THIS TIME ON CODE WACK!
Millions of Americans have health insurance, but still can’t afford to use it. So what happens when high deductibles and corporate profit pressures shape the care patients receive?
To break it down, we spoke with Dr. Adam Gaffney, a pulmonary and critical care physician, public health researcher, and Assistant Professor of Medicine at Harvard Medical School. He’s also a former president of Physicians for a National Health Program, and his work focuses on health care financing and national reform. This is the second episode in a two-part series.
Check out the Transcript and Show Notes for more!
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SHOW NOTES
WE DISCUSS
You’ve emphasized that being underinsured affects more people than being uninsured. How do high deductibles, copays, and cost sharing change how — and whether — people actually use health care?
Gaffney: Well, what do we expect to happen when we impose heavy prices on patients for care? Well, they’re gonna use less of it. Okay. We know that….People do go without needed care when you impose cost-sharing. A, because they have other important commitments and financial obligations. And two, because as patients we don’t really always know what care is necessary or not, ’cause if we did, we wouldn’t need to be going to the doctor.
… the reality is that cost sharing – co-pays, deductibles and co-insurance – can have one of two effects. One … people don’t get care they need because they say, ‘I can’t afford this and I have other things I need to do.’ And why is that bad? Because people don’t get the needed health care, they suffer. They don’t take their medications, they don’t go to the doctor. They may even avoid going to the emergency room, and you can imagine the consequences. Worse health, worse blood pressure control, untreated diseases, undiagnosed conditions, and medical harm. That’s number one.
The other possibility is that people do get the care they need, but they take a big hit to their wallets. So they experience financial strain. And this is very, very common. We actually just recently did a study looking at sort of how those cost burdens, like sort of accrue over time, right?
… we followed Americans for four years and found that over a four year period, about a quarter of us will experience a heavy healthcare financial strain. So the takeaway? The way people respond to cost sharing is either their health takes a hit or their finances take a hit – or both.
From private equity in hospitals to the rapid growth of Medicare Advantage, or privatized Medicare, how has corporate control reshaped healthcare delivery?
Gaffney: Well, we can take each of those separately…. So Medicare Advantage firms have to do a lot of things that traditional Medicare doesn’t have to do. They have to … pay shareholders off. They have executives to pay. They have more to do with network design and product design. And they need these big bureaucracies to try to contest claims, fight with patients, fight with doctors, and reduce the utilization of care because by doing so, that’s how they make money, right?
For every, for every claim they deny that’s money that can be turned into profit. So that’s what the driver of health care is, of sorts, increased costs for Medicare Advantage. We overpay them, but the, and the reason why we’re overpaying them is because the money that we’re giving them is not going to patients. It’s going towards their own administration of profits.
…. So what private equity does is the model … very short term investments, pooling money from investors and the firm … trying to make a quick profit and then flip the business and sell it off. And the idea is to make profit in that period of time. And theoretically they’ll claim that’s through, you know, finding new efficiencies and, you know you know, cutting … the fat. But what we’ve seen play out in healthcare … instead is that private equity … sells off these sort of vital resources of health care and … pockets the money and then gets out of Dodge.
People often think of single-payer Medicare for All mainly as a way to cover everyone, but you have said that it does much more than that. Tell us more.
Gaffney: Right. What do we wanna do with healthcare reform? And I think if you start with the goals, it makes it very clear why a single-payer reform could solve the problems of our healthcare system and other reforms would fall short. So we want to cover everyone. I think that’s absolutely necessary. We want to eliminate the financial barriers that keep patients from their care. So we want to improve coverage for everyone. Now that does take more money. No one’s denying that.
So how do you pay for it? Well, what single-payer allows you to do is to achieve enormous efficiencies by reducing profit-taking and administrative waste in the healthcare sector. 2% of traditional Medicare’s revenues go towards administration…. And in fact, when the Congressional Budget Office scored Medicare for all several years ago, they found that the single biggest savings from it was the reduction in insurance bureaucracy, achieving $400 billion a year in savings by 2030, according to their projections. So what that means is you can cover everyone, and you can do it without breaking the bank; you can achieve those savings. And at the same time you can achieve universal coverage….
… there are other things that national healthcare reform can do beyond achieving savings and covering everyone and getting rid of our financial barriers, although those would be really good.
For instance, when you have a national healthcare program, you can make choices that are not possible in the current environment. You could say, ‘to participate in this system, you can’t be an investor-owned facility.’ Right? And that is actually in the Medicare for All bills in Congress.
You can also say that we’re going to, you know, purposefully and explicitly plan where we build new hospitals, where we bring new infrastructure to remedy some of the longstanding inequities and disparities and availability of healthcare facilities in our country. That’s the consequence of decades of Black systematic racism and so forth.
So yes, …. it doesn’t solve every problem. I don’t wanna sound like it’s a panacea, but … in addition to the universal coverage side and the savings side, it does provide additional tools to accomplish other goals..
Helpful Links
To Heal Humankind: The Right to Health in History, Adam Gaffney, MD, MPH
Physicians for a National Health Program (PNHP)
The State of Health Insurance Coverage in the U.S., The Commonwealth Fund
PESP Private Equity Hospital Tracker, Private Equity Stakeholder Project
The Case for Single-Payer: Reduce Healthcare Cost with Administrative Simplification and Restore Professional Autonomy, Counterpunch
Single Payer and Health Inequities, PNHP
Episode Transcript
Read the full Transcript.
Guest Biography: Adam Gaffney, MD, MPH
Dr. Adam Gaffney, M.D. M.P.H. is an Assistant Professor of Medicine at Harvard Medical School, a pulmonary and critical care physician at the Cambridge Health Alliance, a health policy researcher, and a writer and commentator on issues of medicine and policy.
His research focuses on national healthcare reform, healthcare equity, and disparities in lung health. He has authored or co-authored more than 60 journal articles, with first-author publications in such journals as the Lancet, Annals of Internal Medicine, British Medical Journal, JAMA Internal Medicine, Health Affairs, the American Journal of Public Health, and elsewhere. He is also the author of the book To Heal Humankind: The Right to Health in History, published in 2017 by Routledge.
A past-president of the nonprofit research and advocacy organization Physicians for a National Health Program (PNHP), Dr. Gaffney is also a frequent writer on matters of healthcare and policy, and has published articles in outlets including the New York Times, Washington Post, Atlantic, New Republic, USA Today, and the Boston Globe. He is also a frequent media guest, and has appeared on NPR, MSNBC, Fox Business News, the BBC, and elsewhere.
Dr. Gaffney received his MD from New York University and his MPH from the Harvard T.H. Chan School of Public Health. He completed his residency at the Columbia University Medical Center, where he served as chief resident, and his fellowship in pulmonary and critical care medicine at Massachusetts General Hospital, Brigham and Woman’s Hospital, and the Beth Israel Deaconess Medical Center.
Host Biography: Brenda Gazzar
Brenda Gazzar, the host and co-producer of Code WACK!, has produced over 300 weekly podcast episodes, topping 400,000 downloads. A skilled interviewer and storyteller, Brenda brings nuance, curiosity, and clarity to every conversation.
Brenda has worked as a multilingual and award-winning reporter with more than two decades of experience in California and the Middle East.
Her work has been published by Reuters, Ms. Magazine, USA Today, Los Angeles Daily News, the Orange County Register, The Wrap, The Jerusalem Post, Cairo Times, and numerous other publications. She speaks Spanish, Hebrew, and moderate Arabic and is the recipient of national, state, and regional awards.
Brenda also enjoys being a life coach, helping people align with their purpose so they feel fulfilled while achieving their boldest dreams.
Brenda’s work is grounded in a belief that systemic change and personal growth go hand in hand — and she’s here for both.
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Keywords:
Code WACK podcast, Adam Gaffney, Brenda Gazzar, Medicare for All, health equity, universal healthcare, healthcare reform, U.S. healthcare system, health disparities, primary care access, administrative waste, healthcare costs, underinsured Americans, uninsured population, healthcare inequality, single payer healthcare, public health policy, Physicians for a National Health Program, healthcare financing, health system design
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