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Timothy Jost explains the GOP repeal and replace legislation

Timothy Jost explains the GOP repeal and replace legislation

Examining The House Republican ACA Repeal And Replace Legislation

By Timothy Jost
Health Affairs Blog, March 7, 2017

On March 6, 2017, the House Republican leadership introduced Affordable Care Act repeal and replacement budget reconciliation bills in the Ways and Means (W&M) and Energy and Commerce (E&C) committees. The bills, collectively titled the American Health Care Act, are the committees’ responses to the instructions they received in the Budget Resolution passed by both houses of Congress in mid-January to prepare budget reconciliation legislation to repeal the ACA.

The committees will begin markup of the bills on March 8, 2017.

If the bills are passed by the committees they will be combined by the House Budget Committee and sent to the House Rules Committee, and then to the full House for a vote. The Congressional Budget Office has not released cost estimates of the legislation and it appears that committee markups will proceed without out CBO reports.

Summing Up

In summary, the legislation’s tax cuts will be very attractive to wealthy Americans and health insurers and providers, who would get a trillion dollars in tax breaks. It could cause consternation for Medicaid recipients and state Medicaid programs, which would see federal funding for Medicaid steadily diminish, potentially thinning out coverage. The legislation could be bad news for recipients of current tax credits who are older, sicker, and poorer, and who live in areas where care is expensive. They may be able to afford low actuarial value coverage with the tax credits the bills would provide them, but they are unlikely then to be able to afford the cost sharing that coverage will impose.

Higher-income younger people, on the other hand, would find coverage much more affordable than it is now under the legislation—the tax credits might fully cover their premiums and leave extra for their health savings accounts. Some insurers could find the state reinsurance money and continuous coverage requirement enough of an incentive to stay in the market, but others may not

Finally, one cannot know without a CBO report how this all works out.  But it is hard to see how the bills pay for themselves, and they could result in significant losses in coverage.

http://healthaffairs.org…

Ways and Means summary of their portion of the “American Health Care Act”:
https://waysandmeans.house.gov…

Ways and Means proposed legislation:
https://waysandmeans.house.gov…

Energy and Commerce summary of their portion of the “American Health Care Act”:
https://energycommerce.house.gov…

Energy and Commerce proposed legislation:
https://energycommerce.house.gov…

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G.O.P. Repeal Bill Would Cut Funding for Poor and Taxes on Rich

By Margot Sanger-Katz
The New York Times, March 6, 2017

Legislative language for what House leaders call the American Health Care Act, released Monday evening, would substantially cut back funding to states that cover poor adults through their Medicaid program. It would cut back on financial assistance for relatively low-income insurance shoppers above the poverty line.

It would offer new financial benefits for the upper-middle class and the rich. Americans higher up the income scale would be eligible for subsidies to help them buy health insurance. Taxes on high incomes would be reversed. And the law would allow people to save more money each year in tax-free health savings and flexible spending accounts — accounts that are most valuable to people who pay high income tax rates and have money to save.

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NYT Reader Comments:

By Don McCanne, M.D.
San Juan Capistrano, CA

That’s enough. Single payer.

https://www.nytimes.com…

‘Financial counselors’ add to administrative overload in health care

Got health insurance? That doesn’t mean you’ll be able to pay your medical bills.

By John Murawski
McClatchy DC Bureau, March 4, 2017

Hospitals around the country are reporting record levels of debt on their books from an unlikely source: patients with health care coverage.

As health insurers and employers have shifted health care costs to patients through high deductibles and other out-of-pocket expenses, people who in the past may not have worried about paying for a hospital visit or a surgical procedure are getting hit with massive medical bills that they can’t pay.

Duke University Health System has seen patient interest-free payment plans rise from $19 million in June 2010 to $43 million in January. The increase is largely attributable to rising deductibles, said Keith Stover, Duke’s vice president of finance and chief financial officer.

Duke is fielding 1,500 patient calls a day, most of them asking why they got a bill since they’re insured, Stover said.

WakeMed Health & Hospitals also is experiencing a spike in patients needing help, setting up an average of 1,810 payment plans per month since October.

Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, started offering zero-interest loans through Commerce Bank in November in response to patient deductibles as high as $14,300.

Southeastern Regional Medical Center in Lumberton, North Carolina, in December began assigning “financial counselors” to patients’ rooms to explain insurance benefits and payment options.

Duke Health’s 225 financial counselors contact patients before their scheduled procedures to discuss insurance benefits and payment options; every Duke clinic now has a full-time financial counselor on staff to work with patients.

UNC Health Care has 200 financial counselors to assist patients. “It’s going to be our responsibility to collect,” said Mark Miller, chief financial officer of UNC Health Care in Chapel Hill, North Carolina. “So much is getting left on the table because we can’t get it from the patient, or because they have chosen not to pay it, or they can’t.”

Republicans in Congress have been unable to coalesce around a single proposal to replace the ACA. But their proposals so far could drive up deductibles by lifting the ACA mandated cap on the out-of-pocket costs patients have to pay.

Consumer advocates say the high deductible trend is unsustainable. “They can be a barrier to care for people,” said Mark Rukavina, principal, Community Health Advisors, a Boston organization that advises nonprofit hospitals on billing, collections and finance.

http://www.mcclatchydc.com…

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Comment:

By Don McCanne, M.D.

In a system already tremendously overburdened with administrative excesses, we now have an escalating need for “financial counselors” because of the explosion in medical debt due to the expansion in the use of high deductibles – a tool to protect insurers by slowing the increase in insurance premiums, but at the cost of reducing the financial protection that is the very reason that insurance exists in the first place.

In crafting the Affordable Care Act (ACA) it was recognized that the actuarial value of the plans would have to be decreased (code language for introducing very high deductibles) to keep premiums affordable, and that required fairly generous subsidies and credits for lower-income individuals if they were going to be able to afford health care. But that left moderate-income families exposed to the larger, less affordable deductibles.

What has really increased the need for financial counselors is that employer-sponsored plans – the mainstay of insurance in the United States – have accelerated the adoption of high deductibles with which many working families struggle. It is now a problem in mainstream America. ACA did not directly address the problem of high deductibles in employer-sponsored plans, but it did compound the problem by tightening up on insurance regulation and design. Without higher deductibles, the premiums for employer-sponsored plans would have been driven up even higher.

So ACA made the problem of high deductibles worse. What about the Republican replace proposals? We will find out this week, but it doesn’t look good. The exchange plans will probably have a less generous tax subsidy, making plans less affordable for lower-income individuals. There will also likely be reduced regulatory requirements for private insurance, allowing them to market plans with lower premiums, but that will shift even more costs to individuals and families through yet higher deductibles and other cost sharing and through a reduction in plan benefits – requiring greater out-of-pocket spending.

So what are we getting? Exactly what we don’t need – more administrative costs in the form of financial counselors who assist us in handling the debt that health insurance was supposed to prevent.

We don’t need this. We should get rid of private insurance and replace it with a well-designed single payer national health program that provides first dollar coverage while containing medical spending through much more patient-friendly policies. We can simply fix Medicare and provide it for everyone.

‘Medicare for all’ is still the best solution

By The Editorial Board
The Capital Times (Madison, Wis.), March 6, 2017

Given the choice between maintaining the Affordable Care Act, as many Democrats propose, or eliminating it, as many Republicans propose, The Cap Times favors retaining as much of the current health care program as is possible and practical.

But we have no illusions. We know that the ACA is more costly and inefficient than it needs to be. We are with the plurality of Americans that favors retaining the parts of the ACA that work well and then reforming it so that it can do more.

The best way to do more is to move, as quickly as is politically possible, toward a single-payer “Medicare for all” program.

The single-payer model treats health care as a basic human right and guarantees that everyone is afforded that right. That’s the correct approach and we are pleased that Congressman Mark Pocan, D-town of Vermont, is a co-sponsor of HR 676 — The Expanded and Improved Medicare for All Act.

While Pocan opposes the efforts of Republicans like Vice President Mike Pence and House Speaker Paul Ryan to gut the Affordable Care Act and usher in a new era of profiteering by insurance companies and for-profit health care corporations, the Democrat from Wisconsin recognizes that the best way to provide health care for all while keeping costs down is to build on the successful Medicare model.

Medicare is not perfect. But the government-run program is treasured by Americans because it is so much more reliable and efficient than private programs. That reliability and efficiency, as well as genuine access to quality care, can be enjoyed by all Americans if reforms of the ACA move us in the direction of a “Medicare for all” system.

http://host.madison.com…

Doctor’s prescription for health insurance: Remove the profit motive

Single-payer advocate speaks in Charlotte March 9

By Herbert L. White
The Charlotte (N.C.) Post, March 5, 2017

Is single-payer health insurance inevitable?

American lawmakers are consumed about repealing and replacing the Affordable Care Act. One path that has been regularly touted as a solution is the single-payer model, which advocates say will assure every citizen has access to equal and quality health care.

One of those advocates, Robert Zarr M.D., a practicing pediatrician in Washington, D.C., and an expert on international health and universal health care, will speak March 9 at 6:30 p.m. at Midwood International and Cultural Center, 1817 Central Ave.

Zarr, who provides care for mostly low-income patients, is also an adjunct professor at George Washington University and Children’s National Medical Center. He is also immediate past president of Physicians for a National Health Program.

A February Kaiser Health Tracking Poll finds attitudes towards ACA have shifted, with 48 percent of respondents favoring the law while 42 percent found it unfavorable. The favorable response is the highest measured in more than 60 Kaiser Health Tracking Polls since 2010. Independent voters are driving the change, with 50 percent now viewing the law favorably.

A May 2016 Gallup Poll found 58 percent of Americans favor replacing ACA with a federally funded healthcare system – such as Medicaid and Medicare – that provides insurance for all. Critics, however, contend such a program amounts to “socialized medicine” which leaves government in control of the delivery of service and weakens care.

Zarr spoke with The Post by telephone from Washington, D.C. Responses are edited for clarity and brevity.

Polling suggests the idea of single payer insurance is popular. Why is that?

Zarr: “The reason why it’s so popular is because one, it’s so easy to understand. The second is that it just makes common sense. We remove the shackles from the insurance companies for the delivery of care, which in our opinion, should be left to the private domain. We feel doctors should be able to open up their own practices if they wish. We feel strongly that a pharmacy should be able to provide medicines and medical supplies without having to worry about bankruptcy themselves.

“We feel this can best be done most efficiently by looking at the data and evidence, not just with Medicare but across the world. The only way we can efficiently do this is by publicly financing it, removing it from the private domain in terms of finance. Private delivery, public finance – that is the easy way for us to understand single payer.”

Why isn’t single payer the law of the land now?

“Probably the best way to answer that is that there is a lot of momentum among the moneyed interests in this country to keep status quo. ACA really is and really was the beginning of a prolongation of our status quo. There’s nothing magical about ACA. It took what we already had and it expanded it. It expanded Medicaid in 20-plus states, and I might add, did not expand it in 20-plus states as well and it relied heavily on the private insurance model. The private exchange model is not just what we see in the exchanges that have been set up but also in Medicare and Medicaid as well, so two-thirds of the recipients in Medicaid are receiving their health insurance through private, for-profit plans and it’s about one-third in Medicare.”

Why isn’t there more political will to remove the profit motive from health insurance?

“I think we need to exert our democratic right through pressure on legislators to make sure they understand they’re jeopardizing their next campaign if they don’t support single payer. The strongest thing we can do right now is raise the temperature so that legislators understand that single payer, HR676, is what this country wants and what we need, both by the people and the delivery community – the doctors, the hospitals, the pharmacies. We need to make it politically toxic to not support 676.”

Has the battle over repeal and replace overwhelmed advocacy for single payer?

Because ACA is under threat right now, with all its faults and all its reliance on for-profit insurance industry, which is not leading us to single payer, it still did put an insurance card in the wallet or purse of 20 million Americans. When we remove that against the people’s will, for every million uninsured, you’re looking at 1,000 deaths per year. There’s a lot of pressure going on right now and congressmen are feeling it because constituents are worried, they are anxious about what’s going to happen.”

What do you see four years into the future for health insurance?

“There is a chronic burnout and fatigue in physicans and it’s bad, very bad. We’re spending more of our time trying to get the simplest of tasks done where you’ve got 15 minutes to get this done. As a patient, it’s getting more and more frustrating with the cost shifting with the difficulty of knowing there’s no transparency. I don’t know the coverage my health plan has until I get sick and I get the bill. My crystal ball tells me if we keep going down this same path, it’s a path to destruction, it’s a path to suffering, it’s a path to early death, and that’s not something I want.

“My crystal ball tells me there is only one end point to this and that is to provide every American an equitable and affordable comprehensive health care that will not bankrupt us. We can put this off another few years, four years, six to eight years, but at some point we’re going to have to get to the only solution that anyone’s been able to come up with, and that’s efficient and not going to bankrupt us and it’s fair for everyone.”

http://www.thecharlottepost.com…

What did Jesus really say?

Two months ago, this doctor was delivering babies. Now he’s at the nexus of the Obamacare fight

By Lev Facher
STAT, March 3, 2017

Dr. Roger Marshall was delivering babies in December. By January, he found himself across a breakfast table from Tom Price, offering emotional support to the Georgia congressman as he endured a contentious confirmation process to become the top health official in the new Trump administration.

Marshall, a few months ago just another doctor from Kansas, is now Congressman Roger Marshall.

Marshall has joined the GOP Doctors Caucus, a group of 16 lawmakers with health care backgrounds who have put themselves at the center of the effort to unwind the Affordable Care Act.

Marshall is as quick as any Republican to slam Obamacare, claiming firsthand experience of its effects from his time at Great Bend Regional Hospital in central Kansas. He helped grow the hospital from a four-bed surgical clinic to the full-service, physician-owned facility it is today.

Like many other Republicans, Marshall said he wants the health care system to rely on the free market rather than Obamacare’s regulations. He measures success in how many people can afford to leave the Medicaid program and enter the private insurance market.

The law’s Medicaid expansion, which Kansas has not adopted despite support from many hospitals, including some of Marshall’s former colleagues, is one of the big sticking points for Republicans. Many GOP-led states adopted it and want to see it preserved in some form.

Marshall doesn’t believe it has helped, an outlook that sheds light on how this new player in Washington understands health policy.

“Just like Jesus said, ‘The poor will always be with us,’” he said. “There is a group of people that just don’t want health care and aren’t going to take care of themselves.”

https://www.statnews.com…

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Old Testament

Deuteronomy 15:11

11 For the poor will never cease out of the land; therefore I command you, You shall open wide your hand to your brother, to the needy and to the poor, in the land.

New Testament

Mark 14:1-10

1 It was now two days before the Passover and the feast of Unleavened Bread. And the chief priests and the scribes were seeking how to arrest him by stealth, and kill him; 2 for they said, “Not during the feast, lest there be a tumult of the people.” 3 And while he was at Bethany in the house of Simon the leper, as he sat at table, a woman came with an alabaster flask of ointment of pure nard, very costly, and she broke the flask and poured it over his head. 4 But there were some who said to themselves indignantly, “Why was the ointment thus wasted? 5 For this ointment might have been sold for more than three hundred denarii, and given to the poor.” And they reproached her. 6 But Jesus said, “Let her alone; why do you trouble her? She has done a beautiful thing to me. 7 For you always have the poor with you, and whenever you will, you can do good to them; but you will not always have me. 8 She has done what she could; she has anointed my body beforehand for burying. 9 And truly, I say to you, wherever the gospel is preached in the whole world, what she has done will be told in memory of her.” 10 Then Judas Iscariot, who was one of the twelve, went to the chief priests in order to betray him to them.

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Comment:

By Don McCanne, M.D.

Dr. Roger Marshall, freshman congressman from Kansas, has already exposed his compromised sense of medical ethics by participating in the establishment of a for-profit, physician-owned private hospital – a prime example of the perversities of the medical-industrial complex. But then he had to bring Jesus into it, saying, “The poor will always be with us.” Marshall says that he doesn’t believe that Medicaid has helped the poor because they “just don’t want health care and aren’t going to take care of themselves.”

In the Old Testament, the Scriptures record that the Lord said, “For the poor will never cease out of the land; therefore I command you, You shall open wide your hand to your brother, to the needy and to the poor, in the land.”

In the New Testament, which presumably is Marshall’s source in the Scriptures since he was quoting the words of Jesus himself, Jesus did say, “For you always have the poor with you…”  But Jesus continued (conveniently omitted by Marshall), “… and whenever you will, you can do good to them.” It seems as though Marshall does not will to do good to the poor. (Though, in context, would Marshall have thought the ointment was wasted? Probably not if it would otherwise have gone to the poor – a point with which those writing or translating the Scriptures thought Jesus might agree. An enigma.)

What I knew about Jesus was derived mostly in my childhood when I attended the Pilgrim Congregational Church in Pomona, California (choir practice on Tuesdays, Boys Brigade on Thursdays, Sunday School Sunday mornings followed by singing in the children’ choir in our church services). I have been forever grateful for the  moral lessons that I learned from the Scriptures, including from the words of Jesus. In my earlier years of awakening I was saddened to see that some of the elders in our church – some of the wealthiest people in town – did not seem to have a commitment to what my perceptions were of what Jesus was trying to teach us, so I left the church. My salvation is that I have found that these moral principles hold just as solidly in the secular world and are practiced by my friends in the social justice movement regardless of their personal religious beliefs or lack thereof. Truth is truth, and fundamental morality exceeds all boundaries.

But when a physician – a profession with ethics dating back to the Hippocratic traditions – uses the words of Jesus to tell us that Medicaid – a public program to help the poor with medical needs – has not helped since they don’t want health care and are not going to take care of themselves anyway, then he must be a hypocrite. Jesus would have turned over the tables in the business offices of his physician-owned hospital. We certainly do not want him, nor his colleagues of like mind, making moral judgements as to how legislation defining how to finance health care for all in America should be crafted.

Why Republicans should support universal health care

By Roger LaBonte, M.D.
The Tennessean, March 3, 2017

President Donald Trump has indicated he wants to repeal and replace Obamacare.

His recent statements before the election seem to indicate his desire for a market-based solution. Several recent articles and editorials have demonstrated how dysfunctional our health care system is, principally by its reliance on the insurance-industrial complex.

Every attempt to correct and improve the system by legislation has given the health-insurance industry new incentives and ways to game the system for its own profit motive. Obamacare has turned out to be no different.

The rate increases in Tennessee of 44 percent to 62 percent, approved last year, and similar increases in other states have shifted more and more cost to employers who are mandated to provide coverage and in turn must pass this on to their employees. Employers should be in rebellion at their increasing cost of providing health care for employees as is currently mandated.

I do not understand why many businesses continue to support our current system. In fact, the only businesses that gain anything by this system of employer-provided health care are the insurance companies themselves, which continue to show huge profits while sucking profits from others.

Many of the newly under-insured will be surprised by what they do not have when they try to access health care. The insurance executives who say they cannot weather the losses incurred by their participation in the health-care marketplaces are still raking in profits for their executives. Shareholders are basically just confirming their unwillingness to include those in most need of health insurance in their risk pools.

Some enlightened businessmen have come to that conclusion, including Richard Master, CEO of MCS Industries, Inc., who has supported single-payer national health insurance.

Many years ago, as a successful businessman, Trump had expressed the opinion that the best business solution to our dysfunctional health care system would be a national health care system with universal coverage for everyone, paid through taxes. I agree with his assessment at that time and hope that he will go back to considering this solution.

Imagine what that would do for the Republican Party’s popularity given that greater than 75 percent of our citizens want universal coverage. Under such an egalitarian and utilitarian system taxes would certainly go up for individuals and businesses, but the amount saved by not having to pay health insurance premiums, co-pays, deductibles, co-insurance and other hidden fees would more than compensate businesses and individuals for the increase in taxes.

With Republicans now in control of all branches of government, let’s hope they can achieve universal healthcare for everyone while lowering the cost to everyone.  Much of the rest of the world has shown us that universal health care is achievable at reasonable costs. More importantly we cannot identify as a caring nation until we properly care for the least among us.

Roger S. LaBonte, M.D. is president of the West Tennessee Chapter of Physicians for a National Health Program.

http://www.tennessean.com…

The G.O.P. and Health Care

By Caroline Poplin, M.D.
The New York Times, Letters, March 3, 2017

Re: “The Hole Republicans Dug” (column, Feb. 28):

David Leonhardt is right. If Republicans want to provide health insurance through “free market” competition, their solution will have the same problems as the Affordable Care Act: Healthy, low-risk families will be forced to buy costly policies more expensive than they need, to cover the expenses of the 5 percent of people responsible for some 50 percent of health care costs, with money left over for insurer profits.

A significant infusion of federal money will be required, contrary to Republican philosophy. If the government pays less, people will have to pay more; insurers or providers must accept less; or people will lose coverage. There is no way to square this circle.

What Americans want and need is not affordable health insurance, but necessary health care. Our fundamental problem is that American health care is expensive, which reduces access. Insurers have done little to reduce cost — look at the skyrocketing prices of drugs — and instead have probably increased it.

If we want all Americans to get the health care they need, the only system we can afford is some version of Medicare for all, with negotiated or regulated prices, just like the rest of the developed world.

Caroline Popline, M.D., J.D., is a primary care physician. She resides in Bethesda, Md.

https://www.nytimes.com…

Don’t repeal and replace the ACA, rethink it

By Laura McClure 
The Daily Star (Oneonta, N.Y.), March 3, 2017 

Donald Trump and fellow Republicans rode into office, in part, on a wave of understandable anger at our complicated, expensive and unfair health care system. Much of the fury was focused on the Affordable Care Act, also known as Obamacare. Republicans promised to quickly “repeal and replace” the law.

But in a closed-door meeting in Philadelphia just after Trump’s inauguration, GOP lawmakers were filled with doubt, the Washington Post reported. How were they going to get rid of Obamacare without causing millions of Americans to lose their health care coverage? How on Earth were they going to keep insurance premiums affordable? 

Our new local member of Congress, John Faso, was at the meeting. He worried about the political heat he’d get if Republicans tried to defund Planned Parenthood as part of the ACA repeal.

“Health insurance is going to be tough enough for us to deal with without having millions of people on social media come to Planned Parenthood’s defense,” he said. 

Faso is right to be worried about the impact of ACA repeal. Without the law, an estimated 2.7 million New York state residents would lose their health care coverage — including 5,785 people in Otsego County and 4,461 people in Delaware County.

The state budget would take a $3.7 billion hit. (Be aware that if you are getting health insurance through Medicaid or got your insurance through the New York State of Health exchange, your coverage is at risk.) Repealing ACA without having a better plan in place would endanger millions of people. 

But as of this writing, Republicans don’t have a consensus plan for replacing Obamacare. It’s not a comfortable spot to be in, and that’s probably one reason why many Republican legislators appear to be hiding from their constituents. They’re avoiding potentially explosive town hall meetings filled with people who are afraid they’re about to lose their health insurance.

As of this writing, Rep. Faso has scheduled no public events during the Congressional recess, which is usually legislators’ time for connecting with voters. Although Faso voted “yes” on a recent resolution to open up ACA repeal, he says he wants to “fix” ACA rather than repeal it.

Yet “repeal” is still the word on the lips of Faso’s Republican colleagues. Just before the recess, House Republican leaders came out with a sketch of a health plan to give lawmakers something to say to constituents.

The plan would slash the state funding that helps low-income people and their families get health insurance through Medicaid. And it would replace the ACA’s subsidies for insurance with tax credits and health savings accounts — devices that are helpful mainly to people with higher incomes. In other words: if you’re struggling to make ends meet, this plan is scary.

House Speaker Paul Ryan has gone even further by arguing that Republicans should privatize Medicare and turn it into an ACA-like “marketplace” of private plans. This would essentially mean the end of guaranteed quality health insurance for seniors. 

That would be an even bigger catastrophe, and would take us in the opposite direction from which we need to go. Instead of ditching Medicare, we should improve it and expand it. We should replace Obamacare — with Medicare for all. 

The good thing about Obamacare was that it rescued some 20 million Americans from being uninsured. (Though tragically, another 28 million people are still uncovered.) It also forbid insurance corporations, both inside and outside the ACA, from excluding people because of prior health conditions, and it ensured some preventive care.

The bad thing was that rather than repair our broken system, Obamacare propped it up. The plan was a deal the Obama administration cut with the health insurance corporations, the pharmaceutical corporations, and the medical industry: The government would guarantee them more customers by requiring Americans to buy their wares, in exchange for imposing new rules on their businesses.

Propping up our current health care system, and defending ACA as the best we can do, is wrong both morally and strategically. We have the industrialized world’s worst-performing health care system. It is far more costly than any other system, and has poorer results.

Anyone who has to use our health care system extensively (ACA included) knows its nightmarish complexity and irrationality. We slog our way through the inexplicable claims, rules, and exclusions. We sweat over ever-rising premiums, gigantic deductibles, and mounting out-of-pocket expenses. We’re caught in billing wars between health insurance corporations and hospitals, both trying to profit from our illness. Since most of the people who use the health care system heavily are sick, elderly or both, navigating through this expensive mess is overwhelming, if not impossible. 

Republicans’ proposals would make the system even worse by inviting even more profiteers and administrators into the system and by forcing millions more low-income Americans (the great majority from working families) to go without insurance altogether.

Under a single-payer health care system, everyone would be covered through one insurer: the federal government. We’d all have Medicare, which would guarantee coverage for all. Health care itself would still be provided by a range of public, nonprofit, and private clinics, hospitals and doctors. 

A December 2015 Kaiser poll found that 58 percent of Americans support a single-payer plan. Bernie Sanders’ vocal support for single-payer is one reason he beat his opponent, Hillary Clinton, in the Democratic primary in almost every county in upstate New York. (Sanders got 61% of the vote to Clinton’s 39% in Delaware County. In Otsego County, it was 59% to 40%.) 

Believe it or not, Donald Trump once supported single-payer. He wrote in his 2000 book “The America We Deserve:” “We must take care of our own. We must have universal health care … The Canadian-type, single-payer system in which all payments for medical care are made to a single agency (as opposed to the large number of HMOs and insurance companies with their diverse rules, claim forms, and deductibles) … helps Canadians live longer and healthier than Americans.” 

Although Trump has since changed his tune about single-payer, he still seems to crave its results. Just before his inauguration, Trump described his dream health care plan: “We’re going to have insurance for everybody,” he told the Washington Post. “It will be in a much-simplified form. Much less expensive and much better … They’ll be beautifully covered.” Yes. That would be single-payer. 

Democrats and independents, take heart: If you believe in single-payer health care, fight for it. Republicans, join us. You and your loved ones deserve high-quality health care, too. Everybody in, nobody out.

http://www.thedailystar.com…

Rep. Cooper addresses ACA concerns in Nashville town hall

By Nikki McGee
Fox 17 Nashville, March 3, 2017

Congressman Jim Cooper held a town hall in Nashville Friday after a contentious week in Washington.

New policies from the Trump Administration on immigration, healthcare and the environment dominated the discussion at the meeting. Some also voiced their concerns on President Trump’s cabinet picks.

Out of these issues, Rep. Cooper said the people of Tennessee seem to be most concerned about health care.

“They’re not necessarily fond of Obamacare, but they don’t want to lose the good parts of Obamacare,” Cooper said. “They’re deeply worried, they don’t know what a republican replacement would be.”

The president of the Physicians for a National Health Care Program attended the meeting to talk about the state of healthcare and offer a solution. Dr. Carol Paris is advocating to expand Medicare and come up with a system that makes it available to everyone.

“It is a publicly funded, privately delivered way of financing health care,” Paris said. “For people over 65, it is a very well loved program. It could be improved and we could extend and expand it from birth to death.”

Legislation is in place to repeal the Affordable Care Act, which is one of President Donald Trump’s top campaign promises. Cooper said he’s concerned about what will replace it.

“In the latest news reports, Rand Paul, a republican, went all over Capitol Hill looking for the republican plan, couldn’t find it,” Cooper said. “Steny Hoyer, a democrat, tried to do the same thing, couldn’t find it. That’s pretty scary when apparently there’s going to be a vote on it next and nobody’s even seen the plan. That’s not a good way to govern.”

Other Tennessee leaders, however, said they feel very strongly about repealing ACA.

“If the federal government is in the driver’s seat for regulating individual health choices, competition cannot exist,” Congressman Marsha Blackburn said in a statement earlier this month. “Therefore, it’s important that we allow states and consumers more flexibility in purchasing a health plan that it truly tailored to their needs.”

Paris said she’s seen the need to improve insurance options for patients first hand.

“The American People are having to choose to forego other household expenses and even food to pay for health care.”

Friday’s town hall is one of five community discussions Cooper has hosted since the beginning of the year and he says he wants his constituents to feel that their concerns are being heard.

“The times are a little bit scary right now, but America’s been through way worse than this,” Cooper said. “We’ll get through this. We just need to be kind to each other and to pay attention to the news and not jump to conclusions, but try to do the right thing for the country.”

http://fox17.com…

A single-payer health-care system is needed

By Jonathan Michels
Winston-Salem (N.C.) Journal, March 3, 2017

Ten years ago, I began transporting sick patients at Forsyth Medical Center. Transporters are some of the hardest working and least recognized workers in the hospital. My job was to transfer patients as smoothly and comfortably as possible onto a clean gurney and transport them to the radiology department. Deceptively simple, transporting turned out to be a crash course in humanity. I decided to pitch in as best as I could.

The very first patient I went to transport by myself died in front of me. My astonishment about the patient’s death amused my seasoned co-workers, who helped me understand that the hospital is a place where sometimes people come to die.

“Why is this happening to me?” asked another patient, terminally ill with cancer. Her words hung in the air as I settled her back into bed. I had no answer for her then, and I still don’t.

Transporting overdose victims, some of them younger than me, underscored the fragility of life. And watching stroke patients relearn basic skills like feeding themselves or walking taught me about the resilience of the human body and spirit. Hope Jahren, the celebrated geobiologist and author, echoed my response when she wrote, “Working in the hospital teaches you that there are only two kinds of people in the world: the sick and the not sick. If you are not sick, shut up and help.”

Medicine has changed a lot even in the short time since I began transporting patients. Despite the much-vaunted health-care reform of 2010, the Affordable Care Act, medicine is still driven by profit, not progress.

Twenty of the highest-paid CEOs included in the Standard & Poor’s 500 index hailed from health-care or pharmaceutical companies, according to a 2016 report from the Associated Press and Equilar. Health-care executives continued raking in millions of dollars in salaries and bonuses in the wake of the Great Recession, while I joined hundreds of other health-care workers who were escorted out of the hospital in a massive layoff. The people who remained, many of whom come to work every day to care for the sick and the helpless (and yes, for a paycheck), increasingly feel the pressure of doing more work with fewer resources.

Now a premedical student at UNC-Greensboro, my health-care experience has shown me that sometimes it’s simply not enough to pitch in and help patients on a case-by-case basis. In order to effectively care for our patients, we need to implement a health-care system that meets the needs of everyone and allows medical providers to do their jobs without the intrusion of hospital administrators or private insurance company executives.

Our health-care system is at a crossroads. While the ACA made some improvements around the edges of our health-care system, it clearly wasn’t enough. We need to go beyond the ACA to a single-payer system, an improved Medicare for all. In January, U.S. Rep. John Conyers of Michigan introduced H.B. 676, which would implement an improved and expanded Medicare-for-all.

More than a decade ago, Donald Trump preached the sensibility of covering all Americans in his book, The America We Deserve.

“We must have universal healthcare,” Trump wrote. “I’m a conservative on most issues but a liberal on this one.”

The proposed replacement program put forth by U.S. House Speaker Paul Ryan and Health and Human Services secretary Tom Price gives tax credits for people to buy private insurance and doles out block grants to states to replace the Medicaid expansion provision under the ACA. Critics believe the changes will put more financial burden upon American families and ultimately reduce the number of uninsured.

“Although Republicans’ proposals seem unlikely to achieve President Trump’s triple aim (more coverage, better benefits, and lower costs), single-payer reform could,” wrote Dr. Steffie Woolhandler and Dr. David Himmelstein in the Annals of Internal Medicine.

A single-payer system would eliminate for-profit insurance companies and replace them with a non-profit, public-payer system. It would be privately run but government funded just like Medicare, saving billions in administrative costs and giving doctors the freedom of practicing medicine without intrusion. Patients would no longer pay high deductibles or co-pays and there would be no fear of losing health insurance if someone loses their job.

Rather than jettison any recently-won gains in health-care coverage, let’s push the president to renew his support for universal care — and hope that Congress follows suit with H.B. 676.

The only way to get back to the real business of health care — caring for our patients — is to enact universal health care.

Jonathan Michels is a local radiology technologist.

http://www.journalnow.com…

Affordability continues to deteriorate; CALL FOR ACTION!

Polling Data Note: Beyond the ACA, the Affordability of Insurance Has Been Deteriorating Since 2015

Kaiser Family Foundation, March 2, 2017

The debate about the future of the Affordable Care Act and its individual insurance marketplaces may be taking the focus off the affordability challenges facing the broader population, most of whom get their health coverage through employers, Medicare or Medicaid.

New survey findings from the Kaiser Family Foundation show that health care has become somewhat less affordable even among those with health insurance. Since 2015, larger shares of people with health insurance say they have a difficult time affording their health care costs: from 27 percent to 37 percent for premiums, 34 percent to 43 percent for deductibles, and from 24 percent to 31 percent for copays and prescription drugs.

Other findings include:

* About three in 10 adults (29%) report someone in their household has had problems paying medical bills in the past year, often with real consequences. For example, among those reporting problems paying medical bills, seven in 10 (73%) report cutting back spending on food, clothing, or basic household items, while about six in 10 report using up all or most of their savings (61%) or taking an extra job or working more hours (58%) to pay their bills.

* Concerns about cost are also affecting whether and when some people seek health care. For example, a quarter (27%) of the public says that they or a family member living in their household put off or delayed getting health care they needed in the past year due to costs, and nearly as many say they skipped a recommended medical test or treatment (23%) or did not fill a prescription (21%).

* Nearly half of Americans (45%) say they would have difficulty paying an unexpected $500 medical bill. This includes those who say they wouldn’t be able to pay it at all (19%), those who would put it on a credit card and pay it off over time (20%) and those who would have to borrow money from a bank, payday lender, family or friends (7%). Among the uninsured and those with lower incomes, more than three in ten say they would not be able to pay a $500 bill at all.

* Significant shares of the public say they are “very worried” about not being able to afford health care services they think they need (25%), losing their health insurance (22%), or not being able to afford prescription drugs (21%). Overall, half say they are at least somewhat worried that they won’t be able to afford needed health care services.

Designed and analyzed by public opinion researchers at the Kaiser Family Foundation, the polls were conducted from December 13-19, 2016 and February 13-19, 2017.

http://kff.org…

Full report:
http://kff.org…

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Comment:

By Don McCanne, M.D.

At first blush this looks like just another one of those reports that shows that our health care financing system is not working as well as we would like it to. In fact, this is horrendous news. Let’s look at what this means.

This is brand new data collected after the Affordable Care Act (ACA) has been fully implemented. It provides a cross section of all sectors of the insured and uninsured, not just those in the ACA exchanges. The largest sector is those with employer-sponsored coverage – the mainstay of health insurance.

This survey shows that affordability continues to deteriorate, in spite of the benefits of ACA. More individuals and families are having problems paying medical bills to the extent that they have depleted their savings and are cutting back on other household essentials, including food!

Everyone should have the health care that she or he needs. Health care has become outrageously expensive. The health care financing system should be designed to allow people to circumnavigate the financial barriers to care. But what have we done instead?

For the majority of us we have turned the problem of high health care costs over to the private health insurers, pretending that they can use market forces to control health care costs for us. But what are they doing? They are protecting their own market for their insurance products by keeping their insurance premiums more or less affordable, but they are doing that by creating the very financial barriers from which insurance should be protecting us. Very high deductibles, coinsurance, copays, restricted benefits, narrow networks that create financial barriers to out-of-network physicians and hospitals – all are designed to shift health care financing from the insurance premiums to the pockets of patients. That’s great for the insurers but a disaster for patients.

And what is President Trump, HHS Secretary Price, and Congress offering us now? They have decided to reject the concept of guaranteed health care for all and replace it with the guarantee of ACCESS to insurance products and health care that we cannot afford. Some legislators are considering tax credits, but less that the subsidies under ACA. Affordability is already deteriorating and their proposals will only accelerate that deterioration.

We are already spending $3.2 trillion which is more than enough to provide quality care for everyone. But to do that we need to change to a financing system that would improve the allocation of these resources. A well designed single payer system would recover over $500 billion in wasted administrative services which would be enough to fill in the voids in care today. Also, we do not need to perpetuate cruel policies that block access to care by making it unaffordable in that other single payer tools can control spending in a patient-friendly manner (global budgeting, negotiated rates, bulk purchasing, budgeting of capital improvements, etc.).

Next week the House Energy and Commerce Committee is going to mark up the repeal and replace legislation. Their legislation would only make us even more susceptible to depleting our savings and forgoing basic essentials because of mounting medical bills.

This is catastrophic. It is time for a massive virtual march on Washington. We need far more than the National Mall could accommodate. This needs to go viral. We are all inundated with messages that we need to support health care for all – messages that you can click to donate a nominal amount. Bullshit! This is not simply about the administrative costs of our well-meaning advocacy organizations. This is about the health of our nation.

We need action! Now! Mobilize all of these groups that profess to support health care justice for all. Bombard Washington with 50 million demands for an improved Medicare for all. No, make that 100 million. They seem to be deaf in Washington.

Seriously, leaders of advocacy groups should organize conference calls today to initiate a process by which we could bombard Washington with electronic messages this weekend. The legislation moves forward next week. Remember that depleted savings and hunger are the default option.