Return of the Socreds

Presto Manning is contemplating a run for the leadership of the Party of Calgary. Somethings never change. Preston Manning Expresses Interest In Replacing Klein

That would mean 35 years of Socred power that ended with his father, Ernest, being replaced with a lame duck Premier, then 33 years of PC power starting with Peter Lougheed and ending with a lame duck Premier, and then the possibility of that strange beast the Reformed PC Socreds under Presto.....noooooooo.

Preston Manning, who was once the second-most-powerful leader in Canada as leader of the opposition, is apparently now considering his chances of becoming the second-most-powerful leader in Canada as premier of Alberta.

King Ralph is dead
The Alberta Tories' regicide of Ralph Klein was big news for 12 hours. Then Preston Manning trumped it, telling reporters he was considering running for Klein's job.

Daddy Ernest Manning gave up party power to Peter Lougheed, thus assuring a Liberal Conservative Socred Alliance that was Seventies PC's. That alliance was shattered as neo-cons took over under Klein, the fiscal right was far less powerful than the social conservatives. The social conservatives align behind Oberg, the Reform types around Morton, and the liberal wing under Dinning. Alberta Tories in disarray

Dining did the dirty deed of balancing the budget on the backs of the working class, with wage and benefit cuts to the public sector. Then with victory in his back pocket he left the government.

The neo-cons in the party then went on to shape the Ralph Revolution, using the the debt and deficit hysteria of the ninties to impose their Republican Lite vision on Alberta, while promoting it for the rest of Canada with Prestos Reform Party.

Government that governs least is best — or not

When Mr. Klein became premier, the province had a $3.4-billion deficit and a $23-billion debt. He argued these burdens arose, in part, from governments having involved themselves too much in the economy. There were bad investments. The government taxed too much. Government regulations were too onerous. The free market, he asserted, would be encouraged if the government got out of the way.

This contrasted with the approach of Peter Lougheed, who led the Conservatives to power in 1971. Mr. Lougheed was no socialist, but he did believe the government should try to direct, cajole and even force the market in directions he believed Alberta needed. Only that way, he reasoned, could Alberta's economy be diversified and energy revenues used not just for today's needs, but for the future.

Mr. Lougheed's dirigiste preferences evaporated under Mr. Klein, but now some Albertans want that kind of guiding hand back, at least in a modified form. In a free-enterprise province, the critics are now demanding a “plan” for using the revenues that would be more than driving up spending on ongoing programs.

Presto would be an interesting add to the mix but his chances of winning are less than none. Unless he has something up his sleeve, oh like say Medicare Reform. If anyone could enunciate and promote the Third Way in Medicare it would be Presto.

“Where I think we're headed is a system of universal care, where everybody is covered ... with two tracks for delivery, and two tracks for payment. It's not a question of private versus public, but what mix of the two is appropriate.”

Mr. Manning left what he likes to call "active partisan politics" in 2002 to become more involved in the public-policy debate. He quickly got on board with the Fraser Institute and the Canada West Foundation, and he set up the Manning Centre for Building Democracy.

He and Mike Harris authored the Fraser Institute Report on exactly the musings that King Ralph has been tossing about for the past decade. And perhaps that would be the reason for him to run, otherwise Third Way Medicare Reform is dead in the water.

Third Way predicted to meet Klein's fate

Dead-end way Tories mull future of health-care reform if Ralph exits scene



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PBM profits obscured by mergers and accounting practices, USC Schaeffer white paper shows

Requiring more financial transparency from PBMs would help policymakers understand how money flows through the large healthcare companies that now own them

University of Southern California

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Pharmacy benefit managers (PBMs) under the microscope for their role in high drug prices have often cited their reportedly slim profit margins as evidence that they do not drive up costs. The three leading PBMs, which control about 80% of the prescription drug market, have historically reported profit margins of 4% to 7%, among the lowest in the healthcare industry.

A new white paper from the USC Schaeffer Center for Health Policy & Economics demonstrates that these slim margins are dramatically influenced by the accounting practices PBMs elect to employ. The paper also shows how efforts to assess PBM profits have become more challenging after these companies merged with healthcare conglomerates that own other players in the pharmaceutical supply chain.

States in recent years have advanced or considered numerous measures seeking to increase PBM transparency, and Congress is currently pursuing legislation to reform PBM practices. The Federal Trade Commission, meanwhile, continues to scrutinize PBMs after accusing leading firms of inflating drug costs through strategies like rebates, markups and preferential treatment of affiliated pharmacies.

“Accounting practices make it difficult to judge the health and efficiency of the PBM market, particularly as dominant firms have become part of larger, more complex companies,” said lead author Karen Mulligan, a research scientist at the Schaeffer Center. “Greater financial disclosure requirements for PBMs are needed to develop a better picture of how PBMs make money and the extent to which these practices may raise costs for consumers.”

How accounting choices drive margins

PBMs sit at the center of the pharmaceutical supply chain, acting as intermediaries that pay pharmacies and negotiate rebates with drug manufacturers on behalf of insurers. PBMs retain transaction fees and a portion of manufacturer rebates while passing along payments between manufacturers, insurers and pharmacies.

Historically, PBMs have included these “pass-through payments” in financial reporting. This may also include the share of rebates sent directly to the insurer. While allowed under professional accounting guidelines, this practice may add hundreds of billions of dollars to PBMs’ reported revenue or expenses without affecting their actual earnings. This obscures key determinants of PBMs’ profitability, including the role of rebates, fees and other payments.

Using a simplified example with typical transaction fees and rebates, the white paper illustrates how accounting choices can produce vastly different profit margins for a hypothetical drug listed at $360. If pass-through payments were reported as revenues or expenses, the PBM’s margin would be 10% – or slightly higher at 13% if manufacturer rebates passed to the insurer were not reported. However, the margin jumps to 87% if pass-through payments were not reported at all. (See Figure 5 in the white paper.)

Vertical integration in the healthcare industry has further blurred PBMs’ financial picture. In the past decade, the three dominant PBMs have become part of diverse healthcare corporations that also own insurers, specialty pharmacies and group purchasing organizations (GOPs) that negotiate discounts.

Under this structure, payments between the PBM, insurer and the specialty pharmacy become internal transfers invisible to the public. Using the same hypothetical $360 drug as the previous example, the white paper shows how the publicly reported profit margin can be half of what’s recorded internally, as dollars are shifted to other units within the PBM’s parent company. (See Figure 6.)

Transparency reforms should illuminate revenue streams

The researchers suggest that policymakers consider requiring PBMs to exclude pass-through payments from financial reporting, as regulators have done for intermediaries in other industries.

Policymakers should also consider reforming financial reporting requirements so that healthcare conglomerates provide separate reporting for each distinct business unit, rather than allowing PBM operations to be combined with other units like specialty pharmacy. Further, requiring disclosure of internal transfers and pass-through payments in these companies would provide clarity about what’s driving profits.

“True transparency requires greater visibility into profit flows hidden inside increasingly complex corporate structures,” said co-author Darius Lakdawalla, chief scientific officer at the Schaeffer Center and the Quintiles Chair of Pharmaceutical Development and Regulatory Innovation at the USC Mann School. “Building a more efficient and sustainable pharmaceutical supply chain starts with a better understanding of where dollars are flowing.”

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Article Publication Date

22-Jan-2026

COI Statement

This white paper was supported by the Schaeffer Center. A complete list of supporters of the Schaeffer Center can be found in our annual report online.

Missing Medicare data alters hospital penalties, study finds

Hospitals in areas with high Medicare Advantage enrollment face inflated financial penalties for readmissions, because government uses only traditional Medicare data

Michigan Medicine - University of Michigan

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For more than a decade, hospitals have worked to help older adults avoid repeated inpatient stays, incentivized by a federal program that cuts Medicare reimbursements if hospitals have higher-than-expected rates of readmissions for people with certain conditions.

The Hospital Readmissions Reduction Program has helped spur innovation, including initiatives to better prepare patients and their families to manage care after hospitalization, and to support them virtually at home.

But a new University of Michigan study finds that these financial penalties have hit some hospitals harder than they should, even if those hospitals have done a reasonable job at keeping people with heart failure, pneumonia and other serious conditions from ending up back in a hospital within a month of leaving one.

Such hospitals have been paying inflated readmission penalties for a seemingly unrelated reason: They happen to serve higher percentages of older adults who have chosen to enroll in Medicare Advantage plans run by private insurance companies.

So what’s the connection?

Currently, the federal government only grades hospitals on their readmission performance for older adults with traditional Medicare, which is run by the federal government. Data from Medicare Advantage are not currently included in the calculations that determine these penalties.

This is a problem, because Medicare Advantage enrollees tend to be healthier than traditional Medicare beneficiaries. But the readmission penalty program’s risk-adjustment is unable to capture these differences.

So, the researchers find, hospital performance looks worse for hospitals treating fewer traditional Medicare beneficiaries and more Medicare Advantage enrollees, even if those hospitals take the same actions to prevent readmissions as other hospitals.

The study, published in JAMA Network Open, suggests that not incorporating Medicare Advantage data results in an unwarranted redistribution of nearly $300 million a year in readmission penalties across hospitals nationwide. That’s more than half the total amount of readmissions penalties incurred each year across all hospitals.

Penalties are publicly reported every year and covered by the news media.

The Centers for Medicare and Medicaid Services has issued a rule to begin using Medicare Advantage data in the program. But even when it takes effect later this year, it will not affect hospital penalties for several years.

An unintended consequence with major consequences

The analysis shows an unintended consequence of the intersection between two major health policies of the last 15 years: the rapid rise in Medicare plan enrollment, and the HRRP, says senior author Geoffrey Hoffman, Ph.D., a professor at the U-M School of Nursing and member of the U-M Institute for Healthcare Policy and Innovation.

“Medicare Advantage has experienced extraordinary growth in the past decade, yet policymakers haven’t caught up with implications of this growth for Medicare payment policy that is based purely on traditional Medicare enrollment,” says Hoffman. “The omission of Medicare Advantage data highlights the continuing issue of inadequate measurement of patient risk in the Hospital Readmission Reduction Program, with important implications for the penalties that hospitals face.”

When the HRRP started calculating readmission rates in 2012, only 29% of older adults and people with disabilities chose Medicare Advantage plans.

Today, it’s 54%. But the distribution is not even across the country.

Hoffman and lead author Zoey Chopra, M.A., mapped that distribution and divided more than 3,200 hospitals into five groups based on the MA enrollment levels in 1,486 counties.

Chopra is working toward both a medical degree in the U-M Medical School and a Ph.D. in economics in the U-M College of Literature, Science and the Arts. He is a Medical Scientist Training Program fellow at the Medical School.

Differences in hospitals and populations

The hospitals in the areas with the highest Medicare Advantage enrollment were much more likely to be larger, nonprofit, teaching-oriented and in urban areas than hospitals in the areas with the lowest levels of Medicare Advantage enrollment.

Even when the researchers took into account an aspect of the readmission penalty program that only judges hospitals against groups of their peer hospitals, they still found that the Medicare Advantage enrollment rate mattered.

Past studies have shown that older adults who choose Medicare Advantage plans tend to be in the younger age range of eligibility, and to have fewer serious health conditions.

Hoffman has studied patterns of migration back to traditional Medicare by adults who had previously chosen Medicare Advantage plans, and factors that cause older adults to leave a Medicare Advantage plan for another Medicare Advantage plan or traditional Medicare.

Even though the readmission penalty program adjusts penalties based on the health risks of hospitals’ patients with the conditions that are included in the program, the lack of Medicare Advantage data could be a source of bias, he said.

Areas with more Medicare Advantage enrollees may end up with higher-risk traditional Medicare beneficiaries, because healthier enrollees migrate to Medicare Advantage. But those risk differences can’t be captured in the data models used by CMS. Therefore, by basing the program’s penalties only on traditional Medicare enrollees, hospitals with more Medicare Advantage patients are at greater, unwarranted risk of readmission penalties.

“Our study observes an inadvertent consequence of restricting the readmissions program to traditional Medicare participants,” said Chopra. “At the time of the HRRP’s rollout, this made sense, given lower enrollment and concerns about accuracy of the Medicare Advantage data. However, including Medicare Advantage data now appears imperative to avoid unnecessary penalties for hospitals treating relatively more private pay patients.”

Potential solutions

The new policy taking effect later this year rule will add Medicare Advantage data to HRRP calculations of readmissions, but Hoffman and Chopra have concerns about the completeness of what may be available. Risk-coding and policy differences across Medicare Advantage and traditional Medicare could also complicate comparisons of hospital performance.

It will also base penalties on the last two years’ worth of readmission data, instead of three. While the inclusion of Medicare Advantage data nearly doubles the amount of data used for comparisons, given concerns about data completeness and accuracy, this change may nonetheless make it harder statistically to see how hospitals have really done on keeping readmissions as low as possible, Hoffman said.

In addition to the rule, they suggest, CMS could consider factoring the percentage of Medicare Advantage enrollees in a hospital’s area or patient base into the calculations for its readmission rate and potential penalty.

The study was funded by the National Institute on Aging of the National Institutes of Health (RO1AG074944, T32AG000221). Chopra’s funding is through the Population Studies Center at the U-M Institute for Social Research. Andrew Ryan, Ph.D., of Brown University is a co-author of the study.

Hospital Readmission Reduction Program Penalties for Hospitals with High Medicare Advantage Penetration, JAMA Network Open, DOI:10.1001/jamanetworkopen.2025.54972

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Journal

JAMA Network Open

DOI

10.1001/jamanetworkopen.2025.54972 

Method of Research

Data/statistical analysis

Subject of Research

People

Article Title

Hospital Readmission Reduction Program Penalties for Hospitals with High Medicare Advantage Penetration

Article Publication Date

22-Jan-2026

Trump’s Project 2025 abolishes Medicare; We need to Fight Back and Expand it

By F. Douglas Stephenson

July 21, 2024

Source: Informed Comment




LONG READ


Gainesville, Florida (Special to Informed Comment; Feature) — The Heritage Foundation’s Project 2025, framed by former Trump administration staffers and secretly endorsed by Trump himself, proposes changes in Medicare benefits that could destroy Medicare as we know it. Instead, we must fight back and expand it.

On July 30, 1965, at the Harry S. Truman Presidential Library in Independence, Missouri, former President Harry S. Truman and his wife, former First Lady Bess Truman, became the first recipients of the new Medicare health insurance program. President Lyndon Johnson and the U.S. Congress enacted Medicare under Title XVIII of the Social Security Act to provide health insurance to people age 65 and older, regardless of income or medical history and Medicaid for those whose incomes were below specific levels.

Medicare was a momentous act because it provided new health insurance for people ages 65 and older and the disabled regardless of income or medical history. In the 59 years since, Medicare has become living proof that public, universal health insurance is superior to private insurance in every way. Medicare is more efficient than private health insurance and is administered at a cost of 3 percent to 4 percent, as opposed to private, for-profit health insurance, which has administrative costs above 15 percent.

Following the successful 1965 grassroots campaign to enact Medicare, many believed that the dream of a full national, single-payer health insurance system that included all age groups, “Medicare for All”, was right around the corner. Unfortunately five decades later, Medicare still has not been expanded. Most of the changes have been contractions with higher out-of-pocket costs for beneficiaries and repeated attempts at privatization by Big Pharma, Big health insurance industry companies/oligarchs/profiteers and their champions in the White House and Congress.

Big insurance and Big Pharma continue opposing legislation for the new Medicare for All because these resistant, self-serving industries have the most to lose if their huge profits are redirected to direct patient care for all. Individual and corporate predators regard democracy, government and community as obstacles to their greed and avarice, always placing profits over individual patients, families and public health. It’s no wonder so many beholden members of Congress want to protect the interests of Big Insurance and Big Pharma.

WEALTH ADDICTION OF BIG HEALTH INSURANCE/BIG PHARMA/CONGRESSIONAL PROFITEERING COMPLEX:

“Money is like salt water. The more you drink, the thirstier you get”. Roman proverbs say that the more money a rich man has, the more driven he is to accumulate more. Limitless greed for money the Greek dramatists said, becomes a disease of the psyche. In the 388 B.C. play, “Ploutos”, Aristophanes writes that a person may become over-saturated with food….but no one ever has enough wealth. Wealth addiction is a greedy compulsion to obtain more and more wealth, and specifically obtain what belongs to others. The net effect is to injure others because it is adversarial/harmful to society as a whole.

Although health insurance affordability for the majority of US citizens still remains elusive, President Biden’s health insurance plan still wants to shift many more dollars into private, Wall Street insurance industry hands. The takeover of public health insurance, as with Medicare Advantage plans and others, by private Wall Street entities continues apace as Democrats/Biden propose to increase taxes and give it to the private profit insurance industry—the basic source of our profound administrative waste, along with the costly administrative burdens they place on the delivery system that requires large profits. Profiteering continues unabated as private insurance sells us services we don’t need/want , such as deductibles and other cost sharing, maintenance of narrow networks, requiring prior authorization with increased administrative costs, excessive ongoing paperwork/documentation requirements, all while avoiding paying for surprise bills and other denied benefits.

ABC News Video: “What to know about Project 2025”

PROFITEERING SURVEY FROM GOVERNMENT PROGRAMS: (data from ” BIG INSURANCE 2022: Revenues reached $1.25 trillion thanks to sucking billions out of the pharmacy supply chain – and taxpayers’ pockets”, Wendell Potter, HEALTH CARE-uncovered,02/23/2023)

1). Big Insurance revenues and profits have increased by 300% and 287% respectively since 2012 due to explosive growth in the companies’ pharmacy benefit management (PBM) businesses and the Medicare replacement plans called Medicare Advantage.

2). The for-profits now control more than 80% of the national PBM market and more than 70% of the Medicare Advantage market.

3). In 2022, Big Insurance revenues reached $1.25 trillion and profits soared to $69.3 billion.

4). That’s a 300% increase in revenue and a 287% increase in profits from 2012, when revenue was $412.9 billion and profits were $24 billion

5). More than 90% of health-plan revenues at three of the companies come from government programs as they continue to privatize both Medicare and Medicaid, through Medicare Advantage in particular.

6). Enrollment in government-funded programs increased by 261% in 10 years; by contrast commercial enrollment increased by just 10% over the past decade.

7). Commercial enrollment actually declined at both UnitedHealth and Humana.

8). 85% of Humana’s health-plan members are in government-funded programs; at Centene, it is 88%, and at Molina, it is 94%.

9). The big insurers now manage most states’ Medicaid programs – and make billions of dollars for shareholders doing so – but most of the insurers have found that selling their privately operated Medicare replacement plans is even more financially rewarding for their shareholders.

10). This is especially apparent when you see that the Big Seven’s combined revenues from taxpayer-supported programs grew 500%, from $116.3 billion in 2012 to $577 billion in 2022.

11). Changes in health-plan enrollment over the past decade show how dramatic this shift has been. Between 2012 and 2022
enrollment in the companies’ private commercial plans increased by 10%, from 85.1 million in 2012 to 93.8 million in 2022.

12). By comparison, growth in enrollment in taxpayer-supported government programs increased 261%, from 27 million in 2012 to 70.4 million in 2022.

13). Within that category, Medicare Advantage enrollment among the Big Seven increased 252%, from 7.8 million in 2012 to 19.7 million in 2022.

14). Nationwide, enrollment in Medicare Advantage plans increased to 28.4 million in 2022 (and to 30 million this year). That means that the Big Seven for-profit companies control more than 70% of the Medicare Advantage market.

MEANWHILE, AS BIG INSURANCE THRIVES:(data from Potter)

**27.5 million people remain uninsured in the United States. Up to 14 million more will lose their Medicaid coverage once the pandemic emergency period ends later this year.

**100 million of us – almost one of every three people in this country – now have medical debt.

**In 2023, U.S. families can be on the hook for up to $18,200 in out-of-pocket requirements before their coverage kicks in, up 43% since 2014 when it was $12,700.

**44% of people in the United States who purchased coverage through the individual market and (ACA) marketplaces were underinsured or functionally uninsured.

**46% of those surveyed said they had skipped or delayed care because of the cost.

**42% said they had problems paying medical bills or were paying off medical debt.

**Half (49%) said they would be unable to pay an unexpected medical bill within 30 days, including 68% of adults with low income,

**69% of Black adults, and 63% of Latino/Hispanic adults.

**In 2021, about $650 million, or about one-third of all funds raised by GoFundMe, went to medical campaigns. That’s not surprising when you realize that in the United States, even people with insurance all too often feel they have no choice but to beg for money from strangers to get the care they or a loved one needs.

**62% of bankruptcies are related to medical costs.

**Even as we spend about $4.5 trillion on health care a year, Americans are now dying younger than people in other wealthy countries.

**Life expectancy in the United States actually decreased by 2.8 years between 2014 and 2021, erasing all gains since 1996, according to the Centers for Disease Control and Prevention.

WENDALL POTTER CONCLUDES:
“The companies that comprise Big Insurance are vastly different from what they were just 10 years ago, but policymakers, regulators, employers, and the media have so far shown scant interest in putting their business practices under the microscope. Changes in federal law, including the Medicare Modernization Act of 2003, which created the lucrative Medicare Advantage market, and the Affordable Care Act of 2010, which gave insurers the green light to increase out-of-pocket requirements annually and restrict access to care in other ways, opened the Treasury and Medicare Trust Fund to Big Insurance. In addition, regulators have allowed almost all of their proposed acquisitions to go forward, which has created the behemoths they are today. CVS/Health is now the 4th largest company on the Fortune 500 list of American companies. UnitedHealth Group is now No. 5 – and all the others are climbing toward the top 10”

OPPOSING MEDICARE BY PRIVATIZING PUBLIC SERVICES:

The U.S. Congress/government permits private health insurance companies to exact large profit from its cItizens, Wall Street banks and investors who back Big Insurance turn public money into a bonanza of private riches. High health insurance costs are the result of a political decision to essentially allow Big Insurance to do what they want and charge whatever they want.

Fully backed by Wall Street, the for- profit, private insurance industry thoroughly dominates our national health insurance system and defines the basic concept and purpose of health insurance . The U.S. subscribes to a private business model of health insurance that defines insurers as commercial entities. Private insurers maximize profits by mainly limiting benefits, maximizing health policy premiums or by not covering people with health problems. Like all businesses, their goal is to make money. Under the addictive business model, the greed of casual inhumanity is built in and the common good of the citizens and nation is ignored; excluding the poor, the aged, the disabled and the mentally ill is sound business policy, since it maximizes profit .

INCREASED CORPORATE POWER/PRIVATIZATION OVER PUBLIC RESOURCES:

A new report from OXFAM, 01/24/24, “Inequality. Inc.”, describes how “around the world, corporate power is relentlessly pushing into the public sector, commodifying and segregating access to vital services such as education, water and healthcare, often while enjoying massive, taxpayer- backed profits.This can gut governments’ ability to deliver the type of high-quality, universal public services that can reduce inequality.

The stakes are huge. Essential services constitute trillion- dollar industries and immense opportunities for generating profit and wealth for rich shareholders. The World Bank and other development finance actors have prioritized private service provision, effectively treating basic services as asset classes and using public money to guarantee corporate returns rather than human rights. Private equity firms are snapping up everything from water systems to healthcare providers and nursing homes, amid a litany of concerns about poor and even tragic outcomes”.

OXFAMS “inequality Inc.” report further warns that ”privatization often entails giving corporations control over significant areas of policymaking, as well as access to public resources and capacity that could otherwise be dedicated to providing universal services and reducing inequality. Despite the promotion of privatization as a cost-saving measure, many contemporary arrangements such as PPPs and outsourcing can be highly costly to the state and require taxpayers to guarantee private sector profits. The fiscal risks of PPPs are particularly extreme, earning them the nickname ‘budgetary timebombs’. That such arrangements often place a high burden on public coffers and routinely cost more than public delivery undermines arguments that privatization is necessary because the public sector lacks sufficient resources.

Institutional investors are turning to PPPs and other forms, (eg., Medicare Advantage, ACOs) of privatized services to generate stable returns. Major development agencies and institutions, many of which have adopted policies that prioritize private provision of services, have found common ground with investors by embracing approaches that ‘de-risk’ such arrangements by shifting financial risk from the private to the public sector. This new ‘Wall Street Consensus’ reframes the ‘Washington Consensus’ in the language of contemporary development speak, and envisions the transformation of basic services such as education, healthcare and water into financial assets backed by public resources”.

STRATEGY OF PRIVATE INSURANCE INDUSTRY:

To protect and enhance high profits by opposing improved Medicare for All 2024, the private health insurance industry has mounted a huge campaign using myths, scare and fear tactics ever since ‘Obamacare’, the Affordable Care Act (ACA), was enacted in March, 2010. The U.S. health insurance industry lobbied Congress hard at that time to enact a requirement that most non-elderly Americans become compulsory customers of the private insurance industry and approve taxpayer financing of massive subsidies for that industry. The private insurance industry is very happy that with ACA, Americans are forced to purchase the product of their private industry plus give huge tax-financed subsidies to their industry in the amount of a half-trillion dollars per decade.

FEAR: The expedient health insurance industry seeks to protect high profits using scare/fear tactics against new and improved Medicare for All 2024 legislation. One tactic deliberately confuses the public by not telling individuals what would change if their private insurance is replaced by the new Medicare for All health insurance program. Lack of specificity and avoidance behavior promotes confusion, misunderstanding and great fear because it conflates loss of private health insurance with loss of their own physicians, other health professionals and hospitals. The for-profit health insurance industry knows full well that people are most interested in keeping their own doctors and that the new Medicare for All 2024 does not interfere with that. By conflating private health insurance with the direct provision of medical treatment itself, many patients are mislead into thinking they could lose all their health professionals. Fortunately, once folks understand that losing their expensive, for-profit private insurance plans is the only thing that will change, support for Medicare for All sharply increases. The huge profits of Big Insurance and Big Pharma are threatened once folks become aware of this tactic.

SOCIALIZED MEDICINE: Another industry scare tactic is to stoke public fear and confusion by conflating the “socialized medicine” label with single-payer, “socialized (public) health insurance”. Socialized medicine is a system in which doctors and hospitals work for and draw salaries from the government. The U.S. Veterans Administration is an example. In contrast, most European countries, Canada, Australia and Japan have ‘socialized health insurance’, not ‘socialized medicine’. The term “socialized medicine” is often used by the private insurance industry and politicians to manufacture frightening images of government bureaucratic interference in medical care. In countries with socialized health insurance, health and mental health professionals and patients often have more clinical freedom. This is in sharp contrast to the U.S., where private health insurance bureaucrats attempt to direct/interfere with care .

Manufactured confusion and fear of socialism by the health insurance industry and their political spokesmen impede the public’s ability to differentiate and thereby reduce support for Medicare for All . This allows the private health industry to successfully maintain control of the U.S. health care system for its own profitable purposes.

SEE “PLAYING THE ACE OF FEAR CARD” IN MMT SECTION BELOW: Playing “as if we can’t afford” M4A with the “ace of fear” card, opponents of M4A 2024 use the scary myth that large, confiscatory tax hikes will be needed to “pay for” M4A.

PREJUDICE AGAINST GOVERNMENT: Opposition to Medicare for All is also based on irrational fears, folklore/myth and general prejudice against government programs. Fear-mongering about waiting lists, bankrupt doctors and hospitals, and socialism is exactly the same fearful/false rhetoric used in the campaign to block LBJ’s original Medicare program in the mid-1960s. The Wall Street Journal then warned about “patient pileups,” and the American Medical Association mounted a campaign featuring Ronald Reagan that smeared Medicare as creeping socialism that would rob Americans’ freedom.

Unfortunately many government leaders from both political parties share the same ‘profits over public health’ ideology, even though the Covid-19 pandemic clearly showed how our economic system failed to serve our citizens by allowing these groups to privatize, sabotage, fragment and cripple our health, public health and other social services. No greater disconnect exists between the public good and private interests than in the U.S. system of for-profit health insurance. Using dark money, Big Insurance and Big Pharma are very powerful private interests that have shaped public policy in national health insurance and public health for the past 40 years.

U.S. SUPREME COURT: Strong support for the U.S.Supreme Court, ‘Citizens United’ decision, by unaccountable/unregulated large Big Insurance and Big Pharma corporations and ultra-wealthy individuals/families. is based on their Machiavellian understanding of the purpose of dark money in politics: to use dark money to change political outcomes to favor themselves, the 001% oligarchs and becomes a threat to democracy because its source is not made public. Dark money is corruption that erodes confidence and trust in local, state and national government and in both major political parties. It’s used to throw referendums and elections from which can come many of today’s social, economic, public health, mental health and environmental problems. Dark money is used to hide conflicts of interests and further enhance self promotion with bogus scientific controversies, fake news and fake grassroots campaigns.

REDUCE GOVERNMENT CAPACITY TO RESPOND: To reduce governments capacity to respond to public health problems/environmental crises such as Covid-19, single-payer national health insurance and other social services, these companies fund right-wing think tanks to attack public health/social policy. By presenting government as a threat to freedom, the distinguished writer for The Guardian(U.K.),George Monbiot, described how right wing groups and big business create a narrative by reframing responsible government as the “nanny state”, the “health police” and “elf ‘n’ safety zealots”. They dismiss scientific findings and predictions as “unfounded fears”, “risk aversion” and “scaremongering”. Public protections are recast as “red tape”, “interference” and “state control”.

Although some have negative feelings toward government, and examples of government inefficiency exist, the record of private health insurers is far worse. The only thing that exceeds government inefficiency is the private health insurance industry itself. Dozens of financial profiteering scandals have wracked private insurers and HMOs in recent years. Everyone should categorically reject myths about ‘Medicare for All’ that try to frighten seniors and others by telling them they will lose Medicare benefits under a new M4A program, that pointy-headed government bureaucrats will make medical decisions, determine the cost vs benefits of procedures, including age and quality of life considerations and medical personnel will be in short supply.

TRADITIONAL MEDICARE THREATENED BY NEW PRIVATE PROFITEERS: Private profit “Medicare Advantage” present new threat to Traditional Medicare.

WHAT IS MEDICARE ADVANTAGE? Medicare Advantage is a managed care program offering private health insurance plans as options to replace traditional Medicare. Medicare Advantage plans differ from traditional Medicare in that they are paid with capitation (per member), they are required to limit enrollees’ out-of-pocket spending and can offer extra benefits (e.g. gym memberships, $900 worth of groceries, dental benefits). They almost always offer prescription drug coverage and use a defined and often restricted network of providers that can require enrollees to pay more for out-of-network care. Utilization management techniques are used ,such as prior authorization, and they can also fund special programs such as rewards for beneficiaries to encourage healthy behaviors. The deceptively innocent hope is that these differences will lead to improved care at lower cost compared to Traditional Medicare.

In reality, “Medicare Disadvantage”is a better, more accurate name for the programs however, as insurance companies push Congress to corporatize all of Medicare, yet keep the name for the purposes of marketing, deception, and confusion.

Dismantling Medicare with Medicare Advantage: Over 50% of Medicare beneficiaries now have for-profit corporations in charge of their care through Medicare Advantage (MA). Insurance companies are paid handsomely for these plans, and much of that money goes to corporate profits instead of care. The companies running MA plans want to take over Medicare entirely, leaving patients with no option but to give their money to private insurers.

Denying Treatment: Investigations into claim denials in MA found that insurers were inappropriately denying treatments and tests that should be covered under Medicare. Physician surveys show that these practices often cause patients to suffer unnecessarily, and can even be life-threatening. In some cases, MA insurers were found to spend just seconds on each claim, and even denied claims using artificial intelligence instead of medical experts.

Deceiving Patients and Taxpayers: Reports from journalists, researchers, and government agencies have shown that health insurance companies like UnitedHealth and Cigna overcharge Medicare by giving patients exaggerated or entirely false diagnoses. Several companies have been fined, or sued, and agreed to large settlements. MA insurers are taking citizens tax dollars for conditions they aren’t even treating.

Bottom Line: Medicare Advantage is not the same Medicare program that Americans have come to know and love. The private insurance industry has spend millions on advertising in order to hide the ugly truth: their MA plans raid taxpayer funds and routinely fail to deliver the care that patients expect and deserve.

Terminate Medicare Advantage: Physicians for a National Health Program (PNHP), concludes tnat the Center for Medicare Services (CMS) should terminate the Medicare Advantage program. It would be far more cost-effective for CMS to improve traditional Medicare by capping out-of-pocket costs and adding improved benefits within the Medicare fee-for-service system than to try to indirectly offer these improvements through private plans that require much higher overhead and introduce profiteers and perverse incentives into Medicare, enabling corporate fraud and abuse, raising cost to the Medicare Trust Fund, and worsening disparities in care. These problems are not correctable within the competitive private insurance business model, and the Medicare Advantage program should be terminated.

MODERN MONETARY THEORY- MMT AND MEDICARE FOR ALL:

The US healthcare system is notorious for its high costs and below par outcomes. We already spend 18 percent of GDP on healthcare, and that is projected to reach 20 percent soon. This is approximately twice as much as our peers, other rich, developed, capitalist countries with no discernably better health outcomes (and even worse on a number of measures). Our excessive spending when compared to that of our peers can be attributed to the use of for-profit private insurance to pay for healthcare, higher pharmaceutical and provider costs, and higher administrative costs. Study after study has confirmed that prices and administrative costs in the US are out of line with those in the rest of the developed world, and especially compared to countries that have some type of a single-payer.

The Ace of Fear Card: Playing “as if we can’t afford” M4A with the “ace of fear” card, opponents of M4A 2024 use the scary myth that large, confiscatory tax hikes will be needed to “pay for” M4A. Economists at the Levy Institute of Economics of Bard College alert us how opponents of M4A typically warn of the high financial costs, and hence of prospective dangerously high government deficits. From the perspective of Modern Money Theory (MMT) however, these fear mongering arguments are beside the point and are a myth. A sovereign government’s finances are not like the budgeting by households and firms; the government uses the monetary system to mobilize the nation’s real resources and to move some of them to pursuit of public purposes, such as social welfare programs, public health, public health insurances, Medicare for All, etc. Whatever the financial costs, we already have a financial system that can handle them.

Distinguished Professor of Economics L. Randall Wray, Levy Economic Institute of Bard College and Yeva Nersisyan, Associate Professor of Economics at Franklin and Marshall College, Lancaster, PA, maintain that :“a sovereign government like the USA is not financially constrained; it spends by fiat, i.e., printing money, and/or through creating electronic computer entries in bank accounts and can neither run out of them nor save them for the future. What should constrain the spending of a sovereign government is the nation’s available real resources. Excessive spending, therefore, creates problems not in terms of higher government deficits and debt, but in terms of true inflation. Similarly, taxes are used not to finance government spending, but to withdraw demand from the economy, creating space for government spending to move resources to the public sector without causing inflation”.

Professor Wray notes that“the adoption of a single-payer system (replacing for-profit private insurers) would significantly reduce the resources devoted to our unusual way of paying for healthcare. It would eliminate the private insurance sector’s participation, reduce employers’ costs of administering healthcare plans, reduce the costs incurred by doctors and hospitals due to billing insurers as well as pursuing patients for uncovered costs, lower the costs of appealing denials, and cut costs associated with patients avoiding early treatment of diseases (because of the actual or expected out-of-pocket costs) that become chronic and expensive maladies. If M4A could control prices and lower administrative costs, we could spend significantly less on healthcare than we do currently, while expanding coverage to everyone. All else equal, if we were able to reduce our spending on healthcare to the level of our peers, we would be creating deflationary pressures, not inflation”.

Nersisyan and Wray estimate that “in the short term M4A could save about 3.7 percent of GDP while providing healthcare to the whole population. Even if we lowered healthcare spending by 3.7 percent of GDP, we would still be spending more on healthcare than all of our peers. “We believe our estimates are just the savings possible in the short term. In the long term, increased use of healthcare could reduce spending on chronic diseases. With universal access, cost controls, and elimination of a highly inefficient private insurance system, the single-payer system could shrink US spending on healthcare by much more, bringing us in line with other rich countries at about 10 percent of GDP.”

“Some will object that the savings largely accrue to the private sector, while the government will face additional costs. While it is true that the distribution of spending between the private and public sectors would change”, economist Wray assures us that. “there is nothing about government spending that necessarily makes it more inflationary than private spending. If private spending on healthcare costs falls by more than the increased government spending, the movement to single payer will be deflationary, not inflationary. Only a net increase in demand for resources would be inflationary.”

CONCLUSIONS:
The common good of our nation is ignored because the U.S. subscribes to a private business model for health insurance that defines insurers as commercial entities. Private health insurers maximize profits by limiting benefits or by not covering people with health problems. Like all businesses, their goal is to make money. Under this business model of health insurance, the greed of casual inhumanity is built in and the common good of the citizens and nation is ignored. Excluding many in the middle class, the poor, the aged, the disabled and the mentally ill is sound business practice policy since it maximizes profit.

Today we still have tens of millions of individuals without insurance, many more who are underinsured, many who have impaired access to their physicians and other health/mental health professionals because of insurer network restrictions, many who face financial hardship when health needs arise, and an outrageously expensive system due to the profound administrative waste of the insurers and the burden they place on the health care delivery system when immense profit is required. For example, statistics show that nearly 41% of adults (or nearly 100 million) are forced to get a medical loan to cover their health-care debt because they don’t have enough savings, and nearly 12% of them owe more than $10,000. Also, these data don’t take into account such forms of debt like credit cards or installments offered. When millions lost their jobs due to Covid-19, the dangers of connecting health insurance to employment also became painfully clear. Health insurance must not be tied to employment.

Almost none of these problems would exist if the government, instead of the private insurers, served us as a single-payer, health insurance financing authority. It is inhumane to allow consumer-directed, moral-hazard based private health policies to erect barriers to health care for millions of citizens with minimal or modest resources.

We now have several decades of experience with the conversion of health/mental health care into a business. Our health care is being rationed, with care guidelines determined by profitability and secrecy decided in private Wall Street corporate boardrooms. To realize large profits demanded by Wall Street investors, our health system must attract the healthy and turn away the sick, disabled, the poor, many of the old, and the mentally ill.

To maintain corporate control of U.S. health care insurance, our system is privatized and unregulated. Private, big insurance companies are in the business of making money, not providing full health care, and when they undertake the latter, it is likely not to be in the best interests of patients or to be efficient. Administrative costs (and immense profiteering ) are greater in the private health care insurance system, and even Medicare itself is weakened by having to work through the private system.

The USA is a country where health insurance for medical and mental health care is a function of socio-economic status. Everyone knows that this inhumane system should have been corrected long ago, but the death and illness ravages of the pandemic crisis makes it impossible to any longer avoid reality. We must immediately end our moral crime of having one of the the greatest health systems in the world, but only for those who can afford it. We must support the common principles that health care is a human right, must be free from corporate profit, and must be achieved through national legislation.

Let’s never forget that universal Medicare for All is a solid investment, not an expense, in and for our country by simply promoting a social service for universal access to affordable health care insurance for all. Aren’t we a society that cares enough to see that everyone receive the health care they need? That’s the basic purpose of Medicare for All. The 59 year history of our most successful national health insurance program, Medicare, provides one of the best arguments for expanding the program to cover everyone. It’s time to end inadequate and dangerous health insurance programs. Insist on real health insurance reform essential for all individuals and families.

American history is filled with examples of fundamental, democratic change brought about by successful mass action and public pressure against the counseling of the wealth addicted, neoliberal, privatization, 1% self-serving oligarchs/vested interest/profiteering/crowd. Professor of Economics L. Randall Wray notes that the US healthcare system still has significant gaps in coverage—all while facing the highest healthcare bill in the world. Dr. Wray convincingly argues that the underlying challenge for a system based on private, for-profit insurance is that basic healthcare is not an insurable expense. He concludes that It is time to abandon the current, overly complex and expensive payments system and reconsider single payer for all. Social Security and Medicare provide a model for reform.

Today, the very best way forward is, without ambivalence, avoidance behavior or any further delay, to immediately implement new legislation now filed in Congress, “The Medicare for All Act of 2023” House Bill (H.R. 3421) and Senate Bill (S. 1655) that would establish this long overdue reform.

President Harry S. Truman once said,”There is nothing new in the world except the history you do not know”. Attempts to transfer ownership and control of economic programs/services/financial resources from the government into private, greedy hands have existed in many societies for thousands of years. Father Lactantius, c.250-c.326, an early Christian author and advisor to the Roman Emperor Constantine I, wrote in “ The Divine Institute”, a timely piece about Roman society that well applies to 21st century USA society:

In order to enslave the many, the greedy began to appropriate and accumulate the necessities of life and keep them tightly closed up so that they might keep these bounties for themselves. They did this not for humanity’s sake which was not in them at all but to rake up all things and products of their greed and avarice. In the name of justice, they made unfair and unjust laws to sanction their thefts and avarice against the power of the multitude. In this way they ruled as much by authority as by strength of arms and overt evil.

LINKS: Full text U.S.House of Representatives – H.R. 3421

Full text U.S. Senate – S. 1655