PNHP

Gerald Kominski discusses the politicians’ proposals and the future of U.S. health care

Gerald Kominski discusses the politicians’ proposals and the future of U.S. health care

“The Presidential Candidates: Their Health Plans”

By Dr. Gerald Kominski
Director, UCLA Center for Health Policy Research
Professor, UCLA Fielding School of Public Health
The UCLA Center for Health Policy Research
Health Policy Seminar Series, September 27, 2016

Excerpt at 0:52:24 of the video:

Question: Will the U.S. move to universal health care in the next ten years or so?

Gerald Kominski: Wow! I’ve spent my entire career talking about the history of the effort to get universal health care in the United States. And, again, I’m looking at Mark Peterson whose written about this extensively as well and knows the history. Our history is that we have been trying to do this now for 120 years in the United States. We’ve made progress, but the progress is glacial. Having said that, we never stop fighting for that. First of all, that’s why we’re in Public Health. It’s why this center – The Center for Health Policy Research – does what it does, and it’s why thousands of people across the country, across the state…millions of people are working towards this goal. But the next ten years are very difficult…we are so divided politically right now, it is very, very difficult to imagine the scenarios that lead us to true universal access through, say, a single payer system in the next ten years. But I’m an optimist, and I believe that there are people in this room who will one day see a single payer system in this country. Now I may not be around, but some of you will be. And we’re getting there. It just takes a long time.

Video, with PowerPoint:
http://healthpolicy.ucla.edu…

***

Comment:

By Don McCanne, M.D.

In this seminar Gerald Kominski discusses the health care proposals of presidential candidates Democrat Hillary Clinton and Republican Donald Trump plus those of Libertarian Gary Johnson and Green Party candidate Jill Stein.

Health policy wonks and others certainly understand the complexity of the proposals of the two leading candidates and even that of Libertarian Gary Johnson, as described by Professor Kominski. But he was able to describe Jill Stein’s proposal in full in one brief, elegant sentence. Here is his full description of her plan (at 0:41:12 of the video):

“Jill Stein, the Green Party candidate, is for a Medicare for All plan, basically a single payer plan with no copayments, no deductibles, basically free health care for all Americans.”

That’s it!

Wow!

Physicians for a National Health Program is a nonpartisan educational organization. It neither supports nor opposes any candidate for public office.

Why Health Insurance Industry Consolidation Is Bad For Your Health

By Wendell Potter
The Huffington Post, Sept. 29, 2016

You undoubtedly have heard that some of the country’s biggest health insurers have decided to leave several Obamacare markets, which means that tens of thousands of us will be affected next year.

You probably haven’t heard — at least not lately — that some of the biggest health insurers are moving full steam ahead to merge with each other, which means that tens of millions of us — yes, millions — will be affected next year. And not in a good way. If the consolidation happens as planned, many of us will find ourselves in health plans with much worse patient satisfaction and customer complaint scores.

Here’s some context: Executives of UnitedHealthcare, Aetna and Humana made headlines this summer when they announced plans to quit selling policies on several Obamacare exchanges at the end of the year because they haven’t yet figured out how to turn a profit on that business. That means people enrolled in those companies’ Obamacare plans will have to pick a different insurer for 2017.

If That’s Not Bad Enough

That’s a big inconvenience for those folks, of course. But far more of us, including several million who are enrolled in employer-sponsored plans, will be more than inconvenienced if state and federal regulators approve the Anthem-Cigna and Aetna-Humana mergers.

Employers, consumer groups, the American Medical Association and many other organizations have told regulators they think those mega mergers are not in the public’s best interest. The U.S. Justice Department and several state officials agree. They filed a lawsuit in July to stop both of them. Nevertheless, the mergers are far from dead.

That should worry us. A lot. That’s because the acquiring companies, Anthem and Aetna — but Anthem especially — have higher customer complaint ratios and lower patient satisfaction scores than other companies, as recent reports by the state of California’s Office of the Patient Advocate (OPA) show. And if the Anthem-Cigna merger goes through, Anthem, with the worst scores overall, would become the nation’s biggest health insurer.

“Your Call Is Not Important To Us”

Take a look at OPA’s Annual Health Care Complaint Data Report, which provides a wealth of information about the complaints California regulators received in 2014, the most recent year for which data were available for analysis.

Anthem scored the worst by far of any of the other health plans operating in the state. Data provided to OPA by the Department of Managed Health Care, which has jurisdiction over most of the state’s HMOs, showed, for example, that Anthem had 12.28 complaints per 10,000 enrollees. Compare that with Kaiser Permanente, the nonprofit company that rivals Anthem in terms of enrollment in California. Kaiser had just 4.50 complaints per 10,000. In other words, Anthem had nearly three times as many complaints as Kaiser.

Anthem also led the pack in the ratio of complaints received by the California Department of Insurance. That department said Anthem had a whopping 47.64 complaints per 10,000. Cigna, the company Anthem is trying to buy, had just 2.69 complaints per 10,000.

And it’s not just in California that Anthem has generated an inordinate number of complaints about how it treats its customers. It appears to be nationwide. In fact, the Department of Justice cited Anthem’s less than stellar reputation in its lawsuit to block its takeover of Cigna. This is from a September 20 story in the Hartford Courant about the status of the proposed $54 billion deal:

The federal government claims that many large employers dislike Anthem and that doctors fear the company because its large customer base gives it leverage in negotiations.

The Department of Justice complaint says that although Cigna can’t get as low prices from hospital systems and doctors in some markets as Anthem does, “Cigna competes vigorously with Anthem for large groups by offering exceptional customer service, innovative wellness programs that lower its members’ utilization of health care, and provider-collaboration programs with hospitals and doctors. By contrast, many large-group employers believe that Anthem provides poor customer service and is far less innovative. Soon after the merger was announced, two prospective customers complained to Cigna: “We hate Anthem and you guys are about to become them.”

When it comes to how patients rate their experience with their HMOs, another report by the California Office of the Patient Advocate shows that the big for-profits involved in the proposed mergers also get much lower scores than their nonprofit competitors. Nonprofit Kaiser Permanente’s HMOs were the only ones rated “excellent.”

Earlier this month, a Harvard Law watchdog group filed complaints with the U.S. Department of Health and Human Services against seven big insurers — including Anthem, Cigna and Humana—alleging that they all were in violation of anti-discrimination laws pertaining to the coverage of HIV/AIDS treatments. The allegations involved refusing to cover vital medications that HIV/AIDS patients need and requiring high-cost sharing for other medications used to treat HIV/AIDS.

“When an insurer requires chronically ill patients to pay a disproportionate share of the cost of medication, it violates federal law,” said Robert Greenwald, clinical professor of law at Harvard Law School.

The American Medical Association has become one of the most vocal opponents of the mega-mergers, particularly the Anthem-Cigna deal. On September 21, the AMA released a report showing that Anthem’s “market power” would be significantly increased in several states and numerous metropolitan areas — especially in California — if the deal is approved.

Despite all of this, the mergers could still happen. A U.S. District Court has set a November 21 trial date for the lawsuit the Department of Justice has filed to stop the Anthem-Cigna merger. The Aetna-Humana trial is scheduled to start on December 5. Both trials likely will go on for several weeks. If the Department of Justice loses, millions of Americans will soon find themselves enrolled in health plans administered by companies with some of the industry’s worst quality and customer satisfaction scores. That’s something not only to worry about but also to try keep from happening. The last thing we need is for Anthem and Aetna to be more in control of our lives.

This has also been published by HEAL California.

http://www.huffingtonpost.com…

Wellmark Blue Cross and Blue Shield placing greater squeeze on patients

Wellmark announces individual ACA market changes in Iowa and South Dakota

Wellmark, September 28, 2016

Wellmark Blue Cross and Blue Shield announced today it will make changes in the individual Affordable Care Act (ACA) market in Iowa and South Dakota.

For the past two years, Wellmark members with individual ACA plans have endured double-digit increases. In addition, Wellmark has lost approximately $99 million over the same time period in the individual market in Iowa and South Dakota.

“Wellmark’s mission is to create affordable health insurance for people to access quality health care. And, for the majority of the past 75 years, we’ve been able to achieve that,” said Wellmark Chairman and CEO John Forsyth. “However, it’s apparent that continuing to offer plans with broad networks, combined with the rich benefits of the ACA, is not consistent with managing continually rising costs. While we could seek additional premium increases to mitigate rising costs, this is not sustainable for our members’ pocketbook.”

Iowa changes

In Iowa, Wellmark will narrow its product choices to offer plans that are lower priced and encourage health care delivery by Iowa providers. Specifically, Wellmark will no longer offer gold tier plans nor will the company promote individual under 65 plans that use its Preferred Provider Organization (PPO) network in Iowa.

Wellmark will also continue its plans to introduce a new, simplified HMO plan called Blue Simplicity℠. This plan is like no other on the market today and is designed to help consumers understand the true value of care through simple copay plans – providing members with transparency and predictability of cost as they seek and use medical services.

South Dakota changes

In South Dakota, Wellmark will no longer offer individual Affordable Care Act (ACA) plans effective Jan. 1, 2017.

“Although the ACA has done many positive things, it has also had its challenges and those challenges vary by state,” said Forsyth. “Fortunately, in 2017, the ACA gives states the ability to begin addressing those challenges with the goal of stabilizing the individual under 65 health insurance market. We look forward to working with Iowa and South Dakota policymakers on those solutions in the near future.”

https://www.wellmark.com…

***

Comment:

By Don McCanne, M.D.

The largest health insurer in Iowa, Wellmark Blue Cross and Blue Shield, is discontinuing their more comprehensive gold tier plans and is discontinuing the promotion of its PPO plans with wider provider networks. They are also introducing a new HMO plan “designed to help consumers understand the true value of care through simple copay plans” (i.e., making them better shoppers by having to bear more of the costs). These changes are compounding the two problems plaguing insurance purchasers today: requiring higher out-of-pocket spending for health care, and narrowing the selection of health care providers covered by the plans.

This is a one-way path designed to keep insurance premiums as competitive as possible. As Chairman and CEO Forsyth states, “continuing to offer plans with broad networks, combined with the rich benefits of the ACA, is not consistent with managing continually rising costs.” Insurers are not going to cover more out-of-pocket costs by increasing the actuarial value of their plans (percent of costs they will pay), and they are not going to expand their networks when they can negotiate lower prices by promising provider exclusivity.

Look, as long as we leave these people in charge, we can anticipate that they will engage in strategies that will protect and improve their own market advantage. If we had our own public program, our stewards who work for us would be engaging in strategies that would ensure our access to the health care that we need. There really is a difference. If only for selfish reasons, we should prefer the latter. The fact that it helps everyone else is a bonus.

America needs to adopt VA’s prevention-based approach to health care to improve outcomes

By W.T. “Bill” McKibben
The Buffalo News, Sept. 25, 2016

The Veterans Affairs health care system is America’s favorite political football. We love our vets and are quick to pick up on any failure to care for them or treat them well. We were all stunned by reports of vets dying while waiting to see a doctor. A closer look reveals that they were waiting to be accepted into the VA health care system and be assigned to a primary care doctor. The image of sick and dying vets already within the VA system waiting for care is simply false.

Worse, this myth has been unfairly projected onto the doctors and all those delivering care to the vets in the system. The truth is vets in the system never wait when they need to see a doctor. The VA’s prevention-based approach is very different from the greed-driven, treatment-based system most Americans are stuck with.

A doctor’s appointment for those in the VA system, whether it’s with a vet’s primary physician or a specialist, is never for anything urgent, it’s for a regular checkup, follow-up, specialist consult or a routine medical test.

When vets need immediate care, they don’t call for an appointment. Instead, they just head to one of the system’s 1,700 medical centers and clinics. Not just for emergencies, that’s where vets go for a cold, the flu, or anytime they need to see a doctor. The VA’s facilities are set up to act as immediate care centers as well as standard emergency rooms.

Altogether the VA operates America’s largest integrated health care system, serving nearly 9 million vets annually. It has hundreds of clinics plus 152 medical centers that have full hospital facilities, as well as emergency room/immediate care centers.

The major difference in the care that vets receive – and the source of its superiority – is the VA’s focus. The VA utilizes the system prevalent in every developed nation in the world except America: the prevention-based system as opposed to the treatment-based system most Americans have. Our nation spends twice as much as any other nation in the world on health care. And yet our outcomes rank down among the Third World countries.

When a provider’s only revenue source is to treat or medicate, that’s what he does; and sadly too often greed takes over. Overtreatment and overmedication trigger thousands of deaths and health issues in America every year, but not at the VA. Just like providers all over the world, those at the VA – some of the most skilled medical practitioners in America – are paid to prevent health care issues, not just to treat them.

The VA’s prevention-based approach delivers much better outcomes. Better than Medicare, even though the VA has a more vulnerable patient base. The VA is treating a bunch of beat-up old folks and some horrifically beat-up younger vets. By comparison, Medicare patients, in general, are much healthier than our vets. Yet even with that disadvantage, the VA gets better outcomes than Medicare, and it does it for less – nearly 40 percent less per patient.

It’s clear that we need to follow the rest of the developed nations on this planet and make some dramatic changes. We need to adopt a single-payer, prevention-based system. Big Pharma hates this idea, for-profit hospitals hate this idea and, sadly, even some health care providers hate this idea.

We spend twice as much as any other nation on health care with more than half the cost coming out of taxpayer funds. That would lead one to believe that with a more cost-efficient single-payer system, we might find that we have been paying for a better system all along and throwing away half of what we currently spend. It’s time we got our money’s worth.

W.T. “Bill” McKibben is a Buffalo-based author. He was a Medicare Part B and health care insurer consultant for more than a quarter century.

http://www.buffalonews.com/opinion/viewpoints/america-needs-to-adopt-vas-prevention-based-approach-to-health-care-to-improve-outcomes-20160925

Universal health care would solve crisis of uninsured

By Richard Weiskopf, M.D., Kaye Jaeger, R.N., and Joel Potash, M.D.
Syracuse.com, Sept. 28, 2016

A commentary published Sept. 14 (“How many are insured because of Obamacare? Good question”) points out the challenge of assessing the Affordable Care Act’s impact on closing the insurance gap. Focusing strictly on health “insurance” coverage obscures the crisis in healthcare access across the country that millions continue to live without access to needed health care. In New York, since the passage of the Affordable Care Act, there are still 1.5 million individuals without health insurance and countless more who are underinsured — that is they have insurance but can’t access healthcare they need due to high co-pays, deductibles, and rising drug costs.

In a system dominated by private health insurance corporations, those with high incomes can afford adequate health care, while the poor and many middle class cannot. The consequences are tragic. According to a Harvard study, 45,000 Americans die each year for lack of health insurance. Medical bills contribute to more that 60 percent of all bankruptcies, and most people who file for medical debt related bankruptcy had insurance when they got sick.

What is it like to be uninsured or underinsured? Imagine having asthma or chronic pulmonary disease (COPD) and not being able to afford the medication your doctor prescribes. Beyond daily shortness of breath and chronic cough, untreated respiratory diseases make people more susceptible to pneumonia.

Sudden pauses in medication use are not uncommon and can have serious consequences. For example, a patient who pauses use of hypertension medicine faces an increased likelihood of stroke and heart attack. As healthcare providers, it’s heartbreaking to know that a patient won’t be able to relieve his or her suffering due to financial barriers.

We need to shift our public conversation from discussing issues of insurance to the task of guaranteeing universal access to medically necessary care from cradle to grave.

Under our present system of multiple health insurers, a large amount of the money that private insurance companies collect in premiums is spent on administrative costs and CEO compensation rather than care. The national Medicare program which covers the elderly is much more efficient, allowing a greater portion of the money to be spent directly for health care. Administrative costs in the private insurance infrastructure consume 31 percent of U.S. health spending while Medicare maintains an annual administrative cost of 2 to 3 percent.

An economic analysis conducted in 2015 by economist Gerald Friedman found that implementing a universal public healthcare system, like the one proposed by the New York Health Act, would reduce New York’s health care spending by 25 percent, more than $70 billion, by 2016. The savings would come from reducing burdensome billing expenses, administrative waste, the monopolistic pricing of drugs and medical devices, and fraud. According to Friedman’s analysis, 98 percent of New Yorkers would pay less for health care. But most important, New York Health would provide universal access to healthcare to all New Yorkers.

All of us need health care, regardless of age, income or employment status. The New York State Assembly has passed such a plan with huge majority support. We urge Sen. Dave Valesky to be a champion for universal health care by sponsoring the New York Health Act in the next session and passing it through the Senate.

Dr. Richard Weiskopf is a member of Physicians for a National Health Program (PNHP). Kaye Jaeger is a registered nurse. Dr. Joel Potash is a palliative care physician. All live in Syracuse.

http://www.syracuse.com…

What an Oregon business group gets wrong about single-payer

By Mark Kellenbeck
Portland Business Journal, Sept. 28, 2016

It was with interest that our Health Care for All Oregon membership, 19,000 advocates and 120 organizational members throughout the state of Oregon, read the Guest Opinion in the Sept. 15 issue of the Portland Business Journal by Anthony K. Smith, the state director of the National Federation of Independent Business.

HCAO is particularly committed to expanding our outreach into Oregon businesses of all sizes in order to better understand their needs and concerns about providing their employees’ health care.

We particularly appreciate Mr. Smith’s including a link to NFIB’s website containing the 12 points of further health care reform for which NFIB is lobbying.

There are a number of ideas and opinions contained in Mr. Smith’s piece that HCAO agrees with. At the top of the list is the Affordable Care Act, which HCAO agrees is deeply flawed (we prefer that legislation title to “Obamacare”).

We do not agree, however, with Mr. Smith’s premise that the ACA’s shortcomings are an indictment of single-payer health care. In fact, the ACA’s problems illustrate why single-payer can and will succeed if given a fair chance.

Continue reading…
http://www.bizjournals.com/portland/blog…

Employee health deteriorated under award-winning wellness program

Top wellness award goes to workplace where many health measures got worse

By Sharon Begley
STAT, September 27, 2016

When Idaho’s Boise School District receives the workplace wellness industry’s highest award Wednesday at a celebration in Atlanta, it is expected to be applauded for helping its 3,000-plus employees and their families improve their health and reduce their risk of illness.

It is “an exemplary program,” said Dr. James Fries, an emeritus professor of medicine at Stanford University and member of The Health Project, an industry-sponsored group that makes the annual award. Program participants, he said in an announcement this month, “showed improvements in health behavior,” helping Boise save money on medical costs.

Data collected by the company that sold Boise the wellness program and trumpeted the “Koop Award,” however, cast doubt on that claim. More key measures of health deteriorated than improved. Self-reported quality of health got worse. And health care costs jumped around in a way that suggests any changes were due at least in part to random fluctuations and possibly employee turnover, not any benefits of the wellness program.

This would not be the first time the Koop Award, named for the late US Surgeon General Dr. C. Everett Koop, stirred controversy. Employees in the wellness program that won in 2015, for instance, collectively achieved a lower reduction in smoking than the national average. More gained weight than lost, more raised their total cholesterol level than lowered it, and more had higher blood glucose levels after participating in the wellness program than before.

Such cases reinforce a growing recognition among experts that wellness programs — which constitute an $8 billion a year industry — “don’t lead to any visible results,” Stanford’s Emma Seppala recently wrote in Harvard Business Review. “At best, these initiatives are nothing more than lip service or PR. But at worst, they actually cause more stress.”

https://www.statnews.com/2016/09/27/workplace-wellness-award/

***

Comment:

By Don McCanne, M.D.

We still hear that employers are adopting wellness programs in order to reduce the future costs of their health benefit programs by making their employees healthier. There could be no better evidence that these programs do not work than the fact that the top award for a workplace wellness program went to an employer whose employees’ health deteriorated.

If employers really want to do something about controlling health care costs, they should get on the single payer bandwagon. Not only would that eliminate the hassle and expense of administering their health benefit programs, all of their employees would have health care automatically, and future increases in health care costs would be reduced to sustainable levels.

Any employers reading this who are not yet convinced about single payer would benefit by watching a movie developed by and for the business community, “FIX IT – Healthcare at The Tipping Point.”

http://fixithealthcare.com

Clinton and Trump on healthcare

The Presidential Debate That Wasn’t

By Jeanne Lenzer
The BMJ, Sept. 27, 2016

The 90 minute presidential debate between Hillary Clinton and Donald Trump ended last night without a single word about healthcare. Yet two-thirds of voters said “the future of Medicare and access and affordability of healthcare are top priorities for the candidates to be talking about during the 2016 presidential campaign.”

Clinton, a Democrat, and Trump, a Republican, have both said they support “universal” healthcare and both rely on market forces and private insurers to provide coverage for healthcare. What follows is a summary of what is – and isn’t – known about the candidates’ positions on various healthcare issues, followed by comments from critics right and left.

full, with comments by Dr. Adam Gaffney of PNHP:
http://blogs.bmj.com/bmj/2016/09/27/jeanne-lenzer-clinton-and-trump-on-healthcare/

PNHP note: Physicians for a National Health Program is a nonpartisan educational organization. It neither supports nor opposes any candidate for public office.

What should the candidates tell us about controlling costs?

Editorial: Thank you for that question, Lester

By Merrill Goozner
Modern Healthcare, September 24, 2016

(Question for candidates, proposed by the New York Times): “Health insurance premiums and out-of-pocket costs are rising rapidly. What would you do to control them?”

If I were advising a candidate on how to respond to that question, here’s what I’d recommend he or she say:

(Excerpts)

“Thank you for that question, Lester. I understand why many Americans think their insurance premiums are rising rapidly. There’s been a lot of attention paid to next year’s increases for the individual policies sold on the Obamacare insurance exchanges, which will rise about 9% on average, according to the latest Kaiser Family Foundation survey.”

“Employers are forcing individuals to pick up more of the cost of their plans.”

“The employer portion of your health insurance is going up just 4% next year on average. That means the family share has to go up more than 5.5% to make up the difference.”

“Employers are doing that by putting more of us in high-deductible plans. They’re asking more of us to pay higher co-pays and deductibles. They are raising our portion of the premiums.”

“So what can we do about it? First, we have to recognize this is a big experiment that has been endorsed by economists associated with both political parties. They say by forcing patients and consumers to have more skin in the game, they will become wiser healthcare shoppers.”

“I say, to make that work, we have to have total transparency — in healthcare prices, in insurance prices, in which doctors and hospitals are in health plan networks, in quality ratings, and with good, easy-to-understand information about what constitutes the most effective and cost-effective care. I pledge to work night and day to give consumers the information they need to make smarter choices in the healthcare marketplace.”

“And if some people simply can’t afford to put money into the health savings accounts accompanying these plans, let’s remove some of the tax subsidies given high-income people for their health insurance so we can finance a generous federal match for what lower-income people contribute.”

“Let me now turn to what can we do about those rising individual rates for plans sold on the exchanges. The bottom line is we need more people to sign up. The No. 1 reason why rates are rising is that not enough healthy uninsured people signed up for coverage.”

“We need everyone who is uninsured to jump into the individual insurance pool.”

http://www.modernhealthcare.com/article/20160924/MAGAZINE/309249985/editorial-thank-you-for-that-question-lester

***

Comment:

By Don McCanne, M.D.

Merrill Goozner certainly understands the political realities about health policy. To a question on health costs that could be part of tonight’s presidential debate, he suggests an answer for the candidates that aligns with the current financing system under the Affordable Care Act. Unfortunately, because of the restrictions he apparently placed on himself, it’s a terribly deficient answer.

For the problem of high-deductibles he suggests making patients better shoppers through greater transparency in prices, in network composition and in quality ratings. But that would have almost no impact on making the deductibles and other cost sharing more affordable.

He accepts the dubious concept that health savings accounts should accompany these high-deductible plans, and further suggests that the accounts for lower-income individuals be subsidized. Health savings accounts are strictly an administrative tool that increases the complexity and waste in health care financing. When the accounts are depleted, beneficial health care services are forgone – not a desirable outcome. If you are going to have first dollar coverage built into the HSAs, why not instead save administrative hassles and expenses by building first dollar coverage into the insurance program itself?

For the high premiums of the exchange plans, he suggests enrolling more of the healthy to dilute the risk pool. But the low-lying fruit has been picked. The policy community is beside itself in trying to figure out how to bring more into the exchange plans, while having only negligible success in doing so.

Goozner is certainly highly respected by me and others, but we wish that he and others like him would move beyond feeble patchwork solutions and support a program that would make health care accessible and permanently affordable for all. Of course that would be a single payer national health program – an improved Medicare for all. Goozner understands that we won’t hear that from either candidate tonight, but that doesn’t mean that we shouldn’t be asking for that response.

Health care for all

By Charles Bensonhaver, M.D.
The Post and Courier (Charleston, S.C.), Letters, Sept. 25, 2016

In a Sept. 21 letter to the editor titled “Health care slide,” the writer advances the notion that more government intervention will result in deterioration of our health care.

I disagree. What we need is the right kind of government intervention.

Unfortunately, most Americans are unaware that, among the advanced nations in the world, we have the most costly system. It is almost twice as much as the average of other modern nations such as Germany, France, Australia and New Zealand. Furthermore, among the 25 or so advanced countries in the world we are the only one that does not automatically cover everyone.

The anxiety we have about getting sick and being unable to pay for care is very high and is getting worse because more and more of the cost is thrown onto the shoulders of the patient.

Really now, what is insurance for if it doesn’t cover all or nearly all of the cost?

All of this is completely unnecessary. Effective reforms are known.

However, you can be sure that the health insurance companies, the drug companies, the health care equipment companies and the large for-profit hospital chains do not want you to know this.

What we need is to improve traditional Medicare and phase it in as the single-payer system for all Americans.

Our current overhead is huge, and Medicare single payer will dramatically reduce it. Outsized profits will go away.

All citizens will know that their country is there for them when they are ill. We have been there for all of us with free public education for over a century. We can do the same with health care.

The best resource I can give for more information on this reform is the Physicians for a National Health Program. Check out our website at www.pnhp.org.

Dr. Charles Bensonhaver lives on Johns Island.

http://www.postandcourier.com…

Single Payer: Because black lives matter…and so does black health care

By Jack Bernard
AL.com (Huntsville, Ala.), Sept. 23, 2016

Black Lives Matter has its supporters (43 percent of Americans, per Pew Research Center), as well as its detractors (22 percent), but one thing is unmistakable: it has brought visibility to a very real problem. For too long, the general public has ignored the increasingly frequent violence against African-Americans, especially men.

Homicide mortality rates are much higher for blacks (21 per 100,000 population) than whites (3/100,000). Sometimes, this violence is perpetuated by law enforcement officers.  All too often, it is done by other black men.

But, homicide is not the only area in which black mortality exceeds that of whites. Unfortunately, the national black health crisis is also being ignored by an unknowing and oblivious public.

The overall death rate per 100,000 African Americans vs. whites is 867 versus 734. In fact, rates are much higher in every mortality area:

  • heart disease: 239 white versus 308 black
  • cancer: 196 versus 239
  • stroke: 55 versus 76
  • diabetes: 22 versus 50
  • AIDS: 2 versus 23

The causes of higher African-American mortality rates are complex. There are many factors to consider, including: income, education, gun policies, the ingrained racism that stubbornly persists in our theoretically egalitarian society and health insurance being tied to employment (which is also related to historical racism).

In this short narrative, it is impossible to fully cover all of these topics in detail, but let’s look at the situation from the 20,000 feet view.

Income and employment are directly tied to health status in our society. Americans who have insurance and can afford health care utilize these services at a much greater rate than those who are without assets and insurance. This is not only a fact, it is intuitive.

Education, unemployment and income are inter-related. People who are better educated are able to find and keep their jobs, and get new ones if their jobs are lost. Likewise, higher education and employment leads to higher income.

Undeniably, our nation has a shameful history of prejudice against African-Americans, going back centuries. Although we have made tremendous progress in the last few decades, the legacy of slavery still exists.

Simplistically, let’s look at this as in terms of a foot race. If one contestant has his feet tied together for the first portion of the race, how hard will it be for him to catch up after he is untied? Who can say how long it will take? Our racial history is the cause of these inequities.

Black income levels continue to be much lower than whites ($35,398 vs. $60,256- 2014 Census). Likewise, 2016 2nd quarter black unemployment rates are higher (8.3 percent vs. 4.2 percent – BLS). Partly because health insurance in America is closely tied to employment and employers, the uninsured rate for African-Americans in 2016 is also higher (11.4 percent vs. 6.4 percent- Gallup, 4-16).

There are a multitude of actions that can be taken by America to correct the situation with regard to education, employment and income. Once again, our space is too limited to address these issues. However, I would like to return to the question of health insurance.

When we examine the other developed nations of the world, we find that every one of them provide for universal health insurance for all of their citizens. In America, even after the Affordable Care Act (ACA, Obamacare), we are still left with 30 million uninsured, many of them minorities.

Unfortunately, neither political party has put forth a realistic way of addressing this problem. Democrats want to tinker with the ACA, which will make only minor improvements to the uninsured percentage. The GOP wants to privatize and incentivize, ignoring the basic problem (the private insurance system) and almost certainly worsening the situation for many citizens. And, neither party has advocated for the obvious solution as part of their platform: Medicare for All.

The American public sees a national plan as preferable to the ACA. According to a recent Gallup poll, 58 percent of those surveyed were for it and no wonder.

Premiums are constantly going up for employees as employers cost shift their increasing benefit expenses, driven by insurance companies which are in turn battered by rapidly rising drug prices by price-gouging international pharmaceutical corporations. Bloomberg (6-16) surveyed a sampling of 39 common drugs and found prices for 30 had doubled from 2009 to 2015.

Single payer provides for leverage and cost control. It is the only way to get the rapidly rising cost of health care (currently paid for primarily out of government funds, just not effectively) under control.

The adoption of single payer provides for health insurance for all Americans, removing one of the major barriers to improvement in health care for African-Americans and other minorities, while helping white Americans as well. Rep. Conyers of Michigan has repeatedly introduced Medicare for All bills in the House. It is long past time for members of both parties to unite in backing this legislation.

Jack Bernard is a retired healthcare exec and the former Director of Health Planning for the State of Georgia. He was also on the Jasper County Board of Health and County Commission.

http://www.al.com/opinion/index.ssf/2016/09/single_payer_because_black_liv.html

The rationale for a New Hampshire study commission on single payer

By Ahmed Kutty, M.D.
Granite State Chapter PNHP, Sept. 14, 2016

The following text is an unofficial, lightly edited transcript of testimony delivered by Dr. Ahmed Kutty to a subcommittee of New Hampshire’s House Health, Human Services and Elderly Affairs Committee on Sept. 14, 2016. The session was co-chaired by state Reps. Thomas Sherman, M.D., and John Fothergill, M.D.; and included subcommittee member Rep. Susan Emerson.

1. The Affordable Care Act is not enough. The ACA, now in its third year of implementation, has failed to provide universal, affordable access to care and to control costs. Forty-three percent of enrollees in the ACA report the plan costs to be unaffordable (Commonwealth Fund study). For the impact (in numbers) of the ACA and under our current system, on the uninsured, underinsured, on medical bankruptcy and on preventable (nonviolent) deaths, see table below:

NH Table

Complexity and opaqueness are built into the private system, in contrast to the simplicity and transparency of a public system.
 
2. U.S. expenditure on health care is twice the average of other advanced economies per capita, and as a percent of GDP. See graph below:

NH Chart

3. Economic benefits. Health care expenses borne by business do not enhance value and add to the cost of goods and services, passed on to the consumer. Removing the cost burden of employee health insurance from businesses, large, medium and small, could increase the profit margin and potentially lead to job growth via reinvestment in expansion and innovation, thus facilitating rejuvenation of the local and regional economy.

Workers aged 50 to 64 are often expensive to insure and less likely to find new employment opportunities. Delinking health insurance and employment will increase work-related mobility in this demographic segment. Job loss from illness will not result in loss of coverage, frequently when most needed, as under the current system.

A public system will remove an onerous obligation currently heaped on local entities such as municipalities, school boards and county governments.

4. Cost control by means of price negotiations for drugs, durable equipment, devices, hospital stays and fees for professional services are integral to a publicly funded system. Nationally, savings of $650 billion annually is projected from these measures and from reduction of wasteful administrative spending that prevails in our current, fragmented, multi-payer system, with about 6,000 plans operating in the country, offering 28,000 “products”! This is money siphoned off from funding for direct patient care in all settings.

5. Societal health. The U.S. ranks 19th in the world, in measures of population health as life expectancy, infant mortality and other preventable causes of death, mostly due to lack of access to affordable and timely health care.

6. Administrative advantages. Medicare overhead is 3 percent vs. private insurers’ average of 18 percent – and in some plans up to 28 percent – generated by the need to advertise, distribute dividends to shareholders, and pay exorbitant CEO salaries.

7. Single Payer vs. Socialized Medicine. Single payer is system of privately delivered and publicly funded care, like our Medicare and the Canadian Medicare. The Veterans Health Administration, the military medical system, the Indian Health Service, and the National Health Service in UK are examples of “socialized” systems.

8. Electronic medical records (EMR). A streamlined, interoperable, nationwide information system, similar to the VISTA in use by the Veterans Administration for over a decade, will help reduce waste and redundancy and improve efficiency, if it is designed with clinical utility and service benefit, rather than the bottom line of the vendors, as the focus. At the state level, such a system will be organic to a publicly funded program.

9. Physicians’ and public support. New Hampshire doctors supported a “simplified payer system with public funds” by a two-third majority in a study by the NH Medical
Society in 2007. In several surveys, a tax-funded financing system has enjoyed public support at 60 percent to 70 percent level nationally, over the last two decades.

10. Public health issues. A publicly funded system is significantly better designed to deal with epidemics like opioid addiction (prevention, treatment and rehabilitation), a major public health crisis in our state and in the New England region.

11. Activity in other states. California, New York, Vermont, Oregon, Hawaii and others have bills to legislate or for study commissions to get “a single pipeline mechanism” established for public funding of ALL medically necessary, comprehensive health care services, including drugs and devices. Colorado has a ballot initiative (Amendment 69), with enormous potential to engender systemic change, if it is approved by voters this November.
 
Therefore a Study Commission to consider all aspects of a “Medicare for All” system, providing universal, medically appropriate care through public funding, is strongly warranted and eminently worthy of bipartisan support in the General Court.

As members of the Granite State chapter of the Physicians for a National Health Program, we request your careful consideration of the above bullet points and to take action leading us towards creation of a health care system that supplies truly universal, affordable, high-quality comprehensive care, in a fiscally sustainable milieu here in New Hampshire. Your public voice and your vote for the Study Commission bill will be a major contribution to the sustained multipronged effort needed for resolving the looming crisis in health care facing our state and very likely for the nation as well.

Thank you, Dr. Sherman, for giving me the opportunity to speak before your esteemed subcommittee today on this critical issue that has been concerning our society for over a century. Having heard us, can we hope our words will be heeded?

Ahmed C. Kutty, M.D., FACC
Peterborough, NH