Not sure if you’ve already heard but Aetna is cutting reimbursement rates for therapists and psychiatrists on the behavioral health platform Alma. Just another example of insurance companies screwing over providers and patients (I imagine many of us will get off the Aetna panel as a result)
Wendell, you have hit the nail on the head. When Texas is interested, many will pay attention. Your testimony addresses the main dysfunction; misaligned incentives.
Once every state legislative body starts questioning and request testimony from those that know, we will catalyze a movement for action at both Fed and State.
I caught a key Paul Krugman policy recommendation shift this past Sunday, for those interested.
Formerly, he had gone with that the ACA is the best we can do, as anything like single-payer is not in the political cards.
He's shifted, not towards full and immediate single payer, but just to adding a government option, with possible gradual expansion towards something like single-payer in an evolutionary, force-no-one-to-give-up-what-they-currently-have kind of way.
I quote from his Sunday post, which was behind a paywall:
"Single-payer isn’t a perfect system, but it is a system that has been run effectively not only abroad but in the United States. While I am by no means dogmatic about this, my view is that the next phase in U.S. health reform should involve an effort to transition away from private insurance to single-payer.
Longtime readers may recall that this was not my position in 2009-10, when Obamacare was being put in place. Nor did I support Bernie Sanders’s call for single-payer in 2016. However, like many and probably most supporters of Obamacare, I backed patchwork rather than comprehensive reform not because I believed that it was the best policy but because I believed that it was the only politically realistic way forward in 2010 and in 2016.
But it’s now 2026, and the political landscape has changed in ways that arguably put fundamental reform in reach."
… [and a bit later in the Krugman post]
"This suggests that an attempt to push people into Medicare-for-all would run afoul of concerns about change.
But it would be much less controversial, I believe, to offer a public option — allowing Americans, including employers providing insurance to their employees, to buy into a Medicare-type system. Many people surely would avail themselves of that option. And if they like what they get, which they probably would, we could transition over time to a single-payer system without forcing Americans into it.
Of course, insurance companies would hate this, and campaign furiously against it. But given their current reputation, this might even help the cause of reform.
Now, I am not offering policy specifics, partly because this post is already long but mostly because this is the point at which we need details from real experts. And I am not at all dogmatic about the path forward.
The main point is, instead, that we are approaching a point at which ambitious healthcare reform, well beyond simply repairing the damage to Obamacare, will be possible. And Democrats should be prepared to rise to the occasion."
--
A thing to note is that his allowed range of change still keeps our hyper-complex current system and ACA and expanded Medicaid, where there are numerous problems, which are often dependent on how each state messes up its administration of expanded Medicaid and the ACA (the latter if it has its own exchange).
So, very slow change. Disappointing. Things may get good, by evolution, eventually. Perhaps in 150 years. (We need a "Cathedral Mentality", more than to have those in stress and fear for themselves now to be able to count on relief.)
Krugman is just a man with an opinion. He has a brain that is adapted to financial security. I will explain that statement in a Substack I'm working on. I'm not referring only to Krugman, but he exists in the world differently than people who must count every penny and struggle to survive. It's time to quit listening to the elites and finally create a government that serves the people.
Thanks. I was away for a few days and missed the article.
As more people die for lack of health insurance and from delayed care due to denials, their families will resolve to see this broken system gone and replaced with a fair system, single-payer universal coverage.
Yes, indeed, Paul Krugman seems to have picked up on a broader discontent than just people not insured, and, if you didn't catch it, he switched his recommendation last Sunday. Not all the way to single payer, to to allowing something like a government option on a non-forced bases, possibly eventually taking us close to single payer.
(I extracted some of his text from his paywalled Sunday post in this other comment on this Healthcare Uncovered post:
If you are looking for education & research, hospitals, specialty, clinic, emergency & village/care hotels in the entire USA….choose Passing The Medicare for ALL acts today.
The facts that support your entire argument are eloquently distilled in the quoted excerpts of your presentation. Anyone who reads this should be righteously infuriated!
While we're on the subject of possible change coming from the Democrats (which, of course, cannot possibly start sooner that Jan 2029 based on the need to change the party of both houses of Congress and the president--so, so slow!), I do want to point out one of the numerous things likely to be omitted in the necessary ultra-slow, evolutionary process.
And that is long-term-care/nursing home coverage.
Many people do not know that long-term-care/nursing home coverage is beyond the scope of anything we have in the U.S., except for Medicaid, which requires the family spend down at the full $90,000-$160,000 a year cost of nursing homes, and to then become basically dirt-poor in both income and assets to get Medicaid to pay for nursing homes. (With some exceptions.)
Nursing homes and long-term-care are beyond the scope of the ACA, and beyond the scope of employer and retiree coverage, and beyond the scope of Medicare. It is covered by private long-term-care insurance, which is too expensive for most people, is subject to pre-existing-condition screening, and often has inadequate coverage limits. (About 10% of people over 65 have it.)
The only mention of making it standard in the U.S. context has been Sanders Single Payer.
Long-term-care / nursing home costs have a significant risk of wiping people out financially, even for people with safe health insurance, say from a retiree plan or Medicare plus a Medigap. In some cases, a specialized eldercare lawyer can find a way out of the problem. Sometimes, the only way they can find to get a person whose spouse is in a nursing home out of the problem is a "Medicaid Divorce". (Isn't that lovely? How romantic!)
Anyway, I did a bit of research on this. Not all of the other developed countries have a universal nursing home insurance system. (For example, the U.K. is like the U.S., requiring spend-down first.)
But many developed countries do have something much better. Notably, Canada. And some others.
If interested, I have researched a bit. (I didn't get all of the details I really wanted, but I got some.)
Since 90% of the non-administrative costs of the program are payed for by the Federal government, I have a contempt for those legislators. They are, to save a relatively small cost, leaving many people who are below 100% of the Federal Poverty Level, and above the dirt poor in both income and assets necessary to qualify for traditional Medicaid, in quite a bad situation that I would really fear to be in myself.
(I know there has been some discussion in various Substack policy places about the knowledge and thinking capacity of many of the citizens. I do wonder how many of them down there in Texas in the Republican base know that the cost of covering those people is 90% borne by the federal government. And I wonder, if they do know, if they have the capacity to assess what the likelihood is of they, their family, or their friends getting stuck without health insurance because of the non-expansion, if certain combinations of non-currently-foreseen events occur in their lives.)
Not sure if you’ve already heard but Aetna is cutting reimbursement rates for therapists and psychiatrists on the behavioral health platform Alma. Just another example of insurance companies screwing over providers and patients (I imagine many of us will get off the Aetna panel as a result)
more evidence we need Medicare for All, thank you Wendell
Thank you for your commitment and work on this.
Wendell, you have hit the nail on the head. When Texas is interested, many will pay attention. Your testimony addresses the main dysfunction; misaligned incentives.
Once every state legislative body starts questioning and request testimony from those that know, we will catalyze a movement for action at both Fed and State.
Great point about how an insurance company "wins." It's that enshittification principle at work in yet another industry.
Medicare for all who want it aka public option.
All of this has been well known (and DOCUMENTED) for years. Yet none of the electeds, on both sides of the aisle, have done anything about it.
I caught a key Paul Krugman policy recommendation shift this past Sunday, for those interested.
Formerly, he had gone with that the ACA is the best we can do, as anything like single-payer is not in the political cards.
He's shifted, not towards full and immediate single payer, but just to adding a government option, with possible gradual expansion towards something like single-payer in an evolutionary, force-no-one-to-give-up-what-they-currently-have kind of way.
I quote from his Sunday post, which was behind a paywall:
"Single-payer isn’t a perfect system, but it is a system that has been run effectively not only abroad but in the United States. While I am by no means dogmatic about this, my view is that the next phase in U.S. health reform should involve an effort to transition away from private insurance to single-payer.
Longtime readers may recall that this was not my position in 2009-10, when Obamacare was being put in place. Nor did I support Bernie Sanders’s call for single-payer in 2016. However, like many and probably most supporters of Obamacare, I backed patchwork rather than comprehensive reform not because I believed that it was the best policy but because I believed that it was the only politically realistic way forward in 2010 and in 2016.
But it’s now 2026, and the political landscape has changed in ways that arguably put fundamental reform in reach."
… [and a bit later in the Krugman post]
"This suggests that an attempt to push people into Medicare-for-all would run afoul of concerns about change.
But it would be much less controversial, I believe, to offer a public option — allowing Americans, including employers providing insurance to their employees, to buy into a Medicare-type system. Many people surely would avail themselves of that option. And if they like what they get, which they probably would, we could transition over time to a single-payer system without forcing Americans into it.
Of course, insurance companies would hate this, and campaign furiously against it. But given their current reputation, this might even help the cause of reform.
Now, I am not offering policy specifics, partly because this post is already long but mostly because this is the point at which we need details from real experts. And I am not at all dogmatic about the path forward.
The main point is, instead, that we are approaching a point at which ambitious healthcare reform, well beyond simply repairing the damage to Obamacare, will be possible. And Democrats should be prepared to rise to the occasion."
--
A thing to note is that his allowed range of change still keeps our hyper-complex current system and ACA and expanded Medicaid, where there are numerous problems, which are often dependent on how each state messes up its administration of expanded Medicaid and the ACA (the latter if it has its own exchange).
So, very slow change. Disappointing. Things may get good, by evolution, eventually. Perhaps in 150 years. (We need a "Cathedral Mentality", more than to have those in stress and fear for themselves now to be able to count on relief.)
Krugman is just a man with an opinion. He has a brain that is adapted to financial security. I will explain that statement in a Substack I'm working on. I'm not referring only to Krugman, but he exists in the world differently than people who must count every penny and struggle to survive. It's time to quit listening to the elites and finally create a government that serves the people.
Thanks. I was away for a few days and missed the article.
As more people die for lack of health insurance and from delayed care due to denials, their families will resolve to see this broken system gone and replaced with a fair system, single-payer universal coverage.
Yes, indeed, Paul Krugman seems to have picked up on a broader discontent than just people not insured, and, if you didn't catch it, he switched his recommendation last Sunday. Not all the way to single payer, to to allowing something like a government option on a non-forced bases, possibly eventually taking us close to single payer.
(I extracted some of his text from his paywalled Sunday post in this other comment on this Healthcare Uncovered post:
https://healthcareuncovered.substack.com/p/texas-republicans-invited-me-to-testify/comment/265634731 )
If you are looking for education & research, hospitals, specialty, clinic, emergency & village/care hotels in the entire USA….choose Passing The Medicare for ALL acts today.
The facts that support your entire argument are eloquently distilled in the quoted excerpts of your presentation. Anyone who reads this should be righteously infuriated!
While we're on the subject of possible change coming from the Democrats (which, of course, cannot possibly start sooner that Jan 2029 based on the need to change the party of both houses of Congress and the president--so, so slow!), I do want to point out one of the numerous things likely to be omitted in the necessary ultra-slow, evolutionary process.
And that is long-term-care/nursing home coverage.
Many people do not know that long-term-care/nursing home coverage is beyond the scope of anything we have in the U.S., except for Medicaid, which requires the family spend down at the full $90,000-$160,000 a year cost of nursing homes, and to then become basically dirt-poor in both income and assets to get Medicaid to pay for nursing homes. (With some exceptions.)
Nursing homes and long-term-care are beyond the scope of the ACA, and beyond the scope of employer and retiree coverage, and beyond the scope of Medicare. It is covered by private long-term-care insurance, which is too expensive for most people, is subject to pre-existing-condition screening, and often has inadequate coverage limits. (About 10% of people over 65 have it.)
The only mention of making it standard in the U.S. context has been Sanders Single Payer.
Long-term-care / nursing home costs have a significant risk of wiping people out financially, even for people with safe health insurance, say from a retiree plan or Medicare plus a Medigap. In some cases, a specialized eldercare lawyer can find a way out of the problem. Sometimes, the only way they can find to get a person whose spouse is in a nursing home out of the problem is a "Medicaid Divorce". (Isn't that lovely? How romantic!)
Anyway, I did a bit of research on this. Not all of the other developed countries have a universal nursing home insurance system. (For example, the U.K. is like the U.S., requiring spend-down first.)
But many developed countries do have something much better. Notably, Canada. And some others.
If interested, I have researched a bit. (I didn't get all of the details I really wanted, but I got some.)
It's here: https://normspier828307.substack.com/p/paying-for-nursing-homes-and-long ,
if you are interested.
wasn’t in Texas where an insurance exec acknowledged in court that his company has private investigators targeting lawmakers?
Well, about those conservative Texas legislators.
Texas is one of about 9 states that have not expanded Medicaid yet.
( https://www.kff.org/medicaid/status-of-state-medicaid-expansion-decisions/ )
Since 90% of the non-administrative costs of the program are payed for by the Federal government, I have a contempt for those legislators. They are, to save a relatively small cost, leaving many people who are below 100% of the Federal Poverty Level, and above the dirt poor in both income and assets necessary to qualify for traditional Medicaid, in quite a bad situation that I would really fear to be in myself.
(I know there has been some discussion in various Substack policy places about the knowledge and thinking capacity of many of the citizens. I do wonder how many of them down there in Texas in the Republican base know that the cost of covering those people is 90% borne by the federal government. And I wonder, if they do know, if they have the capacity to assess what the likelihood is of they, their family, or their friends getting stuck without health insurance because of the non-expansion, if certain combinations of non-currently-foreseen events occur in their lives.)
I hope your testimony did some good for us.
You can testify all you want, but I'm the one that has the only viable solution. You should message me and read this:
https://sentiahealth.substack.com/p/saving-healthcare-putting-all-the