Why the NHS is not Medicare-for-All
The Friday Pulse Check
Good morning and happy Friday. Welcome to the Friday Pulse Check. The first part of the newsletter this week is unintentionally hospital themed.
In the news:
Competition is key
As Ron has said on the FLATLINING Podcast many times, competition in the marketplace almost always makes things better. Analysis by Adam Millsap, the Senior Fellow for economic opportunity issues at Stand Together and Stand Together Trust, shows that this might just be true for hospitals as well. He wrote that labor productivity in private hospitals has stagnated, particularly in comparison to the rest of the scientific community. While I don’t necessarily agree with his position on the Medicare Fee for Service Program, I do think he is correct when it comes to deregulating certain aspects that hinder hospital growth (such as certificate of need). Read more in Forbes.
Washington hospitals to cut travel nurses to save money
Providence’s Inland Northwest hospitals are having their worst financial year since the onset of the COVID-19 pandemic and MultiCare Health System’s Inland Northwest Region has had a $256 million operating loss through August. Previous staffing shortages caused the hospitals to increase their reliance on travel nurses, though this has proved financially unsustainable. RNs at Inland Northwest division hospitals make about $78,300 per year; travel nurses in Washington make about $146,400. The other side of the coin is employed nurses asking for the same pay as travel nurses. University of Washington Medicine’s two Seattle hospitals are giving their nurses a twenty-one percent raise over the next two years. Read more in the Spokane Journal of Business.
Skipping an important step
This week, a National Labor Relations Board judge found that Temple University Hospital in Philadelphia, Pennsylvania illegally changed its attendance and discipline policies. Temple University Hospital’s nurses are unionized, and the hospital had made several rule changes without bringing them to the bargaining table first. The hospital attempted to give itself the power to terminate probationary employees with excessive absences with no warning or deeming employees late if they arrive seven minutes past their shift time. Additionally, the judge also found that Temple University Hospital began putting COVID-19 patients in non-COVID-19 wards and, again without bargaining, revoked the COVID-19 accommodation for nurses who had previously been excused from working in those wards.
As I mentioned last week on the Friday Pulse Check, Bright Health Group is essentially going out of business. They are pulling out of their exchange programs in most states and are only keeping a Medicare product available in Florida and California. As we said on the podcast, get your December claims in on 1 January.
So what happens to most of the Bright Health patients? Well during open enrollment, they need to switch to another exchange plan. To our physician readers: if you have patients on Bright Health and you want to keep them as patients, discuss what other exchange products you accept with them soon. In many states, the only other option is BlueCross BlueShield.
As I read Millsap’s analysis on competition in hospitals, the same thought comes to mind in exchange plans. Many insurance companies have pulled out of the exchange plans in recent years leaving only one option in many cases.
What many of those companies realized is what Bright Health realized too late. Exchange plans are expensive to run and if there aren’t enough people on them, you’ll lose money. Bright Health has been hemorrhaging money for months and its investors are ready to break even. That’s why we are predicting Bright Health will go away entirely, once they sell their Medicare plans in Florida and California.
As we discussed in the program, physicians who are contracted with Bright Health are protected when it comes to getting reimbursement for their claims. States require companies like Bright Health to set money aside in the event they go out of business and must payout their remaining claims. Like I said above, get your December claims in by 1 January because the money isn’t infinite.
You can see more articles on Substack about Bright Health by clicking on this live stock ticker: BHG 0.00
If you have more questions about how Bright Health’s closure might affect your practice, I encourage you to take a listen to this week’s podcast. We also discussed how over-the-counter hearing aids could affect ENT groups and audiologists and what legal psychedelics mean in the state of Colorado. Check it out wherever you listen to podcasts.
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The World Health Organization is warning of a potential health crisis as winter approaches in Ukraine. According to the Ukrainian government, more than 800,000 houses have been damaged or destroyed since Russia’s invasion in February. The WHO’s regional director for Europe, Hans Kluge, said in a press conference on Friday that “many people in Ukraine are living precariously, moving from location to location in substandard structures, or without access to heating. This can lead to frostbite, hypothermia, pneumonia, strokes, and heart attack. Destruction of houses and lack of access to fuel or electricity due to damaged infrastructure could be a matter of life if people are unable to heat their homes.” Read more from ABC News.
Liz Truss’ premiership over the United Kingdom was shorter than many Italian governments. That is impressive. In fact, she is the shortest prime minister in Britain’s history.
Britain has one of the world’s most well-known single-payor healthcare systems, the NHS. It is often looked at as a model, by some politicians, for what Medicare for All could look like in the United States. That being said, those same politicians then introduce legislation that looks nothing like the NHS and still call it Medicare for All.
Even though Truss is out, Britians don’t have to worry about their healthcare for two reasons. First, the NHS remains popular across all of the UK’s political parties. There is some disagreement about how to reform it to make it more functional and efficient (maybe they should get rid of pagers), but for the most part, all British governments have thrown more money at the NHS and are “proud” of the NHS.
Secondly, it is constructed in a way that its authority doesn’t rest solely on whoever is in power. Governments can come and go with different priorities, but because of the NHS’ charter, it isn’t going to be drastically changed overnight.
I want to contrast that with what Senator Bernie Sanders has repeatedly introduced into Congress with the title Medicare for All. Unlike the NHS, Medicare for All would be run almost exclusively by the executive branch under the authority of the Health and Human Services Secretary. Under Senator Sanders’ proposals, the HHS Secretary has the full authority to determine who is eligible for healthcare under Medicare for All and what the reimbursement rate looks like for physicians.
Imagine if this was passed under a Democratic government and Medicare for All became law. The Democratic government would undoubtedly grant healthcare access to every resident of the United States, regardless of immigration or citizenship status. As soon as a Republican administration took charge, that would immediately change to citizens and maybe green card holders. Regardless of one’s opinions on immigration, I think all would agree about the administrative nightmare this would create. In this situation, thousands of people are constantly being taken on and off of Medicare for All.
For American citizens, some procedures (elective or otherwise) might be covered by one administration and not another (think abortion or contraception). Maybe one administration implements changes that are very expensive but make the system more efficient, reducing wait times and resulting in better care, but the next administration slashes the budget and takes that away.
Fortunately, our friends in the United Kingdom don’t have to worry about this when a new prime minister or government takes over. Don’t get me wrong, I’m not advocating for a single-payor healthcare system in the US that is identical to UK’s or Canada’s. I’m simply pointing out that the system over there is more stable and the political environment we have here is very unstable, which could create a disaster if we try to overhaul healthcare in the way some are proposing.
As someone who is a bit of an anglophile, I had high hopes for Liz Truss though she wouldn’t have been my first pick. Rishi Sunak appeared to be much more interested in a conservative government that would reform some of the problems brought about by Boris Johnson and others in the wake of Brexit. He also had some common sense ways to reform the NHS and reduce wait times and skipped appointments. I’d be interested to see if he runs again.
Until the podcast next week,
PS. For those of you who are curious, here is a bit of parliamentary procedure.
British governments automatically dissolve after five years, similar to our four-year presidential terms. The current Parliament first met on 17 December 2019 and will automatically dissolve on 17 December 2024. Elections take place after that and the majority party (or a coalition of parties if there is no majority) elects a prime minister.
The party in power can request that the crown, now King Charles II, dissolve the parliament at any time and there would be a snap election. I’ve seen this happen more in Canada when the majority thinks they can pick up an even bigger majority.
Labour leader Sir Keir Starmer has called for a general election after the resignation of Liz Truss, but since the Labour party isn’t in power, they really aren’t able to make that happen.
So who picks the new PM now? Well, that is up to the Conservative party. When Boris Johnson resigned, they allowed party members to vote (party members only, not the general population). Ms. Truss said in her resignation speech this week that the Conservative party would elect a new leader by the end of next week. So in this instance, the new PM will probably be decided by the Conservative members of Parliament.
Who will it be? I do not know, but I did hear on the radio this morning Boris Johnson, the former prime minister who resigned back in September in the wake of the partygate scandal, might be throwing his hat in the ring for round two.