernie. However, if we can’t tolerate a little snark what hope do we have to build the big group of us it will take to make Medicare for all happen?
Sorry to say goodbye
I’ve listened to every episode and in some cases learned something new. I was always aware of the correspondents support for Bernie but was able to overlook the bias. However, now that Bernie has withdrawn from the presidential race, the bias has turned to snarkiness and I just can’t take it. If I hear that the show regains an objective focus on and advocacy for M4All I may consider a return.