By Michael Lighty
Healthcare-Now, Nov. 24, 2014

Below is testimony from Michael Lighty, director of public policy for National Nurses United, to the California Assembly Health Committee regarding Ebola preparedness in a fragmented health care system with cost-barriers to care and declining investment in public health.

This is a proud moment for California Nurses Association/National Nurses United, whose members have taken the lead in blowing the whistle for Ebola preparedness. From a die-in on the Las Vegas Strip in September to the 50,000 strong national day of action on Nov. 12, the nurses of CNA/NNU have made history.

Contrary to what their hospital administrators have said about their adherence to the CDC guidelines — nurses reported quite the opposite in a survey of over 3,500 nurses from every state in the U.S. So this new guidance in California creates a real level of security for nurses, and we thank Governor Brown and Director Baker, and the staff who worked so diligently to set this new national standard.

But what about the patients in a fragmented, under resourced “non-system” who are at the mercy of their insurance company’s high-deductible, minimal benefit, narrow network, sparse drug formulary health plan? And those on Medi-Cal who can’t find a doctor to accept them, or those undocumented workers and others who must rely solely on ER visits and a decimated public health system?

Funding for public health preparedness and response activities in the U.S. was $1billion less in 2013, than in 2002, according to a CDC report from earlier this year.

According to CMS data collected in 2013, patients in California Emergency Departments faced waits that are 23 minutes longer than the national average. Specifically, California patients waited on average more than two-and-a-half hours in the ED.

Further, if a patient is admitted to the hospital, the average wait increased to:

• About five hours and 18 minutes from arrival to the time a patient is admitted; and
• Nearly an additional two hours before a patient is moved to a bed.

At least 5 percent of patients at 20 of the state’s EDs left before being treated because of the long waits, according to Center for Health Reporting/Daily News.

Let’s make a distinction between an integrated, well-resourced system that guarantees a single standard of care for all with a dedicated funding source and real public accountability – known as single payer – verses the existing fragmented approach that seeks to regulate behavior sometimes with the force of law as in the case of this new guidance, and mostly as monetary incentives and voluntary guidance. Now, the treatment response to Ebola, for example, as other in other pandemics is largely governed by private health care corporations who are only accountable to their shareholders or board of directors, not the public.

Understaffing, access to treatment based on ability to pay, technology replacing hands-on care, difficulty gaining admission: it could and does happen everyday in our fragmented corporate health care system. All this happened to Ebola patient Thomas Eric Duncan in a Dallas hospital, and in his case, it was fatal and two nurses were infected.

We know what works, Canada has done it: A province-based single-payer system and federal agency that has the responsibility and authority to ensure local, state and national coordination to detect, respond and treat outbreaks.

The Ebola epidemic reveals the fissures and fatal inadequacies of our health care “non-system.” Only greater integration, planned and directed resources, and authority to a public health system can protect people in California from the dangers of pandemics like Ebola.

This new guidance issued by Cal/OSHA stands out as a clear mandate for precaution and protection establishing a national standard. Let us a create system where that is the rule, rather than the exception.

http://www.healthcare-now.org/ebola-preparedness-without-a-single-payer-system

By Donald M. Berwick, M.D.

The following is an unofficial transcript of the remarks delivered by Dr. Donald Berwick to the Annual Meeting of Physicians for a National Health Program on Nov. 15, 2014, in New Orleans. Dr. Berwick spoke to the assembly via live video.

Greetings, everyone,

I wish I were there in person, but I’m very grateful you’re letting me join you in this way. Obviously I’m talking to people who have had the vision and leadership and energy on this crucial issue for longer than I have, and I feel flattered you’ve asked me to share my thoughts.

As Gordy [Dr. Gordon Schiff] said, I just ran for the Democratic nomination for governor in Massachusetts. Unfortunately, I did not win the primary election. But in that experience I got much closer, face-to-face, with public policy and social justice issues – not just health care, but more than a dozen other issues – housing, homelessness, education, transportation, environment, energy, support for the arts, criminal justice, and frankly everywhere, poverty and immense debt, disparity, and inequality in our society, including in the state of Massachusetts.

And in the course of that campaign, and partly as a result of speaking to that very wide range of issues, I did take a clear stand – for the first time in my career – in favor of single-payer health care, Medicare for All, in Massachusetts.

I did it openly, I did it as forcefully as I possibly could, and I said it to no matter who I was talking to. And I want to explain in a few minutes why I did that, what I’ve learned from that campaign, and then a few thoughts about what I think is next, although I have to defer to you and your colleagues gathered at your meeting today on the latter.

First: Why did I do this?

I want to frame something first: single-payer health care is important in terms of policy, but it is not, in and of itself, a moral commitment. Social justice and equality, ending poverty and hunger: those would be moral aims. But how we pay for the care we want, and how we get that care, isn’t a matter of morality; it’s just a mechanism.

The test of the value of single payer as a policy isn’t whether or not it is self-evidently or ethically right, but only whether it’s a smart way to achieve quality of care, and I think it is. And I want to tell you why that is.

Drawing on my experience at the Institute for Healthcare Improvement, I’ve seen how powerful the concept of the Triple Aim is: an attempt to designate or help advance health care as an enterprise by starting with what specifically needs to be accomplished on behalf of the communities and the people that we serve. There’s a constellation of such aims in each and every system, and you cannot take them apart.

The Triple Aim includes, first, the aim of better care if you need care, from a check-up to treatment for a heart attack. There is a social need for better care for individuals; that means care that is safe, effective, patient-centered, timely, efficient, and equitable. That’s the first aim: better care for individuals.

The second aim is to help people not get sick in the first place, i.e. better health for populations.

And the third aim is to reduce the per capita cost of health care, so that resources are freed up for worthy alternative public and private endeavors.

So what I began to believe, more and more fully, is that if we consolidate payment into a single pool, a single stream, under public accountability, we’ll be better able to attain the Triple Aim. And that is the key argument for single-payer care.

That would help us achieve the first aim, better care. We have problems in our care. We have care that doesn’t match need, and care that is not safe. The progress toward patient safety in America is nowhere near where it really needs to be in this country, and not, very frankly, in other countries as well. Our care could be far, far more effective. People too often get care they don’t need, and care that is not aligned with science. Nor is care truly patient-centered. There has been some progress, but it’s limited.

I think single-payer care is a strong lever on better care. With it, we could decide to make care safer as a nation, and we could decide to align it with science. We have a lot of trouble doing this with a multi-payer system.

In my Medicaid work at the CMS, I got a report from the Inspector General about overuse of anti-psychotic drugs on Medicaid patients in nursing homes. The report came to my desk, and it showed 300,000 patients in nursing homes getting over-sedated.

So I picked up the phone and called in the head of the nursing home associations, the for-profits, the nonprofits, a dozen people, asking that they meet with me. And they all showed up. I said overmedication in our nursing homes was not OK. “Either you fix it,” I said, “or we will.” Within a few weeks I had reports on my desk, replies from those associations, none perfect, but all showing strong plans to decrease the use of such medications, and those projects are still underway today with good success.

With a single-payer system you have leverage, a voice for improvement. The leverage that you have in the form of payment is powerful.

A single-payer system would also help us achieve more meaningful transparency about the quality of care. Uncoordinated and multiple metrics are driving people in health care crazy right now. We need transparency, we need consolidated metrics that really work.

It would be much easier to achieve meaningful and parsimonious measurement under a single-payer system. It allows us to see how we’re doing. Where did the money go? How is our quality? It’s very hard to get that information, across time and space, in a fragmented, multi-payer system. A single-payer system provides much clearer eyes on the care, to the advantage of patients and the community, like it should be.

Under a single-payer system we can shift resources toward need. A single payer can get a better handle on fee-for-service. We can invest in behavioral health care, as some of you are talking about today, I know. And we would have the kind of community risk pool that we need in order to achieve justice and equality in health care.

And finally, a single payer would be even more effective than Medicare is today. We could do much more under the aegis of a consolidated payment system. It would be a powerful lever for better care.

As for Aim Two, better health, a single-payer system would let us invest upstream, for population health, to address population-based causes of poor health, over space and over time. It would be a powerful force for cross-sectional justice.

I have an illustrative story from New Zealand: I was talking with their Chief Medical Officer several years ago who was proudly telling me that they have an annual budget for health care, and that one year he asked that some of the money originally intended for the Ministry of Health be turned over to the Ministry of Housing. He understood that a lot of the burden of illnesses among children, particularly Maori children, is the result of poor housing conditions. So he actually proposed that money be taken from the health care pot and moved to the housing pot. You can’t do that under a multi-payer system. That won’t work.

So a single-payer system can offer new and powerful levers for prevention.

A single-payer system allows us to track a patient, which is very difficult under a multi-payer system.

Finally, the third leg of the Triple Aim triangle, beyond better care and better health, is lower cost. And here is where single payer stands out.

You know from the studies of David [Himmelstein] and Steffie [Woohandler] about administrative costs. I don’t know the total, I don’t know exactly what it is – something like 12 percent or 15 percent of health care spending is spent on supporting the complexity of our system, not better care. As I pointed out as a candidate for governor, some of that money should be used for building housing, schools, roads. It’s not right for health care to take more than it needs.

A single payer would also give us stronger bargaining power in payment for hospital supplies and more. I oversaw several procurements for durable medical equipment under Medicare, which we put out to bid, and which achieved a 42 percent decline in costs, with higher quality and service, over a several-year period.

Consolidated payment means better metrics and better quality on behalf of the people we serve.

An overarching consideration in this picture is justice. Until health care is less costly per capita, we will be unable to properly address the problems of our schools, poverty, and hunger.

So what I learned, very briefly, is that our current approach – a complex multi-payer system – makes it harder for us to get where we should get: to the Triple Aim.

With respect to health care, I think I discovered a sense of helplessness, a latent anger in the public that was sobering. As I campaigned in working-class communities, many of which may have voted Republican, people are weary. They’re worn down by forces they do not understand.

I remember meeting a carpenter, a soft-spoken guy. He told me about his health insurance problems and debts that have been weighing on him for more than a year and that were driving him over the edge.

That said, I want to stress, people don’t really understand the term single payer. They often lack a clear idea of what the term means or intends.

I would say that maybe a majority of the people I spoke with thought that single payer, Medicare for All, means both a government payer and a government provider or governmentally run delivery system. They thought I was speaking of the English or Scottish health systems or the VA.

That is not actually correct. You can have a single payer as a form of payment, and you can have a unified health care delivery system, but they’re not the same idea. Both can be discussed, but they’re not the same idea. It is quite possible to have a single payer and the same time have a pluralistic, partly public and partly private health care delivery system such as we have today in the U.S.

I believe that I saw that much of the business community, which actually may stand to gain the most, doesn’t understand benefits of single payer. They don’t understand what improvements and cost reductions they could get under a system of consolidated payment.

That said, the number of people was large who pulled me aside at a town meeting, a coffee, or a forum, and said quietly, “I’m almost embarrassed to say it, but I think you’re right.”

Some of the largest resistance, it seems to me, comes from some of the largest corporations. The key pushback from the public was job loss, concern about the loss of jobs at insurance companies. Of course, such losses would be largely offset by the number of jobs created in public sector, but we should not be glib or unfeeling about the dislocation that a single-payer system would cause in the existing funding organizations.

Overall, I’ll tell you this: My takeaway is that given my experience in living rooms, libraries, and town meetings, this [single payer] is possible. This can be done.

What is next? You’re in the best position, perhaps, to judge. I have only a couple of ideas.

First, I like the idea of action at the state level.

Second, I like the idea of trying to forge an alliance of groups, including business, in support of this proposal.

Third, a very big obstacle to progressing this policy is the widespread perception that government is unable to solve problems – that government cannot manage itself well. Indeed, some of the problems we have seen at the federal and state level contribute to this belief. I think there’s a natural need here for single-payer advocates to talk about government and responsible management, to make the case that government can solve problems and manage its business well.

Finally, I think we need to continue making the economic analysis for our case. It can be strong, but it has to be disciplined and intellectually honest.

I think I’ll stop there and be happy to take a few questions. Thank you.

Dr. Donald Berwick, an internationally recognized leader in the field of quality, is president emeritus and senior fellow at the Institute for Healthcare Improvement and former chief administrator of the Centers for Medicare and Medicaid Services.

By Philip Caper, M.D.
Bangor (Maine) Daily News, Nov. 20, 2014

A new Harvard study has found that Americans’ trust in the medical profession has dropped dramatically in recent years and lags behind that in many other wealthy countries. At the same time, doctors are becoming increasingly unhappy with our profession. In his new memoir, “ Doctored,” Dr. Sandeep Jauhar eloquently explains why: More and more doctors are coming to view our profession as just another job.

We now have a situation where patients are losing confidence in their doctors, while doctors are losing confidence in our ability to do the right thing for our patients. We have a health care system becoming more hostile to doctors and patients and more friendly to health care corporations.

These trends are collateral damage caused by another trend: our increasingly corporatized, commodified and commercialized U.S. health care “industry” that is being put into hyper drive by the Affordable Care Act. The ACA is accelerating an ongoing wave of hospital consolidations and acquisition of doctors’ practices by large corporations, such as Eastern Maine Healthcare Systems and MaineHealth.

As we continue down this road, doctors see our clinical autonomy disappearing as more and more of us become corporate employees subject to pressure to meet corporate financial goals that often differ from what is best for our patients. Patients sense that pressure as they are rushed through exams and are subject to more tests and procedures, some of them of questionable clinical value. They can almost hear the cash registers ringing as they move through their doctors’ offices, as more wealth is transferred from patients to those selling health care goods and services.

Why is American medicine, once the crown jewel of American professionalism and a proud and respected calling, becoming just another commercial enterprise? In his 2010 book “ Hijacked,” Dr. John Geyman, chairman emeritus of the department of family practice at the University of Washington, explains how during the year-long Congressional debate leading up to enactment of the ACA, the interests of the public, including doctors and patients, were subverted to those of large health care corporations.

The highjacking of health care reform is paying off handsomely. Robert Pear of the New York Times recently described how the federal government and the commercial health insurance industry have morphed into one big fan club for the ACA. He quotes the libertarian Cato Institute’s Michael Cannon explaining that since the ACA’s enactment, “Insurers and the government have developed a symbiotic relationship, nurtured by tens of billions of dollars that flow from the federal Treasury to insurers each year.”

Pear goes on to report that, “Since Mr. Obama signed the law, share prices for four of the major insurance companies — Aetna, Cigna, Humana and UnitedHealth — have more than doubled, while the Standard & Poor’s 500-stock index has increased about 70 percent.”

Pharmaceutical companies also have done very well. The ACA contains no authority for the government to negotiate pharmaceutical prices but continues the federal prohibition on the importation by U.S. residents of lower priced prescription drugs from many foreign countries.

This situation won’t change anytime soon. Congress is gridlocked. What is widely recognized as a drafting error in the ACA — which, in saner times, could have been fixed quickly without attracting much attention — is now headed to the Supreme Court.

Of course, health care is just one of many examples in which the welfare of corporations has been put ahead of the interests of the public, but it may be the poster child. Health care is now more than a sixth of our economy, and human lives and dollars are at stake.

Corporate stranglehold of our public policy traces back to the increasingly corrupt way our political campaigns are financed. The recent midterm elections were a stark reminder of that, setting record levels for corporate spending, even on local races, and saturating voters with negative, intrusive and often obnoxious messages.

What’s at stake is the future of health care and many other issues that will determine what kind of a country our children will live in. That future depends on how active and informed the public is willing to become in electing public officials who place the welfare of their constituents ahead of the wishes of their corporate contributors.

The results of the recent elections are not encouraging. But what’s becoming clearer is that our struggle is not between Democrats and Republicans, liberals and conservatives, or occupiers and tea partiers. It is between real American people and corporations.

I, for one, intend to continue pointing that out. That’s where our attention should be focused.

Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at pcpcaper21@gmail.com or through his website at philcaper.net.

http://bangordailynews.com/2014/11/20/health/blogs-and-columns/how-aca-fuels-corporatization-of-american-health-care/print/

By Neil H. Buchanan
Verdict, Justicia.com, Nov. 20, 2014

The two most recent attempts to reform the American health care system, in the early 1990s and early in this decade, were notable for what the would-be reformers refused even to consider: single-payer health care. Although nearly every major nation in the world uses a version of the single-payer system—and, as I will discuss below, even though the U.S. itself has had great success with a partial single-payer plan—both the Clinton and Obama Administrations ruled out universal single-payer reform even as one of the possible options.

Self-styled realists claimed in both instances that the political obstacles blocking adoption of a single-payer plan were insurmountable—so why even try? Defenders of President Obama’s approach noted that his advisors were worried that proposing anything like single-payer would brand the Administration as being too extreme, and that this would lead to huge losses in Congress for the Administration, and perhaps even the loss of Democratic majorities in both the House and Senate. We all know how that worked out for the Democrats, as former Speaker of the House Nancy Pelosi and soon-to-be Minority Leader Harry Reid sit dazed in their smaller offices.

Even that explanation, however, assumes that the Clinton and Obama Administrations were reluctantly trimming their sails, settling for less than they truly wanted. That could be true, I suppose, but there is an even stronger case—based on the totality of the economic policies that both presidents have enthusiastically embraced—that neither president was ever all that interested in seriously challenging the status quo.

The Affordable Care Act (ACA) is actually working rather well, given that it is by design a wasteful system that continues to pump profits into the bank accounts of unnecessary intermediaries. On the substance of what is included in the ACA—no more denials of coverage for preexisting medical conditions, more choices for many consumers, affordable coverage even for people who move between jobs, and millions of previously uninsured people now receiving coverage—Americans genuinely like the law. Even rising Senate Majority Leader Mitch McConnell, in what by the end was a very easy reelection campaign, refused to admit that he would take away the Kentucky version of the ACA, even as he promised to try to repeal the whole law nationwide.

No matter whether it is a marriage of convenience or a matter of deeper ideological commitments, the Obama Administration now finds itself in the position of having the health insurance industry as its greatest (only?) ally. Indeed, it seems that the rest of the political world is aligned to bring an end to “Obamacare.” An economist who advised the Administration has become the unintentional star of videos in which he disparaged voters’ intelligence. The Supreme Court is poised potentially to drive a stake into the heart of the ACA. And the rabid anti-Obama activists in the Republican Party continue to push for the ACA’s repeal.

The interesting question is what comes next, if the ACA fails or is killed. Republicans have never provided a meaningful alternative, and they dare not repeal the more popular parts of the law (including, in addition to the features noted above, the inclusion of children through age 26 on their parents’ policies). Moreover, the more Republicans attack the government for its supposed incompetence in running the ACA, the more we could reach the paradoxical moment where the public rallies behind the ultimate government solution that is single-payer health care.

How to Understand the Now-Infamous Remarks of One Unfortunate Economist: Both Liberal and Conservative Economists Think They Are Smarter Than Everyone Else

Much of the anti-ACA political landscape is by now utterly familiar. We have seen years of posturing by Republicans at all levels of government, dozens of pointless votes in the U.S. House of Representatives to repeal the law, and a razor-thin loss for repeal advocates in the Supreme Court in 2012. All of this makes the ACA a sore spot, and a focus of rage, for the Republican base. Even so, little new has come along to change the political landscape, until this week.

Now, the MIT economist Jonathan Gruber is at the center of a controversy over arrogant and disdainful remarks that he made at some policy/academic forums over the last few years. In particular, Gruber referred blithely to the “stupidity of the American voter” in explaining why he thought the law was written in less-than-clear ways.

Even a political opposition that was not as extreme as today’s Republican party would understandably respond to such comments with glee. Professor Gruber sounds, after all, more than “a bit dickish,” as Jon Stewart put it on his late-night show recently. If the Obama people relied on Gruber, as they clearly did, in setting up the law, then the President’s opponents would be crazy not to make political hay.

The problem is that people are misunderstanding what was at work in Professor Gruber’s comments. Republicans and their allies want to paint this as a case of “liberal condescension,” where the supposedly smug do-gooders in the Obama Administration are caught showing that they have no respect for “real Americans.” But that is most definitely not what was happening.

I am an economist, and I have spent large amounts of time with other economists. The one unimpeachable fact about economists of all political stripes is that they think that non-economists are stupid. (Indeed, one of the reasons that I now teach in a law school is that I found this mindset among economists to be so unfortunate—and unwarranted.) Economists are trained to think that only they can see through the silly nonsense of politicians, lawyers, pundits, and regular people—people who are too dense to understand that wage increases are not necessarily “real” (because they might be offset by inflation), or who fail to notice that a subsidy is the same thing as a tax reduction, or any of a number of other “simple” issues that economists deal with all the time.

Importantly, this disdain for the public is nonpartisan and not at all ideological. In fact, the Economics Department at the University of Chicago, which is famously conservative in its approach to economics, takes pride in its supposed ability to set the world straight and correct people’s dimwitted misunderstandings. One Chicago-School economist once referred to his colleagues’ approach as an “acid bath,” bringing the harsh reality of brutal logic to bear against the confused and sentimental ramblings of the great unwashed masses.

Professor Gruber, therefore, was simply caught saying to his colleagues what economists say to each other all the time: If everyone in the world were as smart as we are, we wouldn’t have to deal with their nonsense; but because they are easily confused, we can use our superior intelligence to take advantage of their shortcomings and dupe them into doing the smart thing. I have heard virtually the same words coming out of the mouths of conservative economists and liberal economists alike, many times.

Even so, and even though nothing that Professor Gruber said actually bears on the substantive content of the ACA, the new narrative is that the Obama Administration was somehow uniquely Machiavellian in its manipulation of the American people. That is not true, but there are plenty of false accusations against this president that Republicans have refused to abandon.

The net result of this new mess, therefore, is that the Republicans will be able to repeat relentlessly the claim that the ACA is a nefarious trick that was foisted on an unsuspecting public. The general suspicion that “we can’t trust Washington” will have inadvertently been enhanced by one economist being recorded saying what all of his colleagues believe.

The Supreme Court and the New Challenge to the ACA

As Professor Michael Dorf explained in his Verdict column yesterday, the Supreme Court has agreed to hear a new challenge to the ACA, King v. Burwell. There, the Court could decide that the subsidies for low-income Americans that allow them to buy insurance under the new health law must be limited to the dozen or so states that have set up their own insurance exchanges. That would leave the citizens of the majority of states without subsidies, because they are currently buying their insurance through exchanges established on the states’ behalf by the federal government.

The merits of that challenge are not the issue in this column, but I have to say that I find the central claim in King to be extraordinarily weak. Even so, a motivated group of conservative justices could decide to engage in naked partisan politics in that case, which would (among other things) allow Chief Justice Roberts to rehabilitate himself in conservatives’ eyes, after his vote to uphold the ACA in the 2012 NFIB v. Sebelius case.

If the Court strikes down the subsidies in the affected states, what would happen next? The so-called “death spiral,” in which the insurance pools in those states would include fewer healthy people, causing rates to rise and push out even more healthy people, is better thought of as a near-death experience. The exchanges would not be “really most sincerely dead” (in the immortal words of the munchkin coroner in The Wizard of Oz), because there would still be a core group of relatively ill people who are just barely able to buy the now-much-more-expensive insurance, and for whom even expensive insurance is better than nothing.

As the New York Times columnist Josh Barro has written, this unfortunate limbo perfectly describes the pre-ACA world in which New York State’s residents lived for years. It was a bad state of affairs, and no one liked it, but it limped along until the ACA radically improved the situation.

The point here, however, is that conservatives’ preferred result in the King case would lead to a new reality in which two-thirds of the country is stuck with especially dysfunctional private insurance markets. The public might well look back fondly on the days when health insurance was briefly affordable under the ACA.

Of course, even now Republicans are doing everything possible to convince the world that the ACA is impossibly broken. Last week, the Obama Administration announced that health insurance premiums would rise in 2015, in some cases by as much as 20%. Although unfortunate, this outcome (if, indeed, it turns out to be true) was quite common before the ACA came into effect. The reason that there was political support for reform in 2009 and 2010, after all, is that the old health care system was broken, and people knew it.

At this point, the Republicans cannot resist any opportunity to attack the ACA. A news article describing the new cost estimates included an Administration official claiming, correctly, that “the Affordable Care Act is working.” The next sentence in the article, however, says that “Republicans quickly pounced on the data as evidence of the opposite.” Their message: Get rid of the ACA, because we cannot trust a new bureaucracy to get things right.

Single-Payer Could Become a Very Real Possibility After All

If Republicans convince the public that the ACA is broken, then there will be a need for an alternative. As I noted above, however, they have offered nothing to replace the ACA. At best, they will return us to the status quo ante, but more likely, they will end up with a system in which the private health care markets are even worse than they were before. Moreover, state-by-state differences will become more pronounced, and businesses will find that their support of Republicans has made conducting business nationwide much more expensive.

If Americans are convinced that the government cannot run the ACA, would they ever believe that the government can do anything right? Strangely, the answer is yes. Once the Republicans and their allies on the Supreme Court—with an inadvertent assist from Professor Gruber—have convinced the public that the government cannot be trusted, while dooming Americans to an even worse private health care market, people will be looking for an alternative that is simple, clear, and tested.

We have such a system, and it is called Medicare. Even the older voters who skew toward the Tea Party love Medicare. (Famously, some of them apparently do not even realize that Medicare is a government-run program.) It is a single-payer system, and it has been working here in the United States for half a century. It is true that the way we formally finance the Medicare program is currently out of balance, but that is entirely fixable. Moreover, because the program has such low administrative costs, its total cost would be much lower than the private insurance system that it would replace.

I am not going to bet the house that the U.S. will adopt “Medicare For All” any time soon. I am certain, however, that the current road down which the Republicans and the Supreme Court are driving the country does not necessarily lead to their version of a utopia. Health care will always require a large amount of government involvement, as even the pre-ACA system showed. At some point, Americans might decide that enough is enough, and every citizen will finally be able to enjoy a tried-and-true program that works.

Neil H. Buchanan, a Justia columnist, is an economist and legal scholar, a Professor of Law at The George Washington University, and a Senior Fellow at the Taxation Law and Policy Research Institute, Monash University (Melbourne, Australia). He blogs at DorfonLaw.org, and he is the author of “The Debt Ceiling Disasters: How the Republicans Created an Unnecessary Constitutional Crisis and How the Democrats Can Fight Back.”

http://verdict.justia.com/2014/11/20/disdainful-economists-hubristic-jurists-fanatical-republicans#sthash.hyfA2tWh.dpuf

Commonwealth Fund report reveals stark comparison to 10 industrialized countries with universal health coverage

By Steven Reinberg
HealthDay News, Nov. 19, 2014

Seniors in America have more chronic health problems and take more medications than seniors in 10 other industrialized countries do, according to a new global survey.

The United States also stood out among the 11 nations surveyed by The Commonwealth Fund for having more seniors struggling to get and afford the health care they need.

Eighty-seven percent of U.S. adults who are 65 and older suffer from at least one chronic illness, and 68 percent have at least two illnesses, which were the highest rates found, the survey showed. Also, 53 percent of older Americans take at least four medications, another record high, and 21 percent spend at least $2,000 in yearly out-of-pocket health care costs, which was second only to Switzerland.

“The retirement of baby boomers means pressure on Medicare will intensify,” Dr. David Blumenthal, president of The Commonwealth Fund, said during a news briefing Tuesday to announce the study findings, which were published online Nov. 19 in the journal Health Affairs.

Despite the moderating of health care costs in recent years, Blumenthal added, “Costs are still going up too fast to be sustainable over the long term, and this will be exacerbated by increasing numbers of elderly individuals.”

The study’s lead author and Commonwealth Fund vice president, Robin Osborn, noted at the news briefing: “Those over 65 in the U.S. will almost double from 2005 to 2030. These sicker adults will likely put a strain on the health care system [which] will need to transform to meet the challenges of an aging population.”

For the survey, the researchers collected responses from more than 15,000 older adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States.

Most all of the other countries have some form of universal health insurance, and American seniors have Medicare, but Osborn said striking differences emerged in the survey:

• Although the U.S. senior group was the youngest of all the countries in the report, they were also among the sickest: 25 percent of older Americans saw at least four doctors in the past year, second only to Germany at 39 percent.
• In addition, more Americans (19 percent) said they skipped essential health care because they could not afford it, and 11 percent said they had trouble paying their medical bills. In France, only 3 percent of seniors said they skipped health care because of cost, and in Norway only 1 percent said they had trouble paying medical bills.
• In terms of out-of-pocket costs, only the Swiss spent more than Americans. In the United States, 21 percent spent $2,000 or more a year, compared with 22 percent in Switzerland and 2 percent in the United Kingdom. In France, on the other hand, virtually no one spent out-of-pocket costs.
• Only 57 percent of U.S. seniors said they were able to see their doctor the same or the next day when they were sick, compared with 83 percent in France and New Zealand, and 81 percent in Germany.
• Americans use of emergency rooms was one of the highest, at 39 percent. Thirty-five percent of these visits were for conditions their doctors could have dealt with had they been available, the researchers found.
• When a specialist was needed, 86 percent of U.S. seniors and 82 percent of seniors in Switzerland were able to see one within four weeks — the highest rates in the survey. Seniors in Canada (46 percent), Norway (46 percent) and Sweden (50 percent) were the least likely to get appointments that quickly.
• U.S. seniors, like seniors in the other countries, appear to suffer from poorly coordinated care or gaps in communication between doctors: 35 percent of U.S. seniors reported having such problems, as did 41 percent in Germany and 37 percent in Norway. In France, only 7 percent said they had these problems. But, the survey showed, American seniors also had better doctor/patient relationships than seniors in many other countries. 

An expert who was not involved with the study had a simple explanation for the key findings on American senior illnesses.

Dr. Steffie Woolhandler, co-founder of Physicians for a National Health Program, said American seniors are sicker because of the inadequate care they received before they turned 65.

“The health care system for the under-65 population is full of gaps, and lots of people fall through the cracks,” she said.

Woolhandler, who is also a professor of health at CUNY School of Public Health at Hunter College in New York City, added that Medicare is also leaving many Americans underinsured and that the Affordable Care Act will not make a major difference.

“We need to be providing much more comprehensive coverage to everyone, including lower co-pays and deductibles,” she suggested.

SOURCES: Steffie Woolhandler, M.D., professor, CUNY School of Public Health, Hunter College, New York City, and co-founder, Physicians for a National Health Program; Nov. 18, 2014, news conference with: David Blumenthal, M.D., president, and Robin Osborn, vice president and director, International Program in Health Policy and Practice Innovations, both Commonwealth Fund; Nov. 19, 2014, Health Affairs, online

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