Publications

Health Justice Monitor

Weekly emails from Jim Kahn at health justicemonitor@gmail.com.com

Democracy @ Work

Weekly and monthly blogs from Richard Wolff Ph.D www.democracyatwork.info

“Capitation Payment of ACO REACH Plans Will Sabotage Realizing Equity Access, and Community Health”, July 25, 2022

Insurance Industry “Trojan Horses” in “Single-Payer” Proposals

By Steve Kemble, MD

Many purportedly single-payer bills at both the state and federal level, including Bernie Sanders’ S. 1129 (2019-2020), include features that compromise the principles that would make a single-payer system as cost-effective as it could and should be. We are referring to proposals that contain provisions for Health Maintenance Organizations (HMOs), Accountable Care Organizations (ACOs), and capitated chains of hospitals and doctors referred to as Integrated Delivery Systems (IDSs) and which fail to authorize paying hospitals and other “institutional providers” via budgets.

Optimizing payment of physicians for a single-payer healthcare system

By Stephen Kemble and OPS Policy Working Group. Nov. 29, 2020

The COVID-19 pandemic has caused a sharp drop in health care funding through employment and from state taxes, making consideration of a federally funded single-payer healthcare system for the U.S. more urgent than ever. A federally funded system would be much better positioned to weather economic downturns, and single-payer reform would offer opportunities to reduce the enormous administrative complexity that is a major driver of excess cost in U.S. health care.

Hospital Payment Under Single-Payer Proposals: Payments to Risk-Bearing Entities Versus Budgets for Hospitals

By Stephen Kemble and Kip Sullivan June 20, 2020

The COVID-19 pandemic has exposed the severe flaws in financing health care through employment and state tax revenues, both of which have experienced sharp reductions due to the pandemic. This has stimulated renewed interest in single-payer healthcare financing, but different proposals, at both the federal and state levels, rely on very different policies for paying for hospital care. Achieving savings from a single-payer proposal depends on getting the policy right. One Payer States (OPS) is a single-payer healthcare advocacy group, and this paper is a product of the OPS Policy Working Group.

Principles for Designing a Cost-Effective Single-Payer System

By Stephen Kemble and OPS Policy Working Group. Nov. 29, 2020

U.S. healthcare is the least cost-effective in the developed world, by far, with widespread failures in both access to care and cost control. The COVID-19 pandemic has caused a sharp drop in major sources of health care funding through employment and from state taxes, so consideration of a federally funded single-payer healthcare system for the U.S. is now more urgent than ever. The cost would depend on how it was designed.

The Cost Conundrum

It is spring in McAllen, Texas. The morning sun is warm. The streets are lined with palm trees and pickup trucks. McAllen is in Hidalgo County, which has the lowest household income in the country, but it’s a border town, and a thriving foreign-trade zone has kept the unemployment rate below ten percent. McAllen calls itself the Square Dance Capital of the World. “Lonesome Dove” was set around here.

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A citizen's guide to America's most debated policy-in-waiting

There are few issues as consequential in the lives of Americans as healthcare--and few issues more politically vexing. Every single American will interact with the healthcare system at some point in their lives, and most people will find that interaction less than satisfactory. And yet, for every dollar spent in our economy, 18 cents go to healthcare. So what are we paying for, exactly?

Healthcare policy is notoriously complex, but what Americans want is simple: good healthcare that's easy to use and doesn't break the bank. Polls show that a majority of Americans want the government to provide universal health coverage to all Americans.

What's less clear is how to get there.

Medicare for All is the leading proposal to achieve universal health coverage in America. But what is it exactly? How would it work? More importantly, is it practical or practicable?

Largely privately funded with relatively little public regulation, the United States healthcare system is both expensive and inefficient, providing poor care to large parts of the population.

For decades, Americans have wrestled with how to fix their broken healthcare system. In this razor-sharp contribution to the healthcare debate, leading economist and former adviser to Bernie Sanders Gerald Friedman recommends that we build on what works: a Medicare system that already efficiently provides healthcare for millions of Americans. Rejecting the discredited idea that healthcare should be treated like any other commodity, Friedman shows that healthcare is distinctive and can be best provided only through a universal program of social insurance. Deftly exposing the absurdities of the opponents of reform, Friedman shows in detail how the solution to our health care crisis is staring us in the face: enroll everyone in Medicare to improve the health of all Americans.

This bold and brilliantly argued book is essential reading for anyone who wants to see Congress and the White House act to provide America with a 21st-century healthcare system.

Social Isolation and Loneliness: Imperatives for Health Care in a Post-COVID World

-By Eve Escalante, MSW, LCSW; Robyn L. Golden, MA, LCSW; Diana J. Mason, PhD, RN

The importance of social determinants of health has been gaining traction in the health care sector during the last decade. Social determinants of health have been found to be responsible for 80% to 90% of health outcomes, and an abundance of research has demonstrated that no matter the advancements in medicine and health care, the health of individuals and communities will not improve if these root-cause social factors are not addressed. The coronavirus disease 2019 (COVID-19) pandemic is highlighting one of these factors: social isolation.

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Racial and Ethnic Health Disparities Related to COVID-19

-By Leo Lopez III, MD, MHS; Louis H. Hart III, MD; Mitchell H. Katz, MD

One of the most disturbing aspects of the coronavirus disease 2019 (COVID-19) pandemic in the US is the disproportionate harm that it has caused to historically marginalized groups. Black, Hispanic, and Asian people have substantially higher rates of infection, hospitalization, and death compared with White people.1,2 According to an analysis by the Kaiser Family Foundation and the Epic Health Research Network, based on data from the Epic health record system for 7 million Black patients, 5.1 million Hispanic patients, 1.4 million Asian patients, and 34.1 million White patients, as of July 20, 2020, the hospitalization rates and death rates per 10 000, respectively, were 24.6 and 5.6 for Black patients, 30.4 and 5.6 for Hispanic patients, 15.9 and 4.3 for Asian patients, and 7.4 and 2.3 for White patients.2 American Indian persons living in the US also have been disproportionately affected by COVID-19.1

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Rural-Urban Disparity in Mortality in the US From 1999 to 2019

-By Sarah H. Cross, PhD, MSW, MPH; Robert M. Califf, MD; Haider J. Warraich, MD

The economic, social, and political challenges facing rural areas in the US have implications for the entire country. Even though rural-urban disparities in mortality from such diseases as chronic lung disease and cardiovascular disease have been described, less is known about recent trends in rural-urban differences in age-adjusted mortality rates (AAMRs) overall in the US.

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Time to Rethink Nursing Homes

-By Stuart M. Butler, PhD

Hundreds of thousands of people who are older and disabled live in nursing homes not because they need specialized care or want to live in those facilities, but because Medicaid payment rules make that the only housing with daily living care they can afford. Nursing homes serve 2 quite different populations. One requires short-term post-acute care services. The other is long-stay residents who mostly need only basic daily living care, many of whom would prefer to be living in their own communities and among friends.

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Dying Poor in the US—Disparities in End-of-Life Care

By Melissa W. Wachterman, MD, MPH, MSc; Benjamin D. Sommers, MD, PhD

The coronavirus disease 2019 (COVID-19) pandemic has focused attention on stark disparities in the US, with higher rates of infections and deaths among lower-income populations and communities of color. Illness and death rates are not the only sources of health inequity in this country. There are also substantial differences in the care that patients with serious illnesses receive near the end of life that are based on race or socioeconomic status. Although pandemic-related efforts to improve equity rightfully focus on preventing death, in this and numerous other contexts, policy makers and clinicians should also work to eliminate disparities in end-of-life care.

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Financial Penalties Imposed on Large Pharmaceutical Firms for Illegal Activities

- By Denis G. Arnold, PhD; Oscar Jerome Stewart, PhD; Tammy Beck, PhD

Some pharmaceutical companies have received criticism for engaging in illegal activities, such as providing kickbacks and bribes, knowingly shipping adulterated or contaminated drugs to pharmacies, and marketing drugs for unapproved uses. This study examined financial penalties for illegal activities among large pharmaceutical firms in relation to annual revenues.

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Actions to Transform US Preventive Services Task Force Methods to Mitigate Systemic Racism in Clinical Preventive Services

- By US Preventive Services Task Force

The US Preventive Services Task Force (USPSTF) is an independent body that works to improve health outcomes for all people in the US through evidence-based preventive care recommendations, via a rigorous review of existing evidence assessing the effects of clinical preventive services on peoples’ health and quality of life. The USPSTF adheres to transparent processes that are continually refined to ensure the trustworthiness of recommendations.

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Addressing Racism in Preventive Services: Methods Report to Support the US Preventive Services Task Force

- By Jennifer S. Lin, MD; Lynn Hoffman, MPH; Sarah I. Bean, MPH1; et al

In 2020, following the deaths of George Floyd, Ahmaud Arbery, and Breonna Taylor, the US Preventive Services Task Force (USPSTF) established a Race and Racism work group. This work group issued a values statement for the USPSTF that directly acknowledged that systemic racism prevents many people of color from fully benefiting from their recommended clinical preventive services and also denounced racism in all forms against any group of people. As part of this statement, the USPSTF made commitments to address racism and health equity. In support of these commitments, this methods study was conducted to help the USPSTF understand how racism may be preventing it from achieving its prevention goals and how to evolve the USPSTF reports to more directly address racism and health inequities by race and ethnicity.

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Medical Debt as a Social Determinant of Health

- By Carlos F. Mendes de Leon, PhD; Jennifer J. Griggs, MD, MPH

The profound influence of social determinants of health (the conditions in which people are born, learn, play, work, and age) has become widely recognized and accepted. Recent work on health-related social determinants and risk factors has focused mostly on factors such as poverty and income insecurity, housing and employment instability, and structural racism, and other forms of discrimination. For example, important studies in this area have convincingly demonstrated enormous health and health care inequities for people in the lowest income brackets, for people experiencing homelessness and housing stability, and for those who have inadequate employment and wages.

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• Public Health Advocacy Must be Taught (01/19/2022 )
• FQHC and related primary care workforce issues (3/23/21)
• Improving health among rural residents in the US (3/16/21)
• Crucial questions for us health policy in the next decade 4/13/21)
• Confronting challenges in the US health care system: potential opportunity in a time of crisis (4/15/21)
• Declining life expectancy in the US/the need for social policy as health policy (2/16/21)
• Health care is a right not a privilege (1/19/21)
• Public health messaging in an era of social media (1/19/21)
• The language of health care reform (1/19/21)
• Executive action to expand health services in the Biden administration (1/19/21)
• Financial support of medical schools (4/27/21)
• Diversity in medical schools is a much needed new beginning (1/15/21)
• Prioritizing nutrition security in the US (5/4/21)
• Meeting the challenge of caring for persons living with dementia 5/11/21)
• The medical profession and the public (4/6/21)
• Free med school tuition: will it accomplish its goals? (1/15/19)
• How to make the US health care more equitable and less costly (11/27/18)
• The “public charge” proposal and public health (11/27/18)
• Preventing maltreatment of children (11/27/18)
• Reducing admin waste in the US healthcare system (2/2/21)
• Caring for emergency dept pts with complex medical, behavioral, and social needs 12/27/20)
• Accelerating global improvements in health care quality (12/22/20)
• Trends in differences in health status and health care access and affordability by race and ethnicity in the United States (8/17/21)
• US health care spending by race and ethnicity, 2002-2016 (8/17/21)
• Race and the patient-physician relationship in 2021 (8/17/21)
• Uplifting the Latino population from obscurity to the forefront of health care, public health intervention, and societal presence (8/17/21)
• Toward healing and health equity for Asian American, Native Hawaiian, and pacific islander populations
• Ending structural racism in the US health care system to eliminate health care inequities (8/17/21)
• Salve Lucrum: The Existential Threat of Greed in US Health Care” by Donald Berwick MD PPP Mama February 28, 2023 Vol 329,number 8
• New Federal Plan to Reduce Homelessness by 25% by 2025 includes Health Care as Part of the Solution” by Rita Rubin MA, February 28,2023 Vol 329 Number 8
• UN Reports New Insights on Link Between Climate Change and Human Health” by Melissa Suran PhD MSJ June 21, 2022 Vol 327, Number 23
• Clinician Shortage Exacerbates Pandemic- Fueled ‘Mental Health’ Crisis” by Bridget M Kuehn MSJ June 14, 2022 Vol 327,Number 22
• National Academies: US Nursing Home System Needs Fundamental Overhaul” by Jennifer Abbasi June 7, 2022, Vol 327, Number 21
• WHO: Pandemic Sparked a Push for Global Mental Health Transformation” by Bridget M Kuehn MSJ July 5, 2022 Vol 328, Number 1
• Confronting Health Care’s Climate Crisis Conundrum: the Federal Government as a Catalyst for Change” by Kenneth W Kizer, MDD February 22, 2022 Vol 327, Number 8

• American Health Care is Dying.This Hospital Could Cure It by Ricardo Niula, New York Times, March 9, 2023
• “The Death of American Medical Ideology”, video interview of Eric Reinhart, MD, Medpage Today by Emily Hutto, March 1, 2023
• Doctors Aren’t Burned Out From Overwork. We’re Demoralized by Our Health System” by Eric Reinhart, New York times, February 5, 2023
• Medicine is a Miracle, but Only if You Can Afford It” by Gina Kolata and Francesca Paris, New York Times February 2023
• The Health of Our Nation’s Health Care System is Under Attack”, by Sheldon Jacobson, Sacramento Bee, Nov 4, 2022
• “Voting is a Powerful Tool to Achieve Health Equity in US” by Dr. Laruen Gambril and Dr. Deanna Behrens, Sacramento Bee, November 1, 2022
• “100 Million People in America are Saddled With Health Care Debt” (17 pages) by Noam N. Levey, June 16, 2022
  https://khn.org.news/article/diagnosis-eebt-investigation-100-million-americans-hidden-medial-debt