PNHP

Medicare and Medicaid have worked wonders, but we need true national health insurance for everyone

Medicare and Medicaid have worked wonders, but we need true national health insurance for everyone

By Walter Tsou, M.D.
Philadelphia Inquirer, July 30, 2015

By the early ’60s, America was in the throes of the civil rights movement led by its charismatic leader, Rev. Martin Luther King. Discrimination and Jim Crow laws applied not only to bus rides and dining rooms but also to hospital wings and doctors’ waiting rooms, which often had separate curtains for blacks and whites. As it turned out, separate but equal was a failure not only in education, but in health care, too. Well before we started to measure health disparities, it was well known that minorities suffered far worse health outcomes.  

But nothing shook the nation quite like the assassination of John F. Kennedy in 1963. With the overwhelming mandate of completing Kennedy’s unfinished agenda, President Johnson signed the Civil Rights Act in 1964 and the laws creating Medicare and Medicaid in 1965. Led by Wilbur Cohen, who had been the Assistant Secretary of Legislation in the Department of Health, Education and Welfare (HEW) under Kennedy and later Secretary of that department under Johnson, the architects of these laws saw them as a first step toward true national health insurance. To those who created Medicare and Medicaid, national health insurance would not only be a way to end separate but equal in waiting rooms, but also to establish health care as a right of all Americans.

But there was strong opposition by southern legislators as well as many physicians and private insurers. As a result, Congress settled for health insurance only for the elderly (Medicare) and for the very poor who were aged, blind, or disabled (Medicaid). Because Medicare was designed as a companion program to Social Security, 20 million seniors were auto-enrolled in 1965 in one year. (Compare that to the disastrous enrollment problems in October 2014 with the ACA with its complex eligibility rules.)

Fifty years later, Medicare and Medicaid have proven themselves as the most successful health programs in American history. They have given hundreds of millions of Americans access to care and have allowed tens of millions of them to avoid bankruptcy due to medical debt. Equally important, Medicare ended physical separation by race in doctors’ waiting rooms in most of the South, although much provider racial discrimination still persists. 

Unfortunately, the failure to enact true national health insurance for everyone has led to our current patchwork health care financing system that is unimaginably complex, bureaucratic, and inefficient. The system continues to base access to health care on employment, income, and disease category, which indirectly reflect race. Even today, the black infant mortality rate in the United States overall, as well as in Philadelphia, is more than twice the rate for whites. 

Money wasted determining eligibility for coverage could be used to cover everyone. The amount of money wasted on administration in the United States is more than 40% higher per capita than in any other country in the world. It is more than enough to fully fund our schools, build bridges, and address other public priorities.

Wilbur Cohen, while defeated in his goal of achieving national health insurance for everyone, said that he believed in the “salami” approach — getting one slice at a time until there were enough of the pieces together to cover everyone. Fifty years later, it is time to make his dream a reality.

Dr. Walter Tsou is former Commissioner of the Department of Public Health for the City of Philadelphia and past president of the American Public Health Association.  He is currently Adjunct Professor of Family and Community Health at the University of Pennsylvania.

http://www.philly.com/philly/blogs/fieldclinic/Medicare-turns-50–top-health-officials-reflect-on-its-past-and-future.html#J1pIkBQVfijbsYaX.99

Medicare at 50

By Karen Green Stone
WFIU Radio, Indiana Public Media, July 30, 2015

Note: An audio version of this article is available here.

Since Medicare was signed into law fifty years ago today, everyone 65 or over is eligible, regardless of health status or income.

The results have been quite remarkable.

Before Medicare, many of our elders could not afford hospitalization or doctor visits. Our grandparents truly suffered, going without treatment, or depended on their families. Medicare successfully lifted millions of Americans out of poverty and dramatically increased life expectancy. (1)

Medicare totally transformed US healthcare by requiring that segregated hospitals serve all seniors in order to receive reimbursement from Medicare funds, integrating 1,000 hospitals. (2)

Medicare has problems that need to be addressed, but it’s not what many people think. People ask, isn’t Medicare going broke? The answer is no according to the Medicare Trustees. (3)

The problems with Medicare involve privatizing the system with Medicare Part C, the Medicare Advantage plans and Medicare Part D, prescription drugs.

Medicare Part C pays private insurance companies significantly more than traditional Medicare for Medicare Advantage plans. That’s your tax dollars going directly to Big Insurance. (4)

Medicare Part D prohibits Medicare from negotiating drug prices. Despite its size, Medicare is not allowed to “interfere with the negotiations between drug manufacturers and pharmacies and [Part D plan] sponsors”. In comparison to other U.S. government programs such as Medicaid and the VA, significantly higher prices are paid by Medicare Part D. (5)

Medicare is under pressure. There are those who want to privatize Medicare for investor profits and eviscerate a powerful safety net for seniors. (6)

Medicare needs our protection. It needs to be improved and it needs to expand.

Medicare was always intended to be extended to everyone. By establishing a good program that worked for people over 65, It would become the foundation for a national program. (7)

Seniors have benefited from Medicare for 50 years. It’s time for everyone to benefit from a national health program, Medicare for all.

Notes

  1. http://kff.org/medicare/video/the-story-of-medicare-a-timeline/
  2. “The Federal Government’s Use of Title VI and Medicare to Racially Integrate Hospitals in the United States, 1963 Through 1967,” by P. Preston Reynolds, MD, PhD.
  3. Medicare Trustees Report (Premiums covered in Appendix E)
  4. http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2009/May/1265_Biles_Extra_Payments_54_v2.pdf
  5. http://carleton.ca/sppa/wp-content/uploads/Mirror-Mirror-Medicare-Part-D-Released.pdf
  6. http://www.modernhealthcare.com/article/20150318/BLOG/303189965
  7. Ted Marmor, The Politics of Medicare.

http://indianapublicmedia.org/speakyourmind/medicare-50/

Happy 50th Birthday, Medicare

Expanding System for All Would Eliminate Health Care Rationing

By Robert Weissman
The Huffington Post, July 30, 2015

During the debate leading up to passage of the Affordable Care Act, members of Congress thundered against the prospect of health care rationing.

Well, for reasons largely unrelated to Obamacare, we have health care rationing. Indeed, it’s one of the defining features of our private insurer-controlled health care system.

The people who shed crocodile tears about health care rationing five years ago don’t talk about the rationing that we have now (and had then), but they were right to be outraged. We should all be outraged that, in the richest country on the planet, people are denied needed care on the basis of wealth and income.

We should be outraged because it doesn’t have to be so. Today marks the 50th anniversary of Medicare, a system that has made health coverage universal for everyone over 65 and — at least to the extent it has not been eroded through partial privatization — shows the way forward to eliminating rationing.

As President Barack Obama has said, there is one way to ensure that every American has a guaranteed right to health care: A single-payer system. That’s a system in which the private insurers are replaced by a single government insurance program and everyone automatically is covered. As we celebrate today the remarkable achievements of Medicare, we must also commit to defend the system from attack, repair the damage done through partial privatization and expand it to cover all Americans.

How does the current system enforce rationing?

First, although the Affordable Care Act has expanded insurance coverage, tens of millions remain uncovered. The Affordable Care Act has reduced the number of uninsured by roughly a third and may ultimately drop it by half – but roughly 13 percent of the population now remains uncovered. The uninsured don’t get the care they need, plain and simple, leading to tens of thousands of preventable deaths.

Second, there is substantial rationing even among the insured. There is the infuriating issue of insurers overriding doctor decisions to determine what care may be provided. And there is the sharply rising problem of large co-pays and deductibles deterring people from seeking care. Crucially, this is by design — the co-pays and cost-sharing schemes are designed exactly to reduce access to care, and this is a significant part of the insurers’ approach to (artificially) reduce health care spending.

In total, almost one in four Americans report not visiting a doctor or clinic for a health problem due to financial concerns, according to a Commonwealth Fund study. Nineteen percent of Americans did not fill their prescriptions for financial reasons in 2014, according to the Commonwealth Fund study.

Third, the lack of a single-payer program enables all kinds of profiteering and irrational care decisions. The pharmaceutical sector is Exhibit One. Consider the case of Medicare itself. Medicare Part D, which provides drug coverage to seniors, is operated through private firms, and by statute is prohibited from functioning as a rational single payer — that is, Medicare is prohibited from negotiating drug prices. Even within the constraints of the patent monopoly system, this leads to massive overspending. A just released study from Carleton University and Public Citizen shows that Medicare brand-name drug prices are 198 percent of the median cost in OECD (rich) countries. If Medicare merely matched the discounts negotiated by the Veterans Administration, it would save $16 billion a year.

Or consider the example of Hepatitis C drugs. A new crop of breakthrough drugs promises a cure to a widespread, chronic, life-threatening disease. More than 3 million people in the United States have the disease, perhaps closer to 5 million. The makers of these new drugs, Gilead and Merck, are marketing them for $80,000 – $90,000 per person. The direct result is that public and private payers are coming up with methods to ration access to these lifesaving drugs, making them available only to people who are quite sick and meet a long list of eligibility criteria. If we had a well-functioning single-payer system, it would insist on some more reasonable price and compensation for the drug makers (they stand to generate well over than $100 billion in revenue, even accounting for the discounts they are providing) and make sure everyone who needed the treatment received it, expeditiously.

Of course, while pharmaceuticals might be Exhibit One for the irrationality and misallocated spending in the current system, it’s not the only one. We don’t take prevention and public health seriously. Evidence-based care remains an aspiration. And on and on.

What today’s Medicare anniversary should teach us is that we can do better. It’s past time for our nation to move to an Expanded and Improved Medicare-for-All. Join the movement.

Robert Weissman is president of Public Citizen.

http://www.huffingtonpost.com/robert-weissman/happy-50th-birthday-medic_b_7904588.html

Medicare at Age 50: Building on Its Success

By Nancy Altman
Huffington Post, July 30, 2015

Medicare — signed into law fifty years ago, on July 30, 1965 — was supposed to be just the first step.

For the fifty years before Medicare’s enactment, progressives had fought unsuccessfully for universal, government-provided health insurance. In 1912, President Theodore Roosevelt’s Progressive Party platform advocated universal, government-sponsored, health insurance, but he was defeated in his quest for another term as president. In 1917, the California legislature approved universal health insurance, and the governor supported it, but a 1918 ballot resolution defeated the measure after a massive, well-financed business and physician-fueled campaign against it. President Franklin Roosevelt seriously considered including national health insurance in his 1935 Social Security legislation, but decided against it out of fear that it would bring down the entire legislative package. President Harry Truman made universal health insurance a top priority, but got nowhere.

The five-decade long history of defeat convinced activists to shift to an incremental approach. They decided to start with a sympathetic group and debated which one that should be. The top candidates were seniors and children. On the one hand, covering children was relatively inexpensive and could lead to a lifetime of better health. On the other hand, seniors were most in need of health insurance and were already used to and supportive of Social Security’s government-sponsored wage insurance. And they voted.

So the decision was made to start with them. The expectation was that, after Medicare was enacted, children and others would be quickly added. And, indeed, just seven years later, in 1972, President Richard Nixon signed into law legislation which extended Medicare to people with serious and permanent disabilities.

But then came Watergate, distrust of government, and President Ronald Reagan’s famous declaration, “Government is not the solution to our problem; government is the problem.” Expansion of Medicare to children or other demographic groups disappeared from the public agenda. But the need for universal high-quality health care, efficiently provided, did not.

Conservatives and centrist Democrats, increasingly in control, looked for alternative approaches. Inclined toward private sector solutions but recognizing that some limited government role was essential, they favored private sector health insurance and savings supported by favorable tax treatment. For those who fell through the cracks and who were deemed worthy, they favored means-tested health insurance provided at the state level, with federal support.

Those are the solutions that have dominated since 1972, despite the obvious advantages of simply expanding Medicare. Means-tested Medicaid, included in the same 1965 legislation that enacted Medicare, was expanded every few years, most recently as part of the Affordable Care Act in 2010. The means-tested State Children’s Health Insurance Program (CHIP) was enacted in 1997. And, the Affordable Care Act authorized state exchanges offering private health insurance subsidized with income-tested, government subsidies. During these decades, the tax expenditure on health care insurance grew from the fourth largest tax expenditure in 1986 to the largest today — at a loss of revenue of over $200 billion a year. And during this same period, conservatives amended Medicare to include private health insurance and means-tested elements.

But these methods of providing health insurance are vastly inferior to universal, government-sponsored health insurance — essentially, Medicare for All. Universal, government-sponsored insurance is the most effective and efficient way to cover everyone. Insurance is least expensive when it covers the most people; the large size of government-sponsored health insurance provides economies of scale and the greatest ability to negotiate over prices and control costs. Moreover, unlike private health insurance, a government plan has no marketing costs and no high CEO salaries. It can provide health care less expensively and more efficiently for everyone. For these reasons, every other industrialized country provides universal coverage, spends less as a percentage of GDP, and produces better health outcomes.

But we don’t have to look to other countries to see the advantages. Medicare covers seniors and people with disabilities, people who, on average, have the worst health and the most expensive medical conditions, requiring the largest numbers of doctor and hospital visits with the concomitant largest number of health care claims. Yet, Medicare’s administrative costs are the lowest around. Medicaid, whose administrative costs vary from state to state, is less efficient than Medicare, because its coverage is statewide, not national, and it must impose complicated and expensive means testing, Even with that, both Medicare and Medicaid are significantly more efficient than private health insurance. Compared to Medicare’s administrative costs of just 1.4 percent, the administrative costs of private health insurance sponsored by very small firms or purchased by individuals can run as high as 30 percent. Even the administrative costs of health insurance sponsored by large companies typically run around 7 percent.

As a stark illustration of the greater efficiency and effectiveness of Medicare, a proposal floated a few years ago to raise Medicare’s initial age of eligibility from 65 to 67 — requiring people to wait two additional years before they could enroll in Medicare — would have resulted in increased health care costs for the nation as a whole of $5.7 billion a year and increased premium costs for both Medicare and all other health insurance of about 3 percent. Just as shrinking Medicare’s coverage increases costs, expanding coverage would reduce overall health care costs

Imagine if President Bill Clinton in 1993 and President Barack Obama in 2009 had followed the direction of the architects of Medicare, a half century ago. Imagine if they had proposed incremental expansions of Medicare, including lowering the Medicare age to 62 or 55, creating a counterpart universal, government-sponsored Medikidsprogram, covering under Medicare people with pre-existing conditions, and providing all Americans the option of buying into Medicare. We likely would be on our way to Medicare for All, with all of its advantages. We likely would be forecasting long-termsurpluses in our federal budget, with all that would mean for greater spending on other pressing needs. Our businesses would be much more competitive. And we would join other nations in recognizing health care as a human right.

But it is not too late.

This upcoming presidential election could be a powerful defining moment. It could get us back on track to realizing the vision of the architects of Medicare a half century ago. Presidential candidate and Senator Bernie Sanders (I-VT) believes in Medicare for All, as well as expansion of Social Security. In contrast, Governor Jeb Bush is calling for the phasing out of Medicare and wants to cut Social Security. If each Party’s platform reflects these views, the American people will have a clear choice.

I see no better way to celebrate Medicare reaching its fiftieth anniversary than to expand Medicare. If we follow the lead of those visionary architects fifty years ago, those who come after us will inherit a nation where affordable, first class health insurance — Medicare for All — is a birthright.

http://www.huffingtonpost.com/nancy-altman/medicare-at-age-50-buildi_b_7902540.html

Why not Medicare for all?

Local physician talks about the government program’s success on its 50th anniversary

By David Potter, M.D.
Chico (Calif.) News & Review, July 30, 2015

What computer were you using in 1966? Trick question. We didn’t have personal computers back then. Remarkably, during that year, without computers and 11 months after the Medicare bill became law, the government began paying medical bills for 18.9 million seniors.

Medicare turns 50 years old today (July 30) and its benefits to public health have been profound. In 1962, 48 percent of elderly Americans lacked health insurance and often had to forgo necessary treatment. Now, only 2 percent of the elderly lack health insurance. Between 1965 and 1984, life expectancy for 65-year-old Americans improved by 15 percent.

Having universal health insurance is also good for our financial health. The poverty rate for senior citizens was 29 percent in 1965 and it’s only 9 percent today. Meanwhile, for people without Medicare, medical bills are the most common cause of personal bankruptcy in the United States.

When asked, Medicare beneficiaries like Medicare. And it is quite efficient for a government program. Administrative overhead at Medicare is 3 percent, while private insurance companies are said to be five to nine times more expensive.

Of course, Medicare doesn’t cover most of us before we reach the age of 65. Recently, Dr. Linda Fried, dean of Columbia University’s Mailman School of Public Health, made a strong argument for extending Medicare to a younger age group with an emphasis on preventative medicine. The core of her argument is that people who arrive at 65 in better health are more likely to stay healthy with better quality of life and lower health care costs after age 65.

Many of us, including thousands of doctors and a majority of Americans in one poll, favor extending Medicare to Americans of all ages. This would be a fair and efficient way to provide the universal health care coverage that prevails in most of the other industrialized countries in the world. Many of those countries spend less on health care and get better health statistics than we do.

The program has evolved and improved along the way, adding home health services, hospice care and prescription drug coverage, just to name a few innovations. And other improvements may be necessary.

Politicians talk about cutting or privatizing Medicare, but I see no reason to jeopardize a program that is this popular, efficient and effective. Medicare needs to be preserved and, where necessary, improved.

As we celebrate Medicare’s 50th birthday this month, we should ask ourselves this: Why not Medicare for all?

Dr. David Potter resides in Chico.

https://www.newsreview.com/chico/why-not-medicare-for-all/content?oid=17761291

Wishing Happy Birthday to Medicare, Communities Demand Healthcare for All

In nationwide rallies and creative actions, proponents of universal healthcare mobilize to defend—and expand—public program

By Sarah Lazare
Common Dreams, July 30, 2015

From Hawaii to Florida to Maine, communities in 25 cities across the United States are staging rallies, picnics, and flash mobs this week to celebrate Thursday’s 50th anniversary of Medicare—and call for its expansion into a system that provides publicly-funded healthcare for all.

“It is urgent that we continue organizing for the right to healthcare by fighting efforts to roll back or privatize Medicare and joining with movements around the country to establish a publicly-financed healthcare system that includes all people,” Ellen Schwartz, president of the Vermont Workers’ Center, told Common Dreams.

The nationwide actions marking President Lyndon B. Johnson’s July 30, 1965, signing of the bill that created Medicare were organized by a broad array of organizations including Physicians for a National Health Program, Alliance for Retired Americans, National Nurses United (NNU), and Public Citizen.

They also include high-profile supporters, among them 2016 presidential hopeful Sen. Bernie Sanders (I-Vt.), who spoke at a Washington, D.C. rally on Thursday morning. “Healthcare is a right for all people, not a privilege,” Sanders told a cheering crowd.

The nationwide actions come at a time of dramatic consolidation in the health insurance industry, giving way to monopolies that critics charge reveal the shortcomings of the Affordable Care Act’s for-profit model. Meanwhile, Medicare faces a fresh flurry of attacks from the right, as conservatives call for cuts and privatization, despite the program’s broad popularity.

“Medicare came into existence after years of struggle to provide health access for the elderly in the U.S., and ensures that older folks are not left to the whims of the insurance industry and denied coverage due to ‘high risk,'” said Schwartz.

The coordinated protests also come amid the growing movement for Black lives that is taking on institutional racism—and demanding changes to political and economic systems that consign people of color to premature deaths.

In 2010, life expectancy for Black people in America was nearly four years lower than for the white population. A 2013 study finds that Black and Latino people in the United States are far less likely than their white counterparts to have health insurance.

Dr. Claudia Fegan, executive medical director for the Cook County, Illinois Health and Hospitals System and past president of Physicians for a National Health Program, told Common Dreams that efforts to defend Medicare, and fighting for universal health care, are critical to the struggle for racial justice.

“One of the most profound but under-appreciated contributions of Medicare to the well-being of our society has been its role in reducing racial disparities in healthcare,” said Fegan. “As soon as it was enacted, Medicare began to close the gap between Black and White Americans aged 65 and older in access to care and in medical outcomes.”

“Similarly, one of the most compelling reasons for establishing an improved Medicare for all today is to fulfill the unfinished task of achieving equality in healthcare,” Fegan continued. “That is, achieving an equitable health system that provides high-quality healthcare to all, regardless of race or socioeconomic status.”

Proponents of universal healthcare say now is a critical time for people to mobilize and demand this fundamental human right.

“Schemes to privatize or erode Medicare would be devastating for many, many people,” said NNU co-president and registered nurse Jean Ross, in a statement released earlier this month. “The best way to protect Medicare is to upgrade it and expand it to cover everyone. It is time for this country to catch up with other nations and implement a universal system of guaranteed healthcare.”

Updates and commentary on Medicare’s 50th anniversary are being posted to Twitter at #Medicare4all.

Sarah Lazare is a staff writer at Common Dreams.

This work is licensed under a Creative Commons Attribution-Share Alike 3.0 License.

http://commondreams.org/news/2015/07/30/wishing-happy-birthday-medicare-communities-demand-healthcare-all

Health care at the stroke of a pen: 50 years on, Medicare is a model

By Augie Lindmark, M2
MinnPost (Minneapolis), July 30, 2015

On July 30, 1965, President Lyndon B. Johnson carried a considerable number of pens with him when he visited the Harry S. Truman Presidential Library in Independence, Missouri. The occasion for his visit was monumental: He was about to sign into law H.R. 6675 — known to many as the Medicare bill.

President Harry Truman also attended the signing ceremony, and, although it was he who pioneered the practice of using multiple pens to sign legislation, that was not the reason for his presence.

Truman was there because in 1945, as president, he had pushed for the creation of a national health plan that would cover all Americans. Even though he failed to achieve that goal — thanks in part to the American Medical Association’s forceful opposition — his commitment to universal care had never wavered.

‘The real daddy of Medicare’

After Johnson inked his signature to the Medicare bill, he turned to Truman, who sat nearby, and presented him with the first Medicare card.

“President Truman, perhaps you alone can fully know just how grateful I am for this day,” Johnson said. “We haven’t forgotten who is the real daddy of Medicare.”

The moment couldn’t have been sweeter: Truman’s hope for a national health plan was partially fulfilled and health security for the nation’s elderly was finally in place.

One week after the bill’s passage, 1 million people had enrolled in Medicare. After 11 months, some 19 million had enrolled — 99 percent of those eligible. Today, 55 million Americans (ages 65 and older, as well as younger people with permanent disabilities) enjoy health security and stability under this law. 

Poverty rate among elderly dropped by half

Besides making health care accessible to millions, Medicare has also been a critical step in addressing poverty. By 1975, one decade after Medicare passed, the rate of elderly living in poverty had dropped by half. Yes — half.

July 30 marks the 50th anniversary of Medicare, a cornerstone of President Johnson’s sweeping social reforms which included The Civil Rights Act of 1964 (that bill was said to have been signed with more than 70 pens.) Yet the current state of America’s health care is ambiguous and far from celebratory. Our health system is known for groundbreaking research and an eclectic array of technological advancements, but it is not known for its accessibility, affordability or equity. Just ask the 700,000 Americans annually bankrupted by medical bills.

The United States spends 17 percent of its GDP on health, the highest of any nation, and over $8,000 per capita on health care, also the highest. But our health outcomes are mediocre: We are ranked 48th in life expectancy; 29th in infant mortality; and among industrialized nations we are 19th out of 19 in preventable deaths, according to the Commonwealth Fund.

The ACA isn’t enough

The Affordable Care Act, while making some improvements around the edges of our health system, will still leave 23 million to 30 million people uninsured in 2025. It keeps wasteful middlemen — the private insurers — in the driver’s seat. Millions more remain underinsured. The ACA is not enough.

This is where Medicare can help point the way. Improvements to Medicare are essential to prepare for an aging demographic and rising health care costs. But we should embrace Medicare as a proven model of reform and expand the program to cover everyone in the country.

An efficient program, Medicare pancakes administrative costs (in other words, non-medical spending) and functions with a 2 percent overhead — compared to its private insurance counterparts at 12-14 percent. As for growth in costs, Medicare is currently projected at 4 percent annually, well below that of private insurance options.

A more robust Medicare, similar to other industrialized nations, would move toward the “Great Society” that President Johnson envisioned — an America with streamlined access to quality health care, free of fear from financial ruin.

There’s a provision in the ACA, Section 1332, which would allow states like Minnesota to revamp their health system in 2017, as long as the changes cost less and cover at least the number currently insured. The proposed “Minnesota Health Plan” would achieve these benchmarks, and the average family and business would save on health care expenditures with something similar to an improved and expanded Medicare for all.

And when that bill is signed, everyone in Minnesota should receive a pen.

Augie Lindmark is a medical student at the University of Minnesota Medical School, Duluth campus. He currently is an intern with Physicians for a National Health Program (PNHP) in St. Paul.

http://www.minnpost.com/community-voices/2015/07/health-care-stroke-pen-50-years-medicare-model

As Medicare turns 50, it’s time to expand it

By James C. Mitchiner, M.D.
Detroit Free Press, July 25, 2015

This week marks the 50th anniversary of Medicare and Medicaid.

When President Lyndon B. Johnson signed them into law on July 30, 1965, only 56% of Americans 65 years or older were insured, and many were in poverty. Medical and hospital care provided to seniors was often given as charity. Older Americans generally suffered with poor health, and health care disparities were the norm, particularly in the South, where hospitals remained segregated.

After Medicare was enacted, hospitalizations and physician visits increased, access to outpatient services expanded, self-reported health status among beneficiaries improved, and poverty among seniors decreased.

On the whole, Medicare has been wildly successful in achieving its goals of expanding access to care and protecting the elderly and disabled from the financial hardship of health care costs. And with administrative costs of only 3% of program expenditures, Medicare is more efficient than any private health insurance program. In fact, Medicare is a model for comprehensive and universal health care. We should support Rep. John Conyers’ bill (House Resolution 676) that would expand and improve Medicare — and provide it to everyone.

Dr. James C. Mitchiner resides in Ann Arbor. 

http://www.freep.com/story/opinion/readers/2015/07/24/social-security/30647235/

Let’s celebrate Medicare by expanding it to cover everyone

Sadly, Obamacare is incapable of remedying our broader health-care crisis

By Johnathon Ross, M.D.
The Blade (Toledo, Ohio), July 30, 2015

At a local Senior Olympics event a few weeks ago, I talked with other participants about our nation’s continuing health-care problems in the age of Obamacare. 

Many of them were over 65 and on Medicare, a government program that celebrates its 50th anniversary today. It provides indispensable, effective health care to about 55 million Americans.

I argued that the best  solution would be to expand Medicare to cover our whole population. Several people agreed with me. But one person bridled at my proposal, suggesting that a Medicare-for-all system would be un-American and ruin “the best health care in the world.”

America has some of the finest doctors and nurses anywhere. Our hospitals are well equipped, and our treatments and medications are typically world-class. We have the potential to be the best. But on many key indicators, we lag badly behind other nations in health-care quality and outcomes. 

A recent Commonwealth Fund study ranked the United States sixth among seven wealthy countries in quality of care, even though we spend almost twice as much per person on care as the average in these nations. Tens of millions of Americans  remain uninsured or under-insured. 

Health-care costs continue to climb. These costs are shifted to all of us in the form of higher premiums, co-pays, deductibles, and co-insurance. They deter people from seeking needed care — and the results of those delays are often fatal.

A Harvard University study estimates that among every 1,000 uninsured Americans, one will die from an illness that went untreated because of a lack of health insurance. Even when it goes fully into effect, Obamacare will leave nearly 30 million Americans without  insurance.

Nearly 30,000 of our family members, friends, and neighbors will continue to die unnecessarily each year from treatable illness. In the past 100 years, only World War II caused more annual American deaths.

A few days after the Special Olympics discussion, my daughter needed an immediate and unexpected cesarean section to deliver my first grandchild. There was no time to shop or negotiate for better prices or a lower-cost, higher-quality doctor or hospital or neonatal team. 

The procedure brooked no delay to enable the health-care free market to work. The most expensive services are often the most urgent and least negotiable.

My daughter and the baby are home and doing fine. I cannot imagine what this emergency could have done financially to her family if she were not well insured or she had been out of her provider network.

Yet I will hold my breath until all of the bills are in. Even a middle-class family like my daughter’s often gets slammed by out-of-pocket costs. This is the nature of American health care today, after “reform.”

The U.S. Supreme Court recently upheld a key provision of Obamacare that allows public subsidies to help families buy insurance through online exchanges. Had the court ruled otherwise, more than 8.2 million people would have lost their coverage relatively quickly.

Sadly, Obamacare is incapable of remedying our broader health-care crisis because it is built on a crumbling foundation: the wasteful private insurance industry. Health insurers strive constantly to maximize their bottom lines. 

The complexity of insurance plans — with variable benefits, deductibles, co-pays, and restricted provider networks — requires an army of bureaucrats and money-changers to collect the premiums. Providers must cope with this complexity when they bill for care.

This administrative nightmare wastes about $400 billion each year on needless paperwork. This waste feathers the nests of the bureaucrats who run the private health insurance industry and other corporate, profit-oriented interests in U.S. health care.

By contrast, Medicare operates with a minimum of overhead — about 2 percent, according to its trustees, compared with typical overhead of 12 to 19 percent for private insurers.

A publicly financed single payer of all medical bills would enable Americans to achieve truly universal care, affordability, and effective cost control. Co-pays and deductibles would be eliminated. You could go to the doctor and hospital of your choice.

We would best celebrate Medicare’s 50th birthday by expanding the program to all Americans. It should be protected, improved, and expanded, to make it even more efficient and effective.

Dr. Johnathon Ross, of Toledo, is past president of Physicians for a National Health Program.

http://www.toledoblade.com/Op-Ed-Columns/2015/07/30/Let-s-celebrate-Medicare-by-expanding-it-to-cover-everyone.html

At 50 years, time to improve Medicare

Modernizing Medicare’s Benefit Design and Low-Income Subsidies to Ensure Access and Affordability

By Cathy Schoen, Karen Davis, Christine Buttorff, and Martin Andersen
The Commonwealth Fund, July 8, 2015

Abstract

Insurance coverage through the traditional Medicare program is complex, fragmented, and incomplete. Beneficiaries must purchase supplemental private insurance to fill in the gaps. While impoverished beneficiaries may receive supplemental coverage through Medicaid and subsidies for prescription drugs, help is limited for people with incomes above the poverty level. This patchwork quilt leads to confusion for beneficiaries and high administrative costs, while also undermining coverage and care coordination. Most important, Medicare’s benefits fail to limit out-of-pocket costs or ensure adequate financial protection, especially for beneficiaries with low incomes and serious health problems.

Background

There is a pressing need for reform. An estimated 20 million of Medicare’s 52 million beneficiaries live on incomes below 200 percent of the federal poverty level. Nine million beneficiaries have complex care needs with serious functional limitations that hinder their ability to carry out daily activities. Although the poorest are eligible for Medicaid to supplement Medicare, under current policies beneficiaries with low or modest incomes are eligible for only limited help with paying for premiums or medical care expenses.

The absence of a ceiling on out-of-pocket costs can undermine the financial security and exhaust the resources of even higher-income beneficiaries. That’s why most beneficiaries supplement Medicare’s core benefits with coverage sold by private insurers, often purchasing multiple plans. This fragmented coverage is inefficient, generates high administrative costs, and undermines efforts to improve coordination of patient care and prevent avoidable hospitalizations.

Current Medicare Benefits and Low-Income Provisions

Medicare has separate deductibles and cost-sharing provisions for Part A hospital, skilled nursing facility, and home health services and for Part B physician, lab, and diagnostic benefits, with no limit on annual out-of-pocket spending for covered services. Part A includes a $1,216 deductible per hospital episode and substantial cost-sharing for longer-term hospitalization or skilled nursing stays after a hospitalization. Part B has a $104.90 monthly premium ($1,259 per year per person), a separate $147 annual deductible, and open-ended coinsurance of 20 percent for physician services (including surgeons and other hospital inpatient physicians), therapy, durable medical equipment, and outpatient services with no limit on out-of-pocket spending.

For prescription drug coverage, beneficiaries must buy a Part D plan with a separate premium that averages around $440 a year plus a deductible and cost-sharing that varies across private plans. The Affordable Care Act (ACA) is phasing out Medicare’s gap in drug coverage—the “doughnut hole”—but beneficiaries requiring specialty drugs or multiple medications can still face substantial costs.

Supplemental private coverage to fill in Medicare’s deductibles and cost-sharing is costly, with Medigap premiums adding over $2,000 a year, depending on geographic area. It is also inefficient, with 20 percent of the premium, on average, going toward administrative costs.

Some low-income beneficiaries are eligible for assistance paying their Parts A and B cost-sharing and Part B premiums. Medicaid covers Medicare cost-sharing up to 100 percent of the poverty level and provides subsidies for Part B premiums up to 135 percent of poverty for those meeting income and asset tests.6 Personal asset limits for beneficiaries seeking extra help with Medicare premiums or cost-sharing are $7,160 for an individual and $10,750 for a couple (in 2014).

In contrast to Medicare, the ACA eliminates asset tests and provides substantial premium and cost-sharing subsidies up to 200 percent of poverty for the under-65 population and expands Medicaid to 138 percent of poverty for participating states.7 ACA provisions exclude Medicare beneficiaries. As a result, lower-income older adults who age into Medicare will face increased financial burdens for coverage and care.

Underprotected and Underinsured Medicare Beneficiaries

Facing gaps in benefits and premium costs, an estimated 25 percent of all beneficiaries and 40 percent with incomes below twice the poverty level spent 20 percent or more of their income for premiums plus medical care costs in 2014.

An estimated one of five beneficiaries—11 million people—spent at least 10 percent of their income on medical care alone in 2014, not including premiums. Despite having Medicare, they were underinsured, spending a high share of their income on medical care. The risk of being underinsured was highest for low-income beneficiaries: an estimated one-third of those with incomes up to 150 percent of poverty, and 30 percent of those with incomes between 150 percent and 200 percent of poverty were underinsured.

Such high financial burdens undermine access to care, deplete incomes, and drain resources. Notably, a recent study found that the elderly in the United States are far more likely to go without care because of the cost and face problems paying medical bills than their counterparts in 10 other high-income countries. Beneficiaries with complex care needs are particularly at risk.

Policy Options to Modernize Benefits and Improve Low-Income Protections

To modernize Medicare’s core benefits and update policies related to low-income beneficiaries, the brief discusses two complementary options. The first would offer a new Medicare-sponsored plan choice. Available for an extra premium, it would provide an integrated design with prescription coverage, more-affordable cost-sharing, and a limit on out-of-pocket costs—making supplemental coverage unnecessary. The second option would expand subsidies for Medicare’s premiums and reduce cost-sharing for beneficiaries with incomes up to 200 percent of the federal poverty level in ways that align with the Affordable Care Act’s policies for the under-65 population.

http://www.commonwealthfund.org/publications/issue-briefs/2015/jul/modernizing-medicare-benefit-design

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Comment:

By Don McCanne, MD

At the 50th anniversary of Medicare we can be thankful for the assistance it has provided to our seniors and those with long term disabilities in improving access to care and in making health care more affordable for them. However, Medicare does have significant deficiencies and this is a good time to look at them and see what we can do to improve the program.

Probably the most glaring defect is that the coverage is inadequate, especially for those with modest incomes. Premiums for Parts B and D, deductibles for Parts A, B and D, 20% coinsurance for Part B, other forms of cost sharing, and the lack of a ceiling on out-of-pocket costs all combined can create severe financial hardships for far too many. Medicare should be structured to ensure health security without threatening exposure to financial insecurity.

To cover these high out-of-pocket costs, some purchase Medigap plans. But these plans are overpriced, partly because they consume 20% of the premiums for administration. Plus they add administrative complexity for the providers because of having to interact with two payers – Medicare plus the Medigap plan. Employer-sponsored retiree health plans may provide wraparound coverage for Medicare, but this is administratively inefficient as well. More comprehensive coverage by Medicare would relieve employers of their responsibilities for their retiree health plans for the Medicare-eligible population, plus it would free up funds that could be added to retiree pensions. Very low income individuals may qualify for Medicaid coverage, though these dual-eligible individuals, to their dismay, are now often being forced into managed care plans designed for the welfare population. Others select private Medicare Advantage plans, but the government unfairly pays the private plans more – two-thirds of which is kept by the insurers instead of going toward patient benefits. Although Medicare Advantage plans reduce spending for the beneficiaries, they do so by wasting an inordinate amount of taxpayer dollars on non-medical administrative excesses and insurer profits.

The authors of this brief do recommend creating a new Medicare option – “Medicare Essential” – available for an extra premium, which would integrate more benefits and place a ceiling on out-of-pocket costs, obviating the need for supplemental coverage. They would also protect low-income individuals by adding premium subsidies and cost sharing reductions, based on income, much like the subsidies for the plans in the ACA exchanges. These changes would certainly reduce the financial burden that Medicare beneficiaries face, but their analysis of the impact of these two policies shows that 15 percent of Medicare beneficiaries would still be paying over 20 percent of their income on care and premiums.

A better solution would be to go ahead and roll the benefits of these various supplemental or complementary programs into the traditional Medicare program so that it could be administered as one single program, but to also achieve greater efficiency by eliminating all of the premiums, deductibles, coinsurance and other cost sharing, and instead funding all care through a single, equitably-funded Medicare risk pool. Carrying that one step further, the maximum efficiency would be attained by expanding that risk pool to cover absolutely everyone so that we would all have prepaid health care whenever we needed it.

After 50 years, it is clear that Medicare needs improvement, though it still has strong support of the public. The time is ripe for not only improving it, but also expanding it to cover everyone. Let us hope that we do not have to wait another 50 years to get it right.

Celebrate Medicare’s anniversary by improving and expanding it to all

FOR IMMEDIATE RELEASE
July 30, 2015

Contact:
Mark Almberg, PNHP communications director, mark@pnhp.org

Today, July 30, marks the 50th anniversary of President Lyndon B. Johnson’s signing of the Medicare program into law. Dr. Robert Zarr, president of Physicians for a National Health Program, is among those speaking in Washington this morning at a “Medicare turns 50” rally in the Upper Senate Park and, later in the afternoon, at a congressional briefing hosted by Rep. John Conyers Jr.

Medicare, one of our nation’s most valuable and beloved social programs, turns 50 today.

This landmark program, which currently provides guaranteed health coverage to 55 million Americans – people age 65 and older, along with younger people with long-term disabilities – has opened doors to health care that were previously shut, relieving human suffering and saving many lives. 

No less important, Medicare has provided a much greater measure of financial security to our nation’s seniors and their families than they had prior to its enactment. It has significantly reduced poverty and diminished income- and racially-based disparities in care and medical outcomes.

Medicare was originally conceived as a first step toward covering everyone in our society under a national health insurance program. We need to fulfill Medicare’s promise. We need an improved Medicare for All, a national single-payer health care system, to efficiently and equitably cover everyone in the United States.

Today the original Medicare program stands like a rock in a troubled sea of waste, inefficiency and profiteering in the rest of our health care system, dominated as it is by big private insurers whose paramount goal is to maximize their bottom lines.

Commercial insurers increase their bottom lines by enrolling the healthy, avoiding the sick, denying claims, increasing premiums, and erecting barriers to care like co-pays, high deductibles, bureaucratic thickets, and narrow networks.

These same corporate insurers are working feverishly to privatize traditional Medicare through private Medicare Advantage plans and other schemes. They get extra payments from the public program’s coffers – to the tune of $34.1 billion in overpayments in 2012 alone. Such private plans are producing handsome insurer profits, fueling mega-mergers among the largest commercial insurance firms.

Some lawmakers and candidates for public office have called for the outright demolition of Medicare. One idea is to hand vouchers to seniors to buy private health insurance from a marketplace (ironically similar to how insurance “exchanges” authorize taxpayer dollars to subsidize private insurance premiums under the Affordable Care Act). Such a step would be catastrophic for our nation’s patients.

In contrast to the privatized Medicare Advantage plans, which spend about 14 percent on overhead and restrict patients to proprietary networks, traditional Medicare spends only about 2 percent on overhead and allows patients to go to any doctor and hospital of their choice.

The original program has also demonstrated that it is much better at controlling costs than private insurance firms.

Given its existing strengths, traditional Medicare can serve as a useful model for more fundamental health reform, in contrast to the private-insurance-based Affordable Care Act.

Original Medicare is not without its problems, of course. Its benefits package should be richer. It lacks authority to negotiate lower prices with drug companies. In recent years it has been burdened with excessive and unnecessary red tape.

But the best way to remedy these problems — and to bring down skyrocketing health care costs at the same time — is to improve the program and, most important, to expand it to cover every person in the United States.

By replacing our inefficient, crazy-quilt of private health insurers with a streamlined, publicly financed single-payer program, we would reap $400 billion yearly in savings, enough to provide high-quality, first-dollar coverage to all without an additional penny in overall U.S. health spending.

The American people desperately need a universal health system that delivers comprehensive, equitable, compassionate and high-quality care, with free choice of provider and no financial barriers to access. Polls have repeatedly shown an improved Medicare for all, which meets these criteria, is the remedy preferred by a solid majority of the public and the medical profession.

On Medicare’s golden anniversary, we pledge to step up our work for the only equitable, financially responsible and humane cure for our health care ills: single-payer national health insurance, an expanded and improved Medicare for all.

Dr. Robert Zarr is president of Physicians for a National Health Program. He practices pediatrics in Washington, D.C.

Medicare Turns 50: Four Million Floridians Benefit

By Suzanne Potter
Public News Service (Florida edition), July 29, 2015

TALLAHASSEE, Fla. — Thursday is the 50th anniversary of Medicare, and the program’s advocates are using the occasion to push for a major expansion.

Today, it provides health care to 55 million Americans, including 4 million in Florida. Medicare’s proponents say it has been so successful that the country ought to consider universal, government-funded health care – a kind of Medicare for all.

Dr. David Himmelstein, co-founder of Physicians for a National Health Program, said Medicare eases the burdens many seniors face, and does it with one-sixth the overhead costs of private insurance.

“Medicare has been vital to improve both the physical and mental health and financial health of the elderly, who were largely abandoned by the private insurance industry before Medicare existed,” he said.

Opponents of universal health care say the government has too much control over people’s lives already. They also point to the latest government estimates, which show the program will remain solvent until 2030 but would require changes to stay afloat after that.

Himmelstein, a professor at the City University of New York and Harvard Medical School, countered that analysts have been predicting Medicare’s demise for decades — and keep pushing the time frame further and further into the future.

“Medicare is solvent today and will remain solvent if our government makes any reasonable decisions about its future,” he said.

National Nurses United, affiliated with the “Medicare Turns 50 Coalition,” is taking up the cause of universal health care as well. The union plans rallies Thursday in 30 cities across the country, including one at 11 a.m. at the Federal Building in Miami. The nurses want Congress to support House Resolution 676, which would expand Medicare to all U.S. residents. The resolution is online at congress.gov.

www.publicnewsservice.org/2015-07-29/senior-issues/medicare-turns-50-four-million-floridians-benefit/a47445-1#sthash.liUIVzR3.dpuf