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Jack Bernard explains Medicare for All to his fellow Republicans (and Democrats!)

Jack Bernard explains Medicare for All to his fellow Republicans (and Democrats!)

Medicare, an effective program that needs expansion

By Jack Bernard
The Atlanta Journal-Constitution, June 24, 2016

I have been amazed at the number of negative Medicare-for-all attack pieces printed in various respected papers over the last few months, making me wonder why primarily liberal economists would be attacking a program that progressives have been trying to enact since Truman.

The underlying implication is that the current private system is more effective than a federal government run single-payer model. As a Republican former elected official with a very conservative spending record, I too believe in eliminating governmental waste and in utilizing the private sector when it is more effective.

Therefore, my record makes some citizens surprised when I advocate for Medicare for all. Objectively, the U.S. healthcare system is and has been severely broken. Despite our spending far more per capita, our country is far behind all developed democracies, which scoff when our politicians make the false claim that we have the best healthcare in the world.

Taxpayers are beginning to see the benefits of single-payer versus the ACA. In May, Gallup reported that “58 percent of U.S. adults favor the idea of replacing the law with a federally funded healthcare system that provides insurance for all Americans.”

For the most part, it can be funded in much the same way as Social Security, through a payroll tax, with additional funding coming from a variety of other sources. More detail on this subject can be found on the Physicians for a National Health Program website (www.pnhp.org).

But Republicans just continue to repeat their worn-out talking points about our current system being perfect — so long as we repeal the ACA. The Democrat front-runner is little better, supporting the ACA but having no clear plan to cover the 27 million Americans still without coverage or the millions more with inadequate insurance.

Given that special interest groups are making billions from our broken system, and contributing heavily to both parties to keep health insurance private, the real question is “will politicians in both parties ever have the courage to act?”

Jack Bernard, the first director of health planning for Georgia, has been an executive with several national health care firms. A Republican, he’s a former chairman of the Jasper County Commission.

http://www.myajc.com/news/news/opinion/medicare-an-effective-program-that-needs-expansion/nrmsZ/

***

Comment:

By Don McCanne, M.D.

The original intent of the architects of Medicare was to eventually expand the program to cover everyone. Yet the Republicans have been reluctant to do so, and now the Democrats have specifically excluded it from their party platform. The leadership of both parties need to listen to conservative Republican Jack Bernard, an expert in our health care system. His full article is available at the link above.

Jack Bernard explains Medicare for All to his fellow Republicans (and Democrats!)

Medicare, an effective program that needs expansion

By Jack Bernard
The Atlanta Journal-Constitution, June 24, 2016

I have been amazed at the number of negative Medicare-for-all attack pieces printed in various respected papers over the last few months, making me wonder why primarily liberal economists would be attacking a program that progressives have been trying to enact since Truman.

The underlying implication is that the current private system is more effective than a federal government run single-payer model. As a Republican former elected official with a very conservative spending record, I too believe in eliminating governmental waste and in utilizing the private sector when it is more effective.

Therefore, my record makes some citizens surprised when I advocate for Medicare for all. Objectively, the U.S. healthcare system is and has been severely broken. Despite our spending far more per capita, our country is far behind all developed democracies, which scoff when our politicians make the false claim that we have the best healthcare in the world.

Taxpayers are beginning to see the benefits of single-payer versus the ACA. In May, Gallup reported that “58 percent of U.S. adults favor the idea of replacing the law with a federally funded healthcare system that provides insurance for all Americans.”

For the most part, it can be funded in much the same way as Social Security, through a payroll tax, with additional funding coming from a variety of other sources. More detail on this subject can be found on the Physicians for a National Health Program website (www.pnhp.org).

But Republicans just continue to repeat their worn-out talking points about our current system being perfect — so long as we repeal the ACA. The Democrat front-runner is little better, supporting the ACA but having no clear plan to cover the 27 million Americans still without coverage or the millions more with inadequate insurance.

Given that special interest groups are making billions from our broken system, and contributing heavily to both parties to keep health insurance private, the real question is “will politicians in both parties ever have the courage to act?”

Jack Bernard, the first director of health planning for Georgia, has been an executive with several national health care firms. A Republican, he’s a former chairman of the Jasper County Commission.

http://www.myajc.com/news/news/opinion/medicare-an-effective-program-that-needs-expansion/nrmsZ/

The original intent of the architects of Medicare was to eventually expand the program to cover everyone. Yet the Republicans have been reluctant to do so, and now the Democrats have specifically excluded it from their party platform. The leadership of both parties need to listen to conservative Republican Jack Bernard, an expert in our health care system. His full article is available at the link above.

BC/BS of Minnesota dumps broad networks

Minnesota Blues’ decision to alter ACA plans mirrors stampede to narrow networks

By Bob Herman
Modern Healthcare, June 24, 2016

Blue Cross and Blue Shield of Minnesota is cutting back its participation in the state’s Affordable Care Act insurance exchange next year after losing nearly $300 million in the individual market in 2015.

However, the large Blues insurer is not completely exiting the state-based marketplace. Fully withdrawing has its consequences: Federal law bars insurers from re-entering the marketplaces for five years, assuming they discontinue all types of individual policies.

Instead, Blue Cross and Blue Shield of Minnesota is dropping health plans with the broadest networks sold on and off the exchange and will push people toward its narrower HMO option called Blue Plus, according to the Star Tribune.

Blue Cross and Blue Shield of Minnesota’s decision is not unprecedented and has been embraced by other insurers around the country. The Blues plans in Illinois, New Mexico and Texas—all of which are owned by Health Care Service Corp., a giant Chicago-based company that has lost billions of dollars on ACA plans—abandoned their broad-network exchange plans in favor of the narrow-network HMOs.

Dropping broad-network plans can also be seen as a controversial risk dump for insurers. The sickest people who cost the most to insure often chose plans with higher monthly premiums to gain access to broader provider networks and fewer out-of-pocket costs. In Minnesota next year, those people may opt to buy those plans with other carriers, immediately benefiting the Blues’ bottom line while redirecting the insurance risk elsewhere.

http://www.modernhealthcare.com/article/20160624/NEWS/160629943

***

Comment:

By Don McCanne, M.D.

The individual insurance market has always been unstable. The struggles insurers face are not only how they can make their products more effective and accessible to more individuals, but especially how they can ensure that revenues exceed expenditures. So what can we learn from the response of Blue Cross and Blue Shield of Minnesota to unfavorable market conditions?

Most importantly, they are dumping risk onto other insurers. That places a burden on the other insurers which then translates to even higher premiums, higher cost sharing, fewer benefits, or any combination of these for individuals already enrolled in the other insurance risk pools. That’s not good.

In order to maintain a presence in the market, they are continuing to offer its narrow network HMO option. Those who transfer into that plan will have more limited choices of health care providers, perhaps losing coverage for their current health care professionals and institutions. That’s not good.

This instability in coverage is a defining feature of private health insurance plans. The insurers will always continue to introduce innovations as they compete for an advantage in the marketplace. When their products appeal to people who have greater health care needs, their model doesn’t work, and they pull out. What is working now is passing more costs onto the patients through greeter cost sharing, and limiting access to care by narrowing the networks of covered providers. That’s not good.

What seems obvious is that we have selected the wrong intermediary for financing health care. The private insurers function with a business need requiring costly administrative excesses, and they have a need to conform their products to meet business goals rather than patient service goals. That’s not good.

What would work best for patients would be a single payer national health program – an improved Medicare for all. But the Republicans are opposed, and the Democratic platform committee just voted to exclude single payer from their platform, and no other political party has enough traction to prevail in the elections. That’s not good.

Even though the Medicare for all concept remains popular, it seems that we will not have single payer in the foreseeable future. Churchill and others have said that a democracy is the worst form of government other than all of the others, but sometimes you wonder.

Medicare, an effective program that needs expansion

By Jack Bernard
The Atlanta Journal-Constitution, June 24, 2016

I have been amazed at the number of negative Medicare-for-all attack pieces printed in various respected papers over the last few months, making me wonder why primarily liberal economists would be attacking a program that progressives have been trying to enact since Truman.

The underlying implication is that the current private system is more effective than a federal government run single-payer model. As a Republican former elected official with a very conservative spending record, I too believe in eliminating governmental waste and in utilizing the private sector when it is more effective.

Therefore, my record makes some citizens surprised when I advocate for Medicare for all. Objectively, the U.S. healthcare system is and has been severely broken. Despite our spending far more per capita, our country is far behind all developed democracies, which scoff when our politicians make the false claim that we have the best healthcare in the world.

For example, the National Research Council and Institute of Medicine recently commissioned a panel of experts to compare our health with that of 16 other developed nations. We ranked poorly, on the bottom in several key areas! The NRC/IM report stated that our health care is “inaccessible or unaffordable” with “lapses in the quality and safety of care”.

The nations with the lowest cost and best outcomes have comprehensive universal health insurance, either: A.) the government provides direct care (like England or the “socialist” VA here); B.) there is a public utility model (like Denmark and France); or C.) there is single-payer (like Canada, with Medicare covering everyone).

Despite the demagoguery, options “B” and “C” do not represent a government takeover of health care delivery. These options eliminate private-sector insurance company marketing and administrative costs, and big pharma price gouging, directing that money into patient care rather than paying for bureaucracy and multimillion-dollar CEO salaries.

Medicare, the U.S.’s national health care insurance for the disabled and those over 65, has under 3 percent overhead costs (Canada is under 2 percent). Private insurance companies complained because the Affordable Care Act (ACA) required them to get down to 20 percent, or pay a fine.

You will notice that the list of options used by other nations does not include an “Obamacare” model, with dozens of private insurance companies offering a multitude of confusing, expensive plans. In fact, the ACA is a direct descendant of the private insurance plan model derived by the conservative Heritage Foundation as an alternative to “Clinton Care” in the 1990s. That overly complex model became “Dolecare,” which then became “Romneycare.” Oddly, the ACA was then passed by Democrats.

For the ACA to function at all, everyone has to buy insurance, which is the main complaint of the public. Older, sicker folks can afford their premiums only because younger, healthier folks must also pay their premiums. No insurer is going to accept long-term losses, which currently appear to be rising. Insurers will simply raise premiums or get out of the business, as several are currently doing.

The best alternative to the ACA is expansion of Medicare. Americans know and like the program. Few object to paying for Medicare each month versus private insurance premiums.

Taxpayers are beginning to see the benefits of single-payer versus the ACA. In May, Gallup reported that “58 percent of U.S. adults favor the idea of replacing the law with a federally funded healthcare system that provides insurance for all Americans.”

For the most part, it can be funded in much the same way as Social Security, through a payroll tax, with additional funding coming from a variety of other sources. More detail on this subject can be found on the Physicians for a National Health Program website (www.pnhp.org).

A recent study by Dr. Gerald Friedman of the University of Massachusetts found that substantial annual savings can be achieved via single-payer. When combined with the spending reality of other developed countries, this fact should be enough to get our elected officials to objectively examine expanding Medicare, rather than simply attacking the idea due to raw politics.

But Republicans just continue to repeat their worn-out talking points about our current system being perfect — so long as we repeal the ACA. The Democrat front-runner is little better, supporting the ACA but having no clear plan to cover the 27 million Americans still without coverage or the millions more with inadequate insurance.

Given that special interest groups are making billions from our broken system, and contributing heavily to both parties to keep health insurance private, the real question is “will politicians in both parties ever have the courage to act?” If not, this nation is headed towards medical bankruptcy while still failing to insure its taxpayers

Jack Bernard, the first director of health planning for Georgia, has been an executive with several national health care firms. A Republican, he’s a former chairman of the Jasper County Commission.

http://www.myajc.com/news/news/opinion/medicare-an-effective-program-that-needs-expansion/nrmsZ/

BC/BS of Minnesota dumps broad networks

Minnesota Blues’ decision to alter ACA plans mirrors stampede to narrow networks

By Bob Herman
Modern Healthcare, June 24, 2016

Blue Cross and Blue Shield of Minnesota is cutting back its participation in the state’s Affordable Care Act insurance exchange next year after losing nearly $300 million in the individual market in 2015.

However, the large Blues insurer is not completely exiting the state-based marketplace. Fully withdrawing has its consequences: Federal law bars insurers from re-entering the marketplaces for five years, assuming they discontinue all types of individual policies.

Instead, Blue Cross and Blue Shield of Minnesota is dropping health plans with the broadest networks sold on and off the exchange and will push people toward its narrower HMO option called Blue Plus, according to the Star Tribune.

Blue Cross and Blue Shield of Minnesota’s decision is not unprecedented and has been embraced by other insurers around the country. The Blues plans in Illinois, New Mexico and Texas—all of which are owned by Health Care Service Corp., a giant Chicago-based company that has lost billions of dollars on ACA plans—abandoned their broad-network exchange plans in favor of the narrow-network HMOs.

Dropping broad-network plans can also be seen as a controversial risk dump for insurers. The sickest people who cost the most to insure often chose plans with higher monthly premiums to gain access to broader provider networks and fewer out-of-pocket costs. In Minnesota next year, those people may opt to buy those plans with other carriers, immediately benefiting the Blues’ bottom line while redirecting the insurance risk elsewhere.

http://www.modernhealthcare.com/article/20160624/NEWS/160629943

The individual insurance market has always been unstable. The struggles insurers face are not only how they can make their products more effective and accessible to more individuals, but especially how they can ensure that revenues exceed expenditures. So what can we learn from the response of Blue Cross and Blue Shield of Minnesota to unfavorable market conditions?

Most importantly, they are dumping risk onto other insurers. That places a burden on the other insurers which then translates to even higher premiums, higher cost sharing, fewer benefits, or any combination of these for individuals already enrolled in the other insurance risk pools. That’s not good.

In order to maintain a presence in the market, they are continuing to offer its narrow network HMO option. Those who transfer into that plan will have more limited choices of health care providers, perhaps losing coverage for their current health care professionals and institutions. That’s not good.

This instability in coverage is a defining feature of private health insurance plans. The insurers will always continue to introduce innovations as they compete for an advantage in the marketplace. When their products appeal to people who have greater health care needs, their model doesn’t work, and they pull out. What is working now is passing more costs onto the patients through greeter cost sharing, and limiting access to care by narrowing the networks of covered providers. That’s not good.

What seems obvious is that we have selected the wrong intermediary for financing health care. The private insurers function with a business need requiring costly administrative excesses, and they have a need to conform their products to meet business goals rather than patient service goals. That’s not good.

What would work best for patients would be a single payer national health program – an improved Medicare for all. But the Republicans are opposed, and the Democratic platform committee just voted to exclude single payer from their platform, and no other political party has enough traction to prevail in the elections. That’s not good.

Even though the Medicare for all concept remains popular, it seems that we will not have single payer in the foreseeable future. Churchill and others have said that a democracy is the worst form of government other than all of the others, but sometimes you wonder.

Medical Student Prescribes Remedy Our Sick System Needs

By Emily Kirchner
Common Dreams, June 24, 2016

I am a fourth year medical student. I’ve dreamed about being a physician since I was in sixth grade. For a long time, my deepest hopes were to get into college, be accepted by a medical school, and maintain the grades and test scores needed to keep me there.  My clinical rotations have taken me to hospitals across the state of Pennsylvania – from Pittsburgh’s North Side to North Philadelphia with stops in rural and suburban communities in between. Now I’m less than a year away from obtaining my medical degree.

Despite many hours of study and months on the hospital wards, I don’t feel any closer to practicing the kind of medicine I’ve always dreamed about than when I watched my first episode of “ER.”

That’s because I now understand that I won’t be able to take care of patients the way they – or I – would like.

How so? Although we’re living in a time and place where we have more ways than ever before to treat illness, our health care system is broken. It’s clear to me that the current system is set up to make profits for corporate shareholders, not to keep people healthy.

Right now, we are paying exorbitantly – the highest per capita expenditure in the world – for a health care system that leaves too many people out. Even after the Affordable Care Act is fully implemented, 28 million people will still be uninsured in 2026, according to the Congressional Budget Office.

Further, the specter of under-insurance, where insured individuals’ out-of-pocket medical costs are more than 10 percent of their income, is rising. Premiums, deductibles and co-pays are going up, deterring people from seeking needed care and exposing them to the danger of medical bankruptcy.

This very expensive system is also ineffective. I met a patient who first lost her energy, then her appetite, then her hair, and then her insurance in the middle of cancer treatment. She finally lost her oncologist because the latter did not accept Medicaid.

I’ve met parents who guiltily admit they can’t afford their own medicine and use their children’s inhalers when they can’t breathe. I’m trained to ask if patients are taking their medicines and then to follow up: “Do you ever have trouble affording your medications?”

I’ve watched the extent of insurance coverage determine treatment decisions for patients injured in car accidents. Or whether a patient with mental health problems gets treated at all.

So today I’m pouring my energy into a new dream: to practice medicine in a health care system where everyone gets covered for all medically necessary care. I want to help bring about a single-payer, national health insurance program.

This is not pie in the sky. Last month, the nonprofit Physicians for a National Health Program released “Beyond the Affordable Care Act: A Physicians’ Proposal for Single-Payer Health Care Reform” in the pages of the American Journal of Public Health. The proposal is endorsed by more than 2,200 physicians in all specialties.

Under the proposal, everyone will be covered by a publicly financed, nonprofit national health program, or NHP, for both outpatient and inpatient care, as well as rehabilitation, mental health services, long-term care, dental care, and prescriptions.

And it’s affordable. By replacing our redundant, complex private insurance bureaucracy with a single, nonprofit, streamlined program, we’ll reap savings of roughly $500 billion a year. That’s enough to improve and expand coverage to all – i.e. to eliminate the problems of uninsurance and under-insurance, and eliminate all co-pays and deductibles – without any increase in total health care spending.

The new system will be able to rein in costs. Much like we currently fund fire departments, the NHP will pay global, lump-sum budgets to hospitals, clinics, and nursing homes, rather than charging for each aspirin tablet.

Physicians will be paid based on a fee-for-service schedule covering all patients or by salary. The NHP, as a single buyer, will negotiate prices with drug companies, just like other countries already do, reaping additional savings.

We can finance this program by combining all current sources of government health spending, which already accounts for 64.3 percent of the country’s health bill, with modest new taxes based on ability to pay. Ninety-five percent of all households would save money, according to one study.

This is not a government take-over; this is the people reclaiming control over their own health care. This is the only way to keep everyone healthy, and to do it efficiently.

This is the plan I want for my patients, for my family, for myself. Based on recent polls showing solid majority support for “Medicare for All,” I’m obviously not alone. We should implement this remedy without delay.

Emily Kirchner is a medical student at Lewis Katz School of Medicine at Temple University. She is a student member of the Board of Directors of Physicians for a National Health Program, and is also active in Students for a National Health Program.

http://commondreams.org/views/2016/06/24/medical-student-prescribes-remedy-our-sick-system-needs

NHS under Brexit, and what it means for the U.S.

What would Brexit mean for the NHS?

By Denis Campbell
The Guardian, June 14, 2016

Alongside the economy and immigration, the NHS has emerged as a key battleground in the EU debate. That is because the leave campaign decided early on to deploy the health service as a core argument in their plea to voters. Leave leaders Boris Johnson and Michael Gove have said consistently since campaigning began in April that Brexit could free up up to £8bn extra a year to spend on the NHS.

Leaving the EU would not, however, provide more money to spend on the NHS, according to the Institute of Fiscal Studies. “Rather, it would leave us spending less on public services, or taxing more, or borrowing more.”

Labour has dismissed the leave campaign’s claim of a bigger NHS budget as “misleading, simplistic and complete and utter nonsense”. Its own analysis concludes that a post-Brexit economic slump could force the government to cut the Department of Health’s budget by £10.5bn – the equivalent of every hospital in England having to shed 1,000 nurses and 155 doctors.

And last week, Tory MP and former GP Sarah Wollaston defected from the Vote Leave campaign saying its claim that Brexit would unlock up to £350m a week for the NHS “simply isn’t true”.

https://www.theguardian.com/society/2016/jun/14/brexit-nhs-health-social-care-disabled-people-eu-referendum

***

Pharma, researchers, NHS face uncertainty after Brexit win

By Helen Collis
Politico, June 24, 2016

Britain’s Brexit result today ignites a long period of uncertainty in the health sector, on the relocation of the European Medicines Agency, on staffing the National Health Service and on funding research.

http://www.politico.eu/article/pharma-researchers-nhs-face-uncertainty-after-brexit-win/

***

EU referendum: Nigel Farage backtracks on Vote Leave’s ‘£350m for the NHS’ pledge hours after result

By Jon Stone
Independent, June 24, 2016

Nigel Farage has disowned a pledge to spend £350 million of European Union cash on the NHS after Brexit.

The Ukip leader was asked on ITV’s Good Morning Britain programme whether he would guarantee that the money pledged for the health service during the campaign would now be spent on it.

Speaking on the morning of the referendum result he however said he had never made any such pledge.

When it was pointed out that Vote Leave emblazoned the £350 million claim onto the side of a tour bus and drove it around the country, Mr Farage said: “It wasn’t one of my adverts – I can assure you! I think they made a mistake in doing that.

http://www.independent.co.uk/news/uk/politics/eu-referendum-result-nigel-farage-nhs-pledge-disowns-350-million-pounds-a7099906.html

***

Comment:

By Don McCanne, M.D.

There was certainly no uniformity of opinion on what impact Brexit might have on their National Health Service. Now that the results are in, we still will not know until the destabilization begins to settle down.

So what is the most likely outcome? The basic structure of their revered health system will likely remain intact, but it may be subjected to tweaking, the nature of which will depend on the ideology prevalent in the political environment after the shakeup occurs, already beginning with the announcement that Conservative Prime Minister David Cameron will resign.

What impact will this have on health care reform in the United states? Virtually none. The probable Democratic presidential nominee has said that she will perpetuate the current system, adding minor beneficial tweaks. The probable Republican presidential nominee will likely accept the recommendations in the white paper released by the House Republicans which basically proposes perpetuating the current system with tweaks that they consider to be beneficial from a conservative perspective.

Bernie Sanders and colleagues are attempting to shift the Democratic platform to a position of support for a single payer national health program – Medicare for All – but Hillary Clinton has already made it very clear that she would not support such a change.

We can sympathize with the difficulties faced by the Europeans as they work out the Brexit problems and what is to follow. But if we are to learn from this, we must understand how important it is to be informed on public policy and then to elect politicians who will carry out a pledge to make our nation work well for all of us. We don’t seem to be doing that now. We do not have the prospect of a Usexit since we have nowhere to go.

What can we do about high drug prices?

New Directions in Health Care Podcast: Controlling Rising Drug Costs

By Sandy Hausman
The Commonwealth Fund, June 22, 2016

Prescription drug spending, a significant driver of overall health care costs, has been rising rapidly over the last few years. This episode explores the reasons for higher drug prices, including the introduction of new high-value medications, potentially inefficient research and development, and a lack of price regulation. Producer Sandy Hausman interviews Commonwealth Fund President David Blumenthal, M.D., Duke-Margolis Center for Health Policy Director Mark McClellan, M.D., and Johns Hopkins University School of Public Health Professor Gerard Anderson about the underlying causes and potential solutions.

At Johns Hopkins University’s School of Public Health, Professor Gerard Anderson argues government should more aggressively regulate drug prices.

“There are no rules. There’s no legislation. You just basically, as a drug company, have the ability to set the price, and if the government has given you a monopoly – and that’s what a patent is – then there are no competitors for your drug, and so you can charge essentially whatever you want. You don’t have to worry that a lot of people won’t have access to the drug, because you’re going to make a lot of money on a few people, and that’s exactly what happens.”

He adds that even generic drug makers may be charging too much.

“Five drugs companies—and soon it will be four—in the generic drug industry control over half of the market, and the reason why generic drugs have been inexpensive in the past is pure price competition. They’re selling exactly the same product. That’s what a generic drug is, but they’re selling it on the basis of price competition, but if there’s not a lot of competitors, then you don’t get very good price competition.”

But Mark McClellan warns against the imposition of price controls, since they may limit patient access to certain medications.

“In the United Kingdom, which has significantly lower drug prices than the United States, there is a government body set up that reviews whether or not the price set by a manufacturer is worth it for certain kinds of patients, and in some patients makes a decision that the price is not worthwhile. That’s negotiating leverage. That means that unless the price comes down, people don’t have as much access to the drug.”

As that debate continues, Dr. Blumenthal says the federal government has found some ways to negotiate for better prices.

“The Veterans Administration and the Department of Defense negotiate drug prices and have the statutory authority to set an upper limit on drug prices — that is the lowest amount that any single purchaser can get from a drug company, and there are other drug price controls that are imposed, for example, by states on behalf of their Medicaid programs. When you put California and New York together — two blue states that often pioneer with these kinds of new programs — those are big parts of the national market.”

Podcast link:
http://www.commonwealthfund.org/interactives-and-data/multimedia/podcasts/new-directions-in-health-care/drug-costs

Transcript link:
http://www.commonwealthfund.org/~/media/files/multimedia/podcasts/drug-prices.pdf

***

Comment:

By Don McCanne, M.D.

As usual, Professor Gerard Anderson is right again. Between patents for brand products and consolidation in the generic market, drug prices are out of control. He argues that the government should more aggressively regulate prices.

You may remember Anderson as coauthor with Uwe Reinhardt et al. of the classic Health Affairs article, “It’s the Prices, Stupid.”

Mark McClellan argues that government involvement in setting drug prices risks impairing access to higher priced drugs, but it is the excessive prices in the United States that creates much greater access problems because of the lack of affordability.

David Blumenthal points out that the Veterans Administration, the Department of Defense, and some state Medicaid programs have been effective in limiting drug prices, thus the government does have the potential to play a very important role in combating price gouging by the pharmaceutical industry.

And, of course, with a well designed, government funded and administered single payer system our drug costs would be brought down to reasonable, fair levels – for all of us, collectively.

NHS under Brexit, and what it means for the U.S.

What would Brexit mean for the NHS?

By Denis Campbell
The Guardian, June 14, 2016

Alongside the economy and immigration, the NHS has emerged as a key battleground in the EU debate. That is because the leave campaign decided early on to deploy the health service as a core argument in their plea to voters. Leave leaders Boris Johnson and Michael Gove have said consistently since campaigning began in April that Brexit could free up up to £8bn extra a year to spend on the NHS.

Leaving the EU would not, however, provide more money to spend on the NHS, according to the Institute of Fiscal Studies. “Rather, it would leave us spending less on public services, or taxing more, or borrowing more.”

Labour has dismissed the leave campaign’s claim of a bigger NHS budget as “misleading, simplistic and complete and utter nonsense”. Its own analysis concludes that a post-Brexit economic slump could force the government to cut the Department of Health’s budget by £10.5bn – the equivalent of every hospital in England having to shed 1,000 nurses and 155 doctors.

And last week, Tory MP and former GP Sarah Wollaston defected from the Vote Leave campaign saying its claim that Brexit would unlock up to £350m a week for the NHS “simply isn’t true”.

https://www.theguardian.com/society/2016/jun/14/brexit-nhs-health-social-care-disabled-people-eu-referendum

***

Pharma, researchers, NHS face uncertainty after Brexit win

By Helen Collis
Politico, June 24, 2016

Britain’s Brexit result today ignites a long period of uncertainty in the health sector, on the relocation of the European Medicines Agency, on staffing the National Health Service and on funding research.

http://www.politico.eu/article/pharma-researchers-nhs-face-uncertainty-after-brexit-win/

***

EU referendum: Nigel Farage backtracks on Vote Leave’s ‘£350m for the NHS’ pledge hours after result

By Jon Stone
Independent, June 24, 2016

Nigel Farage has disowned a pledge to spend £350 million of European Union cash on the NHS after Brexit.

The Ukip leader was asked on ITV’s Good Morning Britain programme whether he would guarantee that the money pledged for the health service during the campaign would now be spent on it.

Speaking on the morning of the referendum result he however said he had never made any such pledge.

When it was pointed out that Vote Leave emblazoned the £350 million claim onto the side of a tour bus and drove it around the country, Mr Farage said: “It wasn’t one of my adverts – I can assure you! I think they made a mistake in doing that.

http://www.independent.co.uk/news/uk/politics/eu-referendum-result-nigel-farage-nhs-pledge-disowns-350-million-pounds-a7099906.html

There was certainly no uniformity of opinion on what impact Brexit might have on their National Health Service. Now that the results are in, we still will not know until the destabilization begins to settle down.

So what is the most likely outcome? The basic structure of their revered health system will likely remain intact, but it may be subjected to tweaking, the nature of which will depend on the ideology prevalent in the political environment after the shakeup occurs, already beginning with the announcement that Conservative Prime Minister David Cameron will resign.

What impact will this have on health care reform in the United states? Virtually none. The probable Democratic presidential nominee has said that she will perpetuate the current system, adding minor beneficial tweaks. The probable Republican presidential nominee will likely accept the recommendations in the white paper released by the House Republicans which basically proposes perpetuating the current system with tweaks that they consider to be beneficial from a conservative perspective.

Bernie Sanders and colleagues are attempting to shift the Democratic platform to a position of support for a single payer national health program – Medicare for All – but Hillary Clinton has already made it very clear that she would not support such a change.

We can sympathize with the difficulties faced by the Europeans as they work out the Brexit problems and what is to follow. But if we are to learn from this, we must understand how important it is to be informed on public policy and then to elect politicians who will carry out a pledge to make our nation work well for all of us. We don’t seem to be doing that now. We do not have the prospect of a Usexit since we have nowhere to go.

What can we do about high drug prices?

New Directions in Health Care Podcast: Controlling Rising Drug Costs

By Sandy Hausman
The Commonwealth Fund, June 22, 2016

Prescription drug spending, a significant driver of overall health care costs, has been rising rapidly over the last few years. This episode explores the reasons for higher drug prices, including the introduction of new high-value medications, potentially inefficient research and development, and a lack of price regulation. Producer Sandy Hausman interviews Commonwealth Fund President David Blumenthal, M.D., Duke-Margolis Center for Health Policy Director Mark McClellan, M.D., and Johns Hopkins University School of Public Health Professor Gerard Anderson about the underlying causes and potential solutions.

At Johns Hopkins University’s School of Public Health, Professor Gerard Anderson argues government should more aggressively regulate drug prices.

“There are no rules. There’s no legislation. You just basically, as a drug company, have the ability to set the price, and if the government has given you a monopoly – and that’s what a patent is – then there are no competitors for your drug, and so you can charge essentially whatever you want. You don’t have to worry that a lot of people won’t have access to the drug, because you’re going to make a lot of money on a few people, and that’s exactly what happens.”

He adds that even generic drug makers may be charging too much.

“Five drugs companies—and soon it will be four—in the generic drug industry control over half of the market, and the reason why generic drugs have been inexpensive in the past is pure price competition. They’re selling exactly the same product. That’s what a generic drug is, but they’re selling it on the basis of price competition, but if there’s not a lot of competitors, then you don’t get very good price competition.”

But Mark McClellan warns against the imposition of price controls, since they may limit patient access to certain medications.

“In the United Kingdom, which has significantly lower drug prices than the United States, there is a government body set up that reviews whether or not the price set by a manufacturer is worth it for certain kinds of patients, and in some patients makes a decision that the price is not worthwhile. That’s negotiating leverage. That means that unless the price comes down, people don’t have as much access to the drug.”

As that debate continues, Dr. Blumenthal says the federal government has found some ways to negotiate for better prices.

“The Veterans Administration and the Department of Defense negotiate drug prices and have the statutory authority to set an upper limit on drug prices — that is the lowest amount that any single purchaser can get from a drug company, and there are other drug price controls that are imposed, for example, by states on behalf of their Medicaid programs. When you put California and New York together — two blue states that often pioneer with these kinds of new programs — those are big parts of the national market.”

Podcast link:
http://www.commonwealthfund.org/interactives-and-data/multimedia/podcasts/new-directions-in-health-care/drug-costs

Transcript link:
http://www.commonwealthfund.org/~/media/files/multimedia/podcasts/drug-prices.pdf

As usual, Professor Gerard Anderson is right again. Between patents for brand products and consolidation in the generic market, drug prices are out of control. He argues that the government should more aggressively regulate prices.

You may remember Anderson as coauthor with Uwe Reinhardt et al. of the classic Health Affairs article, “It’s the Prices, Stupid.”

Mark McClellan argues that government involvement in setting drug prices risks impairing access to higher priced drugs, but it is the excessive prices in the United States that creates much greater access problems because of the lack of affordability.

David Blumenthal points out that the Veterans Administration, the Department of Defense, and some state Medicaid programs have been effective in limiting drug prices, thus the government does have the potential to play a very important role in combating price gouging by the pharmaceutical industry.

And, of course, with a well designed, government funded and administered single payer system our drug costs would be brought down to reasonable, fair levels – for all of us, collectively.

Thousands rally as 22,000 miners are threatened with cut off of health benefits

UMWA Plans March on Washington

Unions for Single Payer Health Care, June 20, 2016

LEXINGTON, KY — Over 5,000 miners rallied here last Tuesday to protest health benefit cuts threatened to happen before the end of the year. Responding to the call of their union, United Mine Workers of America (UMWA), miners came from seven states to gather at the convention center. Some arrived with walkers, canes, wheel chairs, and oxygen tanks, giving tangible evidence of the toll on human health inflicted by the mining industry.

The UMWA reports that 22,000 retired union miners, widows or dependents would lose health care benefits at the end of the year if federal legislation they are backing isn’t enacted this year. Retirement benefits are also at risk.

UMWA President Cecil Roberts told those assembled that union miners had spent their lives working in dangerous places to provide America’s electricity and steel and make it the most prosperous nation on earth.

“We have stood up for America, and it’s time America stood up for us!” said Roberts, “America owes us, and we will collect on that debt!”

Union miners said the promise of good health care and pensions dates to 1946, when the federal government promised benefits in resolving a labor dispute.

Roberts Calls for March on Washington with Civil Disobedience

Roberts announced at the rally that union members will march on Washington D.C. later this year and risk being arrested if that’s what it takes. He told miners to go home and find at least five others that would be willing to rally at the nation’s capital.

The UMWA is calling for passage of legislation in Congress, Senate Bill 1714 and House Resolution 2403, which would redirect existing appropriations to ensure health care benefits for retirees whose companies have gone bankrupt in the last 4 years, as well as prevent the UMWA pension fund from collapsing. The Lexington Herald-Leader endorsed the proposed bills.

Solidarity Action:

Contact your two senators and ask them to support S 1714 and your representative and ask him/her to support HR 2403. Call the US Capitol Switchboard (202) 224-3121 and ask for your congresspersons by name.

This coal miners’ crisis is further testimony that collective bargaining power alone is insufficient to resolve the health care problem for unions and workers. Workers and the nation must have a legislative solution. If we are to protect and improve health care for workers, the labor movement must lead the battle for national single payer health care. 

HR 676, a national single payer bill, would improve Medicare and expand it to everyone. It includes all medically necessary care including dental and drugs with no co-pays and no deductibles. It was introduced by Congressman John Conyers (D-MI) and has 62 co-sponsors. If your union has not yet endorsed this bill, please do so!

Endorse HR 676:

The sample resolution is here: http://unionsforsinglepayer.org/tools/sample_resolution

Build the movement to make it happen!

Issued by:

All Unions Committee for Single Payer Health Care–HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551
 
Email: nursenpo@aol.com
http://unionsforsinglepayer.org
https://www.facebook.com/unionsforsinglepayer

Letter: Health overhead

By Dr. Loren A. Crown
The Commercial Appeal, June 22, 2016

COVINGTON, TENN. — The writer of the June 19 letter “Single-payer answer” correctly pointed out problems with the current system (i.e., profit-driven insurers, the pharmaceutical industry and providers) resulting in our nation seeing a decrease in longevity, a health care ranking behind 36 other nations, and yet a No. 1 cost rating.

I would add that while Medicare has a 1 to 2 percent overhead expense, the current system results in approximately a 20 percent overhead (health care executives, stock dividends, duplication, etc.).

Single-payer access could eliminate this and leave funds for the 15 percent who have no coverage or marginal coverage without increasing the health care budget.

http://www.commercialappeal.com/opinion/letters-to-the-editor/Letter-Health-overhead-383900731.html