January, 04 2021, 11:00pm EDT
For Immediate Release
Contact:
Clare Fauke, Communications Specialist,,clare@pnhp.org
Health Affairs Study Finds Previous Projections of Costs Under Single-Payer/Medicare for All Ignore Evidence That the Finite Supply of Beds, Nurses, and Physicians Will Prevent a Surge in Health Care Use and Costs
WASHINGTON
With the COVID-19 pandemic accelerating, job and health insurance losses accumulating, and a Democratic administration soon to be in charge in Washington, debate over health care reform looks set to return to the national stage. Previous projections of the costs of universal coverage, much cited by single-payer opponents, have concluded that expanded coverage would lead to surging healthcare use and costs. But a new study by researchers from Harvard Medical School, the University of California San Francisco, the City University of New York at Hunter College, and the Public Citizen Health Research Group published January 5 in Health Affairs concludes that predictions of large cost increases are likely wrong. The researchers, citing real-world experience with society-wide coverage expansions in the U.S. and 10 other wealthy nations, conclude that universal coverage increases the overall use of care only modestly or, in some cases, not at all.
The researchers find that a factor rarely considered in the previous analyses--the finite supply of doctors' and nurses' hours and hospitals beds--has constrained cost and utilization increases in essentially all past coverage expansions, and would similarly prevent a surge in use under Medicare for All or other universal coverage reforms. The study finds strong evidence that new services provided to the people who gain coverage would likely be offset by reductions in useless or low-value care currently over-provided to the well-off.
Health economists have traditionally assumed that because society-wide coverage expansion would reduce cost barriers, patients' use of health care--and consequently costs--would soar. They cite decades of careful research showing that individuals with better insurance coverage use more health care. However, the authors of the Health Affairs study note that after society-wide reforms, all care must still be provided using the same supply of doctors, nurses, and hospital beds, a supply that is mostly fixed, at least in the short run. The authors note that most projections of the costs of universal coverage have ignored the fact that the supply of health care is constrained, and have failed to account for countervailing changes in the use of care by individuals whose coverage did not change. They present evidence that after society-wide coverage expansions, the newly insured do (as economists predict) increase their use of care, but this is offset by small, nearly imperceptible reductions in care to persons who were already well-insured.
The researchers based their conclusion on analyses of coverage expansions in 11 nations. In those cases, the median increase in the number of hospitalizations society-wide was only 2.4%, while doctor visits increased by only 4.6%. Moreover, because hospitalizations and visits were already on the rise before most of these coverage expansions, the increases were even smaller when accounting for those pre-existing trends.
Overall, the study estimates that a Medicare-for-All program offering first-dollar universal coverage would lead to a 7-10% increase in outpatient visits, and a 0-3% increase in hospital use, figures far lower than most previous analyses, and which could be readily offset by administrative cost savings.
"The experience of previous coverage expansions seems paradoxical: while insurance coverage soars, overall health care use rises only modestly," noted lead author Dr. Adam Gaffney, a pulmonary and critical care physician at Harvard Medical School and the Cambridge Health Alliance. "Our findings clash with the traditional economic teaching: that giving people free access to care would cause demand and utilization to soar. That traditional thinking ignores the 'supply' side of the health care equation: doctors' and nurses' time and hospital beds are limited, and mostly already fully occupied. When doctors get busier, they prioritize care according to need, and provide less unnecessary care to those with minimal needs to make way for patients with real needs."
"Past society-wide coverage expansions haven't caused surges in health care use," noted study co-author Dr. Steffie Woolhandler, Distinguished Professor at the City University of New York at Hunter College, Lecturer at Harvard Medical School, and Research Associate at Public Citizen, "so analysts who've confidently projected a tsunami of health care use and costs after Medicare for All are ignoring history."
"The supply-focused framework we advance in our study," commented senior author Dr. James G. Kahn, Emeritus Professor at the University of California San Francisco School of Medicine, "challenges the idea that 'skin in the game' is needed to control health care costs. Many other nations have achieved universal coverage at affordable cost, without imposing big copayments or deductibles. We can too."
Physicians for a National Health Program is a single issue organization advocating a universal, comprehensive single-payer national health program. PNHP has more than 21,000 members and chapters across the United States.
LATEST NEWS
12 Palestinians Drown Trying to Retrieve Airdropped Gaza Aid From Sea
One campaigner called the incident "another deadly example of why airdrops are not the answer to famine in Gaza."
Mar 26, 2024
Human rights defenders on Tuesday pointed to the drowning deaths of 12 Palestinians trying to retrieve humanitarian aid parcels airdropped off the Gaza shore as yet another reason why Israel must stop blocking aid from entering the embattled strip by land.
Video published on social media shows Palestinians running toward the Mediterranean Sea in Beit Lahia as aid parcels parachute downward. Eyewitness Abu Mohammad toldCNN that the people who drowned "don't know how to swim."
"There were strong currents and all the parachutes fell in the water," Mohammad said. "People want to eat and are hungry. I haven't been able to receive anything."
Ramy Abdu, chair of the Geneva-based group Euro-Mediterranean Human Rights Monitor, said that some of the victims died after becoming entangled in parachute ropes.
BREAKING| 9 Palestinians drowned and 5 others missing in the Sea of Gaza while trying to get humanitarian airdrop aid due to falling into the sea. pic.twitter.com/tSPpbrKsTg
— PALESTINE ONLINE 🇵🇸 (@OnlinePalEng) March 26, 2024
According to the U.S. military—which along with Jordan, the United Arab Emirates, Egypt, Germany, the United Kingdom, and Singapore has been airdropping aid into Gaza—parachute malfunctions caused three of the 80 parcels dropped to land in the sea. The Pentagon did not say which country carried out the drop.
Earlier this month, five children were crushed to death and numerous other Palestinians were injured by U.S.-airdropped parcels on which the parachutes apparently malfunctioned.
The airdrops come amid widespread and increasingly deadly starvation in Gaza, where Israeli forces have been accused of using hunger as a weapon of war. Last month, Michael Fakhri, the United Nations special rapporteur on the right to food, called Israel's forced starvation of Gazans part of "a situation of genocide" in the besieged enclave, where more than 114,000 Palestinians have been killed or wounded by Israeli forces since October 7 and around 2 million people out of a population of 2.3 million have been forcibly displaced.
While Israel claims there are no limits on aid entering Gaza by land, Israeli officials said Monday that United Nations Relief and Works Agency for Palestine Refugees in the Near East trucks would be blocked from entering northern Gaza. Israeli forces have repeatedly attacked aid convoys and their police escorts, forcing UNRWA to suspend humanitarian deliveries.
Israeli forces have also on several occasions attacked starving Palestinians as they desperately attempt to get food for their families, including in the February 29 "
Flour Massacre" that left more than 870 Gazans dead or wounded.
Also blocking humanitarian aid from reaching starving Palestinians are Israeli civilians who have camped at border crossings to prevent convoys from entering Gaza. Last month, right-wing extremists set up a giant inflatable children's bouncy castle where aid trucks are meant to pass through the Kerem Shalom border crossing in an effort to lend a festive atmosphere to the action.
Medical Aid for Palestinians, a London-based humanitarian group, said Tuesday that "airdrops will not end famine and are a dangerous proposed 'solution.'"
Palestinians in Gaza expressed similar sentiments.
"We call for the opening of the crossings in a proper fashion," Mohammad told CNN, "but these humiliating methods are not acceptable."
Keep ReadingShow Less
Alabama Mercedes-Benz Workers Accuse Company of Union-Busting in NLRB Complaint
"It's just plain retaliation from Mercedes, but I'm not going to be intimidated," said one worker.
Mar 26, 2024
A month after the United Auto Workers announced that a majority of workers at the Mercedes-Benz plant in Vance, Alabama had signed union cards, employees struck a defiant tone Tuesday as they filed official complaints of union-busting by the company with the National Labor Relations Board.
Workers detailed the illegal disciplinary measures management has taken against them for taking leave and objecting to anti-union materials that have been shown in captive-audience meetings since most of the plant's 6,000 workers indicated they want to join the UAW.
"Since we started organizing, I put in my [Family and Medical Leave Act] leave with management multiple times and every time they said they lost the paperwork," Lakeisha Carter, who works in the company's battery plant, told the UAW. "It's just plain retaliation from Mercedes, but I'm not going to be intimidated."
The U.S. Department of Labor last month recovered $438,625 in back pay, unpaid bonuses, and damages for two people who had formerly worked at the plant in Vance, finding that management had illegally fired the workers when they requested FMLA-protected leave to care for a family member and recover from a serious health condition.
After winning new contracts for workers at the Big 3 automakers last fall following an historic "stand-up strike," the UAW has launched campaigns at non-unionized plants owned by Mercedes, Volkswagen, Hyundai, and Toyota, convincing more than 10,000 autoworkers so far to sign union cards.
Another battery plant worker, Taylor Snipes, told the UAW that managers at the company were forcing him and his coworkers "to attend meetings and watch anti-union videos that are full of lies."
After he objected, Snipes was called into a meeting and "immediately fired for having his phone on the factory floor," even though he had been given permission to have his phone with him so he could be in touch with his child's daycare center.
"I told management that it was suspicious that I was being called into the office on the same day that I spoke up in anti-union meeting," said Snipes. "My manager said the two had nothing to do with one another, but then proceeded to aggressively interrogate me about why I support having a union."
UAW President Shawn Fain met with Mercedes workers in Alabama on Sunday.
"Unlike previous drives, the workers are in command," said Luis Feliz Leon of Labor Notes. "They are the collective force that will either press on to a union victory or a defeat."
Keep ReadingShow Less
US-China Electric Vehicle Dispute Shows Old Trade Rules Imperil Climate Action
"The climate crisis is too urgent for the U.S. or any country to allow outdated trade rules... to distract us from enacting bold climate policies," argued one campaigner.
Mar 26, 2024
As the Chinese government on Tuesday formally challenged what it termed "discriminatory" U.S. electric vehicle subsidies, climate action advocates warned that antiquated trade policies and international bickering must not be allowed to hamper the urgently needed green energy transition.
"Immediate climate action must take priority over compliance with outdated trade rules that were inked long before governments worldwide began taking the climate crisis seriously," said Trade Justice Education Fund executive director Arthur Stamoulis in response to the move by Beijing.
Melinda St. Louis, director of Public Citizen's Global Trade Watch, agreed that "the climate crisis is too urgent for the U.S. or any country to allow outdated trade rules—written long before governments were taking climate change seriously—to distract us from enacting bold climate policies."
"Existing trade rules need to be rewritten so that trade pacts can become tools for helping the world advance towards a clean, just, and sustainable economy—but we don't have time to wait."
China—which has heavily subsidized its own electric vehicle industry—on Tuesday filed a complaint against the United States at the World Trade Organization (WTO), taking aim at rules for EV tax credits included in the Inflation Reduction Act (IRA), a sweeping package signed by President Joe Biden in 2022.
"Under the pretext of 'responding to climate change' and 'environmental protection,' the U.S. has formulated discriminatory policies through its Inflation Reduction Act regarding new energy vehicles, excluding products from China and other WTO members from subsidies," said a Chinese Ministry of Commerce spokesperson, according to a translation by the South China Morning Post.
"Such exclusions distort fair competition, disrupt global industrial and supply chains, and violate WTO principles such as national treatment and most-favored-nation treatment," added the spokesperson. "We urge the U.S. to abide by WTO rules, respect the development trend of the global new energy vehicle industry, and rectify its discriminatory policies."
U.S. Trade Representative Katherine Tai said that "we are carefully reviewing the consultation request" and called out the People's Republic of China for using "unfair, nonmarket policies and practices to undermine fair competition and pursue the dominance of the PRC's manufacturers both in the PRC and in global markets."
Tai also praised "President Biden's leadership," represented by the passage of the IRA, which she described as "a groundbreaking tool for the United States to seriously address the global climate crisis and invest in U.S. economic competitiveness." She said the U.S. would "continue to pursue major new investments in clean energy technology, from solar and wind to batteries and electric vehicles and beyond."
The Associated Pressreported Tuesday that "the real-world impact of the case is uncertain. If the United States loses and appeals the ruling, China's case likely would go nowhere. That is because the WTO's Appellate Body, its supreme court, hasn't functioned since late 2019, when the U.S. blocked the appointment of new judges to the panel."
St. Louis said that "China's threatened trade attack against climate provisions in the U.S. Inflation Reduction Act is another example of why the U.S. and other nations should begin working with one another towards an immediate moratorium on the use of trade challenges against clean energy transition and other climate measures."
"We've been warning since before the passage of the Inflation Reduction Act that antiquated WTO rules would threaten our ability to realize the green transition," she noted. "Prominent labor, environmental, and consumer groups have urged the U.S. government to boldly implement the IRA as intended despite trade pact attacks—and to make a commitment not to use such trade rules to challenge other countries' climate policies."
Stamoulis pointed out that "governments worldwide are wasting considerable amounts of time and political capital attempting to squeeze potential climate measures into compliance with outdated trade and investment rules."
"Ultimately, existing trade rules need to be rewritten so that trade pacts can become tools for helping the world advance towards a clean, just, and sustainable economy—but we don't have time to wait," he continued. "A 'climate peace clause' that brings an immediate end to the ongoing trade attacks against climate measures is a necessary interim step towards helping governments transition to clean energy on the rapid timeline that is required to head off the worse possible impacts of climate change."
"A moratorium on the use of international trade agreements to challenge climate policies would: (1) help governments safeguard existing climate mitigation and transition measures by protecting them from trade challenge; (2) create the space for governments to adopt the bolder climate policies that justice and science demand without fear or threat of new trade challenges; and (3) incentivize and offer countries time to work together and resolve the underlying tensions between current trade law and the imperative for climate action," he explained.
St. Louis also called for implementing a climate peace clause to "temporarily halt cases like this one so countries can prioritize the green transition and revise the WTO rules currently creating unnecessary hurdles."
"We must move forward with IRA implementation and work to enact even bolder policies to transform our economy for a clean energy future, and support other countries that do the same," she asserted.
China's WTO complaint comes on the heels of the hottest year in human history—which concluded with a United Nations climate summit that scientists called a "tragedy for the planet" because the conference's final agreement didn't demand a phaseout of fossil fuels that are driving global heating.
Soaring temperatures have continued this year, with European Union scientists recently announcing that last month was the warmest February on record. Carlo Buentempo, director of the E.U.'s Copernicus Climate Change Service, stressed that "the climate responds to the actual concentrations of greenhouse gases in the atmosphere so, unless we manage to stabilize those, we will inevitably face new global temperature records and their consequences."
Keep ReadingShow Less
Most Popular