A Medicare buy-in is more popular than switching to a single-payer health care system, according to a new poll from Quinnipiac University.
By the numbers: Overall, voters were split on the wisdom of single-payer — 45% said it would be a bad idea, and 43% said it would be a good idea.
Respondents were more bullish on letting people buy into Medicare, with 51% saying it’s a good idea and 30% saying it’s a bad idea.
Republicans were the difference-makers. They overwhelmingly oppose single-payer (79% against), but a plurality of Republican voters (43%) support a Medicare buy-in.
Between the lines: Although the political battle between these rival plans is playing out primarily as a litmus test in the 2020 Democratic primary, Democrats seem fine with either proposal.
69% of Democrats said single-payer is a good idea, compared to 62% who said the same for a Medicare buy-in.
Yes, but:Even a Medicare buy-in limited to people older than 50 — pretty much the smallest option on the table for Democrats — would still provoke a big fight from industry.
The Trump administration’s new legal argument against the Affordable Care Act is a political risk. It may also be a liability in court.
How it works: The legal issue here is “severability” — if the ACA’s individual mandate is unconstitutional, can it be struck down in isolation? Or is it too intertwined with other parts of the law?
Flashback: We’ve seen this movie before — in 2012, at the Supreme Court.
According to behind-the-scenes reporting from the 2012 ACA case, four conservative justices wanted to strike down the entire law. Chief Justice John Roberts reportedly wanted to strike down the mandate and protections for pre-existing conditions while leaving the rest intact.
But the other conservatives wouldn’t budge, and faced with a choice between upholding or striking down the whole thing, Roberts chose the former.
The Justice Department has now forced that same all-or-nothing decision into the case now pending before the 5th Circuit Court of Appeals.
“There’s no way they were getting Roberts’ vote anyway … but this won’t help,” said Jonathan Adler, a law professor at Case Western Reserve University who helped spearhead a different challenge to the ACA.
“It’s contrary to everything he’s ever said and done on severability,” Adler argues.
It may not get that far. “I think the states ultimately lose,” Adler said. “I think the most likely outcome is they lose in the 5th Circuit. If they don’t lose at the 5th Circuit, they will lose at the Supreme Court.”
If that’s what happens, adopting this riskier legal strategy may ultimately be the only thing that saves Republicans from the political nightmare of wiping out 20 million people’s health care coverage with no strategy on how to replace it.
I’ll spare you a long list of quotes from President Trump’s trip to Capitol Hill yesterday. Suffice it to say that no, Republicans still do not have a plan for what happens next if they finally succeed in killing the ACA. Some things never change.
The advantages of working in a high trust environment are evident to everyone from the CEO to the shop floor, from suppliers to customers, and even the competition. Building and maintaining trust within any organization pays off with many benefits.
Here are 12 benefits of working in a high trust culture:
1. Problems are easier to solve – because the energy is on the real problem, and people are not afraid to suggest creative solutions. 2. Focus is on the mission – rather than interpersonal protection. 3. Efficient Communication – less need to “spin” information. 4. Less unrest – little need for damage control. 5. Passion for the work – that is obvious to customers. 6. A real environment – no need to play head games. 7. People respect each other – less bickering and wasting time. 8. Fewer distractions – things get done right the first time. 9. Leaders allowed to be human – can make a mistake and not get derailed. 10. Developing people – emphasis on being the best possible. 11. Reinforcement works better – because it is not perceived as manipulative. 12. People enjoy work – the atmosphere is light and sometimes even fun.
With advantages like these, it is not hard to figure out why high trust groups out perform low trust organizations dramatically. There have been many studies that indicate the leverage you get with a high trust group over a low trust one is at least three times. That is why it is common for groups to more than double productivity in less that a year if the leaders know how to build trust.
There are dozens of leadership behaviors that will develop higher trust. An example would be to do what you say (“walk your talk”). I believe the most powerful leadership behavior that will develop higher trust is to create a safe environment. My quote for this phenomenon is “The absence of fear is the incubator of trust.”
Creating a culture of low fear is not rocket science at all. Leaders simply need to make people understand that they will not be put down for sharing their opinions as long as it is done in an appropriate way and time. I call this action “reinforcing candor,” because the person needs to feel welcome to share a contrary view without fear. Leaders who can accomplish this kind of culture will have the advantages listed above. Work to consistently build, maintain, and repair trust in your organization. I believe the leverage in doing so is the most significant path to greatness in any organization.
The Justice Department now wants the courts to strike down the entire Affordable Care Act — not just its protections for people with pre-existing conditions.
This is a stunning escalation, raising both the real-world and political stakes in a lawsuit where both the real-world and political stakes were already very high.
Where it stands: Judge Reed O’Connor ruled in December that the ACA’s individual mandate has become unconstitutional, and that the whole law must fall along with it.
At the time, the Trump administration argued that the courts should only throw out the mandate and protections for pre-existing conditions — not the whole law.
But in a one-page filing last night, DOJ said the 5th Circuit Court of Appeals should affirm O’Connor’s entire ruling.
Why it matters: If DOJ ultimately gets its way here, the ripple effects would be cataclysmic. The ACA’s insurance exchanges would go away. So would its Medicaid expansion. Millions would lose their coverage.
The FDA would lose have the authority to approve an entire class of drugs.
The federal government would lose a lot of its power to test new payment models — in fact, the administration is relying on some of those ACA powers as it explores conservative changes to Medicaid.
Politically, this makes no sense. Chuck Schumer and Nancy Pelosi must be dancing in the streets.
Health care — specifically pre-existing conditions — was overwhelmingly a winning issue for Democrats in 2018.
Now the administration is doubling down, putting even more people’s coverage on the chopping block.
What they’re saying:
“The bad faith on display here is jaw-dropping,” pro-ACA legal expert Nick Bagley writes.
“I was among those who cheered the selection of William Barr as Attorney General and hoped his confirmation would herald the elevation of law over politics within the Justice Department. I am still hopeful, but this latest filing is not a good sign,” said Jonathan Adler, a conservative law professor who helped spearhead the last big ACA lawsuit.
In a stunning, two-sentence letter submitted to the Fifth Circuit today, the Justice Department announced that it now thinks the entire Affordable Care Act should be enjoined. That’s an even more extreme position than the one it advanced at the district court in Texas v. Azar, when it argued that the court should “only” zero out the protections for people with preexisting conditions.
The bad faith on display here is jaw-dropping. Does the administration really think that the very position it advanced just month ago is so untenable that it must now adopt an even crazier view?
Much as it may dislike the fact, the Trump administration has an obligation to defend acts of Congress. Absent that obligation, the sitting administration could pick and choose which laws it wants to defend, and which it wants to throw under the bus. Indeed, the decision not to defend is close cousin to a decision not to enforce the law. If the ACA really is unconstitutional, wouldn’t continuing to apply the law would violate the very Constitution that empowers the President to act?
Even apart from that, the sheer reckless irresponsibility is hard to overstate. The notion that you could gut the entire ACA and not wreak havoc on the lives of millions of people is insane. The Act is now part of the plumbing of the health-care system. Which means the Trump administration has now committed itself to a legal position that would inflict untold damage on the American public.
And for what? Every reputable commentator — on both the left and the right — thinks that Judge O’Connor’s decision invalidating the entire ACA is a joke. To my knowledge, not one has defended it. This is not a “reasonable minds can differ” sort of case. It is insanity in print.
Yet here we are. An administration that claims to support protections for people with preexisting conditions has now called for undoing not only the parts of the ACA that protect such conditions, but also the entire Medicaid expansion and parts of the law that shield those with employer-sponsored insurance from punitive annual or lifetime caps. Not to mention hundreds of rules having nothing to do with health insurance, including a raft of new taxes, mandatory labeling of calorie counts at chain restaurants, and rules governing biosimilars.
Maybe you think this level of disdain for an Act of Congress is to be expected from the Trump administration. Maybe it’s too much to process because of Russia and immigration and North Korea. But this is not business as usual. This is far beyond the pale. And it is a serious threat to the rule of law.
It’s March Madness! As always, we’re so excited for the annual ritual of hastily filling out brackets based on our (limited) knowledge of the teams, buying into office pools and “friendly” family competitions, keeping one eye firmly glued to the steady drip of results from the games, and ultimately losing to That Guy in Human Resources who picked winners based on the ferocity of the schools’ mascots.
If you’ve waited till the last minute to fill out your bracket, or if your top-seeded Championship pick and beloved alma mater happens to go out in the first round to a 16-seed (take it from us, it ain’t pretty), then we have just the thing for you!
Presenting…Healthcare March Madness!
To keep the next two weeks interesting, and to make ourselves feel better for stealing time from work to watch the games, we’ve constructed our own methodology for filling out our bracket, using a metric we call the Health Value Index (HVI). Working with our friends at Ancore Health, a data consulting firm, we assigned each team a score based on the level of “healthcare value” delivered in the county where their school is located, and then compared that metric for each matchup, picking the team with a higher score to advance to the next round.
Here’s how we calculated the HVI: we used county- and state-level data to assess four aspects of healthcare value important to individual consumers: access to care, cost of care, payment environment, and health of the population. (Specific metrics and data sources are listed in the chart below.) Twelve metrics across those categories were normalized and equally weighted to create county-level composite scores. These normalized scores comprise the county’s HVI, allowing us to compare healthcare consumer value across markets.
In the tables below, you can see how each of the 64 teams in this year’s NCAA tournament stacked up in terms of HVI.
And just in case your favorite team didn’t make it to the Big Dance this year, or you’d like to see how your own county performed on HVI, here’s a map of the US with every county’s score. Click on the map to go to an interactive version, where you can scroll over each county and see its score. (Cool, right? Thanks to the wizards at Ancore Health for making that magic possible!)
When we first looked at this map, it occurred to us that we might just be seeing the impact of higher income levels in the Northeast and on the West Coast. But as it turns out, income level is only moderately correlated with HVI score—wealth only accounts for some of the variability in outcomes. The top four teams according to HVI include University of North Carolina, University of Vermont, University of Wisconsin and University of Washington. Wisconsin and Washington are strong performers across the four HVI dimensions, while UNC and Vermont’s strong scores are driven by high access scores.
At the other end of the spectrum we find Abilene Christian, Wofford, Gardner-Webb and Mississippi State among the bottom four teams. Mississippi State’s score is pulled down by a payment environment that is unfriendly to consumers (low commercial insurance competition and Medicare Advantage participation), but Oktibbeha County’s relatively low cost of care saves them from being even further behind. Gardner-Webb, located in Cleveland County, NC, just west of Charlotte, is weighed down by poor performance on all three health outcomes measures. Abilene Christian’s market, Taylor County in West Texas, is weighed down by a high cost of care and high per-capita rate of emergency department visits. Located in Spartanburg County, SC, Wofford’s performance is brought down by poor health outcomes and a non-competitive insurance market.
Using our HVI methodology, let’s take a look at how we’ve filled out our bracket for this year’s tournament. The scores in parentheses next to the school’s name in each round show the margin of victory that earned the school a win in the previous round. (So, for example, Virginia walloped Gardner-Webb in its opener by having an HVI that was 1.35 higher than its opponent.) While there are some big first- and second-round upsets thanks to the variability in scores, and one very surprising debutant in this year’s Championship Game, we’re picking the top-seeded North Carolina Tar Heels to be national champions this year—thanks to the bracket-leading level of healthcare value delivered in Orange County, NC, where UNC is located.
Surprised? We were. Only two of our top four HVI teams—North Carolina and Vermont—made it to the Final Four in our bracket, as it turned out that the South and Midwest regions were particularly stacked with high-ranking teams. Washington got rolled over in the second round by an unbeatable Tar Heel squad, despite the outstanding level of healthcare value in King County, WA. Wisconsin, another top-four team thanks to being based in downtown Madison, in Dane County, WI, made it all the way to the Final Four only to get edged out by UNC as well. Other top-rated teams that didn’t get nearly as far as their high HVIs would have predicted: Northeastern (Suffolk County, MA); UC Irvine (Orange County, CA) and Iona (Westchester County, NY). None of those schools could match the dominance of North Carolina.
Meanwhile, on the other side of the bracket, Vermont easily bests Florida State (Leon County, FL) and Marquette University (Milwaukee County, WI), and barely edges out Michigan (Washtenaw County, MI) in the Elite Eight to face powerhouse Minnesota in the Final Four. The Golden Gophers sailed through the East—easily the least competitive quadrant of our healthcare bracket—only to get crushed by the Catamounts. For those of you who also hail from outside the Green Mountain State and might not know this, Vermont’s mascot is a large cougar-like cat. Scary!
In the Championship Game, Vermont falls to UNC. What gives the home county of UNC, Orange County, the edge in terms of healthcare value? While both lead the bracket in access to care, UNC brings higher access to primary care and mental health providers. And Vermont suffers from lower payer competition and Medicare Advantage participation.
Of course, we wouldn’t actually advise picking 13-seed Vermont to play in the Final—in fact, the lowest-seeded teams ever to make it to the Final Four were all 11-seeds: LSU (1986); George Mason (2006); VCU (2011); and Loyola-Chicago (2018). But given how many people are likely to pick Duke to go all the way this year, with their incredible freshmen leading the way, you could do worse than to follow our methodology, and base your picks on healthcare value. Better still might be picking your next home based on that metric!
We’ll return next week with a deeper look at the healthcare value statistics for the teams that make the (real) Sweet Sixteen, and then when Final Four time comes we’ll profile each of the markets involved to give some sense of what really drives healthcare value at a local level. Until then…enjoy the games!
We live in a time when acrimony and resentment seem to be at an all-time high. These days, individuals feel comfortable hiding behind screens to voice their opinions without giving much thought to the repercussions or the feelings of others.
I freely acknowledge that there have always been mean-spirited people in our lives, workplaces, schools and communities. However lately, it seems as if there is carte blanche to act like a jerk. Maybe this is why kindness seems a bit harder to come by, and why I find myself mentoring young people on how to deal with difficult colleagues more than usual.
I am certainly not immune to jerks. We’ve all dealt with them — the mean-spirited colleague who thought they knew everything. The person who did not like to share their toys in the proverbial sandbox. The team member who jumped at every opportunity to claim credit for success, plow over others or immediately blame others for failure. Simply put, we’ve all worked with jerks.
While jerks can be highly effective at delivering results, don’t confuse value with productivity. By this, I mean that the toxicity jerks infuse into a team and their work environment can significantly outweigh their contributions. These folks tend to be mean-spirited, manipulative, and can often undermine both the organization’s work and their colleagues’ productivity. They cause strife and, in some cases, drive excellent colleagues away from an organization. At the end of the day, they do far more harm than good, and they make the work environment an unpleasant place to spend the day.
Throughout my career, I have managed a few so-called jerks. While it has not always been easy, and I have certainly made my share of mistakes, I’ve learned to effectively deal with these personalities along the way. Beyond that, I’ve developed some management techniques for how to handle them.
As far as I’m concerned, jerks need not apply to positions within my organization. I have adopted a strict “jerk-free” policy for every organization I lead. From the moment I walk in the door on the first day, I articulate that jerks are not welcome. Personally, I would much rather work with a less experienced person who is kind-hearted and receptive to training than an arrogant jerk, any day of the week.
So, how do you move from simply putting up a “jerks aren’t welcome sign” to creating a jerk-free culture? How can you cultivate anti-jerk behavior across your team and coach others to do the same?
1. Communicate. Talk it out from the outset. You need to communicate, communicate and communicate again. Let your teammates and colleagues know what you need and what you expect. You want to set expectations from the outset, so everyone is on the same page, and there is no room for confusion or deniability. You should also be open, transparent and honest. While there are times it is not the easiest thing to do, the payoff is huge and will keep things running smoothly.
2. Lead by example. Jerks gravitate to jerks. Do your best to be kind, helpful, open and honest. It will do more to inspire others and generate positivity than anything else.
3. Build trust. You build trust and inspire loyalty when you foster an environment where differences of opinion are welcomed and encouraged. Where there is trust and good feeling, it makes it harder for jerks to thrive.
4. Let them know. If someone is a jerk and you feel uncomfortable, let them know. Don’t let behavior that bothers you fester. You want to nip it in the bud. In a positive non-judgmental language explain to them how their behavior is not working for you and reflect on how things can change. I always say the first approach to any situation should be: acknowledge, reflect, move forward.
5. Value differences. It’s important to celebrate differences and the wide variety of skills team members bring to the table. If folks feel they have a unique niche to fill and special skills to contribute, they are less likely to be passive aggressive and will feel confident in their contributions.
6. Celebrate. Having a good time is essential. Work is hard, and it’s important to let off a little steam sometimes. I can’t encourage enough the opportunity to have fun and facilitate opportunities where colleagues can get together outside of the office.
7. Coach it out. I have found that all is not lost when it comes to jerks. There is hope. Some jerks can be rehabilitated. They just need effective coaching to turn their attitude around. Of course, there are rare cases when a jerk is, and always will be, a jerk. Unfortunately, there are times when you will have to make the tough call and leave them behind.
A jerk-free workplace certainly has numerous benefits. Not only is your space more enjoyable and pleasant, but a no-jerk policy also attracts and contributes to retaining the best possible team members — those who are incredibly productive, highly effective and extremely positive.
What team member wants to sign up to work with jerks? A positive environment drives productivity as time is not wasted battling destructive behavior or playing pointless games. It also enhances quality and helps delivers excellent customer service, because team members are happy in their work. The ripple effect of that is that they pass it along to anyone with whom they interact.
Think about it: Your team is like a family, and frankly, we often spend more time with them than anyone else in our lives. While we all enjoy a wacky cousin or a wisecracking uncle, no one likes to engage with the family member who is always complaining or rude to others. So, do you and your fellow team members a favor and say goodbye to the jerks. Make more room at the table for positive and enjoyable folks. Everyone will be glad that you did.
HENRY KOTULA 