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Mark Jacobs

Commentary: Canada’s Health Care Is Abysmal. Why Would We Copy It?

By | Health Insurance

By SALLY C. PIPES

April 26, 2018

Americans have come down with single-payer fever. A whole 59% now back a national health plan, according to a March 2018 Kaiser Health Tracking Poll—way up from the 33% reported by the Pew Research Center in summer 2017.

But the American people don’t really understand what supporting a single-payer plan means. For instance, in October 2017, 47% believed they’d be able to keep their current health coverage if a single-payer plan were put into place, according to Kaiser.

They’re sorely mistaken. Bills that would launch a government takeover of the country’s health care sector are meandering through Congress and numerous statehouses across the country. Those measures would outlaw private insurance within a matter of years. If any of them pass, Americans will find themselves paying sky-high taxes for access—not to care but to a waiting list.

Take Sen. Bernie Sanders’s Medicare for All proposal. Over the course of four years, it would systematically pryBernie Sanders people away from their current coverage arrangements—employer-sponsored insurance, individual-market coverage, Medicare, and Medicaid—and dump them all in a government-run plan. Companion legislation spearheaded by Rep. Keith Ellison in the House would do the same.

The Center for American Progress’s recently released Medicare Extra for All plan would nudge people into single-payer more gradually. Medicaid beneficiaries, the uninsured, and people with coverage through Obamacare’s exchanges would be first. Newborns and seniors turning 65 would soon follow suit.

The proposal also claims to allow Americans to keep their employer-sponsored coverage. But it offers employers incentives to move their workers into Medicare Extra. The end result, after a decade or so, would be single-payer.

Earlier this month, Democratic senators introduced the Choose Medicare Act, a bill that would allow individuals and employers to buy into Medicare rather than purchasing coverage from a private insurer.

As long as there’s a Republican in the White House, these proposals have little chance of becoming law; consequently, many state legislators are taking matters into their own hands. The California Senate approved a single-payer bill last June. It has since stalled in the Assembly, thanks in large part to the absence of a plan to pay for it. But progressive activists, led by the California Nurses Association, have continued to pressure the Assembly speaker to act on the bill. The New York Assembly green-lit a single-payer plan last year, but it never made it out of the State Senate.

Rhode Island, Washington state, New Hampshire, and Massachusetts are all in various states of exploring how they might implement single-payer within their borders.

They’ll quickly find that it’s financially impossible. California’s Senate Appropriations Committee estimates that single-payer would cost $400 billion per year—roughly twice the state’s entire budget. New York’s plan would increase state health spending by more than $87 billion in 2019 and require nearly $226 billion in tax increases, according to the Foundation for Research on Equal Opportunity.

Sanders’s Medicare for All plan makes these state initiatives look cheap by comparison. According to the Urban Institute, his reform package would cost $3.2 trillion a year. Proposed financing options include new payroll and individual income taxes of 7.5% and 4%, respectively—all on top of existing taxes.

Single-payer wouldn’t merely harm Americans’ financial well-being—it would jeopardize their physical health.

When patients face no out-of-pocket costs at the doctor’s office or hospitals, they have no incentive to moderate their consumption of care or seek lower-cost providers. The only way for governments to control spending is to ration the supply of care.

Consider how things work north of the border. Canada effectively outlaws private insurance for medically necessary services—just as the Sanders plan would. Patients must wait months for routine procedures—a median of more than 21 weeks for treatment from a specialist after referral from a general practitioner.

These long waits aren’t due to a lack of funding. The cost of health insurance for the average Canadian family jumped 174% over the past two decades—nearly twice as fast as incomes and four times the rate of inflation.

Canadians are fed up with their “free” health care. Three in four believe they should have the right to pay for care privately if the wait they’re facing is longer than clinically recommended.

Sanders and his progressive allies are working toward a revolution in the opposite direction. But it’s odd that they’re looking to mimic Canada’s single-payer model just as a strong majority of Canadians want to end their government’s ban on private insurance and permit more private options for care.

Americans’ burgeoning support for Medicare for All will quickly fade when patients learn that the government will confiscate their current health plans and force them to wait in line for care—and then charge them exorbitantly high taxes for the pleasure.

Sally C. Pipes is the president, CEO, and Thomas W. Smith fellow in health care policy at the Pacific Research Institute. Her latest book is The False Promise of Single-payer Health Care. Follow her on Twitter.

Low-Cost Health Insurance Limits Access to Top Cancer Doctors

By | Uncategorized

 

Insurers say specialized care available for those who need it, but Oncologists at premier cancer centers cut from some insurance

Excluded DoctorThe nation’s top cancer doctors are more likely to be excluded from low-cost health insurance plans offered on the nation’s individual market, potentially crimping access to the highest-quality care for Americans when they need it most, a new study found.

The individual exchanges, opened in 2014 as part of the Affordable Care Act, often include lower-cost policies that limit the number of physicians available to members as a way to cut costs. Those “narrow networks” are becoming more prevalent in Obamacare, as insurers seek ways to offer cheaper coverage, according to McKinsey & Co. The study was published in the Journal of Clinical Oncology and examined data from 2014.

The study offers a sense of the tradeoffs Americans face when buying health-care coverage on their own: Plans with lower premiums often get costs down by limiting choices of doctors and hospitals, asking patients to pay more out of pocket, or some combination of the two. It’s an issue patients are increasingly facing in insurance provided by employers, too, and one they’d likely continue to deal with under Republican plans to replace Obamacare. The current GOP proposals offer less financial help for people to buy coverage and could shift more people into lower-cost plans.

For the study, researchers from the University of Pennsylvania analyzed data on 23,442 oncologists in the U.S., evaluating how often doctors affiliated with National Cancer Institute-designated centers were covered by lower-cost insurance plans. The University of Pennsylvania is an NCI-designated cancer center.

Oncologists working at the U.S.’s 69 NCI facilities in the U.S., which offer access to scientific research and are known for their handling of complex cases, were twice as likely to be excluded from plans with the narrowest networks, according to the study.

“Most common cancers can be treated well anywhere,” said Justin Bekelman, associate professor of radiation oncology, medical ethics and health policy at the University of Pennsylvania, and one of the researchers. “But there are many patients with rare or uncommon tumors who need access to the most advanced clinical trials, and that access is often only at these NCI cancer centers. On the individual market, when people are spending their own hard-earned dollars, they can chose to have access or not. But right now they are choosing in a blind way.”

Network Questions

The Obama administration had been working to make it easier for people to figure out whether individual doctors and drugs were covered by their Obamacare plans by looking up such information online. It’s harder for consumers to determine the comprehensiveness of an insurance plan’s network, however, and so far there’s only been a limited effort to require plans to disclose the overall size of their networks.

Regulating insurers’ networks is largely left up to the states. The Trump administration has said it will defer to states rather than conduct its own reviews, for the most part.

“Certainly there are real issues with consumers trying to understand what kind of network they’re getting,” said Justin Giovanelli, an associate research professor at Georgetown University’s Center on Health Insurance Reforms who wasn’t involved in the study. “What you want is to have more information so you can make good choices about it.”

Health plans have procedures that let patients who need specialized care get to the appropriate doctors, according to a statement from the industry group America’s Health Insurance Plans. The group noted that the study dealt with coverage for individual physicians, not for the facilities themselves.

“Patient access to an oncologist affiliated with an NCI-designated or NCCN cancer center is separate from patient access to treatment at these centers,” Kristine Grow, an AHIP spokeswoman, said in the statement. “Community oncologists who are part of the plan’s network can recommend patients to these centers based on patient needs.”

Higher Costs

According to the researchers, doctors at NCI-designated cancer centers, such as Memorial Sloan-Kettering in New York, Dana-Farber in Boston, MD Anderson in Houston and the University of Pennsylvania, may be excluded from the narrow networks because of their cost. Because of the doctors’ status, the centers may be more able to negotiate higher reimbursement rates for their services. They may also attract more complicated, and thus costly, patients. Excluding them could help insurers control expenses at the price of limiting access to high-quality, specialized care, the researchers said.

“In an ideal world, narrow networks could be a great tool for insurers to steer patients toward these higher quality providers, to ensure that overall costs are actually lower,” said lead researcher Laura Yasaitis, from the department of health economics at the University of Pennsylvania. “It looks like in the data we looked at that prices may be the more prominent motivator for insurers.”

The Penn researchers analyzed 248 insurance networks across the U.S. operating in areas with NCI-designated centers. They found that one in every three significantly limited the number of oncologists in their insurance plans. Of all the cancer doctors who were part of those narrow networks, 17 percent worked at NCI centers. Of all the doctors who were excluded from those plans, 35 percent participated at NCI centers.

The discrepancy wasn’t seen in broader insurance networks. In those plans, 34 percent of included oncologists were affiliated with NCI centers, compared with 29 percent of those cancer doctors who were excluded, according to the study.