By Lambert Strether of Corrente.
“A company for carrying on an undertaking of great advantage, but nobody to know what it is.” –Prospectus for a joint stock company in the South Sea Bubble (1720)
About 10 days ago, and shortly after Jeff Bezos, Warren Buffet, and Jamie Dimon launched their health care undertaking, a bipartisan group fronted by former CMS administrator and #SaveTheACA hashtag activist Andy Slavitt launched their own undertaking: the United States of Care, “a new non-partisan non-profit, we are building and mobilizing a movement to achieve long-lasting solutions that make health care better for everyone.”[1] (I’m going to use their Twitter handle, @USofCare, for the remainder of this piece.) FAIR describes the launch. The headline:
Media Embrace New ‘Reform’ Group as Bulwark Against Guaranteed Healthcare
(At least on the Twitter, the instant reaction from many was more precise: A “bulwark” against #MedicareForAll, as opposed to the more generic “guaranteed healthcare.”) More:
Andy Slavitt, former head of the Centers for Medicare and Medicaid Services in the Obama administration, pro–Affordable Care Act activist, announced the creation of the USoC in an opinion piece for USA Today (2/6/18). Slavitt also has a long resume in the private sector: He was the founder of healthcare tech startup investor HealthAllies, a former UnitedHealth Group executive, a Goldman Sachs investment banker and a consultant for McKinsey & Co. The group also received a write-up in Axios (2/6/18) as well as a glowing profile from Bloomberg (2/6/18), which played up the group’s interest in promoting an “opening for bipartisan policy-making.”
(We will look in more detail at Slavitt’s “long resume in the private sector” tomorrow.) And more:
Neither the USA Today piece, the Forbes piece nor the United States of Care website mentions single-payer, Medicare for All or anything related to government-guaranteed universal healthcare. The Bloomberg write-up mentioned Sanders’ Medicare for All bill in the context of USoC’s hope of “heading off increasingly volatile swings in health policy when political fortunes shift in Washington.”
Well, that’s certainly a curious omission![2] In this piece, I will take a look at Slavitt’s undertaking, @USofCare. Should we be wary of it? Does it really oppose #MedicareForAll? And what can we expect from any solutions it provides? I’ll answer the first two questions today, and the seond question tomorrow.
Should We be Wary of @USofCare?
By “we,” I mean citizens generally, but particularly #MedicareForAll advocates, as I am. And the answer is “Yes,” for at least two reasons.
1. Undisclosed funding. Slavitt was beaten up pretty bad on the Twitter for not disclosing minor details like who was funding his undertaking, and so after a few days @USofCare emitted a FAQ. Here is their section on funding:
Who are your funders?
Our funders are individuals and non-profit health care organizations including not-for-profit charity hospitals and foundations.
We have not and will not accept funding from trade associations, PACs, insurance companies, or for-profit corporations.
So, funding has been or may be provided by high net-worth individuals — perhaps Bezos, Buffett, or Dimon? — or laundered through a foundation. Since @USofCare does not name its donors, I hardly find this reassuring.
2. The composition of the board. @UsOfCare’s 50-member “Board of Directors & Founder’s Council” is described by PNHP (an actual “movement,” by the way):
In establishing this organization, Andy Slavitt says that we must put “health care over politics.” Yet the several politicians involved are either Republicans (majority) or conservative neo-liberal Democrats (minority). The 52 members of the Founder’s Council… include many strong supporters of the Affordable Care Act. There are many representatives of the health care industry. There are many outspoken opponents to single payer reform, aka Medicare for all. Yet there is not one individual who has taken a prominent stance in favor of single payer, even though a majority of Americans do support Medicare for All.
Does @USofCare Oppose Medicare for All?
Opinions differ, on the @USofCare site and among founders. The FAQ says No:
Does United States of Care oppose single payer or Medicare for All?
[A]No.
[B]United States of Care will identify, evaluate, and provide support for policies that meet our principles: affordable care for all Americans that protects against financial devastation. Our priority is to engage the public for a range of solutions.
(I have helpfully labled the “No” part [A], and the “But yes, really” part [B]. However, the Mission Statement — at least in my translation of the bafflegab — says Yes:
The mission of United States of Care is to ensure that every single American has access to quality, affordable health care regardless of health status, social need, or income.
The key word to watch for is “access.” Access implies a gatekeeper, and a gatekeeper implies eligibility determination, especially means-testing.[3] Ask yourself: Do you want access to care, or do you want care? And the second word is like it: “Affordable.” That means you pay. Ergo, @USofCare is opposed to #MedicareForAll — at least NHS-style “free at the point of care” Medicare, a Medicare cleansed of its current neoliberal infestation — and the FAQ and the Mission Statement contradict each other.
One @USofCare founder, Bill First, introduced a bill to privatize Medicare. But a Board member, Former Obama speechwriter Jon Favreau says No:
I’m a #MedicareForAll advocate. I also want to make sure there’s a path to get there, which involves building a movement and persuading people who don’t currently agree.
— Jon Favreau (@jonfavs) February 6, 2018
(Consistent with the murky public commitments of the entire undertaking, I’ve been unable to find any public statement where Favreau acts as a #MedicareForAll advocate other than this one tweet, and I have looked True, Google search has been crapified, but you’d think an Op-Ed or an interview would crop up. Perhaps his advocacy was during a vow of silence? Or performed in mime? Taking Favreau at his word, it would be interesting to know when, exactly, his Damascene conversion took place. And why.)
And finally, we come not one but two interviews with @USofCare Board Chair Andy Slavitt. whose views on #MedicareForAll are so awe-inspiringly prolix that I cannot bring myself to edit them down — not because they’d lose any flavor, but because of the sheer volume and the sheer effrontery of their evasiveness convey the message — and so have adopted special formatting.
The first interview is by Gregory Krieg of CNN, who does a commendable job trying to nail Our Andy’s Jello to the wall:
KRIEG: Why not then put this energy and these resources behind some of the movements that are already out there? “Medicare for all” obviously now has traction with Senate Democrats, as do other less comprehensive plans. There are a lot of people already out there trying to create a new narrative, in favor of expanding care. Why not put your influence and, maybe, money behind them?
SLAVITT: One of the questions (being asked by critics) is about me personally and, you know, I personally am not changing. I don’t expect that my views or my activities personally around making sure that we’re fighting to get better health care for more people changes. And I don’t expect other people who are affiliated with the organization or part of sponsoring it to change their activities, whether they agree with me or disagree with me.
But we have to do something over the long term in addition to make sure that we’re not having this war forever. The question is how do we do that? And there’s no guarantees that it’ll ever happen. But what is clear to me, and I think a number of other people, is if we don’t take down the temperature of the debate, then, the next time we go at doing this, we’re still going to be more and more divisive.
So I think there is room for us in the debate to focus on both what needs to happen now and over the next couple years — which is, as you point out, there are a number of organizations that are well-suited for that and some of which I’m affiliated with and will continue to be affiliated with — but also for there to be a movement that’s a little bit longer term that changes the equation. Think about big changes that have happened in the country, (like) marriage equality. That didn’t start the year before laws were changed. That started decades before laws were changed. There needs to be a movement and effort to establish successful change that occurs beyond just the current year.
I think this is an organization that has an opportunity, if done right, to make a difference in the long-term debate even while people are working on these very challenging issues in the near term.
Kireg tries again:
KRIEG: To be clear, though, you were speaking to Modern Healthcare about this, and you’re quoted as saying, “We believe every single American should have access to basic, affordable care. But we avoid using language like universal coverage that is polarizing. We want to bring people together, and certain words are used by one party or another to create divides.” So, asking as directly possible: Do you support or oppose single-payer health care?
SLAVITT: Do I personally?
KRIEG: Yes.
SLAVITT: I would personally love to be in a world where we have, once and for all, given every American health care, and that’s certainly one way to do it. So, to that extent, the answer is yes.
KRIEG: OK, but how do you feel, not personally now, but as an activist or political actor?
SLAVITT: What I believe is that there are a number of ideas, including new ideas, that are going to be necessary to get to where we want to get. I believe that it’s going to take a number of years from where we are today, so for someone who believes in single-payer, “Medicare for all,” I hope that you can also be for other things that are good for people in the meantime, and that those things might even build the ability to get there[4].
I also believe that there are lots of approaches, because there’s not even one ready bill[5]; it’s not like there’s a bill that’s ready that can do everything because the Medicare program, of course, is designed for seniors. It’s not designed for younger people, low-income people, etc. So there’s a lot of un-sexy dirty work that has to happen, to make these policies work, to get public support for them. To vet them, to drive them.
So if you look at the three principles of (USoC), they include anything that can get people access to the coverage they need, the care they need, protect them from bankruptcy and do it in a way that can be lasting from an economic and political standpoint. That absolutely includes single-payer and it includes other ideas that are either currently formed or that need to be formed.
Forgive me, again, for quoting Slavitt at length, but you see what we’re dealing with here. And a second interview, even more revealing. This one is from the HealthChangers podcast by Cambia Health Solutions. I have used the same formatting convention is above. This is all Slavitt:
SLAVITT: I was on a right-wing radio program the other day, with a right-wing radio host. This is how he describes himself, so not being disparaging in any way. He says to me during a commercial break, “I’m for single payer.” He said. “I’m so sick of this.” He said, “Now that I know, all of the hands in the pot, all that stuff, screw it. I’m just for single payer,” he said. “And I’m about as right wing as you’re going to find.”
Let me break in for one moment here. Imagine how Sanders would have seized that moment (which, let me remind you, is about as bipartisan as you can get). Now let’s listen while “Jello Andy” emits a voluminous stream of baffegab:
SLAVITT: Something else always sounds better when we’re looking at the problem we’re looking at now.
Hoo boy. “Single payer,” “grass is greener,” ho hum, yadda yadda yadda.
Okay. So, so, let’s just be little bit sober by the fact, and I always think it’s good to remind people that we have to find a way to pay for the things we want, and that may change people’s minds. “Do you like single payer and this tax increase?” I think that’s a fair thing to ask people, but here’s the opportunity. Here’s what I like to see happen, I’d like over the next five to seven years, because I think it’s going to be that long before having that happen at the actual level, two things happen.
One is, at the state level we really try it out[6].We have a Medicaid buy-in opportunity in Nevada. The Governor almost signed, with some more real work with hospitals and others, possibly that could happen, it could happen somewhere else. So, we should try some experiments. See what happens. Stage level, I think we’re stage four.
The second thing is to get to a language that unites us around making how we think about health care in a universal way, rather than divides us. We ought to be smart about it, if we really want it. We ought to be having a dialogue about what it is we want. About what those trade-offs are, and what that language is, and what is it that we have a right to.
I would say we have a right to a regular source of care, and to not go bankrupt when we get sick. I don’t think we all have a right to every heart and lung surgeon, but I think there’s something we do have a right to. I think that’s the conversation that we let play out over the country. We should leave Washington the heck out of it, and then at some point in time, after we make some progress at the state level, the people who really care about this issue really want to see progress, we maybe will have built the foundation to do something more.
Quality work. And if this is “the language that unites us” (granted, for some definition of “us”) please kill me now. But to answer the question posed by this section, at the very best, and ladeling on great gobs of assumed good faith, Andy’s prayer is a lot like Saint Augustine’s: “Lord, give me #MedicareForAll — but not yet!”
What Can We Expect from @USofCare Solutions?
I’m putting this here as a placeholder for the post I’ll write tomorrow. I’ll argue that the three requirements I outlined for the Bezos, Buffett and Dimon undertaking also apply to any solution emanating from @USofCare. to review, those requirements are for:
- Accounting control fraud
- Financial predation
- Abuse workforce
to those three I will add a fourth:
- Conflict of interest
Conclusionse
@USofCare’s big idea is right on the its splash page:
Let’s change the conversation and put health care over politics.
Holy moley. Splinter News has a fine response:
The multi-payer for-profit model of private insurance has had fifty years to address these questions, and the results speak for themselves
Let me reiterate the table stakes. Among so-called “developed” countries, America is the most dangerous place to be sick. America is the most dangerous place to be black. America is the most dangerous place to be pregnant—with the highest maternal mortality rate of any comparably wealthy nation, of which 60% are easily preventable. America is the most dangerous place to be a woman; to be trans; to be disabled; to be elderly; to be poor.
Last year, life expectancy at birth fell for the first time in almost 30 years by a tenth of a year. Across the four million people born last year, that constitutes a theft of 400,000 years. And I do mean theft—because the wealthy men in America get to live fifteen years longer than poor men; wealthy women, ten years longer than poor women.
Their solution, though—to try to place the heathcare battle above partisan politics—makes no sense. It makes no sense because the fight for universal care is a fight against a powerful cadre that opposes that goal.
USC envisions a world in which healthcare is fought for and won by technocrats, a small corpus of the benevolent and powerful. These are the same people who have, through pre-concession, lost any battle they’ve focus-grouped their way into meekly accepting over the past thirty years.
Anyhow, it’s ridiculous to think that Slavitt doesn’t practice health care politics. We’ve seen them, right in this post. They look like this. A voice as hushed as any undertakers…
NOTES
[1] Stoller comments:
I was having trouble keeping track, so it was thoughtful of @ASlavitt to create a list of all the various stereotypes of cloying out of touch elites and put them in one organization. https://t.co/i5oQ6vm4ur
— Matt Stoller (@matthewstoller) February 7, 2018
[2] I’d been wondering why Slavitt, in all his Twitter work on #SaveTheACA, never endorsed Medicare for All — a search on “#MedicareForAll AND from:@ASlavitt” yields zero hits, so he’s really been quite disciplined — so perhaps I have my answer. Slavitt is an interesing figure, and I’ve only begun to disentangle his Flexian network. See this excellent long-form piece by Kam Sandhu of Real Media in the UK; it looks to me, for example, like Slavitt’s cohorts from his United Heatlhcare days are helping the neoliberal effort to gut the NHS on the other side of the pond. I also need to reviisit both the ObamaCare backend and medical coding, two areas with which Slavitt has been intimately involved for most of his career.
[3] Access is also a Jobs Guarantee for the credentialled professionals who determine who goes to HappyVille, and who goes to Pain City, what is “affordable,” and so and so forth.
[4] If this is what Slavitt believes, his hash-tag activism with #SaveTheACA did not reflect it; see note [2].
[5] Sadly, Slavitt commits a terminological inexactitude: The House bill is H.R. 676; the Senate bill is S. 1804.
[6] It’s obviously very important to #MedicareForAll opponents that the currency issuer not implement the program. That way, when there’s a downtown, states will be forced to cut spending on it, and they can then argue the program is a failure.
52 comments
Comments are closed.
This list of jobs he has held says it all, the new company is the same as the old company. Greed not health care. $$$$$$$$$$$$$$$$
Bezos has long experience in operating a non-profit commercial enterprise.
Not so true is you consider the tax advantages of no dividends and Amazon’s stock price.
One could content the stock prices indicate the benefits of “retained dividends.”
Thank you.
As per http://www.bbc.co.uk/news/health-24635890, United Health supplied the UK’s National Health Service with its current CEO. The BBC does not mention that the CEO is a friend of Boris Johnson. The brief references to Alan Milburn and Tony Blair minimises the predations inflicted on the NHS by that neo-liberal trio.
Slavitt’s background likewise says it all about Obama’s thoughts and intentions appointing him to head our nations’s Medicare and Medicaid Services.
Slavitt:
No, this cannot be a “dialogue” because the terms of reference have been predecided. The frame is set as how to provide ”access” to “basic healthcare” on an “affordable” basis. That’s three big constraints imposed right from the get-go.
Yes, “affordable access” is one heck of a tell. Just give me the darned healthcare.
What it is we want:
“OK, do people want an antibiotic for $2, or an antibiotic for $400? Quick, assemble a focus group of consultants! We’ll get to the bottom of this!”
I am so effing sick of a “dialogue” and a “conversation.” Watched the Obama/Letterman interview last night and it was truly amazing to hear the master spin nice words together so nicely into nothing concrete at all. Sick of it.
it’s a dialogue, a bunch of us and a bunch of billionaires, no power imbalance or anything at all, just a dialogue.
For around a decade, Representative Mitch Greenlick in Oregon has been trying to send a referendum to voters to weigh in on health care as a fundamental right. If it passes this short session, it will go to the voters this fall.
Note the same buzz words in its current form, HJR 203, which states: It is the obligation of the state to ensure that every resident of Oregon has access to cost-effective, medically appropriate and affordable health care as a fundamental right.
Newly appointed Representative Andrea Salinas is chairing a Universal Access to Care work group that convenes monthly until fall, just as we are to vote on the referendum (should it pass the legislature this time). Rep. Salinas worked as a lobbyist prior to this appointment, representing SEIU, an environmental group, NARAL… and #1 PBM Express Scripts.
The work group is dedicated to the goal of “incremental” improvement of the healthcare system to make it fairer and more cost-effective.” The work group builds upon an analysis by the RAND Corporation which concluded that Single Payer and the Health Care Ingenuity Plan are the most promising options to achieve universal health care in Oregon. The latter plan would use means based cost-sharing and premiums and would not eliminate employer-sponsored health care.
Are these just rope-a-dope tactics of the Democratic Party of Oregon? Agitate the base with neoliberal platitudes that at best create Obamacare 2.0 and at worst distract single payer activists from their intended goal and wastes a lot of money.
“Politics” is how a “democracy” resolves serious issues regarding rights and resources. To say you are putting healthcare “above politics” just means you aren’t serious…..
Yes. It means we citizens should have no voice, as citizens, in the outcome. Our only voice “above politics” is reduced to the voice of consumers, the voice of “the market”. And trusting the “market” for health care is how we got into this predicament.
Buffett has previously stated that he favors single payer as a means of controlling costs, promoting international competitiveness, and one might hope, on humanitarian grounds as well. At the same time he admits that healthcare is outside his area of expertise.
https://www.realclearpolitics.com/video/2017/06/27/warren_buffett_single-payer_health_care_probably_is_the_best_system.html
Healthcare may be outside his expertise.
Money is not.
I think I am starting to get a handle on Slavitt. I read the CNN interview when it came out. If you pay attention to the arguments he raises and not his ‘conclusion’ I think his position on Medicare For All/single payer is clear. Count the objections and problems he raises on one hand and the benefits on the other, and see which one runs out of fingers first.
I believe this paragraph is the key (emphasis mine):
So there you have it. Andy stands with the private sector, and against government involvement in healthcare (“we need to put health care ahead of politics”). His job is to present a credible view of the future in which people can have affordable, high quality health care delivered by a private sector-dominated industry, an outcome that is spectacularly at odds with recent history and current reality. To sell us on this fairy tale he needs to lay out a road map (hence the large volume of Clintonian waffle), explain how things got so horrible in the first place, and preemptively discredit any possible public sector alternatives. Fortunately one strategy can easily cover both #2 and #3. It’s the damn government! They can never agree on anything! You can’t count on them to get anything done because the other party will just get in and reverse it all! We need to get the politicians out of the way and let the private sector do their thing, because they really, really want to help you. Honest!
I think it will probably go down about as well as it did during the Clinton campaign. People out there are hurting, and the likes of Sanders are telling them: better systems exist and have been proven to work in other countries. They are affordable and deliver high quality care, and the only thing stopping you from having them is political will. Contrast that with Slavitt’s “let’s have a conversation and then maybe in five to seven years we’ll figure out what we want.” I know which one would appeal to me as a voter.
Given that the distinction between dominant elements of the private sector and the gubmint being largely nonexistent, Slavitt’s assertion rather absurd. It is not impossible that what we are witnessing is the further development of a conflict between major private sector players who covet some of healthcare’s fat slice of the gdp pie. Buffett has said as much in his pro-single payer utterances.
Yes, there is a certain amount of chutzpah in portraying the government as hopelessly corrupt and conflicted when you (i.e. large business actors in the private healthcare sector) have been the primary party responsible for corrupting and conflicting it. But they don’t have a lot of choice. Unless they portray the current situation as due to external parties or forces beyond their control, then it means that, at best, the problem is within their scope to resolve and they’ve failed to do it, or even prevent it from getting worse. At worst the system is functioning exactly as they’ve designed it and they are profiting from the unnecessary suffering and death of millions of Americans. Good luck convincing anyone to own up to that.
I do think it is an indication that the private sector has recognized that things have become sufficiently bad that a government sector alternative (e.g. Medicare For All) is becoming an existential threat to the insurance-based care model, and this is an attempt to head that off and protect their turf.
Employer-provided health care insurance is probably the area of healthcare with the least government involvement with it of the various health care coverages. The biggest and best private sector companies are major providers of this type of coverage with generally comprehensive insurance coverage.
Yet, this private sector coverage has been utterly unable to crack the nut of exorbitant health care costs. They can negotiate with every part of of the health care system, including pharmaceuticals, but have been utterly incapable of managing these costs.
So I continue to be utterly baffled about how the private sector is going to suddenly magically solve a problem it has been completely unable to address over the past several decades. There are some health care systems in Europe etc. that have significant private components, but it appears that our private sector doesn’t view those models as appropriate to be learned from.
Heh, I’ve written about this snake in detail for years, following all the years through his dirty algo deeds with United Healthcare, when he was the CEO of Ingenix, for goodness sakes. All of the folks in healthcare with the technology side, we all know he’s a snake. I’ve been calling him the Algo Man for years. All those models CMS runs, came right from United Healthcare folks. He was in there snaking around years before he got the acting director of CMS job and we all just about choked when Obama gave him that job. I have former CMS employees that were choking on it. He and Senator Warren’s daughter, Amelia, started one of the early PBM discount rackets with HealthAllies, and United Healthcare bought it and hired him after that.
I don’t want to be out of line and leave any links here but I have tons of post on his garbage over the years. Funny mention of Matt above as I was tweeting to him about the private equity interests Slavitt has going as well. I do all I can to keep the ghosts of Ingenix alive, where he did a ton of modeling damaged that benefited United Healthcare, not the doctors or the patients, again we all know he’s a snake. This looks like a part of his elevated reputation restore efforts with this non profit gig thing.
You don’t beat the crap out of doctors and patients and then later turn around and try to put across some fake perception that you are the big savior, that’s what makes even more hideous. How many more ways can you model capitation healthcare? I guess he has 9 algo lives to keep trying to make happen even more wide spread.
I can’t speak for this sites operators but maybe you could submit a guest post on a topic about which you have knowledge as it relates to public policy and private financial interests.
Ok I can make that task very easy without using any links, go to the Medical Quack, use that Google search bar and look for Andy Slavitt, Ingenix, United Healthcare and you’ll find a goldmine of past events. I’ve been doing it for over 8 years and now only post something every great once in a while. You can find the video of the talk I did last year at the big AAPS doctor’s convention, jaws dropped and I couldn’t answer enough questions as it brought the doctors out of the dark with what they have been told and I educated them on the PBM business they didn’t quite understand. I’m not trying to toot a horn here, but nobody talks the truth and that’s what I did, history, scoring algorithms and how you denied access and money. I used to write software in healthcare and so I can tell you the mechanics of it in hopefully the best laymans terms I could think of on how to present it. Major media only touches on the technology and constant scoring that takes place to score you right out of benefits, black boxes of the healthcare business that nobody talks much about. Most can’t go there with facts as they have written code and can’t get the down and dirty out there for folks and healthcare are the big advertisers that keep major media going so yes, it’s filtered quite a bit.
Thank you for your efforts and insights. I hope many here take you up on your invitation. Not, of course, that being well schooled in how us mopes are being screwed over by the structures we both work for (in many cases) and pay to build, is likely to be sufficient to catalyze any change for what one might think of as “better…”
This is really interesting detail, thanks!
You’re welcome, I tweeted the link out to this post as well so those who follow me can read as well, we appreciate anything that calls a snake (Slavitt) a snake:) I’ve been calling him the Algo Man of Healthcare for years, that’s all he does is promote scoring algorithms..a lot doctors already see through him as well as a lot of their tedious data entry and scoring by CMS is all his doing with all those models he got CMS to suck in from UNH for years.
“calls a snake a snake…”
A snake on a high wire ? Reminds me of this:
https://boingboing.net/2018/02/17/snake-climbs-a-thin-wire-fence.html
Andy Slavitt is a real piece of work.
If Congress pays for it, Congress will micromanage it. There is no other funding source. And Congress is what Congress does. It isn’t a box of chocolates.
This interviewee is extremely inarticulate.
1. We do not need organizations to frame a debate on healthcare.
2. If we did need organizations to frame debate for us?! that organization should not be affiliated with one who is obtuse and, apparently, illiterate, not to mention incredibly disingenuous. Meaning, if I cannot understand what point(s) he is trying to make perhaps no one else will be able to, either.
3. I understand this much from this interview: Grifters gotta grift. And no one can grift quite like those who run “healthcare” in these United States.
Lambert is, as usual, right about the “access” to healthcare. Medicare for All. Nothing less will do.
If it looks like a scam, swims like a scam, and quacks like a scam, then it probably is a scam, or a duck, or a con, or a shill. Does it matter?
ACA deserves to expire because it is just another insurance hustle – Hillarycare reborn. It is micromanagy for no useful purpose, and still screws people.
We have ample knowledge of Medicare, and it seems to work rather well – especially with co-insurance for those with means (personal experience). All Medicare would need would be a bigger building, outside the Beltway, say in Chicago or St. Louis – a half-day commute from DC.
Lambert, just above the Kelsey Stefanson tweet, shouldn’t the reference be to Bill Frist, not First?
Follow the money.
1. Any member of the Frist (Health Corporation of America) family should not run or consult with any public health initiative.
2. Mark Cuban – Board member – Libertarian (oh that’s going to work well with access to healthcare //$sarc)
3. Trevor Fetter, former president and CEO of Dallas-based Tenet Healthcare, made eight figures, as his total compensation in fiscal year 2012 exceeded $11.24 million, according to a proxy disclosure filed with the U.S. Securities and Exchange Commission. (He was in charge of the Tenet run hospital during Hurricane Katrina. Please read about the nightmare it cause… https://en.wikipedia.org/wiki/Memorial_Medical_Center_and_Hurricane_Katrina)
4. Emily Barson – Executive Director – She said that state-level policy models will be key to shaping the new organization’s approach. The partisan gridlock at the federal level made the opportunity particularly appealing. In her time at HHS, she said she “had a chance to work with a lot of state governments and governors and mayors, and I really appreciated the work that was happening outside of Washington.” (State level approach doesn’t sound like single payer)
http://www.hcanews.com/news/what-will-andy-slavitts-allstar-health-organization-do
More crapification blab blab blab
“The health of our nation is more important than any political party or partisan victory. United States of Care will chart a path toward a long-term health care solution, starting by checking allegiances at the door and putting the patient – our citizens – first”
– William H. Frist, M.D.
Former United States Senate Majority Leader from Tennessee
(I’m sure charting a big old path into the sqillionaire’s pockets, don’t you know //$sarc)
HCA Wm. Frist Family
Quoted from Wikipedia – https://en.wikipedia.org /wiki/Hospital_Corporation_of_America
In 2006, Kohlberg Kravis Roberts and Bain Capital, together with Merrill Lynch and the Frist family (which had founded the company) completed a $33.6 billion acquisition, making the company privately held again, 17 years after it had first been taken private in a management buyout. At the time of its announcement, the HCA buyout was the first of several to set new records for the largest, eclipsing the 1989 buyout of RJR Nabisco. It would later be surpassed by the buyouts of Equity Office Properties and TXU.[8]
In May 2010, HCA announced that the corporation would once again go public with an expected $4.6-billion IPO. In March 2011, HCA sold 126.2 million shares for $30 each, raising about $3.79 billion, at that time, the largest private-equity backed IPO in U.S. history.
United States of Care. It’s a circuit-breaker. It’s meant to short out any solid movement for #MedicareForAll. I’m guessing that the method will be to constantly argue about what is affordable, what is doable and ignore the fact that it is trying to reinvent the wheel when all that is necessary is to import a working model from a country that is doing it successfully and modify it to local conditions. In fact, there is nothing stopping #MedicareForAll from designing it right now so that they have a solid target.
As to how this Slavitt bloke would go about doing things. I would say that he wants to be the one ‘negotiating’ with the health insurance companies for what will get passed. In doing so, he would adopt the Obama method of negotiating. I will use a gridiron analogy to explain how that would work. Two football teams line up against each other at the commencement of a game. The captain of one team then picks up the ball, and then walks it back to his OWN team’s 5 yard line and then shouts ‘Play ball!’
“It’s meant to short out any solid movement for Medicare for All.”
Exactly. From the above article:
Slavitt: “But what is clear to me, and I think a number of other people, is if we don’t take down the temperature of the debate, then, the next time we go at doing this, we’re still going to be more and more divisive.”
Translation: People are pissed and Medicare for all is gaining too much traction, so we are going to have to hyjack the debate.
Slavitt: “Think about big changes that have happened in the country, (like) marriage equality. That didn’t start the year before laws were changed. That started decades before laws were changed. There needs to be a movement and effort to establish successful change that occurs beyond just the current year.”
Translation: We effed up on marriage equality, but it’s still early enough to hyjack Medicare for all by putting out our own ideas, and then calling THAT the “movement”.
Slavitt: “So if you look at the three principles of (USoC), they include anything that can get people access to the coverage they need, the care they need, protect them from bankruptcy and do it in a way that can be lasting from an economic and political standpoint. That absolutely includes single-payer and it includes other ideas that are either currently formed or that need to be formed.”
Translation: We don’t really have any ideas. We just know we need to dream up new ways to make our current system sound inclusive or Medicare for all will get out of hand.
“Undertaking” seems an ironic term for this . . . whatever it really is. Heh.
“The smart way to keep people passive and obedient is to strictly limit the spectrum of acceptable opinion, but allow very lively debate within that spectrum.” — Noam Chomsky
“Health satus or income”; why include “social need” except as an explicit means test?
RE age exclusion in 42 U.S. Code § 1395y for anyone younger than 65. Am I a simpleton to think it is NOT rocket science to scratch that out and be done with it? End of discussion and USoC can bugger off. Seriously I would love to hear a detailed plan to get M4A enacted.
Medicare has been seriously crapified. Extending it to everybody would be better than nothing, but it seriously needs improvement first.
This retired nurse and Medicare “beneficiary” strongly seconds OC’s view. Privatizing and crapifying everywhere you look. OTOH, how the heck does one build a “Medicare for All” that actually serves the purpose, over time, of providing actual uncrapified health care (as opposed to “access” to a “system?” The fix is so completely in, all the incentives and mind tricks and preconditions that have turned the existing need and structure into just another “public function” carcass to be bled and eaten by the sociopaths among us, that one has to wonder how such a miracle could be accomplished.
Tuning in today to NC, for my daily ration of “stories” that reinforce one’s sense that futility and futilitarianism are the watchword and only intelligent religion for a sensate human…
Amazing that Slavitt would dare to compare his hilariously bogus efforts to the fight for marriage equality, which was a radical, uncompromising, audacious fight that won in the face of ferocious and sustained opposition by staking out a position and not backing down ever. If Slavitt and his absurd crew of opportunistic do-nothings had been in charge of that, we’d still have gay couples wearing suits to sedate Pride marches and begging hostile church ladies for a plate of cookies.
…it helped that in the “marriage equality” fight, there were a lot of Fifth Columnists among the “conservatives” (Dick[less] Cheney’s daughter?) who were on board with the “left.” As is the case with marijuana “initiatives—“ a whole lot of “conservatives,” and a whole lot of “deplorables” for that matter, love them their tokes and giggles.
“Of course,” observed the conservative wag, “I very much favor marriage equality. The LGBTQ population should have the same opportunities to be miserable as the rest of us.”
I was struck by this statement from Slaviff: . About what those trade-offs are, and what that language is, and what is it that we have a right to.
My understanding is that one enters into negotiations with a certain set of demands. If you enter into those negotiations beforehand on what you are willing to “trade-off” then it means you have abandoned those demands. At that point you are willing to do some more “trade” offs”. That, almost by definition, means you have abandoned single payer health care. I guess that is the meaning that these negotiations are “above politics”. “Do not enter here unless you are willing to abandon politics.”
Thanks for this Lambert. This Slavitt character is not our ally but is our enemy.
The usual DC bipartisan WaPo-swooning police-the-debate nonsense. .
Separately “health care above politics”, Slavitt also says “keep Washington out of it” and make some progress at the state level first. Sounds great, but the legal hurdles to state-level single payer are daunting (not that they’re not worth attempting to surmount).
Set single payer aside for a second and here’s a test for Slavitt. The most powerful state regulatory body in the country is Maryland’s Health Services Cost Review Commission, which sets hospital rates (now including outpatient rates, which means a significant percentage of physician office services too), under a waiver from Medicare.
Progressive advocates are trying to bring pharmaceutical prices under the purview of the Commission, which would make Maryland the first state to have any real regulatory power over drug prices. Session ends in early April. C’mon Andy, help us “make progress” at the state level!
I’m always wary when I hear of a “bipartisan” initiative. With rare exceptions like the failed Amash-Conyers Amendment, the term is a tell for a corporatist or neoconservative (or both) plan. [1].
Ditto for “public-private partnership,” which is often a euphemism for legalized theft.
[1] https://en.wikipedia.org/wiki/Amash-Conyers_Amendment
When I saw that fabulous example of concern trolling, it became obvious that that the Big Pharma/Medical/Insurance/Dark-Age healthcare pimps with their sycophantic weasels were at work.
The ability to get good medical care whenever you need it regardless of circumstance without fear of becoming destitute and homeless just might be the single most positive consequential action we could do. We all go crazy over drugs, guns, police, corruption, and so on, but I think, with the possible exception of homelessness, lack of medical care kills more people than all the cars, guns, and opioids deaths combined each year. It rather makes me angry.
We already got “universal COVERAGE,” if one takes that to mean that there’s an “
inUNsurance product” that is “available” to anyone. All one has to have is the money to pay the premiums to the “carrierscarrion-eaters” that “provide coverage.” At the top end of “rated policies,” for people with pre-existing conditions or ever more frequently the chance they might develop various illnesses and diseases, that premium might equal the entire cost of service, plus a little for profit, but at least one would have an “inUNsurance Card” to present to the hard-faced “intake person” at the front desk of the “providing facility,” where the first question, after “name?”, is always “what UNsurance do you have?”UNsurance, because you are UNsure whether your doctor will be “in network” tomorrow or next week. UNsure, because your meds may be “off formulary” or “elevated tier” tomorrow or later today. UNsure what your premium and deductibles and co-pays will be, moment to moment, or whether, as the “system’ gets gamed by the death of a thousand cuts, you will be dropped or denied coverage for specious reasons. And on and on, add your own experiences with UNsurance if you can stand to revisit the pain…
Us mopes don’t need “coverage,” we need HEALTH CARE and universal provision of treatment. Of course, getting there is about as easy a task as Indiana Jones had, trying to penetrate that Mayan tunnel loaded with booby traps and pitfalls, to grab the Golden Idol in the first movie in the franchise. And then, of course, there’s that evil sociopath Rene Belloq on hand, to grab the idol for himself… “Once again, Mr. Jones, it appears there is nothing you can obtain that I cannot take from you…”
The quality of health care politics coverage on this site by Lambert, and in many comments, compels me to make another donation.
Thank you!
Lambert highlights the word “affordable” in Slavitt’s ramblings. It’s become such a commonplace that it slips by without comment, but what does this really mean?
Certainly the implication is that the end user is going to be out of pocket at the point of use (the alternative is invariably and pejoratively described as “free”, as in the dreaded “free stuff”, even when it’s financed by taxpayers).
Paying something at time of use may not objectionable in principle but “affordable” means vastly different things to different people. If you have literally no money, even $1 can be unaffordable. If you’re Jeff Bezos, $10 billion would be affordable. Affordability can also vary by time: if you’re employed in January but laid off in June, affordability will vary wildly for you during the year. And of course, “affordable” can itself mean different things: from (a) you can easily pay for it with what you have in your wallet, to (b) it’s slightly less than your total net worth.
So the very term “affordable” is meaningless in any concrete context even if you subscribe to the belief that something good comes out of cost sharing.
(BTW, this has also been the problem with the neoliberal fixation on “co-pays” for health care services. $20 or $50 will only be a slight obstacle to some, but equal to the entire week’s food budget for others. The simpleton idea that there is some fixed dollar amount that serves as a desired incentive only works if all the players have the same amount of money. And maybe not even then.)
You needn’t go past the name of Bill Frist to know this is a Trojan Horse. I hated that asshole the whole time he was in the Senate.
“carefully described in tiny paragraphs so they won’t conflict with the Constitution”
Frank Zappa
Our Lords and Masters lay down yet more astroturf for us sheep to graze on.