Hospitals' profit motive drives costs - the solution is NOT MedAdv/MulgrewCare but reigning in costs with controls

There was a time when hospital and health insurance costs were controlled - public and non-profit but the neo-liberal deregulation craze since the late 70s has created a monster. Last week I attended a film and panel discussion exposing these issues and pointing out that the only way to control costs and deliver better healthcare is a single payer system where the government regulates prices, similar to what Medicare does today. On the panel was former NYSNA president Judy Sheridan Gonzalez, whose husband Angel was a close associate for a few years in organizing in the UFT - and one of the co-founders of the Grassroots Education Movement (GEM). Judy who still works in a hospital pointed out all the scams they are using to drive profit over health. Watch this sort video of a few of her comments: see her summary here.

Here is the email they sent out:

 

Dear Norm,

On Tuesday night, Physicians for a National Health Program - NY Metro, Center for Independence of the Disabled - New York, and New York State Nurses Association hosted a screening of the new documentary American Hospitals, followed by a panel discussion.  Our panel of experts discussed how the issues raised in the film manifest in New York state, systemic solutions to the failings of our profit-centered current system, and modest improvements that would bring some immediate relief.  We had a full house with lots of great questions.  Due to technical difficulties, we are unfortunately unable to share a full recording of the panel. See below for a few highlights and ways to take action!

Speaker Judy Sharidan-Gonzalez succinctly captured how the current financing of healthcare negatively impacts patient care - see her summary here.

Screening attendees expressed the reasons they support single-payer healthcare: the NY Health Act and Medicare for All - guaranteed, universal, comprehensive healthcare that is paid for fairly, according to income, with no out of pocket costs, surprise bills or medical debt. Systemic inequities and injustices require systemic solutions!

Action Items & Resources:

• Contact your representatives TODAY to urge them to include the Ounce of Prevention Act in the final NYS budget AND urge them to include #Coverage4All in the final NYS budget.
• Join us for a bike ride in support of the NYHA this Saturday, April 14: sign up here!
• Our next forum Tuesday May 16 7:30pm is virtual: The Fight for LGBTQIA+ Rights and the Struggle to Expand and Guarantee Care for Every Body. Sign up here.
• Read Barbara Baress’s 2017 report on restructuring NYC Health and Hospitals, commissioned by NYSNA.
• Info on this and our other forums can be found on our Past Forums page.

Featured speakers:

Donald Moore, MD, MPH appears in American Hospitals as a featured expert. He earned his degrees in 1981 from the Yale School of Medicine and the Yale School of Public Health Clinical Assistant Professor at Weill Medical College of Cornell University and SUNY-Downstate Medical School. He has been an Attending Physician at New York Presbyterian Brooklyn Methodist Hospital since 1990 where he currently serves as Chair of the Medical Ethics and Professional Conduct Committee. Dr. Moore is the past President of the Provident Clinical Society, the Brooklyn affiliate of the National Medical Association (NMA) and he has served as the President of the Association of Yale Alumni in Medicine (AYAM) and President of the Medical Society of the County of Kings (MSCK). Dr Moore is chair of the Committee on Physician Health of the Medical Society of the State of New York (MSSNY), Chair of the Health Information Technology (HIT) committee, and serves on the Board of Directors for the NY Metro Chapter of Physicians for a National Health Program. 

Judy Sheridan-Gonzalez, RN has been a health care and social justice activist for most of her life and an ER nurse at Montefiore Hospital, in the Bronx for 40 years. Introducing Single Payer to the New York State Nurses Association 30 years ago, she was instrumental in engaging the legislature to generate such a bill.
After serving nearly a decade as NYSNA president, Judy was a key leader in the January 2023 NYC Nurses Strike of over 6,000 nurses.This historic strike won unprecedented victories around racial and social equity for patients, enforceable nurse patient ratios, accountability requirements for huge hospital systems and served to inspire labor actions across the spectrum to continue similar fights. 

Barbara Caress has over 40 years of experience as a non-profit, union and public agency manager, consultant and administrator. She served as Director of Strategic Policy and Planning for the SEIU Local 32BJ Health, Pension, Legal and Training Funds, which provide benefits to 250,000 people living in seven states where she oversaw the substantial redesign effort dedicated to developing incentives for members to use, and providers to offer, patient centered medical homes and other certified quality providers. Most recently she has been assisting the Professional Staff Congress in their campaign opposing the privatization of City retiree Medicare benefits.
Ms Caress has spent many years as a healthcare consultant working for such clients as the New York City and State Health Departments, the Community Service Society, Local 1199, SEIU, NYSNA, the Freelancers Union, and the United Hospital Fund. She was a member of NCQA’s Standards Committee, NQF Hospital MAP, and the NYC Primary Care Improvement Project Advisory Board. Author of a wide range of health policy articles, reports and reviews, Ms Caress received her undergraduate and graduate education at the University of Chicago and is currently an adjunct faculty member in the Program in Health Administration at the Zicklin School of Business, Baruch College, CUNY.

Moderated by:

Heidi Siegfried, MSW, JD is CIDNY’s Director of Health Policy. She monitors and analyzes trends and initiatives asthey affect people with disabilities in the city and state to help CIDNY develop its health policy agenda, testimony, bill memos, and action alerts. She represents people with disabilities in a variety of healthcare coalitions.
Prior to her position at CIDNY, Ms. Siegfried was a Supervising Attorney at The Partnership for the Homeless and was Executive Director at the Capital Region and Genesee Valley Chapters of the New York Civil Liberties Union. She has a Master of Social Work from the University of Nebraska and a Juris Doctorate from SUNY at Buffalo School of Law.

Thank you for being with us in struggle and for taking action today!

Morgan Moore
Physicians for a National Health Program – New York Metro

Follow us on Twitter, Facebook, and Instagram or the hashtags #PassNYHealth #NYHealthAct #MedicareForAll!

Donate to support our work! www.pnhpnymetro.org/contribute

Wear your support with our Medicare for All face masks and t-shirts!

 

 Amy Rowe commentary

Below my signature are notes taken during the American Hospitals documentary Tuesday night and the panel discussion afterward. Forgive the rough nature of my notes, for time reasons.

Here's a quick introduction and summary, including the documentary's relevance for those fighting a forced transfer to Medicare Advantage. 

Big takeaways from documentary:

- Private insurance companies pay much higher rates to hospitals than traditional Medicare. If you have a percentage copay, you're paying a percentage of a much higher price for a service or procedure. I assume private Medicare Advantage companies have no more protection for patients from this practice than do workplace group private health insurance policies.

- Private insurance companies' prices for hospital procedures and stays are negotiated behind closed doors and basically invisible to consumers - unpredictable, variable, and nontransparent - as well as being very high. Traditional Medicare rates are low, transparent, public, and standardized for each procedure. 

- The quality of hospital procedures is as high when traditional Medicare is billed as it is when expensive insurance is billed. Either the documentary or the panelists, or both, noted that for routine procedures like knee replacements, your community hospital's outcomes are as high-quality as academic-center hospitals (although for exotic procedures, you want the academic-center hospitals).

- Panelists noted after the documentary that the hospital medical error rate is just as high for fancy insurance as for traditional Medicare: "We [nurses and doctors] see what's going on." Fancy or high-priced workplace group insurance doesn't protect you, they said. Conversely, traditional Medicare's lower reimbursement rates to hospitals don't boost your medical risk.

- Rural hospitals are closing because they're small and less able to negotiate aggressively with insurance companies for better reimbursement rates for procedures. When they get less money than it costs to perform procedures, they can't go on and they close. This threatens both the health of people in the area and the health of the local economy, because businesses and people don't want to live where they can't get health care, where if you have a heart attack the nearest medical care is an hour away.

Despite their huge profits - which have different names due to the nominally nonprofit hospital structure - hospitals pay no taxes due to being nominally nonprofit. That loads up the community with higher taxes, such as on real estate, in addition to the burden of high insurance costs and high medical costs.

Thoughts from me - skip this section, friends, if you've heard this before, and scroll straight to the NOTES section below my signature - about how the documentary relates to the fight against a forced transfer to Medicare Advantage (the documentary focused more on group health insurance for employees than on Medicare):

- Medicare Advantage companies will not fail to learn and use every technique perfected by group insurance plans (often owned by the same companies) for employees, which shift more and more costs from the insurance company onto the insured sick person and their families. Many people in medical bankruptcy in the U.S. have medical insurance.

- The requirement for sick patients to fight private insurance companies, such as Medicare Advantage companies, to access necessary medical care is particularly dangerous and inappropriate for retirees, who are older and sicker and have NO human resources department or union to negotiate or fight for them.

- The injustice of a forced transfer to Medicare Advantage and a foreseeable, unwinnable war for essential medical care is magnified for those whose jobs made them sick, such as 9/11 first responders and civilian employees forced to continue to work near the toxic smoke, or whose jobs cause physical danger, wear and tear, high stress, and high fatigue, including police, firefighters, educators, medical professionals, and others whose jobs forced them into public contact during Covid.

- No self-respecting New York City taxpayer (who has a degree of good luck to have enough income to pay taxes) would wish suffering, including that caused medical neglect / denial of care / inferior, restricted, unpredictably accessible care, on any human being, least of all NYC retirees, to save money in a city and state with alternate ways to save and take in money. That is a morally depraved and unnecessary path to more money for the city or for some union leaders.

Amy Rowe

Brooklyn, NY

amyrowe.nyc@gmail.com

NOTES - American Hospitals documentary and panel discussion, Tuesday, April 11, 2023, 7:10 pm, Quad Cinema, New York City

 

 

Event scheduled to begin at 7:10 pm, started a couple of minutes after that.Words in [brackets] are not written on my note pad, but I remember them being stated during the documentary or discussion.

Moderator = Heidi Siegfried

US medical care costs are twice that in other advanced countries [with worse results in longevity and healthy life expectancy.]

2 years after cancer diagnosis, Americans have depleted their savings on average.

$92,000 is average loss a person with a cancer diagnosis experiences in the U.S.

In the U.S. there is either $140 billion or $140 trillion in medical debt (old ears - apologies).

$4 trillion of the U.S. economy is from the medical care sector.

Elizabeth Rosenthal, MD and author, The American Sickness

NPR segment: "Bill of the Month" about someone's medical bill. [A young man who collapsed during an easy day on his job, preparing crullers at a nursing home if I remember correctly, is interviewed.]

Matthew? is his name? He had $20,000 out of pocket. [He is afraid - as a young man - of having a child with his wife, and dying, and leaving his family his medical debt. Another woman with a breast cancer diagnosis had to sell her dream. house and move to a 600 square foot apartment. She drives past her old house, where she raised her children, and cries for the loss of the place and the community. She said it's either the house or paying the bills, and she doesn't want to leave the debt to her kids if she dies. She and others in the documentary comment that the last thing you want after you have a cancer diagnosis is financial terror.]

Matthew featured.

$20,000 out of pocket for COPD treatment - that's maybe an average cost.

But the same diagnosis yields a $7,000 medical bill in the Bronx and a $100,000 medical bill in New Jersey.

Michael Gusmano, Rutgers U.

[Hospitals have what's called] Master charge lists. [They all vary.]

Medicare prices are standardized, but commercial rates [what your job-based insurance plan negotiates with a hospital] are secretly negotiated.

Donald Berwick, M.D.: [There is] No price-quality relationship in health care.

Biggest ?wal?

Cleveland Clinic works with 70,000 billable items and 3,000 insurance companies.

ONE ADMINISTRATOR PER PATIENT IS NEEDED! [Amy's aside here: Don't let this point go by - a 1:1 ratio in the U.S. between ADMINISTRATORS and HOSPITAL PATIENTS! This means every day you're in there, either the hospital or insurance company has a full-time person just doing your PAPERWORK. Based on the context of this statistic, I'm confident that the HOSPITAL needs one full-time administrator for every patient in a bed in their hospital.]

Wendell Potter: Hospitals need large staffs to track all these [insurance] policies.

Alan H. Channing

Potter: This...

Hospital admin. per capita: Canada $146, U.S. $993 [I assume this is medical administration costs per year per patient?]

Employers are burdened. They have complex medical insurance administration. A business leader of a relatively small business - was it craft beer? yes, The Alchemist Brewery - said this is his "biggest waste of time."

Affordable Care Act (ACA) includes a cap on deductible of $17,000 per family. [Which is absurdly high.] 

Woman with breast cancer diagnosis: I gave up my house and moved to a 600 square foot apartment.

Economist Kenneth Arrow [several decades ago] recognized / discovered that regular marketplace dynamics don't operate in health care. [People are frightened to price shop, fearing lower price means lower quality care.] 

Michael Gusmano, MA [and other degrees], Rutgers U.: [There is] no price transparency [in medical services and procedures].

Peter S. Arno, PHD, PERI

Joe White, PHD: People are scared of low-priced doctors.

Medicare: 1.7%/year [I think this is percentage of expense required for administration]. Commercial insurance: 38%/year.

Price growth

Employer pays $20,000-35,000 for a procedure that Medicare pays $10,000 for. [And the quality of care is the same; but later, the documentary deals with MedicAID care quality, unlike MedicARE quality, being lower because it's starved for funds, equipment, and staff by ultra-low reimbursements]. 

Wendell Potter

Hospitals want non-Medicare patients.

The state of Maryland, unlike the rest of the U.S., standardized [hospital] costs [prices].

Harold Miller

Maryland has a rate-setting commission [for hospitals] that includes doctors, patients, and economists.

Switzerland has private and public [can't read writing: looks like victor Rodwin; I remember nonprofit?] and all get paid [the] same [amount of money for the same procedure, unlike in U.S. outside of Maryland, where cost of a given procedure varies wildly, both within the same hospital for different insurances and between hospitals and between U.S. states].

In non-US countries, price control / regulation exists. U.S. does that with Medicare. Maryland has eliminated the need for safety-net hospitals (which treat the poor and uninsured in the U.S.).

[Elizabeth] Rosenthal: Safety net hospitals have fewer staff [per patient], working longer hours, and older, scarcer equipment.

Carla Le Coin, RN at a safety net hospital: "My heart hurts" at having to provide minimal levels of care because there are so many patients per nurse. [I think she's a maternity nurse. She talked about being so sad to hae to neglect mothers in labor; I think she said a nurse is tending to three at once?]

[On an unrelated note: This is reminding me of the documentary segment about hospitals admitting patients to cots in a hallway, no privacy, no bathroom, but charging/billing them as if they've been admitted to a hospital room.]

Donald Moore, MD [who appeared live as a speaker after the documentary]: Hospitals treating patients with commercial insurance have more money per patient and per illness and per procedure [than hospitals that treat Medicare, Medicaid, uninsured patients and safety-net hospitals].

Dr. Susan Rogers: [an increasing number of Americans live in a ] medical desert. Poor people are the patients no one wants to treat. Medicare patients are black and brown.

Carla Le Coin, RN

Philip Longman: Poor and skin color predicts rate of Covid death. Poor, brown, black, have higher rates of severe Covid illness and death.

NY Times: Community hospitals versus hospitals in rich neighborhoods had disparate death rates.

Alex Ortega: Blacks and Latinos have more Covid health damage and death.

Tunapah, Nevada (town) Rural hospitals close because they have poor patients [and get reimbursed at rates below the cost of providing services, which is unsustainable]. 

[Wendell] Potter: Small hospitals negotiate more weakly than big hospitals [with insurance companies]. Rural hospitals close.

[I think the documentary narrator said that 140 hospitals closed in the U.S. in some recent period, including 14 in Tennessee.]

Including in Big South Fork, Tennessee [hospital or hospitals closed]. You're [now] an hour away from care. [Imagine if you have a heart attack, you feel the chest pain, you have trouble breathing, and you know medical care that used to be in the immediate area is now  a full hour away. Will you make it?]

A doctor: I can't retire in a place without a hospital. I can't retire here, even though I'm from here [and it's home, because the hospital closed. Note: I think this doctor was from Tennessee, possibly from Big South Fork area

Tracey Stansberry: Without a hospital, a local economy shrinks [because not only do the related jobs leave, like restaurants serving hospital workers, but people like that doctor can't retire there, and businesses don't want to locate there and expose their employees to no hospital, no emergency care, lower survival chances]. 

[Elizabeth] Rosenthal: Religions did hospital care originally [as community service, not for profit]. Post-World War II, 16 million soldiers returned home [in U.S., wanting the same level of medical care they got in the military.] U.S. Hill Burton Law funded hospital building. [The goal was a hospital in every U.S. county, and the hospitals were built with federal tax money.] Financed by federal government, not for profit. In late 1980s, price regulation [for hospitals] was repealed in all states except Maryland. 

Gerald Frieden, Ph.D: Cost of hospital stay tripled from 1980 through 1992.

Wendell Potter, author of Deadly Spin: Hospials bought each otehr to achivee monopoly power in many commuities.

Richard ?Lander? 

Deborah Mehter? Mehter? MD, Vermont: Surplus is the nonprofit equivalent of Profit.

Vikas Saim

Michael Gusmano at Rutgers: Hospitals invest based on profit, not need [including where they build new buildings]. Every other industrialized country [except the U.S.] views health care as a public good [not as a business opportunity or a money making opportunity]. Orthopedics, ophthalmology, cardio [are profit centers that get investment money over more urgently needed primary care, prevention, and chronic disease management]. There are perverse incentives [in the U.S. hospital sector].

Too much high-tech and acute care, not enough primary care or chronic disease care. We are [meaning the U.S. is] an outlier [among developed countries].

David w. Johnson

Hospital networks have metrics for doctors [to meet. This leads to] overtreatment. [You, doctor, should be performing at least X number of Y kind of procedures per month. If they have 5 CT scanners and one is not in use, if someone is borderline, they'll order the CT scan. If this logic applies to surgeries, you have patients endangered and in pain and billed unnecessarily. Part of the reason that the U.S.'s maternal mortality rate is so much higher than other countries is the higher number of C sections here, surgeries, big scar.]

$$100 billion per year

Overtreatment can hurt people and be expensive.

Woman doctor, Dr. Berwick

Research on overtreatment [is neeeded].

Would ?force? $

US GDP growth is 1.7%. Health care cost growht is 5.5%.

Woman, Tsung-Mei Cheng, Princeton University

1960 - Military spending accounts for 9% of U.S. GDP and health care 5%.

Now - Health care is 18% of US GDP and military is 3%.

Hospitals' excessive growth threatens local economy [because nonprofits don't pay taxes, so everyone else in the community has to pay more, like in property taxes; so you have very high taxes as well as very high medical bills].

Phillip Longman, author of Best Care Anywhere

[A hospital chain's] expanding = not good just to gobble up market share.

Hospital network

?Gerald? ?Fierstein? at U. Mass. Amherst

efficiencies [claimed] result in higher profits.

2007-2014 mergers resulted in 41% price incrases at hospitals [which claimed ahead of time that mergers would yield efficienciest hat would reduce prices - did not happen].

Community hospital care quality equals academic center hospital care quality  in routine procedures like knee replacements.

Stephen Klasko, MD-MBA

Phillip Longman or Langman: Profit-maximizing monopoly. [Nonprofit hospitals pay] no property taxes. So people pay higher insurance [and medical bills] AND [higher] property taxes.

Nonprofits - "earned excess" is their equivalent of profits. It equals 6-7-8% of gross revenue for nonprofit hospitals. They use the money to build or acquire.

Large reserves means the hospital is over-resourced.

Lehigh Valley, Pennsylvania, has $699 million in cash, $417 million in corporate bonds, $668 million in stock, $152 m illino in real estate, $59 million in government securities. So they have over $2 billion in liquid reserves. This is a, or the, nonprofit Lehigh Valley hospital chain.

Richard Master (sp):

Money they have is from the community. Community oversight makes sense. Hospital boards don't do that [don't do effective oversight]. In Florida and Philadelphia, I had great boards. [I think this guy is a good, moral, retired hospital ceo - I he's the one who said later, If I'm running a hospital in Philadelphia orPennsylvania and the community around the hospital has a life expectancy that's 28 years lower than in neighboring communities, I don't care how much money my hospital made; I've failed.]

Stephen Klasko

"The Amazon of Healthcare" UPMC UP = University of Pittsburgh = largest non-government employer in Philadelphia.

Josh Shapiro - government of Pennsylvania

Predatory behavior.

Chelsea Wagner

Pennsylvania government

they shuttered hospitals in poor neighborhoods.

Community

community subsidizes non-profit hospitals [because nonprofits pay no taxes].

Shannon Brownlee, author of Overtreated

Opioid epidemic.

Donald Berwick, former head of CMMS [Center for Medicare and Medicaid Services]

MedicareHere's how to get a community healthy, versus make money

Stephen Klasko, Md, MBA: I can't be successful if my community has a 22-year life expectancy disparity.

Improve health of community.

Lown Hospital Index

Wendell lPotter, author, Deadly Spin

Shannon Brownlee, author, Overtreated

Male speaker: Be involved in prevention

Susan Rogers, FA CD

Improve equity

Male speaker: [Pressure on hospitals to] Optimize revenue: Marilyn breaks that. Maryland caps revenue. Maryland is the only state to do so.

Maryland reduced complications, infections,a nd readmissions.

Michael Gusmano [Rutgers] "Global budgeting" [is the name for the technique Maryland uses for its hospitals]. 

[If you, the hospital] Do less [meaning fewer procedures because you successfully helped people prevent serious illness], you participate in the savings [achieved].

You want people to thrive at home and not need the hospital.

Maryland hospitals via "Global budget" can shift to preventive care.

Joshua Sharfstein

Maryland's [hospital] costs have been going down over the last 5-7 years.

Redirect incentives to maximize community health [rather than revenue]. This could save $2 trillion [in the U.S.] over the next 10 years.

Richard Master

Chair, Center for Health Care Innovation

Ex [can't read my writing - looks like produce? or prilire?] Oh, Executive Producer

Richard Master

Associate Producer

Wendell Hall

Music

Henry Nevison

[I thought documentary's music was very effective]

End of documentary, start of discussion 

Heidi Siegfried, moderator

Panelists:

Dr. Donald Moore, on board of PNHP (Physicians for a National Health Program)

Barbara Caress

Judy Sheridan Gonzalez, ER Nurse, Montefiore Hospital for 40 years.

Dr. Moore: Hospital Systems are the new bad guys [even more than insurance companies; these systems tell insurance companies what is going to happen.]

Barbara Caress: I agree.

[a couple of panelists expressed desire for documentary to be shorter - it was about an hour long. Judy Sheridan Gonzalez expressed the wish there were a half-hour version she could show at work.]

Judy Sheridan Gonzalez: The documentary worshiped Maryland [and its approach to controlling hospital costs, including with a rate-setting commission that sets standard prices for procedures], rather than advocating for Medicare for All.

I'd show a shorter version.

Moderator: There was hospital rate regulation in New York.

Barbara Caress: Medicaid and Blue Cross Blue Shield used to pay the same.

Rockefeller instituted this. He set eligibility [for Medicare] so 50% of NY State residents were eligible.

But in 1968 Congress changed the law.

1975 fiscal crisis.

Gov. Crey - 

Stable system: Almost no hospitals closed 1989-1996.

1996 - Pataki deregulated the system. He set up privatized Medicaid.

Now - incredibly unequal [medical care] system.

"Presby" [New York Presbyterian Hospital] and NYU [Langone, I think] are the most profitable [hospitals in NY state]. Northwell has 85,000 employees.

The few surviving safety-net hospitals are [financially] desperate.

NY "Presby" [New York Presbyterian] - [had] $2 billion in profits last year. $13 billion in reserves.

UPMC [University of Pittsburgh Medical Center] = bad. NY = worse than Pennsylvania.

Moderator: We [NY State]  have 1 "health agency" left, in the Finger Lakes.

Judy (nurse at Montefiore Hospital) 

A true public hospital would have had PPE [during Covid].

80% of us (the staff at Montefiore) contracted Covid in March [2020], [when Covid was serious], and had highest [Covid] death rate in the world. Bronx is the poorest place in New York State.

McKinsey group was involved with opioid epidemic and consulted at Montefiore.

Westchester Square - small community hospital - popular. 

Montefiore closed most of its

They took over Mt. Vernon Hospital and closed it.

Montefiore eviscerated a

We successfully fought Montefiore's effort to close New Rochelle's birthing center.

Closed clinics yielded (up arrow) emergency department. [Does this mean fewer clinics increases use of emergency care?

Our patients are suffering.

Patients "admitted" to stretcher in hallway.

Our demands include: [during nurses' strike]

Reopen clinics.

Fix emergency room.

Treat patients with dignity.

Patients in understaffed units get a 15% discount.

North Central Bronx = a great hospital.

Jacoby = great hospital.

Even with good insurance - so many [medical] errors occur. We see what's going on.

Moderator: We don't allow hospitals to be for-profit in New York State - but nursing homes get ____ stripped off.

75% of our facilities can't meet 3.5 hours per resident per day [standard].

Solution: NY Health Act, Medicare for All

Dr. Don Moore?

Dr. Donald Moore

Hospitals moved from a care model to making money.

US infant mortality is the worst i the [developed] world. Maternal mortality is rising.

I have Medical student who died at age 30 giving birth.

US has low life expectancy because we do so many C-sections.

Large, unnecessary wound [results from unnecessary C-sections] and waste community's resources.

[Covid] testing was done in tents.

Donald Henderson

Most people on ventilators [for Covid] didn't need them.

Doctors infected patients that came into hospitals.

Then we sent them to nursing homes to kill otehrs.

U.S. outcomes are worse for cardiac and cancer.

Life expectancy in U.S. is less [than in other industrialized countries].

In Maryland, scores of insurance companies are still around. United Healthcare gives me 10-15 plans to choose from.

of -

$4 trillion, $1.5 trillion [worth of medical spending per year in the U.S.] goes to hospitals, which is not the same as going to doctors.

In New York State: NY Health Act. It goes further than Maryland's all payer plan.

Medicaid is privatized in New York City.

Natural solution would be eliminate the insurance companies.

Moderator: Long-term are has been added to New York Health Act, which is not managed care. [meaning NY Health Act is not managed care]

Connecticut kicked private managed care out of their state. - Barbara Caress

Public health and health planning council

MSK [Memorial Sloan Kettering] - profitable and has Zero Medicaid patients.

HSS [Hospital for Special Surgery] - 1% of their patients are Medicaid patients. Very good hospital. Of 14,000 admissions 64 were black people. 

Barbara Caress: Misogyny, racism [in health care].

Lown. Lown Institute.

Pittsburgh = worst [for having excess profits, meaning the nonprofit organization's equivalent of profits]. NYU Langone is second worst.

Certificate of Need required when a hospital wants to change something.

Health Equity Impact Assessment is required.

Color, disability, LGBTQ, [illegible word - including?] non-English speakers.

Hospital financial assistance application - patients are not told [that it is available.]

Gov. Hochul - should be one.

First question from audience: Trina, Medicaid patient.

In NY state, we have a law against for-profit hospitals.It's illegal to tell a licensed provider how to practice medicine.

But hedge funds own practice management companies.

Dr. Donald Moore: Doctors sold their licesnes to hospitals.

Few private medical practices.

Now hospitals own them.

Barbara Caress: U. Healthcare [United Healthcare] owns 70% [of medical] practices and bought Crystal ___ [illegible word - looks like Loan or Lawn?} in Hudson Valley yesterday.

Dr. Donald Moroe: They turned us into "Providers."

Woman [in audience I think]: Korea, Japan #1 in outcomes, have 30-40 private insurance companies and good [patient medical] outcomes.

Dr. Moore: Canada and US outcomes used to be the same. Canada went single payer and [their] outcomes [then] rose versus those in the U.S. Cuba has higher life expectancy than the U.S.

Medicare does better than every insurance company with respect to money spent. 98 cents of [every] $1.00 Medicare [spends goes to actual medical care versus administration.]

United Healthcare: $0.85 of $1.00 is spent on care.

Unequal Care - U.S. govt. report: Black people get worse care.

Now: Medicare Advantage - poor patients. Traditional Medicare - rich people. We are almost universal [meaning almost all people in U.S. now have some kind of medical coverage], but it's a caste system. Hospitals of last resort, safety net hospitals.

What's the point of near-universal coverage, if outcomes are so bad?

RN panelist: Canada's and Great Britain's health systems are underfunded.

I deliver better care in tents post-disasters [like floods, tornadoes] than in academic hospital centers. [Less time on computer screens, more time with patients; I can write a detailed report versus having to just check boxes in a standardized checklist]

Feel belly.

Listen to lungs.

Versus cat scan.

...These are predators. 33% of every dollar not going into health care. We have to spend so much time on computers and phones. On Billing versus Caring.

In triage, I used to be able to give a good report. But now I check boxes, which makes my report vague.

In Canada, they started [with universal health care] in [just one province,] Saskatchewan. A man named Douglas started it and is beloved.

Medicaid, Medicare, Indigent care.

New York is different from Vermont [where a statewide health care for all system failed] in ways that strengthen New York's ability to do this [a successful New York Health Act].

[Moderator: Thank you for coming, sign up for emails from us outside, pick up literature, have your picture taken with a Health Care for All themed sign.]