PNHP

Sanders’ health care plan

Sanders’ health care plan

By Ernest A. Canning
Ventura County (Calif.) Star, May 16, 2016

Re: Martin Schram’s column May 13, “Sanders escapes watchdogs’ bark”:

Martin Schram underscores the wisdom behind Mark Twain’s observation that “a lie can travel halfway around the world while the truth is putting on its shoes.”

He repeats the canard, initiated by The Washington Post and reinforced by the billionaire-funded Brookings Institute, that Bernie Sanders’ single-payer health care plan would add $18 trillion to the deficit. In truth, as revealed by University of Massachusetts Amherst economist Gerald Friedman, a single-payer system would save $5 trillion.

Per capita, the U.S. spends three times as much for health care than the U.K., whose taxpayer-funded National Health Service provides health care to citizens without additional charges or co-pays. In 2013, U.S. taxpayers footed the bill for 64.3 percent of U.S. health care — about $1.9 trillion. Yet in the U.S. nearly 30 million of our citizens still lack any form of insurance coverage.

The for-profit U.S. health care system is corrupt, dysfunctional and deadly. In Canada, only 1.5 percent of health care costs are devoted to administration of its single-payer system. In the U.S., 31 percent of health care expenditures flow to the private insurance industry. Americans pay far more for prescription drugs. Last year, CNN reported, Americans paid nearly 10 times as much for prescription Nexium than it cost in the Netherlands.

Before Obamacare, 47 million Americans were uninsured. According to a pre-Obamacare Harvard study, 45,000 Americans died each year for lack of coverage. Through wasteful insurance subsidies, we’ve experienced a 36 percent reduction in the number of uninsured. Simple but ghastly arithmetic suggests our for-profit system is still killing 28,000 Americans each year.

In the U.K., no one one faces personal bankruptcy due to medical expenses. In the U.S., half of all personal bankruptcies are health care-related.

Ernest A. Canning resides in Thousand Oaks.

http://www.vcstar.com/opinion/letters-to-the-editor/Sanders-health-care-plan-379662041.html

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

Dr. Sean Lehmann on ‘Nevada NewsMakers’

Dr. Sean Lehmann, chair of the Nevada chapter of Physicians for a National Health Program, appeared on “Nevada NewsMakers” with host Sam Shad on May 17, 2016. Dr. Lehmann discussed the urgent need for single-payer national health reform, and contrasted his experience billing Medicare with his experience billing private insurance companies. The segment with Dr. Lehmann begins at approximately the 2:36-minute mark.

For more information on PNHP activities in Nevada, please visit the Nevada state page on our website, and/or “like” the chapter’s Facebook page.

Gallup: Majority support federally funded health care system

Majority in U.S. Support Idea of Fed-Funded Healthcare System

By Frank Newport
Gallup, May 16, 2016

Presented with three separate scenarios for the future of the Affordable Care Act (ACA), 58% of U.S. adults favor the idea of replacing the law with a federally funded healthcare system that provides insurance for all Americans. At the same time, Americans are split on the idea of maintaining the ACA as it is, with 48% in favor and 49% opposed. The slight majority, 51%, favor repealing the act.

The results show that many Americans are OK with several ways of handling the ACA rather than favoring only one possibility. In particular, 35% of all Americans say they would favor keeping the ACA in place and separately say they favor the idea of replacing it with a federally funded universal health insurance system. Among Democrats and Democratic leaners, 59% favor both of these approaches. In short, many Americans would apparently go along with Clinton’s idea of keeping the ACA in place as it is now, or with Sanders’ bolder proposal to replace it with a Medicare-for-All system.

Gallup also asked those who favor either keeping the ACA in place or replacing it with a federally funded system to choose between these two options. The federally funded system wins among this group by a 2-to-1 ratio, 64% to 32%, meaning this system garners the most support among the initial favor/oppose questions and wins when those who like both approaches are forced to choose.

Additionally, 27% of Americans say they favor repealing the ACA and say they favor replacing it with a federally funded system. This means the group of Americans in this survey who favor the law’s repeal, a core policy proposal of many Republican presidential candidates during this campaign season, includes some who apparently want the ACA repealed to replace it with an even more liberal system. Only 22% of Americans say they want the ACA repealed and do not favor replacing it with a federally funded system.

The breakdown of reactions to these proposals by partisanship shows the expected patterns: Democrats and Democratic-leaning independents are highly likely to favor the two options put forth by the Democratic candidates, while Republicans and Republican leaners are highly likely to favor Trump’s position, repeal of the ACA.

One notable exception to the strong partisan skew in reactions to these proposals comes from Republicans when they are asked about replacing the ACA with a federally funded system. Forty-one percent of Republicans favor the proposal — much higher than the 16% who favor keeping the ACA in place. This may reflect either that Republicans genuinely think a single-payer system would be good for the country, or that they view any proposal to replace the ACA (“Obamacare”) as better than keeping it in place.

Bottom Line

Americans express considerable support for the idea of replacing the ACA with a federally run national healthcare system, which is similar to the proposal championed by presidential candidate Sanders. To be sure, many Americans, primarily Democrats, also favor the idea of just keeping the ACA in place. But given a choice, those who favor both proposals come down on the side of the Sanders-type proposal. Four in 10 Republicans also favor the idea of a federally funded system.

http://www.gallup.com/poll/191504/majority-support-idea-fed-funded-healthcare-system.aspx

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Comment:

By Don McCanne, M.D.

Although this new Gallup poll has been widely interpreted in the media as showing strong national support for single payer reform, the actual question was about favoring or opposing “Replacing the ACA with a federally funded healthcare program providing insurance for all Americans,” and it was asked with two other options (repealing ACA, keeping ACA in place), any or all of which could be chosen. Replacing ACA with federally funded health care was supported by 58%, repeal ACA by 51%, and keeping ACA by 48%.

Perhaps one of the more important findings in this poll was that 27% of Americans favor both repealing ACA and replacing it with a federally funded system. Since 45% of all Americans support repeal of ACA, this means that over half of those favoring repeal want it replaced with a federally funded system. That gives a new slant to the repeal and replace clarion call of the Republicans.

In fact, 41% of Republicans favor replacing ACA with a federally funded system whereas only 16% of them prefer to keep ACA in place.

Based on this poll, it is no wonder that the May 16 headline in The Washington Post read, “Poll: Most Americans want to replace Obamacare with single-payer — including many Republicans.”

When those who favor either keeping the ACA in place or replacing it with a federally funded system were asked to choose between the two, 32% favored keeping ACA and 64% favored replacing it with a federally funded system.

This should reinvigorate those of us who are working so hard to bring to America the health care system that we need and want – a single payer improved Medicare for all.

Single Payer, Susan Dentzer, and the Diane Rehm Show

By Russell Mokhiber
Single Payer Action, May 17, 2016

The Diane Rehm Show this morning was devoted to the topic — The Affordable Care Act Three Years In: What’s Working And What’s Not.

The guests on the show were Julie Rovner, senior correspondent, Kaiser Health News, Stephanie Armour, healthcare reporter, Wall Street Journal, and Susan Dentzer CEO of the Network for Excellence in Health Innovation (NEHI) — what Dentzer describes as “a non-profit think-tank.”

Just yesterday, the Washington Post ran an article about a Gallup poll under the headline — Most Americans want to Replace Obamacare with Single Payer — Including Many Republicans.

But single payer wasn’t raised as a possibility by any of the guests — until a caller raised it about three quarters of the way through the show.

In response, Armour, Dentzer and Rovner all talked about how much more expensive single payer would be than Obamacare.

Only Diane Rehm seemed sympathetic to single payer.

“Bernie Sanders Medicare for All program would create a single payer system,” Dentzer said. “It has very large payroll tax increases and income tax increases in it to fund it. A legitimate question is — is the American public ready to move from the system we have now — yes we have high deductibles for many people, yes they are paying high premiums — but are we willing to move and float all of the those expenses through the government coffers and pay much higher payroll taxes and much higher income taxes?”

Rehm asks Rovner — what would Bernie Sanders proposal cost?

“A lot more than he has floated in income tax increases,” Rovner said. “The Urban Institute last week estimated that it is $18 trillion short of paying for itself.”

With that statement, Rovner gave the back of her corporate hand to David Himmelstein and Steffie Woolhandler, who recently wrote that the Urban Institute’s estimates “are ridiculous.”

“They project outlandish increases in the utilization of medical care, ignore vast savings under single-payer reform, and ignore the extensive and well-documented experience with single-payer systems in other nations — which all spend far less per person on healthcare than we do,” they wrote.

Rovner said that “it’s important to know that what Bernie Sanders is proposing is not what Medicare is.”

“Medicare as it exists today has lots and lots of requirements for patients for co-pays,” Rovner said. “The deductibles are not that high in Medicare, although the hospital deductible is substantial. But the ongoing out of pocket costs can be enormous. That’s why most people who have Medicare have supplemental insurance. What Bernie Sanders is talking about is that there would be no need for supplemental insurance — that this new Medicare would pay pretty much for everything. That is what would make it so expensive. And that would be a level that even other countries who have single payer plans don’t have.”

Ignoring the results of the Gallup poll, Armour says that while single payer “has intrigued people for decades, it has never gotten a majority of support and in the current political climate, it would be very difficult.”

Given that Rehm had three guests dissing single payer, she felt she had to stand up for it. Since when, she asked, did Congress start ignoring “what people want”?

Armour said that while single payer has always had strong support, “it’s been a plurality, not a majority.”

“There simply isn’t fifty percent plus one and there hasn’t been,” Armour said. “What we are seeing now is the other side — give people more skin in the game. Make them pay more of their own health care bills. And maybe they will shop better.”

Shop better? You mean like in states like West Virginia where there is exactly one insurance company in the Obamacare marketplace?

Shop better?

The last time the Diane Rehm show devoted an hour to single payer was in May 2009.

The guests were Bernie Sanders, David Himmelstein, Roger Hickey — who was pushing a public option — and Susan Dentzer, who was then identified as senior policy adviser, The Robert Wood Johnson Foundation, and on-air analyst on health issues, PBS NewsHour.

During that show, Rehm asked Dentzer why we don’t have a single payer system in the United States and Dentzer replied — “we had a private insurance industry develop.”

“It now has revenues in excess of $400 billion a year. And it’s a very effective interest group,” Dentzer said.

Dentzer should know.

While Dentzer’s group calls itself The Network for Excellence in Health Innovation, in fact if you look at its board of directors, it’s dominated by executives affiliated with health insurance companies (Blue Cross Blue Shield of Massachusetts and HCA) and drug companies (Genzyme Corporation, Sanofi and Merck.)

No wonder she’s hostile to single payer.

Russell Mokhiber is editor of the Washington, D.C.-based Corporate Crime Reporter.  He is also founder of singlepayeraction.org, and editor of the website Morgan County USA.

http://www.singlepayeraction.org/2016/05/17/single-payer-and-the-diane-rehm-show/

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

Gallup: Majority support federally funded health care system

Majority in U.S. Support Idea of Fed-Funded Healthcare System

By Frank Newport
Gallup, May 16, 2016

Presented with three separate scenarios for the future of the Affordable Care Act (ACA), 58% of U.S. adults favor the idea of replacing the law with a federally funded healthcare system that provides insurance for all Americans. At the same time, Americans are split on the idea of maintaining the ACA as it is, with 48% in favor and 49% opposed. The slight majority, 51%, favor repealing the act.

The results show that many Americans are OK with several ways of handling the ACA rather than favoring only one possibility. In particular, 35% of all Americans say they would favor keeping the ACA in place and separately say they favor the idea of replacing it with a federally funded universal health insurance system. Among Democrats and Democratic leaners, 59% favor both of these approaches. In short, many Americans would apparently go along with Clinton’s idea of keeping the ACA in place as it is now, or with Sanders’ bolder proposal to replace it with a Medicare-for-All system.

Gallup also asked those who favor either keeping the ACA in place or replacing it with a federally funded system to choose between these two options. The federally funded system wins among this group by a 2-to-1 ratio, 64% to 32%, meaning this system garners the most support among the initial favor/oppose questions and wins when those who like both approaches are forced to choose.

Additionally, 27% of Americans say they favor repealing the ACA and say they favor replacing it with a federally funded system. This means the group of Americans in this survey who favor the law’s repeal, a core policy proposal of many Republican presidential candidates during this campaign season, includes some who apparently want the ACA repealed to replace it with an even more liberal system. Only 22% of Americans say they want the ACA repealed and do not favor replacing it with a federally funded system.

The breakdown of reactions to these proposals by partisanship shows the expected patterns: Democrats and Democratic-leaning independents are highly likely to favor the two options put forth by the Democratic candidates, while Republicans and Republican leaners are highly likely to favor Trump’s position, repeal of the ACA.

One notable exception to the strong partisan skew in reactions to these proposals comes from Republicans when they are asked about replacing the ACA with a federally funded system. Forty-one percent of Republicans favor the proposal — much higher than the 16% who favor keeping the ACA in place. This may reflect either that Republicans genuinely think a single-payer system would be good for the country, or that they view any proposal to replace the ACA (“Obamacare”) as better than keeping it in place.

Bottom Line

Americans express considerable support for the idea of replacing the ACA with a federally run national healthcare system, which is similar to the proposal championed by presidential candidate Sanders. To be sure, many Americans, primarily Democrats, also favor the idea of just keeping the ACA in place. But given a choice, those who favor both proposals come down on the side of the Sanders-type proposal. Four in 10 Republicans also favor the idea of a federally funded system.

http://www.gallup.com/poll/191504/majority-support-idea-fed-funded-healthcare-system.aspx

Although this new Gallup poll has been widely interpreted in the media as showing strong national support for single payer reform, the actual question was about favoring or opposing “Replacing the ACA with a federally funded healthcare program providing insurance for all Americans,” and it was asked with two other options (repealing ACA, keeping ACA in place), any or all of which could be chosen. Replacing ACA with federally funded health care was supported by 58%, repeal ACA by 51%, and keeping ACA by 48%.

Perhaps one of the more important findings in this poll was that 27% of Americans favor both repealing ACA and replacing it with a federally funded system. Since 45% of all Americans support repeal of ACA, this means that over half of those favoring repeal want it replaced with a federally funded system. That gives a new slant to the repeal and replace clarion call of the Republicans.

In fact, 41% of Republicans favor replacing ACA with a federally funded system whereas only 16% of them prefer to keep ACA in place.

Based on this poll, it is no wonder that the May 16 headline in The Washington Post read, “Poll: Most Americans want to replace Obamacare with single-payer — including many Republicans.”

When those who favor either keeping the ACA in place or replacing it with a federally funded system were asked to choose between the two, 32% favored keeping ACA and 64% favored replacing it with a federally funded system.

This should reinvigorate those of us who are working so hard to bring to America the health care system that we need and want – a single payer improved Medicare for all.

sdrawkcab reform

Sorry, We Don’t Take Obamacare

By Elisabeth Rosenthal
The New York Times, May 14, 2016

Amy Moses and her circle of self-employed small-business owners were supporters of President Obama and the Affordable Care Act. They bought policies on the newly created New York State exchange. But when they called doctors and hospitals in Manhattan to schedule appointments, they were dismayed to be turned away again and again with a common refrain: “We don’t take Obamacare,” the umbrella epithet for the hundreds of plans offered through the president’s signature health legislation.

“Anyone who is on these plans knows it’s a two-tiered system,” said Ms. Moses, describing the emotional sting of those words to a successful entrepreneur.

The goal of the Affordable Care Act, which took effect in 2013, was to provide insurance to tens of millions of uninsured or under-insured Americans, through online state and federal marketplaces offering an array of policies. By many measures, the law has been a success: The number of uninsured Americans has dropped by about half, with 20 million more people gaining coverage.

Yet even as many beneficiaries acknowledge that they might not have insurance today without the law, there remains a strong undercurrent of discontent. Though their insurance cards look the same as everyone else’s — with names like Liberty and Freedom from insurers like Anthem or United Health — the plans are often very different from those provided to most Americans by their employers. Many say they feel as if they have become second-class patients.

Some early studies of the impact of the Affordable Care Act plans are proving patients’ grumbling justified: Compared with the insurance that companies offer their employees, plans provide less coverage away from patients’ home states, require higher patient outlays for medicines and include a more limited number of doctors and hospitals, referred to as a narrow network policy. And while employers tend to offer their workers at least one plan that allows them coverage to visit doctors not in their network, patients buying insurance through A.C.A. exchanges in some states do not have that option, even if they’re willing to pay higher premiums.

The research thus far suggests that the differences between plans offered through the A.C.A. and those offered by employers may be quite significant. A study in the policy journal Health Affairs found that out-of-pocket prescription costs were twice as high in a typical silver plan — the most popular choice — as they were in the average employer offering. In research conducted with the Robert Wood Johnson Foundation, Dr. Polsky found that 41 percent of silver plans offered a “narrow or very narrow” selection of doctors, meaning at best 25 percent of physicians in an area were included. The consulting firm Avalere Health found that exchange plans had 42 percent fewer cancer and cardiac specialists, compared with employer-provided coverage.

When designing the new plans, for-profit insurers naturally tended to exclude high-cost, high-end hospitals with whom they had little clout to negotiate discounts. That means, for example, that as of late last year none of the plans available in New York had Memorial Sloan Kettering Cancer Center in their network — an absence that would be unacceptable to many New York-based employers buying policies for their employees.

And when Simon F. Haeder of the University of Wisconsin and his colleagues studied the plans sold on the California exchange, they found that they included 34 percent fewer hospitals than those sold on the open market and tended to exclude the priciest medical centers, like Cedars Sinai, a highly regarded hospital that runs the largest heart-transplant program in the country.

http://www.nytimes.com/2016/05/15/sunday-review/sorry-we-dont-take-obamacare.html

***

Special Enrollment Periods for the Health Insurance Marketplace

CMS.gov, May 6, 2016

Special Enrollment Periods

While SEPs provide a critical pathway to coverage for qualified individuals who experience qualifying events and need to enroll in or change qualified health plans (QHPs) outside of the annual open enrollment period, it’s equally important to avoid SEPs being misused or abused.  As it announced today, HHS is tightening the rules for certain special enrollment periods and making clear that SEPs are only available in six defined and limited types of circumstances.

An Interim Final Rule with Comment (IFC) published in the Federal Register provides that individuals requesting a “permanent move” SEP must have minimum essential coverage for one or more days in the 60 days preceding the permanent move, unless they were living outside of the United States or in a United State territory prior to the permanent move. This ensures that individuals are not moving for the sole purpose of obtaining health coverage outside of the open enrollment period.

https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-05-06.html

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Comment:

By Don McCanne, M.D.

When explaining that health care reform seems to be moving backwards, does it improve communication to discuss reform that is sdrawkcab (ananym of backwards)?

NYT’s Elisabeth Rosenthal has provided us with another great article that describes how some of the supposedly forward advances in reform are really backwards. The ACA exchange plans are undoing some of the financial protection that health insurance should afford us, while impairing access through narrower provider networks. If we said that this reform is sdrawkcab, would that help us understand it better?

As small business owner Amy Moses stated, “Anyone who is on these plans knows it’s a two-tiered system.” Does it not seem absurd that the policies inherent in ACA would place a business owner in the lower tier of a two-tiered system? Isn’t that sdrawkcab? Yes and no. Actually what is sdrawkcab is that we would even have tiers in our health care system when it would be much more efficient, more equitable, and more effective to have a single high level system for everyone – an improved Medicare for all.

A specific example of the wrong direction in which too much of our policy is headed is provided by the new CMS rule that describes yet another technical reason to prohibit individuals from obtaining coverage through special enrollment periods. Although health reform supposedly was designed to expand access to insurance plans, this rule is sdrawkcab in that it prohibits access for certain uninsured individuals. True, the rule was designed to protect insurers from individuals who might have an acute need for coverage outside of the open enrollment period, but the entire system should have been designed to automatically enroll everyone instead of ignoring individual needs while providing insurers with their optimal business model.

No more sdrawkcab reform. Everybody in, nobody out!

What single-payer healthcare would mean to doctors

By Liz Seegert
Medical Economics, May 25, 2016

Health insurance is again in the political spotlight as Democratic presidential candidate Bernie Sanders promotes his version of single-payer that he calls “Medicare for all.” He says it will improve care, reduce administrative burdens and allow physicians to focus just on practicing medicine. Dissenters say it’s a pipe dream that will only lead to rationed care, lower reimbursement rates and long waiting lists.

Single payer is held up by supporters as the ideal egalitarian healthcare model. If other nations can provide expansive medical care for their citizens, they ask, why can’t the U.S.? Opponents disparage the idea as anti-choice; they predict the implosion of the healthcare system and demise of physician autonomy.

Could single payer be the boon to medical practice its supporters insist? Or would we end up with a system that limits care and ignores best practices in favor of the bottom line? Who’s right?

The short answer is, both sides are.

Continue reading…

http://medicaleconomics.modernmedicine.com/medical-economics/news/what-single-payer-healthcare-would-mean-doctors

Single payer essential to controlling health-care costs

By David Woods
The Philadelphia Inquirer, May 16, 2016

One hears these days mutterings by disaffected Americans that if Donald Trump becomes president, they will pack their bags and leave for Canada. One assumes, of course, that no wall will be built along the border to thwart their exit.

I made the reverse trip. Having emigrated from Britain to Canada, where I became the editor in chief of the Canadian Medical Association Journal, I opted to come to the United States in 1988 for personal reasons.

But I was also taken with American rugged individualism and a health-care system focused on market forces and competition. I wrote articles for the Economist Intelligence Unit and other periodicals on the wonders of the American system. In print, I debated longtime advocates of single-payer national health insurance, extolling the virtues of the health-care market that others abhorred.

Gradually, though, I too began to have doubts about market-driven health care. Over the 25 years that I’ve lived on the U.S. side of the border, I’ve come to the view that the American health-care system – which still leaves 11 percent of the population uninsured, despite the Affordable Care Act – is inferior to the health systems in Canada and the United Kingdom.

One of the ACA’s architects, Dr. Ezekiel Emanuel, describes the U.S. health system as a “terribly complex, blatantly unjust, outrageously expensive, grossly inefficient, error-prone system.” Unfortunately, that’s still true, six years after the ACA’s passage.

The reform didn’t address the fundamental problem in U.S. health care: It’s more about profit than patients.

Controlling health-care costs is essential to the long-term financial health of the United States. A single-payer system would make truly universal coverage affordable, costing no more than we already spend on health care. Of the $3.1 trillion the United States will spend on health care this year, 63 percent is taxpayer-financed, funding Medicare, Medicaid, and Veterans Affairs, along with private coverage for government employees and tax subsidies for employers.

Because of its fragmented, profit-driven system, the United States spends 18.1 percent of gross domestic product on health care, compared with about 8 percent in Britain and 11 percent in Canada. Much of U.S. health spending is simply wasted. For example, 25.3 percent of hospital expenditures go to administrative costs, compared with 12.4 percent in Canada, where there is a single payer in each province and hospitals are mainly funded on a global or lump-sum basis.

Canadians also save money by training a higher percentage of primary-care doctors relative to specialists, negotiating drug prices with pharmaceutical companies, and prohibiting drug companies from advertising directly to consumers. These measures would save Americans billions annually. Americans spend $1,010 per capita on pharmaceuticals; Swedes spend less than half that, according to the Organization for Economic Cooperation and Development. The reason? Sweden doesn’t pay the list price.

Lobbying and influence-peddling by the pharmaceutical and insurance industries keeps the United States from adopting a single-payer health system. Several presidential candidates this season seemed completely under their hypnotic sway. The private insurance industry brazenly tells me, now a U.S. voter, which doctors I can see, charges me astronomical premiums, not to mention co-pays and deductibles, and then wants me to believe that having publicly funded health care that would allow me to go to any doctor in the United States without a $5,000 deductible would be “socialism.”

And don’t believe the widely held U.S. notion that Canadians suffer long waits for care. That’s a canard. We are not going to cut U.S. health spending to Canadian levels. With our much higher level of spending, waits would not be an issue, even with the population aging. Japan and many countries in Europe already have higher percentages of elderly citizens than the graying of the baby boomers is projected to produce.

In his book “In Search of the Perfect Health System,” British economist Mark Britnell notes that the British love their single-payer National Health Service because of its fairness; it’s available to everyone. He even quotes a former U.K. finance minister who said that the NHS is the closest thing the English have to a religion. Their single-payer system keeps quality indexes up and costs down for the population at large. This enables the British to invest additional funds in education and economic stimulation, areas that also contribute to health and well-being.

The United States should take a lesson from the example of nations with single-payer systems. They offer a measure of hope and optimism that high-quality health care can be the right of all Americans, if they demand it.

David Woods is a former editor in chief of the Canadian Medical Association Journal. hmi3000@comcast.net

http://www.philly.com/philly/health/20160516_Commentary__Single-payer_essential_to_controlling_health-care_costs.html

Why American doctors are calling for Canadian-style medicare

At a time doctors to the south are looking to Canada for answers, we are at risk of losing the health advantage we have

By Karen Palmer
Toronto Star, May 15, 2016

In a dramatic show of physician support for deep health care reform in the U.S., more than 2,200 physician leaders have signed a “Physician’s Proposal” calling for sweeping change.

The proposal, published May 5 2016 in the American Journal of Public Health, calls for the creation of a publicly financed, single-payer, national health program to cover all Americans for all medically necessary care.

If that sounds familiar, it should. These American doctors are calling for Canadian-style medicare. They want a decisive break from the expensive and inefficient private insurance industry at the heart of the U.S. health care system.

How ironic that at the same time U.S. physicians are calling for a single-payer health system like ours, Canada is in the midst of a legal battle threatening to pave the way for a multi-payer system resembling what has failed Americans.

What’s at stake? A trial about to begin in British Columbia threatens to make the Canada Health Act unenforceable.

The Canada Health Act is federal legislation that guides our health care system. It strongly discourages private payment for medically necessary hospital and physician services covered under our publicly funded medicare plans. This includes out-of-pocket payments in the form of extra billing or other user charges. Legislation in most provinces further prohibits private insurance that duplicates what is already covered under provincial plans.

If patients are billed for medically necessary hospital and physician care, the federal government is mandated to withhold an equivalent amount from federal cash transfers to provinces or territories violating the Act.

At least that’s what supposed to happen.

Unfortunately, the last decade saw a proliferation of extra billing in several provinces, and few instances of government clawing back fiscal transfers. Perhaps, things will change. Health Minister Jane Philpott recently said the government will “absolutely uphold the Canada Health Act.”

In B.C.’s upcoming trial, the plaintiffs — including two for-profit investor-owned facilities, Cambie Surgery Centre and the Specialist Referral Clinic — are attempting to have the court strike down limits on private payment. They support the creation of a constitutionally protected right for physicians to bill patients, either out-of-pocket or through private insurance, for medically necessary care, while also billing the public plan.

In other words, the plaintiffs want to undo our elegantly simple single payer system for hospital and physician care, creating instead a multi-payer system like the U.S. If their constitutional challenge is successful, the door will swing wide open in BC — and across Canada — for insurers to sell what will amount to “private queue jumping insurance” for those who can afford it, potentially harming the rest of us who can’t.

The outcome of this trial could be that those who can pay for care would jump the queue, drawing doctors and other resources out of the public system. Those who can’t pay would likely wait longer. Rather than a solution for wait times, private payment in the Canadian context would make them worse.

Global evidence shows that private insurance does not reduce public system wait times. The Achilles heel of health care in several European countries, such as Sweden, has been long waiting times for diagnosis and treatment in several areas, despite some private insurance. After Australia introduced private insurance to save the government money, those with private insurance have faster access to elective surgery than those without. Divisions in equitable access to care is one of the biggest challenges now facing countries that have adopted multi-payer systems.

Multi-payer systems are administratively complex and expensive, explaining why the U.S. health insurance industry spends about 18 per cent of its health care dollars on billing and insurance-related administration for its many private plans, compared to just 2 per cent in Canada for our streamlined single payer insurance plans. Hospital administrative costs are lowest in Canada and Scotland — both single payer systems — and highest in the U.S., the Netherlands, and the U.K. — all multi-payer systems.

For all of its warts in how we deliver health care in Canada, the way in which we pay for care — a single public payer in each province or territory — avoids the high administrative costs of multi-payer systems.

Abundant evidence shows private insurance is at the root of what ails the U.S. system. Dr. Marcia Angell, co-author of the Physicians’ Proposal, Harvard Medical School faculty and former editor-in-chief of the New England Journal of Medicine, sums it up: “We can no longer afford to waste the vast resources we do on the administrative costs, executive salaries, and profiteering of the private insurance system.”

A Canadian-style single payer financing system would save the U.S. about $500 billion annually.

Meanwhile, in Canada, abandoning our single payer health care system for a U.S.-style multi-payer system would be the worst possible outcome for Canadians. Let’s hope the evidence convinces the judge. The trial begins in September.

Karen Palmer is an advisor with EvidenceNetwork.ca, a health policy analyst, and adjunct professor in the Faculty of Health Sciences at Simon Fraser University.

https://www.thestar.com/opinion/commentary/2016/05/15/why-american-doctors-are-calling-for-canadian-style-medicare.html

sdrawkcab reform

Sorry, We Don’t Take Obamacare

By Elisabeth Rosenthal
The New York Times, May 14, 2016

Amy Moses and her circle of self-employed small-business owners were supporters of President Obama and the Affordable Care Act. They bought policies on the newly created New York State exchange. But when they called doctors and hospitals in Manhattan to schedule appointments, they were dismayed to be turned away again and again with a common refrain: “We don’t take Obamacare,” the umbrella epithet for the hundreds of plans offered through the president’s signature health legislation.

“Anyone who is on these plans knows it’s a two-tiered system,” said Ms. Moses, describing the emotional sting of those words to a successful entrepreneur.

The goal of the Affordable Care Act, which took effect in 2013, was to provide insurance to tens of millions of uninsured or under-insured Americans, through online state and federal marketplaces offering an array of policies. By many measures, the law has been a success: The number of uninsured Americans has dropped by about half, with 20 million more people gaining coverage.

Yet even as many beneficiaries acknowledge that they might not have insurance today without the law, there remains a strong undercurrent of discontent. Though their insurance cards look the same as everyone else’s — with names like Liberty and Freedom from insurers like Anthem or United Health — the plans are often very different from those provided to most Americans by their employers. Many say they feel as if they have become second-class patients.

Some early studies of the impact of the Affordable Care Act plans are proving patients’ grumbling justified: Compared with the insurance that companies offer their employees, plans provide less coverage away from patients’ home states, require higher patient outlays for medicines and include a more limited number of doctors and hospitals, referred to as a narrow network policy. And while employers tend to offer their workers at least one plan that allows them coverage to visit doctors not in their network, patients buying insurance through A.C.A. exchanges in some states do not have that option, even if they’re willing to pay higher premiums.

The research thus far suggests that the differences between plans offered through the A.C.A. and those offered by employers may be quite significant. A study in the policy journal Health Affairs found that out-of-pocket prescription costs were twice as high in a typical silver plan — the most popular choice — as they were in the average employer offering. In research conducted with the Robert Wood Johnson Foundation, Dr. Polsky found that 41 percent of silver plans offered a “narrow or very narrow” selection of doctors, meaning at best 25 percent of physicians in an area were included. The consulting firm Avalere Health found that exchange plans had 42 percent fewer cancer and cardiac specialists, compared with employer-provided coverage.

When designing the new plans, for-profit insurers naturally tended to exclude high-cost, high-end hospitals with whom they had little clout to negotiate discounts. That means, for example, that as of late last year none of the plans available in New York had Memorial Sloan Kettering Cancer Center in their network — an absence that would be unacceptable to many New York-based employers buying policies for their employees.

And when Simon F. Haeder of the University of Wisconsin and his colleagues studied the plans sold on the California exchange, they found that they included 34 percent fewer hospitals than those sold on the open market and tended to exclude the priciest medical centers, like Cedars Sinai, a highly regarded hospital that runs the largest heart-transplant program in the country.

http://www.nytimes.com/2016/05/15/sunday-review/sorry-we-dont-take-obamacare.html

***

Special Enrollment Periods for the Health Insurance Marketplace

CMS.gov, May 6, 2016

Special Enrollment Periods

While SEPs provide a critical pathway to coverage for qualified individuals who experience qualifying events and need to enroll in or change qualified health plans (QHPs) outside of the annual open enrollment period, it’s equally important to avoid SEPs being misused or abused.  As it announced today, HHS is tightening the rules for certain special enrollment periods and making clear that SEPs are only available in six defined and limited types of circumstances.

An Interim Final Rule with Comment (IFC) published in the Federal Register provides that individuals requesting a “permanent move” SEP must have minimum essential coverage for one or more days in the 60 days preceding the permanent move, unless they were living outside of the United States or in a United State territory prior to the permanent move. This ensures that individuals are not moving for the sole purpose of obtaining health coverage outside of the open enrollment period.

https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-05-06.html

When explaining that health care reform seems to be moving backwards, does it improve communication to discuss reform that is sdrawkcab (ananym of backwards)?

NYT’s Elisabeth Rosenthal has provided us with another great article that describes how some of the supposedly forward advances in reform are really backwards. The ACA exchange plans are undoing some of the financial protection that health insurance should afford us, while impairing access through narrower provider networks. If we said that this reform is sdrawkcab, would that help us understand it better?

As small business owner Amy Moses stated, “Anyone who is on these plans knows it’s a two-tiered system.” Does it not seem absurd that the policies inherent in ACA would place a business owner in the lower tier of a two-tiered system? Isn’t that sdrawkcab? Yes and no. Actually what is sdrawkcab is that we would even have tiers in our health care system when it would be much more efficient, more equitable, and more effective to have a single high level system for everyone – an improved Medicare for all.

A specific example of the wrong direction in which too much of our policy is headed is provided by the new CMS rule that describes yet another technical reason to prohibit individuals from obtaining coverage through special enrollment periods. Although health reform supposedly was designed to expand access to insurance plans, this rule is sdrawkcab in that it prohibits access for certain uninsured individuals. True, the rule was designed to protect insurers from individuals who might have an acute need for coverage outside of the open enrollment period, but the entire system should have been designed to automatically enroll everyone instead of ignoring individual needs while providing insurers with their optimal business model.

No more sdrawkcab reform. Everybody in, nobody out!

The elephant in the room: health care’s inaccessibility

By Paul Redstone, M.D.
Clinical Psychiatry News, May 14, 2016

As I read the array of articles in medical newspapers and on websites, I am intrigued by various reports about medications, such as the article, “Antidepressants tied to lower dementia mortality.” This and other articles about new therapeutic approaches involving medications are useful and interesting. However, what is lacking in this coverage of health care are articles about the “elephant in the room.” That elephant is the sadly deficient state of health care availability for vast numbers of the population who might, in fact, benefit from these treatments. This problem obviously is not unique to psychiatry; I am sure this could be said for all branches of medicine.

I have been working for many years in the Medicaid/Medicare inner city sector of society and am continually appalled by the lack of support available to the people I serve. I am not talking about the problem of availability and access to doctors – which is another important issue. I am talking about people who “drop out” of treatment for 6 months or more because, as they have said: “I had trouble with my insurance changing!” or “They sent me a letter, and I didn’t know what it was for and discovered by not replying I lost my coverage,” and on and on.

Then there are those who confess that they didn’t fill the prescription “last month” or for several months because they could not afford the copay. Yes, that $3-$7 required copay added to other health medications plus food and shelter needs simply did not exist! And on and on go the stories. I am not talking about Ronald Reagan’s imaginary welfare queens or drug users who are diverting money elsewhere. These are people who might or might not even be on welfare. Contrary to myth, many people on Medicaid actually work but are still unable to earn enough money for food and rent, much less prescription copays.

In addition to this glaring deficiency in medicine as a whole, has anyone noticed the deafening silence regarding dental care? If we think about what we are trying to treat, how does giving an antidepressant serve the person with chronic dental problems, or the person who is reluctant to smile because of being self-conscious about not having dentures? How does the antidepressant help that patient? The field of psychiatry constantly includes discussions about addressing problems in the context of the whole individual. Does that not include the mouth? I am amazed that there is not more public discussion by psychiatrists and other physicians about this unconscionable state of affairs. We keep discovering new drugs and treatments, but so what if it is only for a select few?

Our publications and organizations like the American Psychiatric Association and the American Medical Association need to be producing blazing headlines about this terrible state of affairs. As physicians, we are in the business of helping people by treating and hopefully alleviating suffering. It shouldn’t be our problem to figure out how our patients can pay for this treatment. But if they can’t pay for it, what good is our training, intention, or business?

If our patients cannot reliably afford the treatments we prescribe, it seems our only choice as physicians is to become politically vocal: So when will we all unite to insist on accessible health care (including dental) for all? The article published within the past few days in the American Journal of Public Health from 2,000 doctors supporting a single-payer health care system is a wonderful start. I am sure that more than 2,000 doctors would agree. However, it is only a start! And if you object to the sound of “single payer,” that is fine as long as we create a situation in which there is a health care system that effectively provides truly comprehensive access for all.

Dr. Redstone is a psychiatrist who practices in Springfield, Mass.

PNHP note: This opinion piece was originally published under the title “The elephant in the room: Health care for the working poor.”

http://www.clinicalpsychiatrynews.com/views/single-view/the-elephant-in-the-room-health-care-for-the-working-poor/bbbf597e0f4398c5fe92bccc19265283.html

Doctors’ single-payer prescription for health care reform

By Steffie Woolhandler & David U. Himmelstein
The Hill, Congress Blog, May 12, 2016

Many months before Bernie Sanders entered the presidential race, we (along with Dr. Adam Gaffney, an energetic younger colleague, and Dr. Marcia Angell, the former editor of the New England Journal of Medicine) convened a nonpartisan group of 39 leading physicians to envision health care reforms that would fix the glaring problems that remain despite the Affordable Care Act (ACA).

After the Supreme Court removed the final roadblock to the law in 2015, President Obama declared that at last “in America, health care is not a privilege for a few, but a right for all.” Yet doctors on the ground knew that wasn’t entirely true. We continue to see patients who dangerously delay their care because of cost concerns or insurance obstacles.

At least 27 million Americans remain uninsured, and for tens of millions with insurance, sky-high copayments and deductibles (which average $5,300 in the bronze plans sold on the ACA exchanges) mean they’d be bankrupted by a serious illness. Many more people have narrow network coverage that won’t pay for care at top cancer centers or academic hospitals.

Meanwhile, giant insurers and hospital conglomerates with a single-minded focus on their bottom line increasingly dominate health care. And doctors and nurses contend with insurers’ growing demands for mind-numbing electronic documentation. These trends predated the ACA, but the law accelerated them. The ACA has also fueled medical merger-mania and the health system’s administrative complexity and cost.

The alternative we and our colleagues developed (which has now been endorsed by 2,227 other physician colleagues) appears in the current issue of the American Journal of Public Health. It calls for radical change: a single-payer national health program, essentially an expanded and improved version of Medicare for all, much along the lines that Bernie Sanders has advocated.

The single-payer plan we propose would cover everyone for all medically necessary care – including dental care, prescription drugs and long-term care – without copayments or deductibles. In contrast to private insurers’ narrow networks that restrict patients’ choice of doctors and hospitals, the single payer would cover care from any doctor or hospital.

Our nation can readily afford such expanded and improved coverage if we replace the current wasteful patchwork of insurers with a streamlined single-payer system. At present, private insurers’ take 12.3 percent of total premiums for their overhead; only 88 cents of every premium dollar ever reaches a doctor, hospital or pharmacy. And insurers inflict massive paperwork on doctors and hospitals, which spend about one-quarter of their revenues on billing and administration.

In contrast, insurance overhead is only 1.8 percent in Canada’s single-payer system, about the same overhead as in our Medicare program. And Canadian hospitals have administrative costs less than half those of their U.S. counterparts. That’s because Canadian hospitals are paid annual global budgets, like U.S. fire departments, instead of billing separately for each Band-Aid and aspirin tablet. Billing is also simple and inexpensive for Canadian physicians.

Overall, a single payer would save about $500 billion annually by trimming administrative spending to Canadian levels. Moreover, as in other nations, the single payer could use its purchasing power to lower drug prices, saving tens of billions more each year. These savings could fully cover the new costs of the coverage expansions we propose, a conclusion in keeping with past estimates by the Government Accountability Office, the Congressional Budget Office, and private consulting groups (including one that’s owned by an insurance company).

Contrary claims, including those contained in a report published by the Urban Institute this week, are fraught with flawed assumptions and grossly underestimate the savings a single-payer system would assure.

We and our colleagues recognize that, despite widespread public support for Medicare for all, passage of our proposal is unlikely absent sweeping changes in the makeup of Congress. But the same can be said about any salutary health reform; Congress has resisted even modest tweaks to the ACA.

Yet as physicians we feel obliged to offer our best advice. Our health care crisis can be solved. We have the resources needed to provide excellent care for all Americans; an abundance of hospitals and sophisticated equipment; superbly trained doctors and nurses; prodigious research output; and generous health care funding. Yet only thoroughgoing single-payer reform can realize the healing potential that is currently thwarted by our dysfunctional health care financing system.

The authors are internists who teach at the City University of New York at Hunter College and Harvard Medical School. They co-founded Physicians for a National Health Program, a nonpartisan organization that advocates single-payer reform.

http://thehill.com/blogs/congress-blog/healthcare/279508-doctors-single-payer-prescription-for-health-care-reform

PNHP note: This article, with many hyperlinks included, was also published at The Huffington Post on May 18.