Featuring Dr. Stephanie Kang, PhD, speaking about how the COVID-19 pandemic influenced Rep. Pramila Jayapal’s 2021 Medicare-for-All bill, and whether Americans enjoy “choices” with commercial health insurance that Medicare for All would take away. Kang, who serves as Jayapal’s health policy director, is speaking on behalf of herself and not necessarily on behalf of Jayapal’s office.
This is part two of a two-part series.
The Fallacy of Choice in U.S. Health Care
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Welcome to Code WACK!, your podcast on America’s broken healthcare system and how Medicare for All could help. I’m your host, Brenda Gazzar.
What’s the latest with Rep. Pramila Jayapal’s Medicare-for-All bill? How would it safeguard struggling rural hospitals and expand choice? To find out, we spoke to Dr. Stephanie Kang, who serves as Jayapal’s health policy director and has assisted in crafting Medicare for All legislation in the House of Representatives. She completed her doctorate of public health at the Harvard T.H. Chan School of Public Health.
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Welcome to Code WACK, Dr. Kang!
Kang: Hi, thanks for having me.
Q: In 2019 Rep. Jayapal’s first Medicare for All bill – H.R. 1384 – was characterized by Salon as “the most ambitious plan yet.” How does her latest bill, H.R. 1976, compare? Did anything change in the legislation in light of the COVID pandemic?
Kang: So, definitely we’re very excited when we introduced the Medicare-for-All Act last Congress, and I’m glad that Salon characterized it that way because that’s what we were aiming for. We wanted it to be the most comprehensive, progressive legislation that had come forward on a single-payer plan because, as you know Brenda, Rep. (John) Conyers who had been championing Medicare for All before Rep. Jayapal in the House, he had his Medicare-for-All Act, but it was this resolution. It was this 20-something page resolution that gave this like great blueprint or an outline of a single-payer plan but it wasn’t in-depth the way that H.R. 1384 is and now H.R. 1976.
This is an over 135-page plan that really goes into detail about not only what are the goals, but how it would be designed and implemented. And so, in particular for this Congress’s version versus last Congress, we definitely tried to expand on pieces so I mentioned the Office of Health Equity piece, ensuring that was at the center of a lot of the work we’re doing. Another piece of this was taking out the public direct care system and TRICARE so for our military members who are in the TRICARE system, that would be separate from the Medicare for All system similarly, to how it already had been treating the IHS and Veterans Affairs system.
And then also another piece of that was specific to COVID. What we saw during the COVID pandemic was that nonprofit hospitals or hospitals that were already operating in the red were shutting down in the middle of a pandemic simply because they weren’t profitable enough. With a Medicare-for-All system, that wouldn’t happen because we have a global budget system which means that you get your revenue prospectively and the money that you need to operate your hospital at maximum capacity is given to you on a quarterly basis. And included in this newest iteration of the bill factors that would go into play especially if there was ever a crisis or a pandemic or the next COVID-19, to ensure that hospitals have the flexibility and again, the tools and resources that they need, particularly for rural hospitals and safety net hospitals, that they would have that at hand, rather than what we were seeing right now where they’re really at the hands of Congress and as we know, Congress moves slowly. And so, people we’re just sort of barely — like they were drowning in their ability to be able to keep their hospitals operating waiting for Congress to pass their stimulus bills and that shouldn’t happen. It shouldn’t be based on that.
Q: Yeah, you mentioned the shutting down of hospitals during the pandemic. What impact did that have especially in rural areas?
Kang: I mean it was just devastating. As we know, even before COVID rural areas simply just did not have the resources that they needed to be able to provide sufficient care, and I live in Tennessee and there are plenty of areas here. We have the highest rural hospital per capita closing but also I mean people have to drive three hours before they can receive care. And so for a lot of these communities, the rural hospitals or clinics were the only source of care that they were able to access and then when those were shutting down, I mean, it was devastating.
We weren’t able to implement systems in terms of contact tracing, in terms of testing but also in terms of any of the triaging that would need to happen for patients in order to save their lives. And so it’s just really devastating to see that that was even a possibility because again that just wasn’t happening in other health systems. Other health systems were focusing on fortifying.
Q: Dr. Kang, What do you expect will happen with H.R. 1976 in the coming months?
Kang: I hope we continue to get more cosponsors. I mean just even in the last months, we’ve been getting more cosponsors after introduction, which is fantastic. We’re at the highest percentage of the Democratic Caucus than we’ve ever been so it’s like well over the majority, which again, that’s just never happened for a bill this comprehensive. I believe we will get more cosponsors on throughout the year. And I’m also hopeful that again the grassroots movement will continue to engage, continue with the education that they are doing, continue with passing city resolutions. Public Citizen has been doing a phenomenal job passing city resolutions all throughout the country. I know New Jersey just had a few and continuing the town halls and so I fully expect the movement to be keeping the drumbeat very loud and clear.
Q: Critics claim Medicare for All will take away people’s freedom to choose between insurers. How would Medicare for All actually expand the choices that we have when it comes to things like choosing doctors and hospitals?
Kang: I mean, every year I have to enroll my parents into a Marketplace plan, and I don’t… I hate having to figure out, like even with the level of knowledge and training that I have and the expertise that I have, it is so complicated. Going on the marketplace, and looking at 20 different terrible plans and then choosing the least evil plan that there is is extremely frustrating, and I still have a hard time deciphering exactly what’s the best fit for my parents and again, this is like with I’m a Doctorate in Public Health. I work in health policy. I deal with this every day, and it is still very difficult. So let alone give anyone else with slightly less or if not none of that expertise in this area, I cannot imagine how unfathomable it is to try to decipher all of that, and then try to pick the best plan for you.
So in terms of the choice that I think people really want, it’s about being able to go to the doctor that you need. It’s about being able to seek the care that you need. This is something I really saw for my father. My father found out that he had a tumor in his spine last year. He has a marketplace plan as I mentioned, and when I looked to see if any of the doctors were in his network for a neurosurgeon, there were only four in the entire state. I called two offices. They were no longer taking that insurance and so we were forced to pick between these two hoping that they are good because neurosurgery, you know, is quite complicated.
And the whole entire way, I mean, the neurosurgeon was at a hospital. It turns out he also has his own practice. And so at the hospital that was covered under the insurance, but through his practice, it wasn’t, and so we got billed twice. It’s just nuts. Just stupid things like that that just happened and so like that’s not a choice to me right. We absolutely had no choice. We were forced into every one of these situations, and had to accept the outcomes for a surgery that was incredibly, incredibly intensive. And so I truly believe people want choice and being able to make sure they get the best quality care that they can and I think this is a point that we’ll have to make over and over and over again. I mean it really speaks to the whole idea of America and freedom and choice and all that right? Core values that I think can really be tapped into, if framed correctly.
Q: I’m so sorry you and your dad went through all of that. How’s he doing by the way?
Kang: Ahh, that’s been, it’s insane. He’s still not able to walk independently. The healing process has been really slow. He’s only allowed to go to PT twice a week because of the insurance, which he just obviously needs so much more than that and so the whole step of the way was just really really insane. Actually, with this insurance when the surgery was scheduled because the neurosurgeon saw him and said, Wow, we have to get you into surgery right away.
So it was scheduled for a few days later, and the day before the surgery, they call us and say we have to cancel because the insurance decided it was medically unnecessary. And so I went crazy. I’ll use positive words. I went crazy on the health insurance company and, you know, demanded that they review and blah blah blah and got the doctor onto the phone from the health insurance company and they’re like, “Oh,no of course it’s medically necessary” and approved it so we got his surgery. But again, like I have a lot more agency than a lot of people and if I had not pushed that way, he wouldn’t have been able to get the surgery he needed. And then even afterwards I mean, just some days in the ICU, plus the surgery. Well they told us if the insurance didn’t cover it, they’re like “well you can do a $6,000 down payment and then pay $4,000 monthly” as if that was even an option. Luckily, it covered but if we had not been able to pay for it… The bill came out to be $300,000 for his hospital stay, and then another $300,000 for the rehab. So, it’s great. Best health care system ever. (laughter)
Q: Thank you Stephanie for everything that you do to change our broken healthcare system.
Find more Code WACK! episodes on ProgressiveVoices.com and on the PV App. You can also subscribe to Code WACK! wherever you find your podcasts. This podcast is powered by HEAL California, uplifting the voices of those fighting for health care reform around the country. I’m Brenda Gazzar.
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