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The Keckley Report

The Story Lines about Healthcare are Incomplete and Unflattering

By September 16, 2019March 1st, 2023No Comments

Media attention to healthcare is widespread. Two familiar themes surfaced in last week’s news cycle:

1. Health insurance coverage is a surrogate for access to healthcare.

  • In last Thursday’s 3-hour Democratic Presidential Debate from Texas Southern University in Houston, opinions about ‘Medicare for All’ (M4A), which is viewed by most voters as universal coverage, figured prominently. The Democratic aspirants for the White House currently fall into three camps: pro ‘Medicare for All’ candidates led by Bernie Sanders and Elizabeth Warren, the ‘fix and repair the Affordable Care Act’ contingent led by Joe Biden, Amy Klobuchar, and the ‘Medicare for All who want it‘ led by Kamala Harris, Pete Buttigieg and Cory Booker. Per Kaiser Family Foundation polling, 55% of likely Democratic voters favor fixing the Affordable Care Act vs. 40% who favor Medicare for All.

  • In Tuesday’s Special Election for North Carolina’s 9th Congressional District, Republican Dan Bishop beat Democrat Dan McCready 50.7% to 48.7%. Polls showed access to healthcare insurance was the key issue for McCready voters while immigration and support for President Trump attracted Bishop voters.

  • Last week, the U.S. Census Bureau reported that the percentage of Americans without health insurance increased to 27.5 million, or 8.5% of the population in 2018, up from 25.6 million, or 7.9 % in 2017—the first increase since 2010. The uninsured rate decreased in three states (WY, SC and NY), but increased in 8. TX has the highest (17.7%) and MA the lowest (2.8%).

2. The healthcare delivery landscape is shifting. New players are entering. Outside investors are playing a bigger role. And physicians are not happy.

  • Friday, Walmart opened its first primary care first clinic, called Walmart Health, in Dallas, Ga. The clinic accepts health insurance and offers primary care, lab, imaging, dental and counseling services at prices 30-50% below local providers. Sean Slovenski, Walmart’s president of health and wellness, told Business Insider that Walmart’s strategy is to position itself as a national competitor to Walgreens, CVS Health and Amazon by offering primary and specialty care services across its network of fixed and mobile facilities.

  • Physicians are increasingly looking to deals with private equity investors to maintain their independence and increase their bargaining leverage with hospitals and insurers. Notably, most of the transactions involve specialty groups wherein physicians retain 20-30% of ownership by agreeing to cuts in their take home income.Per Bloomberg Law, PE funded 181 deals with medical groups in 2018 led by dermatology and others.

  • Tension between Erlanger’s (Chattanooga) medical staff and its administration resulted in the ouster of CEO Kevin Spiegel last Wednesday. The board of the nation’s 10th largest safety net hospital said it would announce a successor September 26 drawing criticism that its selection process needed more thoughtful deliberation.


The attention healthcare gets these days is not flattering nor is it lending to a needed adult discussion about its future. Politicians in both major parties are dodging tough questions. Media are complicit in dumbing down relevant matters to the public. The result: the public’s views about healthcare are poorly informed but strongly held.

The two themes from coverage this week are illustrative:

Theme 1: ‘Health insurance coverage is a surrogate for access to healthcare. And premiums are increasingly not affordable to many.’

  • Reality: Insurance premiums have increased faster than wages for most who are covered through their employer. But having access to an insurance policy is no guarantee of getting seen by a physician or preferred hospital. Therefore, insurance is not a surrogate for access to care.

Theme 2: ‘The healthcare delivery landscape is shifting. New players are entering. Outside investors are playing a bigger role. And physicians are not happy.’

  • Reality: Physicians believe the health system has subordinated quality to profits and, in so-doing, compromised their role as patient advocates. But the majority of physicians are specialists due, in some measure, to the lucrative compensation they earn. The median pay for the profession is 4 to 12 times the median for most U.S. households, but many don’t think it’s enough. Therefore, physician discontent is more complicated than it appears.

The healthcare industry’s biggest challenge is to engage more effectively with consumers: the users, enrollees, buyers and voters who determine our fate. Media coverage offers an incomplete picture. We need to fill the gaps in their understanding so purchases, choices and votes are based on facts and objectivity.


P.S. The major items on the healthcare watchlist this week are:

1-Drug prices: Speaker Nancy Pelosi’s (D-CA) drug pricing proposal released late last week will get attention. The draft outline focuses on cost-sharing, price caps and penalties in Medicare Parts B and D.
2-Health insurer rebates: Health insurers have until September 30 to deliver $1.3 billion in rebates to employers and beneficiaries with $743 million going to those who purchased insurance on the individual market in 2018.
3-Purdue bankruptcy filing: Details about the opioid maker’s filing last week are not known but how the 2000 lawsuits filed by cities, states, insurers and others will be handled and funds recovered is certain to get attention.
4. And a decision in Texas v. Azar is anticipated any day. If upheld, it’s back to the drawing board for the Affordable Care Act throwing insurance coverage vis a vis Medicaid expansion and marketplaces in limbo.