eHealth technology not ready for prime time

Posted by on Friday, Jan 21, 2011

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview

By Ashly D. Black, Josip Car, Claudia Pagliari, Chantelle Anandan, Kathrin Cresswell, Tomislav Bokun, Brian McKinstry, Rob Procter, Azeem Majeed, Aziz Sheikh
PLoS Medicine
January 18, 2011

Editors’ Summary

Background

There is considerable international interest in exploiting the potential of digital health care solutions, often referred to as eHealth — the use of information and communication technologies — to enhance the quality and safety of health care. Often accompanied by large costs, any large-scale expenditure on eHealth — such as electronic health records, picture archiving and communication systems, ePrescribing, associated computerized provider order entry systems, and computerized decision support systems — has tended to be justified on the grounds that these are efficient and cost-effective means for improving health care. In 2005, the World Health Assembly passed an eHealth resolution (WHA 58.28) that acknowledged, “eHealth is the cost-effective and secure use of information and communications technologies in support of health and health-related fields, including health-care services, health surveillance, health literature, and health education, knowledge and research,” and urged member states to develop and implement eHealth technologies. Since then, implementing eHealth technologies has become a main priority for many countries. For example, England has invested at least £12.8 billion in a National Programme for Information Technology for the National Health Service, and the Obama administration in the United States has committed to a US$38 billion eHealth investment in health care.

Why Was This Study Done?

Despite the wide endorsement of and support for eHealth, the scientific basis of its benefits — which are repeatedly made and often uncritically accepted—remains to be firmly established. A robust evidence-based perspective on the advantages on eHealth could help to suggest priority areas that have the greatest potential for benefit to patients and also to inform international eHealth deliberations on costs. Therefore, in order to better inform the international community, the authors systematically reviewed the published systematic review literature on eHealth technologies and evaluated the impact of these technologies on the quality and safety of health care delivery.

What Did the Researchers Do and Find?

The researchers divided eHealth technologies into three main categories: (1) storing, managing, and transmission of data; (2) clinical decision support; and (3) facilitating care from a distance. Then, implementing methods based on those developed by the Cochrane Collaboration and the NHS Service Delivery and Organisation Programme, the researchers used detailed search strategies and maps of health care quality, safety, and eHealth interventions to identify relevant systematic reviews (and related theoretical, methodological, and technical material) published between 1997 and 2010. Using these techniques, the researchers retrieved a total of 46,349 references from which they identified 108 reviews. The 53 reviews that the researchers finally selected (and critically reviewed) provided the main evidence base for assessing the impact of eHealth technologies in the three categories selected.

In their systematic review of systematic reviews, the researchers included electronic health records and picture archiving communications systems in their evaluation of category 1, computerized provider (or physician) order entry and e-prescribing in category 2, and all clinical information systems that, when used in the context of eHealth technologies, integrate clinical and demographic patient information to support clinician decision making in category 3.

The researchers found that many of the clinical claims made about the most commonly used eHealth technologies were not substantiated by empirical evidence. The evidence base in support of eHealth technologies was weak and inconsistent and importantly, there was insubstantial evidence to support the cost-effectiveness of these technologies. For example, the researchers only found limited evidence that some of the many presumed benefits could be realized; importantly, they also found some evidence that introducing these new technologies may on occasions also generate new risks such as prescribers becoming over-reliant on clinical decision support for e-prescribing, or overestimate its functionality, resulting in decreased practitioner performance.

What Do These Findings Mean?

The researchers found that despite the wide support for eHealth technologies and the frequently made claims by policy makers when constructing business cases to raise funds for large-scale eHealth projects, there is as yet relatively little empirical evidence to substantiate many of the claims made about eHealth technologies. In addition, even for the eHealth technology tools that have proven to be successful, there is little evidence to show that such tools would continue to be successful beyond the contexts in which they were originally developed. Therefore, in light of the lack of evidence in relation to improvements in patient outcomes, as well as the lack of evidence on their cost-effectiveness, the authors say that future eHealth technologies should be evaluated against a comprehensive set of measures, ideally throughout all stages of the technology’s life cycle, and include socio-technical factors to maximize the likelihood of successful implementation and adoption in a given context. Furthermore, it is equally important that eHealth projects that have already been commissioned are subject to rigorous, multidisciplinary, and independent evaluation.

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000387#pmed.1000387-Garg1

Digital health care solutions, or eHealth, include electronic health records, picture archiving and communication systems, ePrescribing, associated computerized provider order entry systems, and computerized decision support systems. These researchers performed a systematic review of the systematic reviews of eHealth published since 1997, providing us with a perspective of the impact that eHealth has had on the quality and safety of health care.

What did they find?

“Our systematic review of systematic reviews on the impact of eHealth has demonstrated that many of the clinical claims made about the most commonly deployed eHealth technologies cannot be substantiated by the empirical evidence. Overall, the evidence base in support of these technologies is weak and inconsistent, which highlights the need for more considered claims, particularly in relation to the patient-level benefits, associated with these technologies. Also of note is that we found virtually no evidence in support of the cost-effectiveness claims.”

This is of particular importance right now as health care providers and institutions are gearing up to establish accountable care organizations (ACOs), as called for in the Patient Protection and Affordable Care Act (PPACA). Although various models of ACOs are being developed, all of them have in common interconnectivity through eHealth. In fact, the simplest form is the so-called virtual ACO which is nothing more than isolated, independent practices connected through eHealth.

Since eHealth provides the fundamental framework through which ACOs function, it is important to be sure that we have it right. But we’re not certain. The authors report that eHealth systems have proven to be beneficial when carefully designed in house for a handful of large institutions, but the evidence is simply not there for most systems in use today.

The reason that our politicians included ACOs in the PPACA is that theoretically they would help to control health spending primarily through the transparencies, efficiencies and error reduction of eHealth. Yet there is “virtually no evidence in support of the cost-effectiveness claims.”

We have to get health care costs under control. Maybe someday eHealth will help with that, but we’re definitely not there now. It is certainly fine to continue with studies of ACOs and eHealth, but for cost containment, we should move immediately to policies that have been proven to be effective – a single payer national health program, aka an improved Medicare for all.

Medicare Advantage plans work the float

Posted by on Thursday, Jan 20, 2011

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Rollup Review of Impact on Medicare Program for Investment Income That Medicare Advantage Organizations Earned and Retained From Medicare Funds in 2007

Office of Inspector General
U.S. Department of Health & Human Services
January 18, 2011

If Federal requirements had been established to delay prepayments to Medicare Advantage organizations (MA organizations) until after the beginning of the beneficiary’s coverage period by the same number of days that we estimated that MA organizations held Medicare funds, the Medicare Part A and Part B trust funds (which finance the Medicare Advantage program) could have earned approximately $450 million of interest income in calendar year (CY) 2007. Alternatively, if Federal requirements had been established to require MA organizations to reduce their revenue requirements in their bid proposals to account for anticipated investment income, the Medicare program could have saved an estimated $376 million that the 457 MA organizations that were included in our sampling frame earned in CY 2007.

We recommended that CMS evaluate these audit results and either (1) pursue legislation to adjust the timing of Medicare’s prepayments to MA organizations to account for the time that these organizations invest Medicare funds before paying providers for medical services or (2) develop and implement regulations that require MA organizations to reduce their revenue requirements in their bid proposals to account for anticipated investment income. CMS did not concur with our recommendation.

http://oig.hhs.gov/oas/reports/region7/71001080.asp

Simply stated, the private Medicare Advantage plans receive hundreds of millions of dollars by investing advance payments of taxpayer funds used to pay their health care claims. This is not unusual since all insurers work the float. The longer they can hold on to premiums before they pay out benefits, the greater the returns from investing those funds. It is so commonplace that the Centers for Medicare and Medicaid Services did not concur with the Inspector General’s recommendation to pursue changes to recover that investment income.

The opportunity cost of interest-free cash advances to private insurers is yet one more cost of our flawed system of health care financing. It is a very real cost, amounting to hundreds of millions of dollars just for the private Medicare Advantage plans alone. This is just one more reason that we should establish our own public insurance program – an improved Medicare for all.

William Hsiao’s single payer proposal for Vermont

Posted by on Wednesday, Jan 19, 2011

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Statement by William C. Hsiao

Vermont State Legislature
January 19, 2011

Act 128 calls upon our team to develop three options. The Legislature requires that we evaluate a state government-administered and publicly-financed single-payer health benefits system. This system, which we refer to as Option 1, would provide all Vermonters with a uniform benefits package. Within those parameters, we looked at costs of both a “comprehensive” benefits package and a leaner, “essential” benefits package, which I will define and discuss later. The second option is a state government-administered, public option that would allow Vermonters to choose between public and private insurance coverage. Option 2 is designed to allow for and promote competition between the public and private plans, while keeping in place the current multiple payer system. Act 128 allows our team to develop a third option that we design after analyzing all aspects of Vermont’s health care and assessing the positions of key stakeholders across the State of Vermont. We call Option 3 a public/private single-payer system. It provides an “essential” benefits package, is administered by an independent board with diverse representation, and it employs a competitively-selected third party to manage provider relations and claims adjudication and processing.

In analyzing the three options, we determined that all will yield significant savings. However, our research and analysis indicate that the single-payer options will have a more dramatic impact on reducing cost than the public option because they incorporate a uniform benefits package and reduce much of the administrative structure needed to compensate multiple payers. Therefore, we estimate that Option 1 will produce savings of 24.3% of total health expenditure between 2015 and 2024. Option 2 will produce savings of 16.1% of total health expenditure between 2015 and 2024. Finally, Option 3 will produce savings of 25.3% of total health expenditure between 2015 and 2024. Option 3 produces additional savings as compared to Option 1 because it incorporates a public/private partnership in governance and administration.

In 2015, the first full year of implementation, PPACA would reduce the number of uninsured by 18,000 people; however 32,000 Vermont residents will remain uninsured. Ultimately in 2019, PPACA will reduce the number of uninsured by 22,000 in 2019. PPACA will likely add an additional $240 million of federal funds in 2015 to the State of Vermont, which will eventually rise to $420 million in 2019. All of these dollar values are expressed in 2010 dollars.

In comparison with option 1 and 3, Option 2 would still leave approximately 30,000 Vermonters uninsured. Option 2 would not expand the current benefits to cover some dental and vision care nor bring up the benefits for those who are currently under-insured.

The comprehensive benefit package under option 1 covers all health services with minimum cost sharing. As a result, it costs more and requires more funds to finance it. Under a payroll contribution scheme of financing, employers and workers will have to pay more than what they would pay if no reform takes place. This comprehensive benefit option would also increase the total health spending in Vermont which would make this option less feasible.

The essential benefit package under option 1 and 3 have leaner benefits and they can be financed through payroll contributions without increasing the amount that most employers and workers would have to pay as compared to if no reform takes place. It would reduce the total health spending in Vermont slightly in 2015 when the proposed reforms are implemented.

Statement (10 pages):
http://WWW.leg.state.VT.us/jfo/healthcare/FINAL%20VT%20Hsiao%20Written%20Statment%20for%20Jan1911_1.pdf

Full report – William Hsiao, Steven Kappel and Jonathan Gruber (138 pages):
http://www.leg.state.vt.us/jfo/healthcare/FINAL%20VT%20Draft%20Hsiao%20Report.pdf

Although advocates of the pure single payer model will find some problems with this report on a reform proposal for Vermont, there is very good news in this analysis. The report emphatically confirms the superiority of the single payer model in ensuring that everyone is included while containing health care costs.

In an analysis of the impact of the Patient Protection and Affordable Care Act (PPACA), the authors demonstrated that far too many would still be left without insurance, and it would have a negligible impact in controlling health care costs. As we have said all along, the financing system in PPACA is grossly inadequate and needs to be replaced.

The authors’ Option 2 is essentially PPACA with a “public option” added – a public insurance plan that competes with the private plans. Their analysis shows that it would have only a very modest impact on reducing costs, and an almost negligible impact on reducing the numbers of uninsured. Thus the bluster in support of the public option was misdirected. That energy should have been redirected to supporting single payer instead.

Options 1B and 3 are almost identical. They are both single payer models that totally replace the private insurance plans. They have an “Essential Benefits Package” with an actuarial value of about 87 percent which is close to the typical employer-sponsored plans before they began introducing high deductibles. Their analyses shows that these plans would cover everyone without any increase in spending since the single payer efficiencies would be enough to pay for those currently uninsured or under-insured. So this is the really good news – single payer works (though read on).

The primary difference in 1B and 3 is that 1B is publicly administered whereas 3 is administered by an independent board that contracts with a competitively-selected third party to manage provider relations and claims adjudication and processing. The authors state a preference for Option 3 claiming that it saves a little bit more money by requiring potential managers to compete for the contract. That is highly dubious and more likely was inserted to appease the market ideology of a sector of the twenty some odd contributors to this study. Considering this, I think that we can extrapolate the fact that the authors would also endorse Option 1B, since it is otherwise identical.

Option 1A is like 1B except that it provides a “Comprehensive Benefits Package” – virtually all health care services and products – achieving approximately an actuarial ratio of 97% for medical and mental health services, 90% for drugs and vision care, and 85% for dental, nursing homes and home care. It would cost more than Option 1B, but not that much more. It was not selected by the authors since one of the goals of study was to cover everyone without increasing spending over current levels. In a single payer system the benefits should be comprehensive.

One very serious deficiency is that they decided to leave in place Medicare and Medicaid, primarily because of existing barriers to move them into a single payer system. Thus their proposal is not a single payer system. Leaving these programs in place sacrifices some of the important single payer efficiencies.

They also tout accountable care organizations (ACO), suggesting that capitation should apply to primary care and salaries should apply to specialists. Yet by questions that they pose, they recognize that ACOs are not well defined. For instance, how can they effectively manage the care of a patient that PPACA grants the right to move in and out of the ACO at any and all times?

Within the next couple of days, we’ll have a clearer concept of where the single payer community should be on this report. Tentatively, it seems that it deserves our support, but support that is qualified by strong advocacy to make it right by such measures as including comprehensive benefits, and rolling in and eliminating Medicare and Medicaid.

IOM’s “essential benefits” may serve interests of private insurers

Posted by on Tuesday, Jan 18, 2011

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Health care lobby mum on repeal

By Kate Nocera
Politico
January 18, 2011

It’s at meetings like the Institute of Medicine’s Committee on the Determination of Essential Health Benefits where these groups (AHIP and others) can begin to voice their concerns. The committee convened for three days last week to hear from experts, lobbyists and special advocacy groups. The IOM will soon make recommendations to the Department of Health and Human Services on what defines an “essential benefit” that insurers must cover if they want to be listed on the exchanges that are coming in 2014.

Carmella Bocchino, AHIP executive vice president of clinical affairs and strategic planning, asked HHS not to load specific benefits into the bill, so the 10 broad categories of benefits would remain as they are and the market would decide what type of coverage is needed. The group also asked HHS not to include the 2,000 state mandates as part of an essential benefit package. Each state directs insurance providers on what must be covered in the policies they sell. The inclusion of every state mandate in the health care reform law would significantly drive up consumer costs and mandates for all states, which does not necessarily make sense, AHIP argues.

http://www.politico.com/news/stories/0111/47711.html

IOM meeting on essential benefits:
http://iom.edu/Activities/HealthServices/EssentialHealthBenefits/2011-JAN-12/Agenda.aspx

The Institute of Medicine (IOM) will be making recommendations to HHS on the definition of required essential benefits for the health plans that are to be offered through the state insurance exchanges. Several experts testifying before IOM’s Committee have called for flexibility in the definition (testimonies provided at IOM link above).

We should all be concerned that the insurance industry intends to use this approach to “let the market decide what type of coverage is needed.” Although the health reform legislation closed large loopholes in insurance coverage, it is clear that the industry fully intends to use innovations in essential benefit design to continue to profit by depriving patients of essential health care.

It was a terrible mistake to design health care financing reform based on the existing model of private insurance plans. No matter how much the private insurers are regulated, they will always find a way to place their own interests first.

It is not too late to stop this nonsense and do it right – establish our own publicly-administered and publicly-financed single payer national health program, an improved Medicare for all.

Wishful thinking on health costs?

Posted by on Monday, Jan 17, 2011

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Wishful Thinking on Health Costs

By David Leonhardt
The New York Times
January 13, 2011

Opponents of the health law sometimes like to suggest that cutting health costs would be easy, if only we’d be willing to try common-sense ideas. But that’s wishful thinking. The law does include most of the common-sense ideas supported by health economists ranging from Mark McClellan (the former Bush administration official) to David Cutler (a former Clinton and Obama adviser). There’s just no getting around the fact that reducing the growth rate of health costs will be difficult.

So many noted policy experts have trumpeted the supposed fact that the health reform law contains essentially all of the cost containment ideas known that now this concept is being accepted unchallenged. This ignores the fact that the most effective model of cost containment was rejected at the very beginning of the reform process.

Numerous microsimulation studies plus the experience of several nations has demonstrated that a single payer system (e.g., an improved Medicare for all) actually bends the cost curve down when contrasted with the fragmented, multi-payer system that we have in the United States.

These same microsimulation studies show that building on our current system, which is precisely what the current law does, is the most expensive model of reform, primarily because it retains the profound administrative inefficiencies that are a major contributor to our very high costs. Setting medical loss ratios recovers only a negligible portion of the administrative waste which permeates our system. The many other efficiencies of a single payer system, such as reducing the administrative burden on the health care delivery system, would recover much of this waste.

Another factor that is not receiving the attention that it should is that the current law can never result in truly universal coverage – tens of millions will remain uninsured. A single payer system not only costs less and slows the growth of health costs into the future, it also automatically covers everyone. Moreover, it uses progressive tax policies to ensure that funding is equitable, making health care affordable for everyone.

The popularity of Medicare is understandable, since it provides us with health security in our later years. But the projected spending increases in this high-risk pool are of concern. We could fix that problem immediately by diluting the costly Medicare pool with the couple hundred million of us who are relatively healthy.

We’re already paying for the Medicare pool anyway, so why shouldn’t we all have the advantage of an efficient health care financing system that eliminates the profound waste of our costly, dysfunctional, fragmented system of a multitude of private and public payers? An improved Medicare for all is the only practical solution to our problem of intolerable cost increases.

http://community.nytimes.com/comments/economix.blogs.nytimes.com/2011/01/13/wishful-thinking-on-health-costs/?permid=16#comment16

Gov. Christie claims that health care will bankrupt New Jersey

Posted by on Friday, Jan 14, 2011

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Christie Says Health-Care Costs to Bankrupt New Jersey Without Concessions

By Terrence Dopp
Bloomberg
January 13, 2011

New Jersey Governor Chris Christie said health-care costs “will bankrupt” the state unless it requires workers to pay more for medical coverage.

Christie wants all public employees in New Jersey to contribute more than the current 1.5 percent of salary toward their health benefits.

“We have to have a plan where everyone has some skin in the game,” Christie said. “Right now 1.5 percent is just something we can’t afford. Everyone knows that but they won’t say it.”

http://www.bloomberg.com/news/2011-01-13/christie-says-health-care-costs-to-bankrupt-new-jersey-without-concessions.html

“Health care bills are going to bankrupt the government.” New Jersey Gov. Chris Christie is but the latest of conservative politicians to sound this alarm. You would think that they would recommend truly effective policies to bring escalating health care costs under control. But no. They merely wish to shift health care costs from the government, in this case, to their own public employees.

Virtually all economists agree that employer-sponsored health plans actually are paid for by the employees in the form of forgone wage increases. Gov. Christie’s proposal to shift the costs to the employees is not merely a nominal transfer of the payment responsibility; it is a true shift because he is not going to replace the forgone wages.

In trying to contain health care costs we need to look at our entire health care spending, not simply how it is distributed between public and private payers. Reducing government spending on health care by shifting it to others does not reduce total health care spending, except in one very important regard. Making health care unaffordable rations health care based on the inability to pay – the most inhumane form of rationing, and one that is uniquely American.

The claim that health care costs will bankrupt the government is a false claim since we have one of the lowest total tax burdens of all industrialized nations. A very modest increase in tax revenues would solve this problem. On the other hand, passing health care costs onto already financially-strapped employees will surely increase the rate of personal bankruptcies.

I am especially appalled by Gov. Christie’s use of the old standby argument that patients need “more skin in the game.” It creates visions of patients who are out of money and are forced to turn to their own skin to barter for the health care that they desperately need – only to learn that skin is not accepted at banks or currency exchanges.

Is anybody listening on controlling costs?

Posted by on Thursday, Jan 13, 2011

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

The CBO Is Telling Us Something. Is Anybody Listening?

By Austin Frakt
Kaiser Health News
January 11, 2011

The problem is health care costs. They’ll cause budgetary distress with or without health reform. The CBO’s estimates, both of them, show it clearly. Health care costs have been the source of budgetary woes for decades, and there’s no end in sight under any realistic scoring of any serious health reform proposal.

One way to get serious is to embrace the cost control provisions of the new law and to protect them from the likely efforts of future policymakers to undo them. In this, I agree with health economist Henry Aaron, who wrote about the health reform law:

“[T]he bill contains, at least in embryonic form, virtually every idea for cost control that any analyst has come up with. … The most practical cost-control strategy that is now available to Congress is to accelerate the implementation of these provisions, not to stymie them.”

http://www.kaiserhealthnews.org/Columns/2011/January/011111frakt.aspx

And…

A Milestone in the Health Care Journey

By Ronald Brownstein
The Atlantic
November 21, 2009

“I’m sort of a known skeptic on this stuff,” (Jonathan) Gruber told me. “My summary is it’s really hard to figure out how to bend the cost curve, but I can’t think of a thing to try that they didn’t try. They really make the best effort anyone has ever made. Everything is in here….I can’t think of anything I’d do that they are not doing in the bill. You couldn’t have done better than they are doing.”

http://www.theatlantic.com/politics/archive/2009/11/a-milestone-in-the-health-care-journey/30619/

Austin Frakt’s voice is now added to those of Jonathan Gruber , Henry Aaron and others who claim that every cost control measure is in the Patient Protection and Affordable Care Act (PPACA). Yet they left out the most effective measure of all – single payer – the one that wasn’t even granted a seat at the table.

Over 30 percent of our national health expenditures are diverted to administration. That is almost twice the percentage of administrative costs in Canada – a nation with a single payer system. If we were to adopt the administrative efficiencies of Canada’s single payer system, we conceivably could recover about 14 percent of our national health expenditures, not in just the first year, but in every year to follow. Even if we were to recover only 10 percent, think of what that would amount to over the years.

The authors of PPACA were aware of this administrative waste, but because they elected to leave the fragmented system of private insurers and public programs in place, they focused narrowly on the administrative costs of the private insurers, which is only a fraction of the administrative costs of our system. They decided to allow the insurers to continue to use 15 to 20 percent of their revenues for administrative functions and profits. Since some were already functioning at this level – especially the non-profits – the net savings is almost negligible. More importantly, this did not address any of the other administrative excesses – especially the huge administrative burden placed on the providers of health care.

There are other important cost-saving features of a single payer system that were also left out of PPACA. These include very effective tools such as the monopsonistic power of a single buyer, global budgeting, negotiated rates, bulk purchasing, and preventing over-utilization of excessive capacity through separate budgeting of capital improvements. These measures, along with the permanent administrative savings, truly bend the cost curve down to more sustainable levels.

Austin Frakt asks the right question. Is anybody listening?

California financial crisis, health students, and single payer

Posted by on Wednesday, Jan 12, 2011

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Brown Unveils Budget Plan With Extensive Spending Reductions

California Healthline
January 11, 2011

(Gov. Jerry) Brown’s proposed budget would reduce spending by about $135.7 million by enacting changes to Healthy Families, California’s Children’s Health Insurance Program.

Brown’s budget also proposes $1.7 billion in cuts to Medi-Cal, California’s Medicaid program.

http://www.californiahealthline.org/articles/2011/1/11/brown-unveils-budget-plan-with-extensive-spending-reductions.aspx

And…

Labor is out-organized at budget protest

By Michael J. Mishak
Los Angeles Times
January 10, 2011

If today’s budget protests are any indication, organized labor needs to get, well, organized.

After Gov. Jerry Brown unveiled his budget, a handful of labor leaders gathered on the north steps of the Capitol to talk about the concerns of workers and recipients of In-Home Supportive Services and other programs that would see steep cuts. They didn’t get very far.

George Popyack, of the American Federation of State, County and Municipal Employees, was explaining how shifting state services to local governments could compromise quality when he was drowned out by hundreds of students descending on the steps for a separate demonstration in support of single-payer healthcare. Reporters and a camera crew turned to observe the students, who were chanting through bullhorns and banging drums.

“Well, we just lost the camera,” Popyack said.

http://latimesblogs.latimes.com/california-politics/2011/01/if-todays-budget-protests-are-any-indication-organized-labor-needs-to-get-well-organized-after-gov-jerry-brown-unvei.html

For report on the single payer rally by Erica Mu of KALW (audio and transcript):
http://kalwnews.org/audio/2011/01/10/could-single-payer-be-future-healthcare-california_782712.html

California Health Professional Student Alliance (CaHPSA):
http://www.cahpsa.org/CaHPSA/Lobby_Day.html

California’s budget crisis is a disaster. The draconian budget cuts will especially impact the state’s health and human services programs, including Medi-Cal and the Children’s Health Insurance Program. The good news is that California’s health professional students are not going to put up with it. They showed up by the hundreds to demand the enactment of a single payer system.

The future of our health care system is in good hands.

A conservative and a liberal on single payer

Posted by on Tuesday, Jan 11, 2011

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Buckle Up for Round 2

By David Brooks
The New York Times
January 6, 2011

Over all, there is a strong likelihood that the current health care law will face an existential threat over the next five years. Each party should be preparing contingency plans.

After the trauma of the last two years, many people wish the issue would go away. But it’s not going away, especially since costs will continue to rise.

When the crisis comes, Democrats will face an interesting choice — to patch the Obama system or try to replace it with something bigger. The administration may want a patch, but by a ratio of nearly 2 to 1, according to a CNN poll, Democratic voters would prefer a more ambitious law. Liberals could logically say that the mistake was trying to create a hybrid system, rather than moving straight to a single-payer one.

http://www.nytimes.com/2011/01/07/opinion/07brooks.html

And…

ObamaCare Repeal: GOP Should Be Careful What It Wishes For

By Robert B. Reich
The Wall Street Journal
January 7, 2011

Nonetheless, there’s a great irony in the Republican assault. The federal government wouldn’t be nearly as vulnerable to these political and legal obstacles had the health-care law been built upon the framework of Social Security or Medicare — public insurance financed by payroll taxes — as many Democrats had initially urged. Not only are these programs enormously popular — “Don’t take away my Medicare!” was a rallying cry among some conservative populists during the debates over the health-care law — but they also rest on a more widely accepted relationship among the individual, the government and the market.

Americans are accustomed to paying for public insurance through their payroll taxes. Such payments aren’t viewed as federal mandates that encroach upon individual freedoms, or as payoffs to private companies likely to make even more money from mandatory purchases of their products, but as well-deserved entitlements.

Set against this background, the current Republican attack on mandatory coverage is curious because it raises the essential question of how society would otherwise spread health-care risks. If successful — either in Congress or in the courts — a Republican victory could turn into a Pyrrhic one by opening the way to the alternative model, based on the system Americans seem to prefer: payroll taxes and public insurance.

http://online.wsj.com/article/SB10001424052748704723104576062350518299650.html

Above are yet two more examples of a common theme. Conservative New York Times columnist David Brooks and liberal Berkeley Professor Robert Reich both imply that the opposition to the government mandate to purchase expensive private health plans may drive us to a much more logical and effective solution for financing health care: single payer (public insurance financed by taxes).

If so many individuals across the political spectrum believe that single payer is likely the inevitable outcome then why aren’t we taking a more serious look at it right now, before people are dragged, screaming and kicking, and then locked into the private insurance exchanges?

Carrying the metaphor further, their screaming should die down by the time they are transferred to the paupers’ prisons.

Metaphors are often used to appeal to the emotions. In this instance, it certainly isn’t humor. There is nothing funny about a government mandate that forces you to buy an overpriced private insurance product that takes away your choices in health care.

So which emotion? Depression? Anger? Rage? We have just seen once again the potential for tragic consequences of the latter. Please. Let’s fix our health care financing system before we’re all in a rage.

A pause

Posted by on Monday, Jan 10, 2011

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Instead of contemplating a health care Quote of the Day today, let’s take a moment to consider what each of us might do to harness the energy behind the forces that would destroy social solidarity, and bring us all together in efforts to heal our social problems such as our sick health care system that leaves so many suffering and dying.

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