Speaker – Page 367

Krugman: “Skin in the game” is counterproductive

Dentists and Skin in the Game

By Paul Krugman
The New York Times, July 30, 2015

Wonkblog (The Washington Post, 7/29) has a post inspired by the dentist who paid a lot of money to shoot Cecil the lion, asking why he — and dentists in general — make so much money. Interesting stuff; I’ve never really thought about the economics of dental care.

But once you do focus on that issue, it turns out to have an important implication — namely, that the ruling theory behind conservative notions of health reform is completely wrong.

For many years conservatives have insisted that the problem with health costs is that we don’t treat health care like an ordinary consumer good; people have insurance, which means that they don’t have “skin in the game” that gives them an incentive to watch costs. So what we need is “consumer-driven” health care, in which insurers no longer pay for routine expenses like visits to the doctor’s office, and in which everyone shops around for the best deals.

The usual response has been that this involves going where the money isn’t — that because health costs are dominated by big expenses that must be paid by insurers, there just isn’t much potential savings from increased deductibles, co-pays, etc..

But what if even the underlying premise, that individual choice will hold down costs, is all wrong?

As it turns out, many fewer people have dental insurance than have general medical insurance; even where there is insurance, it typically leaves a lot of skin in the game. But dental costs have risen just as fast as overall health spending, and it may be that the reduced role of insurers actually raises those costs. According to the post,

“In the rest of medicine, insurers have an important function in limiting costs and promoting quality. The market power of Medicare and major national insurance companies allows them to insist on better rates for their customers when they negotiate with doctors and hospitals.

“‘There’s been less presence from all kinds of insurance payers in the dental sector,’ explained Andy Snyder, who is in charge of oral health at the nonpartisan National Academy for State Health Policy. ‘Medicare does not cover routine dental services, and private dental coverage is far less common than private medical coverage. So, the dental industry has faced less of the cost containment and quality improvement pressures that the rest of the health care sector’s experienced over the last couple of decades.’”

So more skin in the game is not just useless but actually counterproductive.

http://krugman.blogs.nytimes.com/2015/07/30/dentists-and-skin-in-the-game/

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Why dentists are so darn rich

By Max Ehrenfreund
The Washington Post, July 29, 2015

Dentists in some places are so well compensated that they earn more than the average doctor. According to a 2012 report in The Journal of the American Medical Association, the average hourly wage of a dentist in America is $69.60 vs. $67.30 for a physician. As recently as 1996, dentists were making less than doctors. Meanwhile, the average general dental practitioner took in $181,000 in 2013, according to the dental association, compared to $175,000 for a family doctor, according to WebMD Medscape’s annual compensation report.

(Also see excerpt in Paul Krugman’s article, above.)

http://www.washingtonpost.com/news/wonkblog/wp/2015/07/29/why-dentists-are-so-darn-rich/

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Comment:

By Don McCanne, MD

High deductibles and other cost sharing – “having more skin in the game” – make patients better health care shoppers the advocates of consumer-directed health plans tell us. Let’s see what insight comparing dentists to physicians can provide on this concept.

Free market advocates tell us that when patients are uninsured and spending their own money they will shop for lower priced care that is of higher quality. This supposedly also applies to patients with high-deductible health plans who are seeking care below the deductible limit.

Take the case of dentists. Patients are basically oblivious to the quality of the care so they are really interacting with the prices, but in what way? Patients have very little influence over the prices so their decision is whether to accept or reject the dentist’s recommendation for care. Unmet dental needs are ubiquitous in the United States. People are not getting the care that they need because they cannot afford it. Dental insurance has not begun to fill this need.

Revenues are dependent on price and quantity, and with the great unmet need, dentists are assured of an adequate quantity of patients without having to yield on their prices. Thus “skin in the game” for dental patients does not a bearing on more favorable prices but rather determines whether or not care will be received.

What about care from physicians that is expected to cost less than the deductible? There may be some price shopping at the periphery where the patient has options, such as diagnostic imaging, Lasik, or cosmetic surgery. But, by and large, patients are not negotiating prices in advance with their physicians, laboratories, emergency departments and other providers (though later on they may attempt to negotiate bills they can’t pay). Generally they are offered services at a given price and their decision is to either accept it or go without. Once again, “skin in the game” does not have much influence on prices but rather greatly influences whether or not the patient will forgo the recommended care.

Most of our nation’s health care spending is for patients with major problems who have exceeded their deductibles, thus “skin in the game” does not apply to them. So, as a policy to reduce total spending, high deductibles are quite feeble.

The incomes of dentists have improved such that they are now comparable to primary care physicians, with higher incomes for specialists in both fields. Empowering patients as shoppers certainly has not driven prices down. What it has done is to further entrench the suffering and injustices of grossly impaired oral health.

And in medicine, we are now expanding consumer-directed policies, especially high deductibles, that can only increase the scourge of unmet health needs – an especially tragic policy track since it will have little effect on prices but will reduce the quantity of beneficial health care services.

Paul Krugman quite appropriately labels this “skin in the game” approach to controlling spending as counterproductive.

In contrast, single payer is a much more powerful method of containing costs but does so in a system designed to get patients the care that they need. Shouldn’t that be our goal instead? Seriously.

Health care should be a birthright

By the Editorial Board
Bennington (Vt.) Banner, July 30, 2015

As the nation marks the 50th anniversary of Medicare the discussion of expanding the program and offering universal health care is resurfacing.

It’s not a new debate. Fifty years before Medicare’s enactment, progressives had fought unsuccessfully for universal, government-provided health insurance, wrote Nancy Altman, founding co-director of Social Security Works, for the Huffington Post.

In 1912, President Theodore Roosevelt’s Progressive Party platform advocated universal, government-sponsored, health insurance, but he was defeated in his re-election bid. In 1917, the California legislature approved universal health insurance, and the governor supported it, but it was defeated in a ballot resolution after a massive, well-financed business and physician-fueled campaign against it. President Franklin Roosevelt 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.

So progressives settled on first creating Medicare for seniors, with the goal of expanding coverage to other groups incrementally and ultimately offering universal coverage.

“Universal, government-sponsored insurance is the most effective and efficient way to cover everyone,” Altman wrote. “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.”

Compared to Medicare’s administrative costs of just 1.4 percent, the administrative costs of private health insurance by very small firms or purchased by individuals can run as high as 30 percent, Altman notes. Even for large companies the administrative costs run around 7 percent.

Unfortunately, politicking and heavy lobbying by the insurance industry over the years waylaid those efforts to expand Medicare. But there are still some pushing for real health care reform — not the Affordable Care Act version that still involves profit-motivated companies and isn’t quite so affordable for everyone.

Addressing a rally outside the Capitol to mark the 50th anniversary of Medicare on Thursday, presidential contender and U.S. Sen. Bernie Sanders, I-Vt., said he will introduce legislation to provide Medicare-for-all health insurance.

He said providing health insurance for all Americans would result in better care, improved access and lower costs by eliminating the middle-man role played by insurance companies that now rake in billions of dollars in profits. Sanders’ bill would set federal guidelines and strong minimum standards for states to administer single-payer health care programs.

“The United States is the only major nation in the industrialized world that does not guarantee health care as a right to its people,” Sanders said. “Meanwhile, we spend far more per capita on health care with worse results than other countries.”

As Sanders noted, thousands of people die each year in the U.S. because they delay seeking care they cannot afford. Health care eats up one-fifth of our economy, but the U.S. ranks 27th among major, developed nations on life expectancy and 31st on infant mortality.

Sanders said his proposal also would rein in skyrocketing prices for prescription drugs. Americans pay pharmaceutical companies nearly twice for the exact same drugs manufactured by the exact same companies in other countries.

“This is unacceptable,” Sanders said. “Until we put patients over profits, our system will not work for ordinary Americans.”

In contrast to Sanders, GOP contenders are calling for the phasing out of Medicare.

As Altman wrote, “This upcoming presidential election could be a powerful defining moment. If each Party’s platform reflects these views, the American people will have a clear choice. … 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.benningtonbanner.com/editorials/ci_28564118/our-opinion-health-care-should-be-birthright

America should celebrate 50 years of Medicare

By Dimitri Drekonja, M.D.
St. Cloud (Minn.) Times, Letters, July 23, 2015

On July 30, America celebrates the 50th birthday of Medicare.

Signed into law by President Lyndon Johnson, this remarkably successful program finances medical care for over 55 million Americans — those over age 65, and others with permanent disabilities. It enables patients to go to the doctor or hospital of their choice, and has kept millions of senior citizens out of poverty.

While Medicare has had funding problems, these are due to a fixed funding source tied to a set 1.45 percent payroll tax paid by both employers and employees — at a time when health care costs are steadily rising.

Medicare contends with the same skyrocketing health care costs as private insurers, but has to do so without annual premium increases. As such, Medicare by necessity has become an amazingly efficient payer. Whereas private insurers run overhead costs of 15 percent to 30 percent, Medicare spends just 2 percent on overhead, making it the most efficient way of paying for care — regardless of who is delivering the care.

Medicare’s 50th birthday is an important milestone, and also a glimpse of what could be available to all Americans.

An expanded Medicare, covering all Americans, not just the elderly or the disabled, would dramatically simplify how we pay for health care in America. Americans would see the same doctors and go to the same facilities, but instead of dealing with mazes of insurance paperwork, open-enrollment periods, pre-authorizations, and denied care, there would be a single organization with a single set of rules.

Opposing this goal is a coalition of enormously profitable and influential organizations, all of whom have vested interests in reaping enormous profits that can be made by playing middleman between the care provider and patient.

Let’s celebrate the fact the Medicare has made it to 50 years, and expand it to cover all Americans.

Dr. Dimitri Drekonja resides in Minneapolis.

http://www.sctimes.com/story/opinion/2015/07/23/america-celebrate-years-medicare/30590957/

Medicare turns 50: A time for celebration and action

By Ahmed Kutty, M.D.
Monadnock Ledger-Transcript (Peterborough, N.H.), July 30, 2015

Fifty years ago today, on July 30, 1965, President Lyndon Johnson signed the Medicare Act into law, a historic and transformative moment when our polity gave expression to America’s highest ideals of inclusion and compassion by providing for a publicly-funded healthcare program for the elderly and the disabled in our society. Today over 50 million seniors are guaranteed a basic minimum of healthcare services, regardless of their ability to pay or their health status. Like the momentous Social Security Act signed 20 years earlier by President Franklin Roosevelt, both programs became enormously popular and have evolved into the third rail of our politics.

Twenty-five years ago, in July 1990, President George H.W. Bush enacted the Americans With Disabilities Act (ADA), another great piece of legislation giving voice and restoring dignity to the disabled, a fifth of our population. Five years ago in April 2010, President Obama gave us the Affordable Care Act (ACA, also known as Obamacare), a significant step toward assuring access to healthcare services for about 17 million of our fellow Americans hitherto uninsured, mostly from the lower middle-class and the near-poor segments of our society.

With 35 million people who will remain uninsured after full implementation of the ACA in 2018, according to the Congressional Budget Office, and another 35 million who will be grossly underinsured upon accessing our current system of healthcare financing, we cannot be complacent and rest on the laurels of gains made thus far. Our total health care spending consumes 18 percent of the gross domestic product, as opposed to an average of 9 percent in all the nations that belong to the Organization for Economic Cooperation and Development. Yet we rank in the lower middle of the pack when measured with metrics for population health such as life expectancy, infant mortality, maternal health, vaccination rate and others. This is not sustainable long-term.

The ADA of 1990 soon became a model that inspired a global movement for social and legislative programs that empowered and enriched the lives of the disabled everywhere. Now it is our turn to look outward, with an open mind, at the systems of healthcare financing and delivery prevalent among the major industrialized nations and, without emulating, to incorporate their core features into a uniquely American model that is universal (covers everybody from cradle to grave),is affordable to individuals and families (financed by payroll and progressive taxation), sustainable (with cost controls built in via global budgeting, negotiated pricing for services, drugs, devices and medical supplies), equitable (all 320 million of us in a single risk pool, and a one-tier only program), comprehensive (covering all medically necessary care) and without economic barriers to care (no premiums, deductibles, copay, coinsurance and arbitrary exclusions of coverage).

First-dollar coverage and full choice of doctors and hospitals are available under the Conyers Bill in the House (HR 676), known as the U.S. National Health Care Act or the Improved Medicare for All Act. This bill, when passed, would replace the deeply flawed Obamacare and, by preserving, enhancing and expanding Medicare of 1965, would give us a world-class, yet equitable, self-sustaining system of financing health care, still delivered privately as now and controlled locally, transparently and with public accountability. An estimated $590 billion in savings nationwide could be had in the first year of operation of the national plan.

Health care spending costs us about $4 trillion a year, nearly a fourth of our $17 trillion gross domestic product. Any attempt to change the course of such a behemoth is akin to steering the Titanic. Yet steer we must, lest the ship of our economy hits the iceberg. Entrenched, well-heeled and formidable interest groups in our country are happy with status quo, while the other 99 percent are to confront hardships and avoidable financial ruin to varying degrees now and in the near-term under the highly priced, unequal and insanely inefficient system we now have. Of course there is more to attaining health than merely having a national health plan in place. Each one of us carries personal responsibility for a healthy lifestyle and also shares the burden of providing for a system of social insurance, not for profit, based on a service rather than a business model, resulting in a dynamic, ongoing engagement between the individual and the society. The system design will have baked into its DNA, like all living systems, the capacity to evolve over time and for adaptation to the changing milieu of contemporaneous political economy.

We Americans, who put a man on the moon in July 1969, and this July had our spacecraft get 8,000 miles close to Pluto, the outermost heavenly body in our solar system, have it in us to meet one of mankind’s oldest challenges: how to care for the ill among us with dignity, compassion, competence, affordability and efficiency of cost and quality, if only we harness our collective will to build upon and out from Medicare, the foundation laid for us by President Johnson 50 years ago.

David did prevail over Goliath. Support HR 676 and a similar bill in the New Hampshire legislature (HB 686). Therein lies our last best hope for bringing forth a national health care system with everybody in and nobody out.

As the late South African leader, Mr. Nelson Mandela, said about the struggle for a good cause to prevail, “It always seems impossible until it is done.”

Dr. Ahmed Kutty lives in Peterborough.

http://www.ledgertranscript.com/news/townbytown/peterborough/17966588-95/medicare-turns-50-a-time-for-celebration-and-action

Happy 50th Birthday, Medicare! Next Steps in the Fight for Universal Health Care

By Robert Zarr, M.D.
Truthout, July 30, 2015

I love to celebrate birthdays, but this year there’s one birthday that really needs a special pie – not a cake, but a pie. Medicare turns 50 today, on July 30.

For the last 14 years, I’ve practiced primary care pediatrics at a community health center located just two miles north of the White House. I love what I do, but not necessarily how I have to do it.

I’m grateful to practice alongside colleagues who share my commitment to provide high-quality, comprehensive care to all, regardless of their ability to pay, their employment status or the language they speak.

But I am frustrated when patient after patient gets inadequate treatment – not because I’m not working hard, but because of the irrationality and cruelty of the complicated way in which we pay for care.

I am disheartened when a 15-year-old patient is asked to spend $800 so she can be seen at the concussion specialty clinic to help her recover from a lacrosse-related head injury, or when my uninsured 17-year-old patient is refused a postoperative follow-up visit with his surgeon.

Growing up in Texas, I was taught to embrace words like “self-determination” and “freedom,” even if the real world didn’t always measure up to those ideals. But something sunk in, and now I find myself wanting to be free to practice medicine without the bureaucratic shackles imposed on all of us by the private insurance companies and other for-profit players in US health care.

The private insurers’ primary mission is to create “value” for their shareholders, not to provide care. They maximize their profits 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 private-insurer practices are good for neither patients nor physicians. Patients suffer needlessly, and doctors are afflicted by endless bureaucratic paperwork, contributing to burnout.

The Affordable Care Act hasn’t changed this picture very much.

But back to Texas. My home state is also the birthplace of Lyndon B. Johnson, who signed Medicare into law 50 years ago. Medicare has since become one of our nation’s most beloved social programs.

Traditional Medicare offers important lessons. It runs on very low overhead – around 2 percent, versus the 12 to 15 percent overhead typical of the big private insurers. It allows seniors to go to the doctor and hospital of their choice. It controls costs better than private insurers do, even though it serves the oldest and sickest segments of our population.

If only all my patients were covered by a single, simple program like Medicare. The administrative savings would be immense – more than $375 billion annually, according to a recent study. That’s more than enough money to cover everyone’s medically necessary care with no co-pays or deductibles.

In point of fact, in 1965, the authors of Medicare intended to create a social insurance fund to cover all Americans, not just seniors. We still need such a single-payer program. We have to go beyond the Affordable Care Act. Too many people are still suffering and dying prematurely.

As a patient, imagine never again having to worry about whether the doctor’s office, hospital or pharmacy takes your insurance, because there is only one insurance, improved and expanded Medicare for all, which pays all the bills.

As a provider of health care, imagine never again having to worry about being paid for the services you provide. Imagine working for yourself and having the freedom to set your hours most conducive to your lifestyle and to that of your patients. Imagine the autonomy of running your own practice, or at the very least, spending less time on paperwork hassles.

This is no pipe dream. Medicare points the way. We merely need the political will to enact legislation like H.R. 676, the Improved and Expanded Medicare for All Act, into law.

And that birthday pie I spoke about? When it comes to Medicare, the three crucial ingredients are to protect it, improve it and expand it (pie). Let’s celebrate Medicare’s birthday by extending it to all.

Dr. Robert Zarr is president of Physicians for a National Health Program.

http://www.truth-out.org/opinion/item/32132-happy-50th-birthday-medicare-next-steps-in-the-fight-for-universal-health-care

Grow Medicare to save lives, money

By Arthur J. Sutherland III, M.D.
The Commercial Appeal (Memphis, Tenn.), July 30, 2015

Medicare, one of our nation’s most valuable and popular social programs, turns 50 on July 30, and we have the chance to make it even better.

Medicare is a federal health insurance program enacted and signed into law in 1965 by President Lyndon B. Johnson. The program currently covers 55 million Americans-people age 65 and older, and younger people with permanent disabilities. That’s about 17 percent of the population.

Medicare was originally conceived as a first step toward covering everyone in U.S. society under a national health insurance program. The program has sharply reduced poverty among seniors and significantly improved the financial security of their families. It has reduced health disparities related to race, ethnicity, and socioeconomic status.

Traditional Medicare only spends about 2 percent on administration/overhead. It’s very frugal versus private insurance, whose overhead and profits amount to closer to 12-14 percent or more.

Medicare has a slower rate of health cost growth than private insurance, and it pays providers quickly and with fewer hassles than private insurers. Patients in traditional Medicare can go to the health provider or hospital of their choice.

There are misguided political pressures to privatize Medicare because of skyrocketing health costs, but Medicare is one of the victims of our dysfunctional system of insurance dominated by the private insurers, and our supply driven medical markets.

The United States has never had a well-thought-out and debated national health care program with national standards, regional planning, and local implementation.

Cutting Medicare would be a mistake because it would increase poverty, worsen health outcomes and increase costs.

We already see what is happening in the Medicare Advantage plans, which are operated by private insurers. They cost the Medicare program about 14 percent more than traditional Medicare.

Research done by Physicians for a National Health program, pnhp.org, shows that in 2014, Medicare Advantage plans were overpaid $34.1 billion, or $2,526 per enrollee. This documents that having private MA plans competing with traditional Medicare does not save money, but costs taxpayers billions of dollars more each year.

The solution to our health care crisis and the economic suffering it contributes to everyone in this country is to establish a publicly financed, mainly privately delivered national improved and expanded Medicare for All – a single-payer system.

Private insurance companies have clearly failed us. To increase their bottom line, they strive to enroll the healthy, screen out the sick, and deny care. They afflict our health system with a mountain of unnecessary paperwork – about 31 cents of each health care goes to administration, most of it waste.

Meanwhile they pay their CEOs multimillion-dollar salaries and squander money on advertising, etc.

The Affordable Care Act unfortunately builds of the faulty foundation of private insurance companies, and adds more cost and complexity to health care access and delivery. Transitioning the ACA into the Medicare single-payer national health program would solve this problem. At the same time, rolling Medicaid into Medicare would complete the consolidation of our national programs.

A pipe dream? No. There is legislation in Congress, the Expanded and Improved Medicare for All Act, H.R. 676 that would put such a single-payer system in place.

Other nations have enacted systems like this with great success. Our neighbor to the north, Canada, implemented their single-payer Medicare Program in 1971. They spend half of what we do, and live longer. Their people will not allow their Medicare to be privatized.

Passing an improved Medicare for All will save lives and money, and put our nation on the path of becoming one of the best health systems in the world.

We have the talent, we have the resources: let’s put them to work! That would show real “American Exceptionalism.”

Dr. Arthur J. Sutherland, III, a retired cardiologist, is the Physicians for a National Health Program Tennessee chairman and national board adviser.

http://www.commercialappeal.com/

Medicare, Medicaid mark 50 years of national impact

By Mark Liebow, M.D.
The Post-Bulletin (Rochester, Minn.), July 30, 2015

Fifty years ago today, President Lyndon B. Johnson flew to Independence, Mo., the retirement home of President Harry S. Truman, to sign the bill that created Medicare and Medicaid. He gave Truman and Truman’s wife, Bess, Medicare cards No. 1 and No. 2.

When in office, Truman had advocated for a national health insurance program, but wasn’t able to get it enacted into law.

Between Truman’s time in the White House and Johnson’s, many more workers and their families obtained health insurance, so there no longer seemed to be a need for a national health insurance program. However, seniors and poor people did not benefit from this employer-based expansion of health insurance. Most had no insurance and often were unable to afford health care. This was especially a problem for seniors who often had more medical problems than they had ever had before. President John F. Kennedy unsuccessfully tried to get a federal health insurance program for seniors passed.

When Johnson took office after Kennedy’s assassination, he promised to get Kennedy’s health insurance proposal passed. Republicans fought the proposal, saying it was “socialized medicine,” but in 1964, the coattails from Johnson’s landslide victory brought many liberal Democrats to Congress. A year later, those Democrats started working on legislation to create what had come to be known as Medicare.

The health insurance program for the poor, known as Medicaid, was added during congressional debate. Democrats in Congress voted overwhelmingly for the two programs while Republicans were split almost evenly.

The two programs started on Jan. 1, 1966. In the years since then, they have had a huge impact on the people they help.

The life expectancy for 65-year-old women has risen by 12.2 percent while that of 65-year-old men has climbed 33.3 percent. Seniors have gone from the poorest age group in the U.S. to being the richest because they no longer have to cope with large medical expenses on fixed incomes.

Medicaid covers a large share of pregnancies, which has saved lives. Maternal mortality has gone down by 41.5 percent, while infant mortality has gone down by 75 percent.

The programs came along at just the right time. From 1965 to 1980, we had huge improvements in what medical care could provide, including coronary bypass surgery, joint replacements and CT scans. Because of Medicare, many more seniors could take advantage of these medical advances. Medicaid made it possible for many poor children to have a healthier childhood. At the other end of life, Medicaid paid for nursing homes when people ran out of money, allowing seniors who could no longer live at home to live out their lives with more dignity than the traditional poorhouses offered.

Medicare and Medicaid were the first federal programs to pay private doctors and hospitals to care for patients. Before that, care was provided directly, as in the VA system, or through grants given to states.

The programs have grown to be the two biggest programs covering Americans today. Medicare covers 52.3 million Americans, and Medicaid, along with the later addition of Children’s Health Insurance Program, covers 71.1 million, so they together cover 38 percent of Americans. Their experience has shown us a partial single-payer system can work.

Medicare and Medicaid haven’t been problem-free. Medicare was set up so patients had to pay 20 percent of the costs of professional services, which quickly became a financial burden for seniors and led to Medigap policies to protect against those costs. At first, there was no coverage for oral medications, which made sense in 1965 when there were far fewer medications, but it took 38 years to create that coverage. Medicaid often has had such low fees for doctors that many refused to see Medicaid patients. However, many of the problems were eventually fixed.

These programs fundamentally transformed Rochester. We have 2.5 times as many people as we did in 1965, driven largely by the growth of medical practices. Mayo Clinic had fewer employees than IBM in 1965. It is about 10 times bigger now than it was in 1965. Olmsted Medical Group has grown dramatically, too. No other city in Southern Minnesota has grown like this. Austin and Albert Lea have fewer people now than in 1965, while Winona’s population is only slightly larger.

Medicare and Medicaid have transformed America, as well. The vision of several Democratic presidents made our country a better place. Much of American health care and graduate medical education over the last 50 years has been paid for by the programs. Technology helping all of us became available faster because more people could afford health care. Generations of seniors have led longer and better lives due to Medicare.

Medicaid has made the difference between life and death for many poor people.

Perhaps before 2065, we can have Medicare for all.

Mark Liebow is a Rochester physician and the chairman of Senate District 26 DFL.

http://www.postbulletin.com/opinion/mark-liebow-medicare-medicaid-mark-years-of-national-impact/article_9b91da27-0f99-5e55-8939-9b53b207db98.html

Medicare Turns 50: More Than 3 Million New Yorkers Covered; Aims To Improve Health Of Elderly

By Andrew Cohen
News Long Island, July 30, 2015

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

LONG ISLAND, NY – Today is the 50th anniversary of Medicare, and the program’s advocates are using the occasion to push for a major expansion.

Medicare provides health care to 55 million Americans, including 3.3 million New Yorkers.

Its supporters 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, says 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 stresses.

Opponents of universal health care say the government has too much control over people’s lives already.

But Alice Brody, state coordinator of the group Single Payer New York, says it’s time the U.S. caught up with other nations, including Canada, France and Great Britain, which have had government health programs for all citizens for years.

“All of the developed countries, basically, have a system that’s similar to Medicare, but even goes beyond that,” she points out.

National Nurses United, along with the Medicare Turns 50 Coalition, holds events to celebrate the anniversary in 30 cities across the country today, including New York City, Buffalo and Cohoes, near Albany.

The nurses want Congress to support House Resolution 676, which would expand Medicare to all U.S. residents.

Medicare Turns 50: More Than Three-Million New Yorkers Covered; Aims To Improve Health Of Elderly

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

http://kff.org/medicare/video/the-story-of-medicare-a-timeline/
“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.
Medicare Trustees Report (Premiums covered in Appendix E)
http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2009/May/1265_Biles_Extra_Payments_54_v2.pdf
http://carleton.ca/sppa/wp-content/uploads/Mirror-Mirror-Medicare-Part-D-Released.pdf
http://www.modernhealthcare.com/article/20150318/BLOG/303189965
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

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Expanding System for All Would Eliminate Health Care Rationing

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