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Latest News

Recent Articles of Interest

Medicare for All Explained Podcast: Episode 82

Posted August 1, 2022

This article includes audio

August 1, 2022

Information technology and digital health researcher A Jay Holmgren, Ph.D., talks about the current state of electronic medical records in the U.S. and the problems that arise when different systems can’t “talk to” one another.

“We really need to move beyond siloed data sets and unlock the power of aggregated national-level data,” he says. “There’s a big potential for research, for public health, [and] for policymakers to be maximally informed.”

Additional episodes will be uploaded twice monthly. Subscribe in iTunes, or access a complete archive of the podcast, below.

https://medicareforallexplained.podbean.com

Why conservatives should support Medicare for All

Posted July 30, 2022

By Jay Brock, M.D.
The (Fredericksburg, Va.) Free Lance Star, July 30, 2022

Most Americans get it: our dysfunctional health insurance system isn’t working for too many. Thirty million have no insurance. Another 40 million, given skyrocketing out-of-pocket costs, can’t afford to use the insurance they have. Some half-million Americans—most with insurance—undergo a medical bankruptcy each year, and 78% of Virginians worry about affording medical bills.

The system, while benefiting a few lucky Americans, isn’t working for most of us.

You’d think that making sure every American had not just “access” to health care but care they could actually afford would be a nonpartisan, bipartisan endeavor.

Not for most Washington politicians: health care lobbyists spend more than $600 million of our health care dollars each year making sure industry gets its way rather than assuring the rest of us can get affordable care.

Conservatives, apparently indifferent to the success and popularity of Social Security and Medicare, both publicly funded, seem to be especially adept at labeling affordable health care for all as some nefarious un-American plot that would destroy America (“Socialism!” “Government control!”) rather than as something that would allow us to keep up with the world’s other advanced nations.

So let’s look at seven reasons why conservatives of both parties should be keen to support Medicare for All—a popular single-payer health insurance system funded by public contributions, where health care would still be delivered by America’s excellent private providers.

MFA is much cheaper to run, consuming just 2–3% of healthcare dollars rather than the 15–20% it takes to run some private health insurers. Switching to MFA will save 600 billion health care dollars yearly just in administrative costs. That is a lot of money. Better to spend it on patients than on building a bigger medical bureaucracy.

MFA also saves money when it “bends the health care cost-curve”—the Holy Grail of health care economists and conservatives alike—because as a monopsony it will lower costs for goods and services it purchases. We could save $100 billion yearly on pharmaceuticals alone. No, essential creative health care industries won’t disappear—they will thrive just as they do in every other advanced nation with affordable universal coverage.

Everyone contributes, based on income, not an arbitrary premium, so it’s truly affordable. Universal contributions, by the way, is an idea straight from the conservative Heritage Foundation, based on “personal responsibility”—if you can share in its benefits, you should pay into the system. (It was only when Democrats used it that Republican conservatives began to despise such mandates.)

Based on the popularity of other similar government-funded programs, there should be less political interference with MFA than our current system, where politicians frequently put their fingers on the scales of healthcare access. Anyone familiar with the cries of “Keep the government out of my Social Security and Medicare” understands why interfering with these programs is still considered to be the “third rail” of American politics.

There is more competition under MFA, as artificial networks of providers that benefit the health insurance industry at the expense of patients are eliminated. All providers will compete for all patients based not on price (which will continue to be negotiated between the insurer and providers) but on service.

MFA is great for business. It takes the burden of health care costs off employers. Warren Buffett has called our current health care system the tapeworm of American competitiveness. Funding health care with public dollars will improve American competitiveness, globally and locally. It will also be easier to start a business. Or, since health insurance is no longer tied to one’s employment, for employees to change jobs.

Public funding of health care will help many areas, urban and rural, where health care access is sorely lacking. These areas don’t suffer from a lack of patients—they have too many patients who cannot afford medical care and either forgo care or receive care for which providers are not compensated. So hospitals go bust, or physicians aren’t to be found. Don’t believe anyone who says MFA will hurt these areas. When everyone has insurance they can afford, the reality is just the opposite.

Finally, what about the health insurance industry? As a hugely expensive and entirely unnecessary middleman, its days are numbered. Economists call its eventual demise “creative destruction.” (MFA sets aside billions of saved health care dollars to assure industry employees who lose their jobs will have a “soft landing” economically).

Liberal or conservative, these are health care values we should all share.

Most Americans support MFA.

Check with your candidate to see whether or not they agree.

https://fredericksburg.com…

Dr. Jay D. Brock is a retired physician living in Fredericksburg.

Value-based payment has produced little value. It needs a time-out.

Posted July 26, 2022

By Kip Sullivan, Ana Malinow, M.D., and Kay Tillow
STAT, July 26, 2022

The value-based payment crusade is now two decades old. But despite the tens of billions of dollars — perhaps hundreds of billions — spent on these programs, they have done little to improve Americans’ health or lower health care costs. It is time for proponents of value-based care to call a halt to these programs until they have an answer to this question: “Why have the vast majority of value-based payment experiments failed to improve value?”

Advocates of value-based care are not about to do that. Although some of the leading lights of the movement are willing to admit they have little to show for all the money and time sunk into accountable care organizations and kindred value-based entities, none has been willing to call for an end to continued experimentation with schemes that have clearly failed.

The concept of value-based payment became widespread among U.S. health policymakers and analysts during the 2000s. It collectively refers to interventions that offer doctors and hospitals financial incentives that, in theory, induce them to improve both components of health-care value — cost and quality — without generating the hostility provoked by managed care insurance companies during the HMO backlash of the late 1990s.

The most prominent and frequently discussed value-based payment methods — the accountable care organization and the medical home — focus on primary care doctors. An ACO is a group of doctors and hospitals that is “held accountable” by a public insurance program (such as Medicare) or an insurance company for the cost and quality of medical services provided to a defined population. The medical home is similar, but it consists only of primary care doctors. Medicare beneficiaries and policy-holders do not enroll in ACOs and medical homes. Instead, they are assigned to them based on which primary care doctor they saw the most often over a “look-back” period that is typically two years long.

The pages of the nation’s medical and health policy journals and health care blogs are filled with calls to double down on ACOs, which are by far the largest and most comprehensive of the various iterations of value-based payment reforms. The Centers for Medicare & Medicaid Services, the nation’s most influential and aggressive proponent of these programs, announced in 2021 it will redouble its efforts to push Medicare beneficiaries into accountable care organizations.

The agenda for the National Primary Care Transformation Summit, a four-day conference underway this week featuring the nation’s best known value-based care evangelists, suggests it will be a celebration of accountable care organizations, not an examination of why they have failed.

Experimentation with value-based methods, especially ACOs, accelerated rapidly after 2010, when the Affordable Care Act was enacted. This act authorized CMS to insert all manner of value-based payment schemes into the traditional Medicare program (the non-Medicare-Advantage part of Medicare). It also created an agency within CMS, the Center for Medicare and Medicaid Innovation, to run experiments testing the assumptions of value-based payment advocates. The Affordable Care Act also authorized the Department of Health and Human Services, which oversees Medicare and Medicaid, to “certify” — meaning expand and make permanent — any of these experiments that lowered costs without harming quality or raised quality without raising costs.

The Center for Medicare and Medicaid Innovation has conducted experiments with more than 50 models of value-based payment. Brad Smith, a former CMMI director, reported last year in the New England Journal of Medicine that only five of 54 models had cut Medicare costs. “[T]he vast majority of the Center’s models have not saved money,” Smith wrote, “with several on pace to lose billions of dollars. Similarly, the majority of models do not show significant improvements in quality….”

Smith’s successor, Elizabeth Fowler, confirmed Smith’s assessment in a January 2021 interview. “Now, ten years later, … there is no silver bullet. We have four models that were certified to be expanded…. I wouldn’t say they’re the most transformational: … home value-based purchasing, Pioneer ACO, but then also the recurrent non-emergent ambulance and diabetes programs.”

Fowler’s characterization of these four certified programs as not the most transformational is the understatement of the year.

  • The Home Health Value-based Purchasing Model demonstration cut Medicare spending by 1% with mixed effects on quality.
  • The Pioneer ACO program, which saved no more than a few tenths of a percent net, suffered an astonishing attrition rate: the number of participating ACOs fell from 32 at the beginning of the program in 2012 to nine when the program ended in 2016. CMS rushed to certify the program based on data gathered in just the first two years using a questionable methodology.
  • The non-emergent ambulance prior authorization demonstration and diabetes prevention programs are not value-based programs. The ambulance program merely tested the use of prior authorization for ambulance service. The diabetes prevention program simply confirmed what previous research had shown: for individuals at high risk for developing type 2 diabetes, lifestyle changes can prevent or delay disease.

The largest of CMS’s accountable care organization programs, the Medicare Shared Savings Program, is permanent and does not need to be certified because it was created by Congress via the Affordable Care Act. It has also performed poorly, raising or lowering Medicare net spending by a few tenths of a percent depending on which year one examines and how control groups are constructed. It has also had mixed and trivial effects on quality.

The relatively few studies of private-sector experimentation with accountable care organizations and medical homes, the primary value-based payment methods adopted by the private sector, confirm the Medicare-focused research.

It’s important to note that the spread of accountable care organizations has driven up administrative costs for providers and induced further consolidation of an already highly consolidated health care industry. The final evaluation of the Pioneer ACO program reported, for example: “Approximately three-quarters of Pioneer physicians indicated that participation had required them to increase time spent on administrative, documentation, and reporting tasks ‘somewhat’ or ‘a lot’.” A 2019 report in the journal Health Affairs found “a clear association between physician consolidation and county-level ACO penetration. In counties with the highest ACO penetration, there were large declines in the number of small practices and increases in the number of large practices.”

An honest analysis of why value-based payments have failed should consider at least these four explanations:

  • wrong diagnosis
  • no definition of what ACOs are expected do
  • requiring that ACO “members” be assigned rather than enroll
  • no evidence for the assumption that price and quality can be accurately measured

Wrong diagnosis. Proponents of ACOs assume that the cost problem, be it rising costs for Medicare or for the country, is due to the excessive volume of medical services being rendered rather than excessive price (price times volume of services equals total spending), and that the fee-for-service method of paying providers induces overuse. To be sure, there are pockets of overuse in the U.S. health care system and in Medicare, but no evidence that they are caused by the fee-for-service method.

No definition. In its June 2009 report to Congress, the Medicare Payment Advisory Commission (MedPAC), a nonpartisan independent agency of the legislative branch that provides the U.S. Congress with analysis and policy advice on the Medicare program, recommended that Congress insert accountable care organizations into Medicare but “defined” ACOs only in these aspirational terms: “The defining characteristic of ACOs is that a set of physicians and hospitals accept joint responsibility for the quality of care and the cost of care received by the ACO’s panel of patients.”

What does “accepting responsibility” mean? Whatever it means, it conveys no information about what the “set of physicians and hospitals” must do differently. MedPAC has repeated this useless definition in virtually every report to Congress about ACOs since.

The lack of a clear definition makes it extremely difficult for providers to know what they’re supposed to do, and it impedes intelligent discussion about why accountable care organizations fail. At least two evaluations of Medicare’s ACO programs have commented on the vague definition problem. A 2012 evaluation of the Physician Group Practice Demonstration (an early test of the ACO concept that demonstrated it doesn’t work) stated: “The demonstration was not designed to test specific interventions; therefore, participating sites had complete autonomy in determining strategies that would provide higher quality care and expenditure savings. Since these strategies … were not uniformly designed, defined, or implemented across the ten PGPs, evaluations of interventions could not be done.”

Similarly, an evaluation of the Pioneer ACO program, which ran from 2012 through 2016, reported, “The ACO ‘treatment’ under investigation is not a prescribed set of activities or interventions.”

Assignment of ACO “members” rather than enrollment. To avoid a repeat of the backlash over health maintenance organizations, the Affordable Care Act required that Medicare beneficiaries be assigned to ACOs “based on their utilization of primary care services.” CMS measures “utilization of primary care services” by examining claims filed for beneficiaries over a look-back period. This method of populating ACOs results in high rates of leakage — the industry term for people assigned to accountable care organizations who seek care outside of their networks. Leakage rates are typically 30% annually. How are ACO providers supposed to be “accountable” for patients they never see?

Inaccurate measurement of “value.” Proponents of accountable care organizations assume that CMS and other insurers can accurately measure the cost and quality of providers and ACOs, and when financial carrots and sticks are attached to these measurements, only good things will happen.

This assumption is sheer fantasy. Measurement of cost and quality is wildly inaccurate — especially at the level of the individual doctor — and always will be. The bonuses and penalties dished out to ACOs, and to individual providers, more closely resemble white noise than useful feedback. They create incentives to deny care and to game the measurements by upcoding and teaching to the test.

Years ago, a consulting company’s blog post joked that “ACO” stands for “amazing consulting opportunity.” To understand the truth in this wisecrack, just review the list of sponsors and speakers at the National Primary Care Transformation Summit. Many hold positions in firms that supervise, own, or consult with accountable care organizations and other value-based payment entities.

The “amazing” opportunity to make a buck off the tortured U.S. health care system while rarely laying eyes on patients may be the single most important reason why health policy mavens continue to embrace value-based payment despite its miserable track record.

Kip Sullivan is a member of the advisory board of Health Care for All Minnesota. Ana Malinow is a retired pediatrician and professor of pediatrics at the University of California, San Francisco. Kay Tillow is a union activist, chair of Kentuckians for Single Payer Health Care, and coordinator of the All Unions Committee for Single Payer Health Care.

https://statnews.com…

Recent Members in the news

Dr. Ana Malinow on “Rising Up With Sonali”

Posted May 25, 2022

This article includes video

PNHP past president Dr. Ana Malinow appeared on “Rising Up With Sonali” on Free Speech TV and Pacifica radio stations on May 25, 2022. Dr. Malinow described the dangers of Medicare Direct Contracting and REACH, which allow third-party (often corporate) middlemen to “mange” the care of Traditional Medicare beneficiaries.

Dr. Malinow was especially critical of the claim that these programs would do anything to advance equity: “We cannot possibly trust corporations, which created inequality in the first place, to achieve health equity.”

Dr. Adam Gaffney on “The Jacobin Show”

Posted May 18, 2022

This article includes video

PNHP immediate past president Dr. Adam Gaffney appeared on “The Jacobin Show” on May 18, 2022. Dr. Gaffney discussed the recent U.S. Senate hearing, “Medicare for All: Protecting Health, Saving Lives, Saving Money,” where he testified along with Dr. Abdul El-Sayed and National Nurses United executive director Bonnie Castillo, and why now is an especially crucial time for a resurgence in single-payer activism.

Dr. Adam Gaffney U.S. Senate Testimony

Posted May 12, 2022

This article includes video

PNHP immediate past president Dr. Adam Gaffney testified before the U.S. Senate Budget Committee on May 12, 2022. The topic of the hearing was “Medicare for All: Protecting Health, Saving Lives, Saving Money,” and it was held on the same day that Sen. Bernie Sanders introduced the Medicare for All Act of 2022.

Dr. Gaffney’s opening remarks are excerpted below, and the full committee hearing can be viewed here.

Recent Quote of the Day

John Geyman: The Medical-Industrial Complex…plus exciting changes at qotd

Posted April 28, 2021

“America’s Mighty Medical-Industrial Complex: Negative Impacts and Positive Solutions”

By John Geyman

This book has three goals: (1) to bring an historical perspective to how medicine and health care have evolved over the last 100 years, including the transformation of their original ethic of service with a moral purpose and how that ethic has been compromised by corporate greed; (2) to describe where an engulfing medical-industrial complex has brought us in terms of decreasing access to affordable health care, unacceptable quality of care, profiteering and fraud; and (3) to consider whether and how our unsustainable health care system can be brought into line against this deepening crisis in serving the needs of our people.

Copernicus Healthcare: http://www.copernicus-healthcare.org

Amazon: https://www.amazon.com…


Comment:

By Don McCanne, M.D.

Most of us want a health care system that has a mission to maintain and improve our health, yet we have a system that has lost its way in that its mission places a priority on advancing the interests of the medical-industrial complex at the cost of compromising our health care. John Geyman explains how we got there and how detrimental the impact has been. Although the political barriers to reform seem almost insurmountable, he does show us that there is a path to the essential reform that we need to bring health care justice to all. By understanding the source and nature of the dysfunctions, we can find our way out.


Exciting changes at qotd

As some of you may have heard, the interruption in the Quote of the Day messages was due to a TIA/stroke suffered by the author. Fortunately, the recovery has been dramatic, though incomplete. As a result, after two decades of daily commentaries in his retirement years, it is time for a change.

Future messages will be from noted health policy experts within and outside of PNHP. We will be receiving the latest from the best. With this change in format, we will also be changing the name to “Health Justice Monitor.” Launch is planned for next week.

I hope that you are as excited as I am as I become a consumer rather than a producer of the latest in health policy science. The more we understand, the sooner we will have health care justice for all.

Peace,
Don McCanne

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Quote of the Day interlude

Posted April 12, 2021

By Don McCanne, M.D.

Quote of the Day will take a brief interlude. We are refining our approach to communicating information to educate and advocate for single payer and health care justice for all.

See you soon.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

More trouble: Drug industry consolidation

Posted April 8, 2021

Over 30 years, dramatic consolidation has meant higher prices, fewer treatment options and less incentive to innovate

By Robin Feldman
The Washington Post, April 6, 2021

In the past few decades, three waves of mergers have substantially increased concentration in the pharmaceutical industry.

All told, between 1995 and 2015, the 60 leading pharmaceutical companies merged to only 10.

As a result, now only a handful of manufacturers are responsible for sourcing the vast majority of prescription drugs: Just four companies, for example, produced more than 50 percent of all generic drugs in 2017.

Drug companies were drawn to merging because of the lure of increased market power, improved synergies, larger economies of scale and more diverse product portfolios.

In the period following merger waves one and two, the industry generated fewer new molecular entities each year compared to pre-merger levels. Merged drug companies also spent proportionally less on research than their non-merged competitors.

Consolidation also enabled drugmakers to directly quell competition through what were known as “killer acquisitions,” in which they acquired innovative peers solely to stop potential competition.

In short, consumers were the losers from the two waves of drug company mergers. They confronted higher prices and fewer choices — and saw companies exploring fewer paths that might produce breakthroughs. To make matters worse, around 2010, another wave of mergers began.

As with the earlier waves, giant drug companies have merged. But in a new twist, in recent years, most consolidation has featured bigger players acquiring smaller start-ups. The difference reflects a dramatic shift in the structure of the pharmaceutical industry. Faced with stagnating research productivity, large drugmakers now rely on outsourcing their new drug research to start-ups and other small pharmaceutical firms.

Increasingly, these smaller players specialize in high-risk research and early drug development, with larger firms then gobbling them up and navigating the FDA’s regulatory process. For example, 63 percent of all new molecular entities in 2018 came from smaller biopharma firms, compared with just 31 percent in 2009.

The end result of now three waves of pharmaceutical consolidation is decreased or diverted new drug innovation, fewer treatment options and higher prices. Consumers have lost as firms fuse together to bolster the bottom line.

Robin Feldman is director of the UC Hastings Center for Innovation.

https://www.washingtonpost.com…


Comment:

By Don McCanne, M.D.

Yesterday we discussed consolidation of UnitedHealth/Optum and how it has become a mega-corporation of the medical-industrial complex. Today’s selection discusses consolidation within the pharmaceutical industry. The article describes how we can expect decreased or diverted drug innovation, fewer treatment options, and above all, higher prices. Works for the industry, but not so well for the people.

We’re just trying to introduce single payer Medicare for All. How much impact can that have on these mega-corporations? Where is our government in all of this? Aren’t they supposed to protect us? Maybe we’re aiming too low by advocating for a social insurance program. Maybe we should be taking over the industry so that we can gear it up to better serve us, the people. International comparisons do rate national health services very high in performance. Maybe if we talk about it a little more we can convince them that Medicare for All is a compromise that they can live with. We think we can too.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Recent State Single Payer News

N.Y. Assembly passes universal health care bill

Posted May 28, 2017

By Dan Goldberg
Capital New York, May 27, 2015

The state Assembly on Wednesday voted for a single-payer health bill, the first time in more than two decades the chamber has taken up the measure.

The vote was 89-47, an overwhelming but largely symbolic step toward universal health insurance. The bill now heads to the Republican-controlled Senate where it is not expected to pass.

Assemblyman Richard Gottfried, chair of the health committee, gave an impassioned speech on the floor in support of the New York Health Act, arguing that it was long past time for New Yorkers to rid themselves of the intrusive insurance companies whose goal is to deny claims rather than provide care.

“You do not have to be an Einstein to understand New York Health is the right choice for New York,” Gottfried said.

Gottfried, a Democrat from Manhattan, spent the legislative session barnstorming the state, trying to gain support for his bill, which would be funded through a progressive income tax and payroll assessments. There would be a net savings of $45 billion in health spending by 2019, Gottfried said, based on an analysis from Dr. Gerald Friedman, a professor at the University of Massachusetts at Amherst, though that figure was attacked by Republicans.

The bill, Gottfried said, would lower costs by getting rid of insurance companies. It would lower administrative costs and allow doctors to focus their time on treating patients instead of fighting for reimbursements.

“What will bring down health care costs is taking out of the equation the more than 20 percent we now spend on administrators whose job it is to fight with insurance companies,” he said.

The plan’s benefits, Gottfried said, would be more generous than any plan on the current market, and there would be no co-pays or deductibles. The bill would also require a care coordinator for every member, though that coordinator is not empowered to choose the type of care a patient receives.

For some Republicans, it was all too good to be true.

“This bill promises remarkable things for New York State residents,” said Assemblyman Andy Goodell, a Republican from Chautauqua. “It says providers, ‘you’ll be paid a lot more money,’ and it says to the employees ‘you’ll contribute a lot less money,’ and it says to the patients ‘you’ll have much broader access,’ and to the employers ‘you’ll pay $45 billion less.’ My background is in math and economics and I haven’t been able to figure out how this all works. … There is no free lunch, there is no free health care.”

Leslie Moran, spokeswoman for the New York Health Plan Association, which represents insurers, said the bill “represents an unrealistic, utopian view of a universal health care system where everyone would be covered, everything would be covered and the system would magically pay for it all.”

One problem, pointed out by Republicans, is that the offering, while generous, is the opposite of what public health officials are pushing, including those in the Cuomo administration, who have professed that insurance systems, and high deductibles and co-pays help ensure people use the health system judiciously instead of opting for more, often unnecessary, care.

“There is a role for insurance companies,” state health commissioner Dr. Howard Zucker said Wednesday before the debate.

The last time a universal health care bill was on the Assembly floor was 1992. It passed but the debate was sidelined because of federal efforts to reform health care, which ultimately failed under the Clinton administration.

The passing of the Affordable Care Act, which subsidizes private insurance for people below a certain income level, was a valid effort, Gottfried said, but ultimately served to highlight why the system needs to be entirely scrapped.

“I think the A.C.A. has made it clear to people … there are profound problems in our health care system that cannot be addressed by incremental change in that system,” Gottfried said.

Wiping out an industry — even the insurance industry — was not seen as popular by many Republicans who worried about the loss of jobs and what might happen should this plan fail.

Goodell asked why the state should go down this road when when Medicaid — a government run insurance program for lower-income residents — is expensive, burdensome and not well liked.

“Why would we want to expand that type of approach,” he asked.

Gottfried responded that his bill would improve Medicaid by putting everyone into one pot. He would, he said, eliminate the two-tiered system. There’d be no greater risk of fraud under this law than in the current Medicaid program.

Republicans also pointed out how much was left to be done. The income tax rates have yet to be decided, but would likely cost the highest earners more than they currently pay for health insurance, while subsidizing lower income residents.

The analysis provided by Gottfried estimates no income tax on the first $25,000, an income tax of 9 percent on income between $25,0001 and $50,000, graduating to 16 percent tax for income over $200,000.

The legislation is also not specific on how to deal with residents of New York State who retire to another state.

That would have to be resolved at a later date, Gottfried said.

“Though we have numerous pages on this legislation, we have numerous holes also,” said Al Graf, a Republican from Holbrook. “There is no way I can go back to my constituents and tell them you may have coverage in the future. … This is an exercise in insanity.”

Moran said there is no certainty that providers would accept government set reimbursement, though Gottfried said almost all would receive more for their services than they are currently being paid.

The bill also “completely disregards the economic contribution of health plans — both to the state and to local communities,” Moran said.

Joseph Borelli, a Republican from Staten Island, cited Vermont, which tried and failed to enact a single-payer health system.

Vermont’s collapse has been a cautionary tale for even the most enthusiastic supporters of government sponsored health insurance, but Gottfried was having none of it.

“New York … bears no resemblance to Vermont,” Gottfried said. “The bill bears very little resemblance to Vermont. Their financing system is different. The two have absolutely nothing to do with one another, nothing! Why don’t you ask me whether New York will flood Just like Texas flooded if we enact this plan. The weather in Texas has as much to do with this as Vermont does.”

Read the bill here: http://bit.ly/1JVUg1I

http://www.capitalnewyork.com/article/albany/2015/05/8568890/assembly-pa…


N.Y. Assembly votes for universal health coverage

By Michael Virtanen, Associated Press
Democrat & Chronicle (Rochester, N.Y.), May 27, 2015

ALBANY – The New York Assembly voted 89-47 on Wednesday for legislation to establish publicly funded universal health coverage in a so-called single payer system.

All New Yorkers could enroll. Backers said it would extend coverage to the uninsured and reduce rising costs by taking insurance companies and their costs out of the mix.

With no patient premiums, deductibles or co-payments for hospital and doctor visits, testing, drugs or other care, New York Health would pay providers through collectively negotiated rates. It would be funded through a progressive payroll tax paid 80 percent by employers and 20 percent by employees.

Also, waivers would be sought so federal funds now received for New Yorkers in Medicare, Medicaid and Child Health Plus would apply.

“Employers are shifting more and more health care costs to workers or are dropping it entirely,” said Assemblyman Richard Gottfried, chief sponsor. “The only ones who benefit are the insurance companies.”

The Manhattan Democrat estimated universal care would save New Yorkers more than $45 billion annually, cutting the statewide total cost for health care to about $255 billion in 2019.

Assembly Republicans doubted Gottfried’s estimate and questioned what would happen to everyone now employed by insurance companies.

“All I can say right now I think this is the last think New York state needs as far as an additional cost,” said Assemblywoman Jane Corwin, an Erie County Republican. She said they’re still trying to grapple now with the cost of the federal Affordable Care Act. That extended health care coverage to about 1 million New Yorkers, more than half in Medicaid and the others in private insurance with possible tax subsidies to offset costs.

An identical bill hasn’t advanced in the state Senate and isn’t expected to before the legislative session ends in June. Senate Health Committee Chairman Kemp Hannon said Wednesday that Gottfried’s bill faces two major hurdles, resistance from senior citizens to giving up Medicare for a new state program and obtaining federal waivers to apply Medicaid and Medicare funding to support it.

http://www.democratandchronicle.com/story/news/local/2015/05/27/assembly…

Single-Payer Health-Care Bill to be Introduced in Pa.

Posted October 27, 2016

Berks Community Television (Reading, Pa.), Oct. 25, 2015

HARRISBURG, Pa. – A bill to create a single-payer health-care system in Pennsylvania will be introduced in the state Legislature by the end of the month.

The legislation is being introduced by Representative Pamela DeLissio of Philadelphia and was crafted with the assistance of HealthCare 4 ALL PA, a not-for-profit advocacy group. David Steil, past president of that organization, says the bill is simply called the Pennsylvania Health Care Plan.

“What it does is create a health-care system that includes every resident of Pennsylvania, that is publicly funded and privately delivered,” says Steil.

The cost of the program would be covered by increased taxes, which Steil acknowledges may present a significant obstacle to passage by the state Legislature.

The plan would increase the state personal income tax by an additional three percent, substantially less than most pay for private insurance. It would also add a 10 percent payroll tax on businesses which, as Steil points out, is much less than what businesses spend on health insurance now.

“The average cost for health care benefits for companies that provide health care is about 17 percent of payroll,” he says. “So at 10 percent of payroll, the saving is significant.”

Similar legislation has been introduced in each legislative session since 2007.

Most recently it was introduced as Senate Bill S-400. None of the earlier versions have not gotten very far. Raising taxes is a hard sell, especially to conservative lawmakers. But Steil insists they’re asking the wrong question.

“The question each one has to ask is not just ‘look at the taxes’ because there are taxes to it, it’s not free,” he says. “The question is, ‘How much less than you’re currently paying is this plan to you?'”

Steil says the bill would also eliminate health-insurance costs on pension plans and vehicle insurance, making the potential savings even larger.

http://www.bctv.org/special_reports/health/pa-legislature-introduces-sin…

Single-Payer Health-Care Bill to be Introduced in Pa.

Posted October 27, 2015

Berks Community Television (Reading, Pa.), Oct. 25, 2015

HARRISBURG, Pa. – A bill to create a single-payer health-care system in Pennsylvania will be introduced in the state Legislature by the end of the month.

The legislation is being introduced by Representative Pamela DeLissio of Philadelphia and was crafted with the assistance of HealthCare 4 ALL PA, a not-for-profit advocacy group. David Steil, past president of that organization, says the bill is simply called the Pennsylvania Health Care Plan.

“What it does is create a health-care system that includes every resident of Pennsylvania, that is publicly funded and privately delivered,” says Steil.

The cost of the program would be covered by increased taxes, which Steil acknowledges may present a significant obstacle to passage by the state Legislature.

The plan would increase the state personal income tax by an additional three percent, substantially less than most pay for private insurance. It would also add a 10 percent payroll tax on businesses which, as Steil points out, is much less than what businesses spend on health insurance now.

“The average cost for health care benefits for companies that provide health care is about 17 percent of payroll,” he says. “So at 10 percent of payroll, the saving is significant.”

Similar legislation has been introduced in each legislative session since 2007.

Most recently it was introduced as Senate Bill S-400. None of the earlier versions have not gotten very far. Raising taxes is a hard sell, especially to conservative lawmakers. But Steil insists they’re asking the wrong question.

“The question each one has to ask is not just ‘look at the taxes’ because there are taxes to it, it’s not free,” he says. “The question is, ‘How much less than you’re currently paying is this plan to you?'”

Steil says the bill would also eliminate health-insurance costs on pension plans and vehicle insurance, making the potential savings even larger.

http://www.bctv.org/special_reports/health/pa-legislature-introduces-single-payer-health-care-bill/article_a41a6da0-7996-11e5-b8a4-2ba3ba19b536.html

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