Privatized Medicare Advantage for All: The Latest Assault on U.S. Health Care

Privatized Medicare Advantage has grown rapidly among seniors in the United States in recent years. It is now being promoted actively by corporate stakeholders and even by the Centers for Medicare and Medicaid Services itself as a new proposal to extend this approach to cover all Americans. There is little public awareness, however, of the current costs and adverse impacts of Medicare Advantage on enrollees’ access, costs, and outcomes of care while deceptive marketing and disinformation prevails. This article traces the history of Medicare Advantage, outlines false assertions being made by proponents of Medicare Advantage for All, and refutes them based on evidence and their track record. If ever enacted, it would end up lining the pockets of corporate stakeholders and Wall Street investors while limiting access to care, increasing costs, and reducing quality and outcomes of care. The United States already ranks last for access, equity, and outcomes of care in periodic studies by the Commonwealth Fund. This proposal would worsen that situation while costing patients, families, and taxpayers more as their health suffers.

The path to improving equitable access to healthcare in Canada

If Canada were judged on its ability to provide accessible, equal and timely healthcare to all its citizens, it would receive a failing grade. Out of eleven countries studied in the 2017 Commonwealth Fund report, Canada was ranked second last for overall access to care, and last for timeliness of care [1]. Access is a multifactorial issue, but two key problems that arise are wait times, and equitability. It is widely acknowledged that Canadians need to wait a long time for many health interventions, but it can often erroneously be assumed that equal access and affordability are no longer issues in a universal healthcare system. Evidence demonstrates that this is wishful thinking. As we deal with the Covid 19 pandemic, these challenges protrude in an already failing system.

Could be efficient management a solution for the success against Covid-19

Globally, the last 15 months have put health systems under unprecedented pressure during the last century, facing significant challenges in the management of organizations, patient care and the protection of medical staff, and the time to respond to the needs of communities. The context created by the SARS-CoV-2 pandemic shows us how important the functionality of a health system is, how manages could prevent the spread of the virus, how the number of tests or vaccinations could stop the spread of the virus. It is also important to provide access to health services for as many patients as possible, especially for those in vulnerable categories, but also to succeed in ensuring maximum safety conditions for specialized personnel (doctors, nurses, paramedics, ambulance drivers, pharmacists etc.). The authors considered that the essential features of each health system, in the analysis of how they responded to the challenges of the SARSCoV-2 (or COVID-19) pandemic, must be analyzed from the perspective of the medical act, its financing, and also from the use of modern technologies and resilience. Synthesis was made between the results of the 4 official studies presented by the Commonwealth Fund, Health Consumer Powerhouse, Bloomberg and U.S. This information, put by the authors in a comparative analysis with the updated data of the World Health Organization, constantly highlighted several health systems that had an effective management in the fight against the Covid-19 pandemic.

Healthcare funding and its relationship to equity and outcomes: A QCA analysis of Commonwealth Fund and OECD data

This article examines Organisation for Economic Co-operation and Development (OECD) and Commonwealth Funding data to explore the relationship between the level and means of funding of 11 different healthcare systems, on the one hand, and overall equity and health outcome measures, on the other. It utilises qualitative comparative analysis (QCA) and the idea of ‘fitness landscapes’ for the clusters of funding combinations and outcomes they present. It finds that health systems with relatively high levels of voluntary health insurance tend to be associated with poor outcomes almost across the board, but healthcare systems with higher overall expenditures combined with low voluntary insurance levels offer combinatory possibilities for achieving both high equity and high outcomes. The article also explores how ‘contradictory cases’ can be used to explore how systems falling short of the outcomes of others with the same funding patterns, might find improvements.

A Fairer Mirror: Equity-limited Healthcare System Rankings

Objective● Describe the diverse determinants of national health and how they are compositely graded in health care system rankings.● Articulate intrinsic reasons why equity should not be subsumed within other evaluative categories.● Design an equity-limited ratings framework for limiting maximum ratings of inequitible healthcare systems.IntroductionHealthcare systems are often evaluated using comparative health care rankings. Simulations have shown that maximally inequitable health care systems can perform well in published, influential health care system rankings by excelling in non-equity categories1, resulting in highly ranked yet grossly inequitable healthcare systems. Recently, despite below average equity rankings, the healthcare systems of Australia and New Zealand ranked among the top four in The Commonwealth Fund’s international comparative study Mirror, Mirror 20172. Equity rankings should logically limit non-equity rankings given the insignificance of healthcare system improvements to those lacking adequate healthcare coverage. We analyzed whether an equity-limited ranking methodology would limit overall rankings for significantly inequitable healthcare systems while maintaining the general findings of the Commonwealth Fund study.MethodsWe reanalyzed The Commonwealth Fund’s 2017 international health care system comparison using a modified, equity-limited methodology. For each country, maximum non-equity domain summary scores were limited to the equity domain summary score. Countries were ranked using the mean of the five domain-specific performance scores. Overall rankings were compared to the original rankings.ResultsSeven of eleven countries had an overall rank change in the equity-limited model. Countries with above average overall ratings but poor equity ratings had the greatest changes in overall rank. Australia’s overall ranking decreased from second to seventh, thereby matching its equity ranking of seventh. New Zealand changed from fourth to eighth overall, matching its equity ranking as well. Other changes were less significant, with changes of only one overall rank position. Notably, the bottom three countries and the top country were unchanged.ConclusionsEquity-limited ranking methodologies can prevent inequitable health care systems from attaining high overall ratings. Such equity-limited rankings are logical considering the diminished significance of health care system improvements to those lacking adequate health coverage. Methodologies that incorporate equity limits should be used to produce fairer rankings that respect the dignity and rights of all individuals.References1. Reisman S, Blumenkranz Z. Comparative health care system rankings can obscure maximal inequities: A simulation study.Society for Public Health Education (SOPHE) 69th Annual Conference. 2018, June.2. Schneider EC, Sarnak DO, Squires D, Shah A, Doty MM. Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care. The Commonwealth Fund. 2017, July.