PNHP

Why we need a National Health Plan

Why we need a National Health Plan

By Paul L. Burnley
Fayetteville (N.C.) Observer, Sept. 12, 2013

The objection to a national health plan by many of our lawmakers is similar to the reaction years ago to the Social Security program. It was seen as a tax-imposed on the public by the government. It was thought to be a struggle between the conservatives and liberal factions of government when, in reality, the only people affected by these programs are the poor, those who are at the bottom of the political spectrum.

Many believe a national health program is also a tax imposed on the public by the government. When the Social Security program began, there were those who said, “Why should the government take money from my paycheck to save for my retirement? I can save that money myself. How do I know I will live to retirement?” Today, millions are able to live and maintain themselves because of this program.

As for a national health insurance program, it will affect those who are not able to afford health insurance. If you are in an income bracket where you are able to pay for any and all medical emergencies, I can understand your reluctance about a national health program. But the majority of the residents of North Carolina are not in that income bracket.

Brokering the middle

I am not in favor of the government running the lives of its citizens; however, in some cases there must be an overseer that is fair and reasonable. If some issues that affect the general population were left to individual states, as they were years ago, they would be abused. That’s especially so in some Southern states, where the “good old boy” process was upheld. I can imagine the abuse that would have taken place had certain states been in control of the Social Security program.

Medical bankruptcy

The lack of medical insurance is the cause of many economical disasters, not only for individuals, but for communities. Many lose time from their jobs, because of illnesses that would be treated if medical insurance were available.

The majority of bankruptcies in this country are caused because of medical bills that people are not able to pay, due to the lack of medical insurance. If there were a national health program, many of these problems would not exist.

There are those who say, well, now we have Medicare. That should take care of most of the medical problems. This only covers those over 65 years of age, or those unable to work. This leaves the majority of the public out of the loop. This is why,when there are any free medical services offered by groups trying to address this situation, they are overwhelmed by people needing medical attention.

I am not saying that all elements of our lives should be controlled by the government, but when it comes to a large segment of the population, the decision should not be left to local or state authorities. In many cases opinions are governed by political, racial and social attitudes and choices. Had Social Security been administered by the states, millions of people whose income is derived from Social Security would not have received it.

Paul L. Burnley is a retired newspaper writer and editor and a former member of the Observer’s Community Advisory Board.

http://www.fayobserver.com/articles/2013/09/13/1282406?sac=fo.opinion

Sen. Bernie Sanders on single payer

A single-payer system makes economic sense

By Sen. Bernie Sanders (I-Vt.)
The Hill, September 10, 2013

Americans spend about twice as much per capita on healthcare as almost any other developed nation, but our outcomes are not as good as others that spend much less. We can do better. We must do better.

Today, some 50 million Americans lack health insurance. Many others delay going to the doctor because of high deductibles and unaffordable copayments. While the number of uninsured Americans will go down with the implementation of the Affordable Care Act, widely known as ObamaCare, tens of millions of Americans will remain uninsured.

The goal of an effective healthcare system is to do everything possible to enable people to live long and healthy lives. Sadly, the American system fails to do that and falls behind many other countries. While we devote 18 percent of our gross domestic product to healthcare, we rank 33rd in life expectancy and 34th in infant mortality, and trail in many other health outcomes. A Harvard University study indicated that, incredibly, some 45,000 Americans die needlessly each year because they do not get to a doctor in time.
 
I start my approach to healthcare from a very basic premise: healthcare is a right, not a privilege. Unfortunately, uniquely among major nations, that statement is not true for the United States, where access to healthcare depends on how much money you have and what your employer is willing to provide.

It is simply unconscionable that the most advanced nation in the world has so many people who lack health insurance. It makes no sense that millions more are one diagnosis or car accident away from financial disaster. And, despite the trillions of dollars we spend on healthcare, the disparity in the quality of care between the rich and everyone else grows wider.

Our system doesn’t make economic sense, and it certainly doesn’t make moral sense. In a civilized, democratic society, every man, woman and child must be able to get the medical care they need regardless of income.

It is incomprehensible that drug companies still get away with charging Americans twice as much — or more — than citizens of Canada or Europe for the exact same drugs manufactured by the exact same companies. It is an outrage that insurers still want to hike premiums by as much as 60 percent a year on individual policyholders.

It boggles the mind that approximately 30 percent of every healthcare dollar spent in the United States goes to administrative costs rather than to delivering care. Taiwan, for example, spends only a little over 6 percent of its GDP on healthcare, while achieving better health outcomes on some key indicators than we do. The reason, of course, is that they spend a fraction of what we do on administrative costs.

If our goal is to provide high-quality healthcare in a cost-effective way, what should we be doing?

Clearly, we must move toward a single-payer system.

The health insurance lobby and other opponents of single-payer care make it sound scary. It’s not. In fact, a large-scale single-payer system already exists in the United States. It’s called Medicare. People enrolled in the system give it high marks. More importantly, it has succeeded in providing near-universal coverage to Americans over the age of 65.

Establishing a single-payer system will mean peace of mind for all Americans. When health insurance is no longer tied to employment, people will not fear losing both their job and their family’s access to healthcare. Millions of Americans won’t have to stay in jobs they don’t like because their family needs healthcare. Entrepreneurs and small businesses will be free to develop their business plans without worrying about the cost and complexity of providing healthcare for themselves and their employees.

For these reasons and more, Rep. Jim McDermott (D-Wash.) and I have introduced the American Health Security Act, which would guarantee healthcare as a human right and provide every U.S. citizen and permanent resident with healthcare coverage and services through a state-administered, single-payer program.

I am very proud that my home state of Vermont is now taking big steps to lead the nation in healthcare by moving forward on a plan to establish a single-payer healthcare system that puts the interests of patients over corporate profits. The American Health Security Act would make sure every state does the same.

The goal of real healthcare reform must be high-quality, universal coverage in a cost-effective way. We must ensure, to as great a degree as possible, that the money we put into health coverage goes to the delivery of healthcare, not to paper-pushing, astronomical profits and lining CEOs’ pockets.

http://thehill.com/special-reports-archive/1549-healthcare-september-2013-/321477-a-single-payer-system-makes-economic-sense

Comment:

By Don McCanne, M.D.

Although the nation is distracted with the implementation of the Affordable Care Act, the single payer concept is not going to go away. Soon the nation will understand why.

AFL-CIO reaffirms support of single payer

2013 Convention

AFL-CIO

September 11, 2013
Adopted Resolutions

Resolution 54: AFL-CIO Convention Resolution on the Affordable Care Act

WHEREAS, in 2009, the AFL-CIO Convention passed two health care resolutions—Health Care Reform Now and the Social Insurance Model for Health Care Reform—which reaffirmed the labor movement’s commitment to health care for all, ultimately through a single-payer system. In 2010, Congress passed the Affordable Care Act (ACA);

(23 more WHEREASs)

NOW, THEREFORE, BE IT RESOLVED, that the AFL-CIO reaffirms the health care resolutions adopted by the 2009 convention, including the commitment to pursue health care for all ultimately through a single-payer system;

(8 more BE-IT-FURTHER-RESOLVEDs)

http://www.aflcio.org/About/Exec-Council/Conventions/2013/Resolutions-and-Amendments/Resolution-54-AFL-CIO-Convention-Resolution-on-the-Affordable-Care-Act

Comment:

By Don McCanne, M.D.

There are two important health care reform issues before us today. The most important by far is that this nation desperately needs a single payer system. The other is that the Affordable Care Act is well on its way to being fully implemented, with all of its intolerable flaws. Yesterday, AFL-CIO passed a resolution dealing with both of these.

The first WHEREAS and the first BE-IT-RESOLVED reaffirmed organized labor’s support of single payer reform. It is an imperative.

The other twenty-three WHEREASs and eight BE-IT-FURTHER-RESOLVEDs can be accessed at the link above. They concern very serious flaws in the Affordable Care Act, especially applicable to union members, which will be very difficult to correct. They are important to understand because flaws such as these permeate the entire Act.

Maintaining and expanding our highly dysfunctional health care financing system while adding administrative complexity is precisely what we did not need. All of this could have been avoided by moving directly to a single payer system. We can still do that, even if we have already wasted much time and money, while prolonging hardship and suffering.

Although organized labor’s targeted attack on the Affordable Care Act is making headlines today, they passed another resolution that is also very important:

Resolution 15: Protecting and Expanding Medicare Benefits

Excerpts:

Instead of cuts and cost shifting, we call for improvements to Medicare. Doing so is an essential prerequisite to establishing it as a model for a universal, single-payer system.

Instead of looking for ways to destroy Medicare, which has been a leader in improving our dysfunctional health care system, we must build on its experience as a single-payer program, demonstrating that single payer is the most cost-effective and equitable way to provide quality health care.

http://www.aflcio.org/About/Exec-Council/Conventions/2013/Resolutions-and-Amendments/Resolution-15-Protecting-and-Expanding-Medicare-Benefits

AFL-CIO reaffirms commitment to single payer, demands fixes to ACA

By Kay Tillow
Single Payer News, Sept. 12, 2013              

The just-concluded AFL-CIO convention in Los Angeles reaffirmed its commitment to a single-payer health care system while demanding that the Affordable Care Act (ACA) be fixed to protect Taft-Hartley (multi-employer) plans, to end the excise tax, to make employers cover workers who average 20 hours a week, to require construction companies with five or more employees to provide health care, to penalize companies who dump their workers onto Medicaid, plus more.

Some of the debate on the resolution can be seen here:

http://www.youtube.com/watch?v=vpVOf9Qsmno

Full text of the resolution can be found here:

http://www.aflcio.org/About/Exec-Council/Conventions/2013/Resolutions-and-Amendments/Resolution-54-AFL-CIO-Convention-Resolution-on-the-Affordable-Care-Act

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

Other media coverage:

AFL-CIO heads off health care fight by criticizing, not dumping, Affordable Care Act

By Mark Gruenberg
Press Associates Union News Service, Sept. 11, 2013

LOS ANGELES – Leaders of the AFL-CIO headed off a knock-down drag-out fight over the Affordable Care Act – the Obama administration’s signature 2010 health care law that organized labor strongly supported – with a compromise resolution that specifies the act’s ills and puts the administration on notice they must be fixed.

But if they aren’t fixed, Laborers President Terry O’Sullivan said, the ACA should be dumped.

The health care fight was the most open controversy at the four-day convention. A compromise headed off another battle, where the building trades unions questioned the role and power of nonunion groups – particularly environmentalists – in labor’s councils. Complaints about lack of protection against inter-union raiding were diverted to the federation’s executive council, with a February 2014 reporting deadline.

But the health care fight couldn’t be headed off.

The resolution and several union leaders said administration’s interpretation of the ACA would virtually trash multi-employer health care plans, which cover 20 million people – workers, retirees and their families – nationwide.

Those plans, prevalent in construction, but present in other industries – such as food processing and seafaring – let joint union-management boards run health care plans that cover workers who frequently shift from job site to job site in an industry.

“If the ACA is not fixed, if it destroys the health and welfare funds we fought for, it needs to be repealed!” O’Sullivan roared. “The proud men and women we represent cannot be collateral damage” of the health care law.

“The ACA as it currently stands is not meeting its promise,” added IBEW President Ed Hill, whose union and five others openly wrote congressional leaders saying they must fix the health care law.

“This is make-or-break for a lot of unions, not just the building trades,” warned Sheet Metal Workers President Joe Nigro. “A resolution is a piece of paper and may offend a lot of politicians, but a labor movement is run by leaders who represent working men and women. …You let the ACA bill go through like this and you won’t need a room a quarter of this size” for the next federation convention four years from now, he added.

“We have to follow this with action,” declared Unite Here President D. Taylor, after reminding delegates of ACA’s benefits – and of exceptions Obama already illegally granted to businesses, congressional staffers and to some religious-run enterprises.

Dissent also came from those who want to go further. Though both federation President Richard Trumka and Professional and Technical Engineers President Greg Junemann said the eventual goal of the resolution is single-payer government-run national health care, the compromise downplays that goal.

The other dissenter was Kathryn Donahue, board member of the California Nurses Association/ National Nurses Organizing Committee. Her union stayed away from the convention until its final session due to, among other issues, disagreement about the ACA. CNA/ NNOC, part of National Nurses United, has been one of labor’s most ardent advocates of single payer, which 21 unions endorsed before the AFL-CIO’s 2009 convention.

“The ACA does not solve the health care crisis facing all of the people, not just union people,” Donahue declared. “It will not improve access to health care” and “will not remove health care from collective bargaining,” she said. Her union provided the scattered “no” votes in the crowd when delegates approved the health care resolution by voice vote. The resolution specifies, among other things, that:

• The AFL-CIO backs single payer – along with other alternatives it OK’d in 2009.

• Demands Congress amend the ACA unless the act is “administered in a manner that preserves the high-quality coverage” of multi-employer plans.

• Says the multi-employer plans “should have access to the ACA’s premium tax credits and cost-sharing reductions … just as for-profit insurance companies will.” The difference between the two has been the big problem in private talks Trumka and other union leaders have had with White House staffers. The White House has stonewalled.

• Says workers toiling more than 20 hours a week must be covered by ACA’s employer responsibility rules. The ACA now sets the lower limit at 30 hours per week. Several speakers at the convention said private firms – and some state and local governments – are racing to cut full-timers to 29 hours, to get out from under the act.

• Declares the employer responsibility rules should extend to construction companies with at least five employees, not 50. The 50-worker rule would exempt the overwhelming majority of construction firms, building trades leaders say.

• Reiterates unions’ strong opposition to taxing health care benefits. Obama strong-armed the AFL-CIO, at the end of the 2010 health care fight, into accepting such a tax on so-called “Cadillac” plans, in 2018.

Mark Gruenberg is editor of Press Associates Union News Service, 2605A P Street NW, Washington DC 20007. Phone: (202) 898-4825. E-mail: paiunionnews@yahoo.com. www.paiunionnews.com

AFL-CIO Convention Calls for Fixes in Affordable Care Act

By Mike Hall
AFL-CIO NOW blog, Sept. 11, 2013

Delegates to the AFL-CIO Convention this afternoon passed a resolution expressing support for the goals of the Affordable Care Act (ACA) but also addressing a number of issues about the ACA’s implementation, including the way the ACA treats multi-employer health care plans. The resolution reiterates that the labor movement’s ultimate health care goal is health care for everyone under a single-payer model.

The resolution calls for preservation of high-quality coverage under multi-employer plans. It also calls for greater employer responsibility, especially in regards to part-time workers. Sean McGarvey, president of the AFL-CIO Building and Construction Trades Department (BCTD), said the resolution, “Points out the key facts that must be addressed by the administration and if needed, by Congress.”

AFL-CIO President Richard Trumka called the issues raised by the resolution ones of “fundamental fairness,” including if low- and moderate-income union members and their collectively bargained health care plans will
be able to benefit from the same premium support that big insurance companies will receive and if they will have to pay fees to subsidize big insurance companies. There also are concerns that smaller employers will be able to get away with taking health care away from workers while paying no penalty. 

Laborers (LIUNA) President Terry O’Sullivan, who endorsed the resolution, told the convention delegates that without changes to the way the ACA is implemented, there are likely to be “unintended consequences” that will hurt workers’ health care coverage.

It needs to be changed and fixed now….We will work with the president to do everything we can to fix the Affordable Care Act….We want it fixed, fixed, fixed.

AFT Secretary-Treasurer Lorretta Johnson called the resolution “a road map to making the Affordable Care Act a success” and called the ACA, especially in the way it is being implemented by the federal agencies involved, “a work in progress.” She also said many AFT members, including para-professionals, adjunct college professors, nurses and public employees, have had their hours cut to under the 30-hour week threshold they must work before ACA requires employers to provide affordable, comprehensive health care coverage or pay a penalty.

Trumka did tell the delegates that “the labor movement is engaged in ongoing dialogue with a number of government agencies regarding implementation of the Affordable Care Act — especially the way it treats collectively bargained multi-employer funds.”

http://www.aflcio.org/Blog/Political-Action-Legislation/AFL-CIO-Convention-Calls-for-Fixes-in-Affordable-Care-Act

AFL-CIO steps up criticism of health care law

By Sam Hananel
The Associated Press, Sept. 11, 2013

WASHINGTON (AP) — The AFL-CIO on Wednesday approved a resolution critical of parts of President Barack Obama’s health care law in spite of efforts by White House officials to discourage the labor federation from making its concerns so prominent.

The strongly worded resolution says the Affordable Care Act will drive up the costs of union-sponsored health plans to the point that workers and employers are forced to abandon them. Labor unions still support the law’s overall goals of reducing health costs and bringing coverage to all Americans, the resolution says, but adds that the law is being implemented in a way that is “highly disruptive” to union health care plans.

Some individual unions have complained about the law’s impact for months. The resolution marks the first time the nation’s largest labor federation has gone on record embracing that view. Unions were among the most enthusiastic backers of the law when it passed in 2010.

A labor official told The Associated Press that White House officials had been calling labor leaders for days to urge them not to voice their concerns in the form of a resolution. The official, who wasn’t authorized to discuss the conversations publicly and requested anonymity, said many union leaders insisted that they wanted to highlight their concerns.

Asked about any efforts to discourage unions from passing the resolution, the White House said in a statement Wednesday night that officials “are in regular contact with a variety of stakeholders, including unions, as part of our efforts to ensure smooth implementation and to improve the law.”

The AFL-CIO, one of the president’s major boosters, approved the resolution just as the administration began rolling out a multimillion-dollar advertising campaign to encourage Americans to sign up for health care exchanges starting Oct. 1.

Harold Schaitberger, president of the International Association of Firefighters, said the intent of the resolution is to “point out the criticisms without being overly caustic.”

“There have to be some changes made in the area that are giving a number of our unions great concern,” said Schaitberger, who chaired the committee that hammered out the resolution’s language.

The resolution was approved at the AFL-CIO’s quadrennial convention in Los Angeles. It claims the new law will increase costs for health plans that are jointly administered by unions and smaller employers in the construction, retail and transportation industries. That could encourage employers to hire fewer union workers or abandon the health plans altogether and force union members to seek lower-quality coverage on the new health exchanges.

Union officials are seeking rule changes that would make their low-income workers eligible for the same types of federal subsidies they could get in the exchanges. They have also suggested rules that would treat their multi-employer plans as qualified exchange plans under the new law.

But the Congressional Research Service issued a memo earlier this year finding that neither change is allowed through rulemaking. The AFL-CIO resolution calls for the law to be amended by Congress if new rules cannot satisfy their concerns.

AFL-CIO President Richard Trumka held meetings at the White House last month in which he and other union leaders pressed the administration to make changes. Trumka has said he is encouraged that the White House is listening, but that no firm proposals have been made.

In a statement issued earlier Wednesday, the White House said there is nothing in the Affordable Care Act that changes the law for union plans. The statement said the White House would continue to work with unions and other stakeholders on ways to ensure smooth implementation of the law.

The AFL-CIO resolution was toned down from a draft originally offered by Sean McGarvey, head of the AFL-CIO’s Building and Construction Trades Department. The early draft said the AFL-CIO could no longer support the health care law and called for its repeal unless changes were made to protect union multi-employer plans.

Republican critics of the health care law have seized on the union complaints to fuel their push to repeal the law. At the same time, GOP leaders have warned the White House against carving out any special deal for unions.

“We will do whatever is within our power to ensure that the administration does not once again provide a special exemption to unions at the expense of American taxpayers,” Michigan Rep. Dave Camp and Utah Sen. Orrin Hatch wrote in a letter this week to Treasury Secretary Jack Lew. Camp is chairman of the House Ways and Means Committee and Hatch is top Republican on the Senate Finance Committee.

http://www.usnews.com/news/politics/articles/2013/09/11/afl-cio-steps-up-pressure-for-health-law-changes

Michael Hiltzik: To fix health law, go single-payer

Health law's ailments can be cured by single-payer system

By Michael Hiltzik
Los Angeles Times, September 10, 2013

All the shortcomings of the healthcare restructuring result from the decision to leave it in the hands of private insurers.

With the Oct. 1 rollout of a major facet of the Affordable Care Act on the horizon, you’ll be hearing a lot about the glitches, loopholes and shortcomings of this most important restructuring of America’s healthcare system in our lifetimes. Here are a couple of things to keep in mind:

First, the vast majority of these issues result from one crucial compromise made in the drafting of the 2010 law, ostensibly to ease its passage through Congress. That was to leave the system in the hands of private health insurance companies.

Second, there’s an obvious way to correct this flaw: The country should progress on to a single-payer system.

The idea that the ACA is a logical precursor to single-payer, in which the government would be the source of all medical reimbursement, has been gaining traction as key thresholds for healthcare reform approach. The biggest milestone is the Oct. 1 launch of open enrollment for the health insurance exchanges that will offer individual insurance starting Jan. 1.

Last month, Senate Majority Leader Harry Reid made that point in a Nevada news broadcast, calling the ACA “a step in the right direction” but adding that the U.S. would have to “work our way past” private insurance-based healthcare. “We’re far from having something that’s going to work forever,” he said.

“There isn’t a popular groundswell yet” for a single-payer plan “because most people haven’t seen the ACA at work in detail yet,” says David Himmelstein, a professor of public health at the City University of New York and co-founder of Physicians for a National Health Program, the leading advocacy group for single-payer healthcare. But he anticipates that discontent will start in October “and accelerate through the winter.”

Among the law’s shortcomings, he says, are the lack of effective provisions to control healthcare costs and insurance premiums. Premium regulation remains in the hands of the states, and many don’t have strong regulatory oversight of health insurance. In California, health insurance premiums are exempt from prior approval by the insurance commissioner, unlike home and auto insurance. (An initiative to remove the exemption will appear on the November 2014 ballot.)

That’s not to say that the ACA won’t make health insurance more affordable and accessible to millions of Americans now excluded from the market. Published exchange premiums in 18 states have generally come in below expectations, and the federal subsidies available to most buyers will make them cheaper still.

In some cases the premiums may be higher than those of plans on the market now. But because of exclusions for preexisting conditions — which will no longer be legal — they’re actually unavailable at any price to people who will have no trouble qualifying for the exchange plans.

The ACA’s critics observe that a plurality of Americans still view the ACA unfavorably (43%, according to an opinion poll released in June by the Kaiser Family Foundation). They rarely acknowledge, however, that nearly 1 in 5 of those critics think the law doesn’t go far enough — that is, further toward single-payer.

In its earliest incarnation, the Affordable Care Act included a prototype government single-payer provision — the “public option,” a government-sponsored plan to compete with commercial insurers in the exchanges. The public option was deleted at the insurance industry’s insistence.

But the U.S. does offer a healthcare program that resembles single-payer. It’s Medicare, the broadly popular health plan that covers all Americans over 65. Medicare’s administrative costs are only about 2%, and its size gives it the clout to extract large discounts from doctors and hospitals. That’s why one oft-proposed version of single-payer is “Medicare for all” — simply expand its coverage beyond the 65-plus.

Canada’s single-payer system is another model. It’s popular and efficient and costs about one-third of America’s system to administer. Don’t believe the myths purveyed about Canada’s healthcare by the U.S. insurance industry’s minions.

As health economist Aaron Carroll has documented, Canadian patients and doctors are satisfied with the program. As for the contention that it “rations” care, he points out that care in the U.S. is rationed by cost: one-third of adult Americans surveyed by the Commonwealth Fund in 2010 said they had put off important treatment because of the cost. In Canada, the figure was 15%.

There’s little question that taking private insurers out of the American healthcare system would save hundreds of billions of dollars a year. Dozens of studies of federal and state single-payer proposals have found that single-payer plans could provide universal coverage — not even the ACA does that — and still save money.

Estimates of the administrative costs of commercial health insurers exceed 10%. That doesn’t include the costs to doctors and hospitals of maintaining billing staffs to deal with insurers and keep all their rules and peculiarities straight, or the time lost to individuals and their employers of navigating this unnecessarily byzantine system.

Add those, and the overall administrative costs embedded in the U.S. healthcare system come to 31% of all spending, according to a 2003 article co-written by Himmelstein for the New England Journal of Medicine. Administrative and clerical workers accounted for nearly 44% of all employees in doctors’ offices, they calculated.

What do Americans receive in return for all this overhead? Practically nothing. The insurance industry says its role is to hold down costs by negotiating for preferential fees from doctors and hospitals and trolling for abuses, but the truth is they’re totally ineffective at cost control.

Just last year I reported on an admission by Aetna and United Healthcare, two of our biggest insurers, that they had been snookered to the tune of $60 million by one chain of small surgical clinics in Northern California. That happened because the insurers didn’t hire enough staff to give the claims from those clinics decent scrutiny — in other words, their administrative costs, high as they were, didn’t buy adequate oversight.

The result, to cite just one example, was that United paid the chain more than $97,000 for a kidney stone operation that it usually covers for $6,851.

“Private insurance is a parasite in the system,” says Arnold S. Relman, the former editor of the New England Journal of Medicine and an advocate of healthcare reform. “It adds nothing of value commensurate with its cost.”

Relman believes that fixing the healthcare system will require more than single-payer. The delivery of care needs to be reorganized by promoting the formation of more “accountable care organizations” — medium- and large-scale group practices with hospital affiliates whose physicians would be salaried to discourage the overuse fostered by the fee-for-service system.

What’s really needed is political will. It would help if big companies, which grouse incessantly about the rising costs of covering their employees, would throw their weight behind a system that would relieve them of that burden.

The forces of opposition won’t l
ie down; the insurance industry won’t give up its central role in the healthcare system without a costly and bruising fight, as it showed in Congress and in numerous states, including California, where single-payer plans were on the table.

“It’s going to be a slow and painful process,” Relman says. “But sooner or later we’ll have to turn to single-payer. It’s the only logical solution.”

http://www.latimes.com/business/la-fi-hiltzik-20130911,0,2211922.column

Comment:

By Don McCanne, M.D.

This is an article that you should share with your friends and others who may not have an adequate understanding of single payer. If this kindles an interest in them, which it certainly should, then let them know that they can learn more by accessing the website of Physicians for a National Health Program at www.pnhp.org.

My gosh, who wouldn’t want a lifetime of guaranteed, affordable health care, free of the intrusions and inherent waste of the private insurance industry?

A single-payer system makes economic sense

By Sen. Bernie Sanders
The Hill, Sept. 10, 2013

Americans spend about twice as much per capita on healthcare as almost any other developed nation, but our outcomes are not as good as others that spend much less. We can do better. We must do better.

Today, some 50 million Americans lack health insurance. Many others delay going to the doctor because of high deductibles and unaffordable copayments. While the number of uninsured Americans will go down with the implementation of the Affordable Care Act, widely known as ObamaCare, tens of millions of Americans will remain uninsured.

The goal of an effective healthcare system is to do everything possible to enable people to live long and healthy lives. Sadly, the American system fails to do that and falls behind many other countries. While we devote 18 percent of our gross domestic product to healthcare, we rank 33rd in life expectancy and 34th in infant mortality, and trail in many other health outcomes. A Harvard University study indicated that, incredibly, some 45,000 Americans die needlessly each year because they do not get to a doctor in time.

I start my approach to healthcare from a very basic premise: healthcare is a right, not a privilege. Unfortunately, uniquely among major nations, that statement is not true for the United States, where access to healthcare depends on how much money you have and what your employer is willing to provide.

It is simply unconscionable that the most advanced nation in the world has so many people who lack health insurance. It makes no sense that millions more are one diagnosis or car accident away from financial disaster. And, despite the trillions of dollars we spend on healthcare, the disparity in the quality of care between the rich and everyone else grows wider.

Our system doesn’t make economic sense, and it certainly doesn’t make moral sense. In a civilized, democratic society, every man, woman and child must be able to get the medical care they need regardless of income.

It is incomprehensible that drug companies still get away with charging Americans twice as much — or more — than citizens of Canada or Europe for the exact same drugs manufactured by the exact same companies. It is an outrage that insurers still want to hike premiums by as much as 60 percent a year on individual policyholders.

It boggles the mind that approximately 30 percent of every healthcare dollar spent in the United States goes to administrative costs rather than to delivering care. Taiwan, for example, spends only a little over 6 percent of its GDP on healthcare, while achieving better health outcomes on some key indicators than we do. The reason, of course, is that they spend a fraction of what we do on administrative costs.

If our goal is to provide high-quality healthcare in a cost-effective way, what should we be doing?

Clearly, we must move toward a single-payer system.

The health insurance lobby and other opponents of single-payer care make it sound scary. It’s not. In fact, a large-scale single-payer system already exists in the United States. It’s called Medicare. People enrolled in the system give it high marks. More importantly, it has succeeded in providing near-universal coverage to Americans over the age of 65.

Establishing a single-payer system will mean peace of mind for all Americans. When health insurance is no longer tied to employment, people will not fear losing both their job and their family’s access to healthcare. Millions of Americans won’t have to stay in jobs they don’t like because their family needs healthcare. Entrepreneurs and small businesses will be free to develop their business plans without worrying about the cost and complexity of providing healthcare for themselves and their employees.

For these reasons and more, Rep. Jim McDermott (D-Wash.) and I have introduced the American Health Security Act, which would guarantee healthcare as a human right and provide every U.S. citizen and permanent resident with healthcare coverage and services through a state-administered, single-payer program.

I am very proud that my home state of Vermont is now taking big steps to lead the nation in healthcare by moving forward on a plan to establish a single-payer healthcare system that puts the interests of patients over corporate profits. The American Health Security Act would make sure every state does the same.

The goal of real healthcare reform must be high-quality, universal coverage in a cost-effective way. We must ensure, to as great a degree as possible, that the money we put into health coverage goes to the delivery of healthcare, not to paper-pushing, astronomical profits and lining CEOs’ pockets.

Sanders, I-Vt., is the junior senator from Vermont, serving since 2007. He sits on the Environment and Public Works; the Energy and Natural Resources, the Health, Education, Labor and Pensions; and the Budget; and the Veterans’ Affairs committees, as well as the Joint Economic Committee.

http://thehill.com/special-reports-archive/1549-healthcare-september-2013-/321477-a-single-payer-system-makes-economic-sense#ixzz2ebEei2sQ

PNHP note: see also Sen. Sanders’ op-ed in Sept. 30 edition of The Guardian (U.K.) titled “A single-payer system, like Medicare, is the cure for America’s ailing healthcare.”

Health law's ailments can be cured by single-payer system

All the shortcomings of the healthcare restructuring result from the decision to leave it in the hands of private insurers

By Michael Hiltzik
Los Angeles Times, Sept. 10, 2013

With the Oct. 1 rollout of a major facet of the Affordable Care Act on the horizon, you’ll be hearing a lot about the glitches, loopholes and shortcomings of this most important restructuring of America’s healthcare system in our lifetimes. Here are a couple of things to keep in mind:

First, the vast majority of these issues result from one crucial compromise made in the drafting of the 2010 law, ostensibly to ease its passage through Congress. That was to leave the system in the hands of private health insurance companies.

Second, there’s an obvious way to correct this flaw: The country should progress on to a single-payer system.

The idea that the ACA is a logical precursor to single-payer, in which the government would be the source of all medical reimbursement, has been gaining traction as key thresholds for healthcare reform approach. The biggest milestone is the Oct. 1 launch of open enrollment for the health insurance exchanges that will offer individual insurance starting Jan. 1.

Last month, Senate Majority Leader Harry Reid made that point in a Nevada news broadcast, calling the ACA “a step in the right direction” but adding that the U.S. would have to “work our way past” private insurance-based healthcare. “We’re far from having something that’s going to work forever,” he said.

“There isn’t a popular groundswell yet” for a single-payer plan “because most people haven’t seen the ACA at work in detail yet,” says David Himmelstein, a professor of public health at the City University of New York and co-founder of Physicians for a National Health Program, the leading advocacy group for single-payer healthcare. But he anticipates that discontent will start in October “and accelerate through the winter.”

Among the law’s shortcomings, he says, are the lack of effective provisions to control healthcare costs and insurance premiums. Premium regulation remains in the hands of the states, and many don’t have strong regulatory oversight of health insurance. In California, health insurance premiums are exempt from prior approval by the insurance commissioner, unlike home and auto insurance. (An initiative to remove the exemption will appear on the November 2014 ballot.)

That’s not to say that the ACA won’t make health insurance more affordable and accessible to millions of Americans now excluded from the market. Published exchange premiums in 18 states have generally come in below expectations, and the federal subsidies available to most buyers will make them cheaper still.

In some cases the premiums may be higher than those of plans on the market now. But because of exclusions for preexisting conditions — which will no longer be legal — they’re actually unavailable at any price to people who will have no trouble qualifying for the exchange plans.

The ACA’s critics observe that a plurality of Americans still view the ACA unfavorably (43%, according to an opinion poll released in June by the Kaiser Family Foundation). They rarely acknowledge, however, that nearly 1 in 5 of those critics think the law doesn’t go far enough — that is, further toward single-payer.

In its earliest incarnation, the Affordable Care Act included a prototype government single-payer provision — the “public option,” a government-sponsored plan to compete with commercial insurers in the exchanges. The public option was deleted at the insurance industry’s insistence.

But the U.S. does offer a healthcare program that resembles single-payer. It’s Medicare, the broadly popular health plan that covers all Americans over 65. Medicare’s administrative costs are only about 2%, and its size gives it the clout to extract large discounts from doctors and hospitals. That’s why one oft-proposed version of single-payer is “Medicare for all” — simply expand its coverage beyond the 65-plus.

Canada’s single-payer system is another model. It’s popular and efficient and costs about one-third of America’s system to administer. Don’t believe the myths purveyed about Canada’s healthcare by the U.S. insurance industry’s minions.

As health economist Aaron Carroll has documented, Canadian patients and doctors are satisfied with the program. As for the contention that it “rations” care, he points out that care in the U.S. is rationed by cost: one-third of adult Americans surveyed by the Commonwealth Fund in 2010 said they had put off important treatment because of the cost. In Canada, the figure was 15%.

There’s little question that taking private insurers out of the American healthcare system would save hundreds of billions of dollars a year. Dozens of studies of federal and state single-payer proposals have found that single-payer plans could provide universal coverage — not even the ACA does that — and still save money.

Estimates of the administrative costs of commercial health insurers exceed 10%. That doesn’t include the costs to doctors and hospitals of maintaining billing staffs to deal with insurers and keep all their rules and peculiarities straight, or the time lost to individuals and their employers of navigating this unnecessarily byzantine system.

Add those, and the overall administrative costs embedded in the U.S. healthcare system come to 31% of all spending, according to a 2003 article co-written by Himmelstein for the New England Journal of Medicine. Administrative and clerical workers accounted for nearly 44% of all employees in doctors’ offices, they calculated.

What do Americans receive in return for all this overhead? Practically nothing. The insurance industry says its role is to hold down costs by negotiating for preferential fees from doctors and hospitals and trolling for abuses, but the truth is they’re totally ineffective at cost control.

Just last year I reported on an admission by Aetna and United Healthcare, two of our biggest insurers, that they had been snookered to the tune of $60 million by one chain of small surgical clinics in Northern California. That happened because the insurers didn’t hire enough staff to give the claims from those clinics decent scrutiny — in other words, their administrative costs, high as they were, didn’t buy adequate oversight.

The result, to cite just one example, was that United paid the chain more than $97,000 for a kidney stone operation that it usually covers for $6,851.

“Private insurance is a parasite in the system,” says Arnold S. Relman, the former editor of the New England Journal of Medicine and an advocate of healthcare reform. “It adds nothing of value commensurate with its cost.”

Relman believes that fixing the healthcare system will require more than single-payer. The delivery of care needs to be reorganized by promoting the formation of more “accountable care organizations” — medium- and large-scale group practices with hospital affiliates whose physicians would be salaried to discourage the overuse fostered by the fee-for-service system.

What’s really needed is political will. It would help if big companies, which grouse incessantly about the rising costs of covering their employees, would throw their weight behind a system that would relieve them of that burden.

The forces of opposition won’t lie down; the in
surance industry won’t give up its central role in the healthcare system without a costly and bruising fight, as it showed in Congress and in numerous states, including California, where single-payer plans were on the table.

“It’s going to be a slow and painful process,” Relman says. “But sooner or later we’ll have to turn to single-payer. It’s the only logical solution.”

Michael Hiltzik’s column appears Sundays and Wednesdays. Reach him at mhiltzik@latimes.com.

http://www.latimes.com/business/la-fi-hiltzik-20130911,0,2211922.column

Will the Affordable Care Act obviate the need for employer-sponsored insurance?

Will Employers Drop Health Insurance Coverage Because Of The Affordable Care Act?

By Thomas Buchmueller, Colleen Carey and Helen G. Levy
Health Affairs, September 2013

Abstract

Since the passage of the Affordable Care Act, there has been much speculation about how many employers will stop offering health insurance once the act’s major coverage provisions take effect. Some observers predict little aggregate effect, but others believe that 2014 will mark the beginning of the end for our current system of employer-sponsored insurance. We use theoretical and empirical evidence to address the question, “How will employers’ offerings of health insurance change under health reform?” First, we describe the economic reasons why employers offer insurance. Second, we recap the relevant provisions of health reform and use our economic framework to consider how they may affect employers’ offerings. Third, we review the various predictions that have been made about those offerings under health reform. Finally, we offer some observations on interpreting early data from 2014.

Summing Up And Looking Ahead

For an employer, deciding whether or not to offer health insurance already requires a complex calculus that takes into account a host of factors—including employees’ preferences, wages, taxes, and regulations. The Affordable Care Act throws new taxes, subsidies, requirements, and insurance markets into the mix. But it does not fundamentally change the economics of the firm’s decision. Microsimulation models built on sound economic principles have for the most part predicted relatively small declines in employer-sponsored coverage as a result of health reform, and we believe that these predictions are likely to be correct.

If we are wrong, though, how will we know? Inevitably, reports will come in that some employers are dropping coverage. Although it will be tempting to attribute such reported changes to the Affordable Care Act, it is important to interpret new data on employer-sponsored coverage in the context of the basic economics of firms’ behavior and preexisting trends. The combination of rising health care costs and stagnant earnings for middle-income workers has for decades led to a gradual but steady decline in employer-sponsored insurance. This trend is the appropriate baseline against which to measure the impact of health reform.

It is, perhaps, stating the obvious to add a caution against reading too much into anecdotal reports. But for reasons described above, even surveys with large samples can produce results that are difficult to interpret. Fortunately, there are several high-quality data sources that will be useful for monitoring changes in employer-sponsored insurance and drawing inferences about the effect of health reform.

We expect that the earliest data on rates of coverage will come in September 2014, when both the National Health Interview Survey and the Current Population Survey should report on individuals’ sources of coverage in early 2014. If historical patterns hold, the Kaiser Family Foundation/Health Research and Educational Trust Employer Health Benefits Survey will be published the same month. In September 2015 the American Community Survey will provide state and metropolitan-area estimates of individual-level coverage patterns, and in July 2015 the Medical Expenditure Panel Survey will provide further information on employer offerings.

Of course, effects in early 2014 will not be the last word, as individuals and employers may take a wait-and-see approach. And since the employer penalty for not offering coverage will not take effect until 2015, it may be several years before the true effects of health reform on employer-sponsored insurance become evident.

However, these data will begin to answer the question posed in the title of our article. Given the historical importance of employer-sponsored insurance, the attention that is paid to this question is understandable. However, it is not a question of great economic significance. There is no efficiency argument for preferring private insurance facilitated by employers to private insurance facilitated by the state or any other mechanism that could be used to pool risk and achieve administrative economies of scale.

It is also important to remember that relying on firms as a mechanism for pooling insurance risk generates efficiency costs because it distorts the labor market. A better-functioning individual health insurance market has the potential to improve labor-market efficiency by reducing job lock, and thus eliminating a barrier to entrepreneurship and making it easier for workers to find a job and an insurance plan that matches their preferences. If the shift from employer-sponsored insurance to individual coverage is greater than projected, these labor-market gains may be substantial.

http://content.healthaffairs.org/content/32/9/1522.full

and

Small Increases To Employer Premiums Could Shift Millions Of People To The Exchanges And Add Billions To Federal Outlays

By Daniel R. Austin, Anna Luan, Louise L. Wang and Jay Bhattacharya
Health Affairs, September 2013

Abstract

The Affordable Care Act will expand insurance coverage to more than twenty-five million Americans, partly through subsidized private insurance available from newly created health insurance exchanges for people with incomes of 133–400 percent of the federal poverty level. The act will alter the financial incentive structure for employers and influence their decisions on whether or not to offer their employees coverage. These decisions, in turn, will affect federal outlays and revenues through several mechanisms. We model the sensitivity of federal costs for the insurance exchange coverage provision of the Affordable Care Act using the nationally representative Medical Expenditure Panel Survey data set. We assess revenues and subsidy outlays for premiums and cost sharing for individuals purchasing private insurance through exchanges. Our findings show that changing theoretical premium contribution levels by just $100 could induce 2.25 million individuals to transition to exchanges and increase federal outlays by $6.7 billion. Policy makers and analysts should pay especially careful attention to participation rates as the act’s implementation continues.

http://content.healthaffairs.org/content/32/9/1531.abstract

Comment:

By Don McCanne, M.D.

There has been considerable speculation as to whether or not employers will discontinue their health benefit programs and shift their employees to the state insurance exchanges established by the Affordable Care Act (ACA). What is the likely outcome, and, more importantly, does it even matter?

The majority of studies suggest that the impact of ACA on employers’ decisions regarding the continuation of their employee health benefit programs will be relatively modest initially.

Examples that predict more extreme shifts, such as that above by Austin et al – three Stanford medical students and their faculty advisor – are often based on narrow assumptions. In this case the assumption is that quite modest differences in net costs of plans offered through the exchanges compared with employer-sponsored plans could cause large shifts from employers to the exchanges.That ignores a great many other considerations that enter the employers’ action plans. Another infamous study by Douglas Holtz-Eakin made questionable assumptions that resulted in the spurious claim that employers would drop up to 35 million employees from coverage simply because of the provisions of ACA.

The Health Affairs article by Thomas Buchmueller and his colleagues provides a much more objective, if nuanced, analysis of the probability of a shift from employer-sponsored plans to the exchanges
. Based on several more credible microsimulations and based on employer surveys, they conclude that the more immediate impact of ACA will be quite modest. They suggest resources that we can follow which should provide us with better evidence of developing trends in the employer provision of health benefits.

While much attention is being directed to employer responses, Buchmueller et al state that employer-sponsored insurance “is not a question of great economic significance.” There is “no efficiency argument for preferring private insurance facilitated by employers to private insurance facilitated by the state or any other mechanism that could be used to pool risk and achieve administrative economies of scale.”

Although this study compared employer-sponsored private insurance with private insurance offered by the state exchanges, the subtle comment above on the efficiency argument perhaps should be refined: “…no efficiency argument for preferring… private insurance facilitated by the state or any other mechanism that could be used to pool risk and achieve administrative economies of scale.” There is, in fact, a very strong efficiency argument for the state to use another mechanism to pool all risks and achieve administrative economies of scale; that is, of course, single payer reform – an improved Medicare for all.

Shumlin To Rely On Payroll Tax Hikes

By Peter Hirschfeld
Vermont Public Radio, Sept. 9, 2013

Gov. Peter Shumlin said increases in the payroll tax will “play a major role” in the public financing system he wants to use to fund single-payer health care.

The public discussion over single-payer has taken a back seat of late to the health insurance “exchange” set to come online in the beginning of October. The new online marketplace, a product of the federal Affordable Care Act, will offer consumers a platform from which to comparison shop from a more strictly regulated slate of coverage options.

But even as the state launches a $6 million outreach campaign aimed at building awareness of “Vermont Health Connect,” as the exchange is being called, Shumlin said his administration still has its eyes on the single-payer prize.

“What (the exchange) does is basically subsidize the current system, so that’s OK,” Shumlin said. “But like most things that come out of Congress, it doesn’t really solve the problem.”

In an interview this week on “City Room,” a public-access cable show, Shumlin said he’s still committed to delivering a publicly financed, universal health care system by 2017. And his administration, he said, is readying a financing plan that will rely in large part on the payroll tax.

“And the question is where do you have capacity in the other taxes — income, sales, room and meals, we all know what they are — to be able to integrate some of those taxes with a payroll tax to come up with a more fair system based upon ability to pay,” Shumlin said. “And that’s the challenge for the Legislature. And for us.”

The “challenge” of developing a plan looks to be falling more on Shumlin than on his Democratic colleagues in the Statehouse, who rejected a plan earlier this year to split responsibility for the development of a public-financing proposal between the legislative and executive branches.

The administration is spearheading that task now, with input from lawmakers, and will present a proposal to the Legislature in January 2015.

Shumlin said there’s no question that the payroll tax will figure prominently in the plan, but that his administration will have to figure out how to avoid the kind of economic disruption that would inevitably accompany a sudden increase in the surcharge on wages.

For companies that already provide health insurance to their employees, Shumlin said, the new payroll tax won’t be terribly jarring.

“Right now as an employer I can tell you that I pay something that I call a health care tax … And for businesses … that are already paying a health care premium … it’s not a big shock to tell us we’re going to be paying a payroll tax instead of a health care premium,” Shumlin said. “We don’t care what you call it, we’re already paying it.”

The problem with the payroll tax, according to Shumlin, arises when the new surcharge is assessed on Vermont companies that don’t already provide insurance.

“And the question is how to ratchet in the folks that are paying nothing slowly enough so it doesn’t hurt their bottom line,” Shumlin said.

Ultimately, he said that in the single-payer system, the state needs “to have everybody who’s in business in Vermont paying something.”

Shumlin said the job will be a heavy lift politically. But he said he’s convinced the debate is a winnable one.

“Opponents are going to say this will be the biggest tax increase in Vermont history. Fair enough,” Shumlin said. “But it’s going to be the biggest health care premium reduction in American history. We’re just going to swap a health care premium for a publicly financed health care premium.”

Peter Hirschfield writes for the Times Argus – Rutland Herald.

http://digital.vpr.net/post/shumlin-rely-payroll-tax-hikes

Shumlin plan to use payroll tax to fund single payer unpalatable to many in business

By Andrew Stein
Vtdigger.org, Sept. 9, 2013

If Gov. Peter Shumlin pursues a payroll tax to fund a publicly financed health care system, he will meet heavy resistance from one of the state’s most influential business groups.

Betsy Bishop, director of the Vermont Chamber of Commerce, says her organization and its members would not look favorably on a payroll tax.

“When you take away the decision-making process, but leave the payment still in place, it disconnects the employer from the payment,” she said. “What we’re interested in is continuing a system where employers, if they are paying for health care, have some level of control over what they are paying for.”

Last week, Shumlin told Times Argus Editor Steve Pappas that a payroll tax would be one of the vehicles for funding a single-payer, universal health care system in Vermont. Shumlin has been touting single payer for years, but he has provided little detail to date about how the state would pay for the system.

“Clearly, the payroll tax is going to have to play a major role,” he told Pappas.

Shumlin’s Office of Health Care Reform is working on a financing plan to raise an estimated $1.61 billion for the system, and the governor says he will hand the plan to the Legislature in January 2015. The state would not be eligible for a waiver from the Affordable Care Act to implement a single payer plan until 2017.

“Opponents are going to say this will be the biggest tax increase in Vermont history — fair enough,” Shumlin told Pappas. “But it’s going to be the biggest health care premium reduction in American history. We’re just going to swap a health care premium for a publicly financed health care premium.”

Jim Harrison, who runs the Vermont Grocers’ Association, which represents 700 retailers and 250 suppliers, says he is not surprised the administration is considering a payroll tax.

“It is logical a payroll tax would be under consideration because a lot of insurance premiums are paid for by employers,” he said.

Exactly how a payroll tax would affect businesses, however, depends entirely on how it would be leveraged.

“You could have a number of employers that could be dramatically hurt and others who could be substantially helped by such a system,” Harrison said.

Shumlin said the biggest shock would be felt by businesses that don’t currently contribute to their employees’ insurance.

“The question is: How do you ratchet in the folks that are paying nothing slowly enough so that it doesn’t hurt their bottom line?” he said to Pappas.

“We pay about 18 percent of payroll for health care premiums,” Shumlin said about his family business, Putney Student Travel. “You can call it a tax or a premium, but it’s coming out of our bottom line.”

This isn’t the first time a payroll tax has been proposed as the main funding mechanism for a single-payer system. Harvard economist William Hsiao recommended an 11 percent payroll tax on employers and a 4.5 percent payroll tax on employees in 2011. At the time, many employers balked at the idea.

Vermont Businesses for Social Responsibility supports a publicly financed health care system, and the organization’s team has been looking at various funding options for the past couple of years.

Dan Barlow, a lobbyist for the group, says, “There really aren’t that many buckets of money.”

“Taxing junk food is not going to pay for our health care system,” Barlow said. “The payroll system is one of those big buckets you can go to. The income tax is as well.”

David Coates, who chairs the 20-member Governor’s Business Advisory Council, says he prefers the payroll tax to an increase in income taxes.

“It’s one of the funding mechanisms that has to be on the table from my perspective,” he said. “It certainly beats the income tax. You have to look at whether something will be so onerous it will make us anti-competitive and drive people out of the state of Vermont. There are people saying that our income taxes are too high.”

Michael Costa, Shumlin’s health care financing czar, says every option is on the table.

“I think it’s really fair to say that the current system relies heavily on payroll contributions, and we certainly continue to take a hard look at this option,” Costa said. “I wouldn’t be shocked to see the payroll tax as a component of one or more of the plans.”

A plan, however, has not yet been developed, he said.

“A secret plan would make my life easier, and I’m really certain one does not exist,” Costa said. “Why? Because I asked during my job interview. It would make my life a lot easier.”

Shumlin also articulated this sentiment, in his interview with Pappas.

“If we could lift up the veil on this thing, and we had it all planned out, and we could tell you exactly how it was going to work, I wouldn’t be sitting here,” he said. “We would have done it already.”

Rep. Janet Ancel, who chairs the House Ways and Means Committee, said that she is unsure whether her committee will look at tax options this legislative session for single payer. Sen. Tim Ashe, who chairs the Senate Finance Committee, says his committee won’t vote on a financing plan before 2015.

Bishop of the Vermont Chamber said legislators ought to know what the system looks like before they vote on a financing plan for single payer.

“Before we can define what tax this comes from and how much money we can raise from a tax, I think the state needs to be very clear about what the definition of single payer is, and what the benefit package is, and who is eligible for it, and how much we are paying providers,” she said. “If you change any single one of those factors, the overall cost of the system changes.”

http://vtdigger.org/2013/09/09/shumlin-plan-to-use-payroll-tax-to-fund-single-payer-unpalatable-to-many-in-business/#sthash.wAc9JOnz.dpuf

Single Payer: A Universal Plan that Curbs Obscene Costs

By Joie Meissner, N.D.
Vital News, Summer 2013 (Seattle)

First introduced to the House of Representatives in 2003, H.R. 676, the national version of the universal single-payer health care plan, is very much like Medicare. One entity collects all the fees and pays all the clinics and doctors.

A single-payer plan eliminates the excessive administrative costs inherent in managing the thousands of different health care plans and organizations such as PPOs (preferred provider organizations), CDHPs (consumer directed health plans), HMOs (health maintenance organizations), and HSAs (health savings accounts) in our current multi-payer system. By streamlining all of these plans and carriers into one efficient system that contains checks and balances on hospital, drug, and device prices, a single-payer system would provide an estimated savings of more than $200-$300 billion annually.1,2 By controlling drug prices in a manner akin to that of other countries with single-payer systems, we could save billions each year on our drug costs.

Another result of combining all the current plans into a single, user-friendly system is that many health care providers and patients who submit their own claims (including naturopathic physicians and their patients) would spend less time haggling over insurance claims. Doctors would have more resources to devote to their patients, and patients would have more time to devote to their own health. As the legions of billing clerks at hospitals such as Duke University Hospital are reduced to manageable numbers, fewer resources would be expended on the financial overhead of health care. With less need for physicians to act as billing clerks, the quality of care provided to patients would be greatly enhanced. (More on this topic will be discussed in article 3 of this series.)

Whereas our current multi-payer private insurance system is run as a for-profit enterprise, a Medicare-style, universal single-payer system is a socially responsible health care plan designed to serve the public good.

Unlike our current multi-payer system under which 30 million Americans will remain uninsured after Obamacare is fully implemented in 2022, all Americans would be covered under a universal single-payer system.3 Since universal single-payer health care covers all persons regardless of their health status and is free at the point of care, it eliminates the current standard operating practices such as ‘cherry picking’ and ‘lemon dropping’, where health plans offer coverage to healthy patients and deny or restrict coverage to those whose needs are greater. Under a universal single-payer system, health care coverage would no longer be tied to employment and its cost would no longer be an incentive for employers to limit an employee’s work hours. Furthermore, medical bankruptcies would no longer be a commonplace phenomenon, but instead would become a relic of the past.4

Should a single-payer health care system be implemented, we would no longer be the only industrialized country in the world that does not provide some type of universal health coverage to its people.5 All Americans would be comprehensively covered for medically necessary services such as office visits, inpatient and outpatient services, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs which could include certain drugs, medical equipment; midwifery and natural medicines may also be included.6

Under a Medicare-style single-payer plan, patients would be able to see any licensed health professional of their choice, and most hospitals and clinics would remain privately owned and operated, receiving a budget from the NIH to cover all operating costs.7 Rather than imposing increased financial burdens on those most ill, everyone (including the healthier among us – the cherries) would be included in the insurance pool, such that the burdens of health care expenditures are more humanely distributed.

How Would We Pay for a Universal Single-Payer Health Care Plan?

Proposed single-payer systems place a strong emphasis on preventive care. In general, it is less expensive to prevent a disease or to properly manage a disease process that has already begun rather than provide treatment in its more advanced stages. Because providing access to preventive care would presumably lead to increased primary and secondary prevention of disease it would lessen the use of expensive heroic treatments like by-pass surgery, chemotherapy, and kidney dialysis and decrease the number of costly emergency room visits for routine care.

Studies have shown that a universal single-payer system could be successfully funded using monies currently paid into government health care programs (Medicare, Medicaid, trusts and other federal health care programs), along with increasing the personal income tax on the top five percent of income earners, instituting a modest and progressive excise tax on payroll and self-employment income, a modest tax on unearned income and a small tax on stock and bond transactions.8

By eliminating expensive governmental payouts to the privatized multi-payer system, recapturing tax loopholes to employers who provide health benefits, streamlining costs and enabling the ability to bargain down costs of goods and services, dismantling our current for-profit, multi-payer health care system would result in huge savings. Health care economist Gerald Friedman, PhD, reports that “While providing superior health care, a single-payer system would save as much as $570 billion now wasted on administrative overhead and monopoly profits. A single-payer system would also make health care financing dramatically more progressive by replacing fixed, income-invariant health care expenditures with progressive taxes.”9

The combination of capturing the money that the federal government now spends on health care, plus the modest tax increases, plus the savings from increased efficiency would finance a single payer health care system at reduced cost to most individuals, families and businesses. Additional revenue currently paid into state funded health care programs can also be used to fund a single payer system.

Health care economists have conducted studies for numerous states. Such studies demonstrate that switching to a single-payer model would lead to substantial savings. The latest of these studies, published in 2013 by economist Gerald Friedman, examined the economic effects of implementing a single-payer style plan in Pennsylvania. Results indicate that Friedman’s plan would reduce health care costs by 23%, saving $33 billion in 2014. Friedman explains that the savings would enable Pennsylvania to cover all residents and still save the state $17 billion, which he calculates would amount to a savings of $1,335/person. Another positive effect of this plan would be the creation of 120,000-200,000 new jobs in Pennsylvania.10 In the near future, Dr. Friedman plans to do a similar study in Washington State.11

For a quick summary of how single-payer health care works and how it can be funded, click the link below to watch this fun and informative 4 minute YouTube video http://www.youtube.com/watch?v=RAvy9jew9dM.12

What Is the Current Status of Single-Payer at the State and Federal Levels?

Many states have single-payer bills. For example, Vermont’s version of single-payer legislation was passed by both houses and the state is currently applying for a waiver (allowable under P-PACA/Obamacare) to implement a state single-payer system. In Washington, there is a single-payer bill, HB 1085, the Washington Health Security Trust (WHST). As licensed health care practitioners, naturopathic physicians are included in HB 1085. A hearing on HB 1085 that took place on February 1st of this year was very well attended by Washington residents who provided compelling testimony to our
legislature. Nevertheless, the bill did not get out of the House Health Care Committee, so the bill did not pass during the recent legislative session.13,14

Single-payer bills in most of the states have a number of advocacy organizations actively pursuing their passage. For example, Physicians for a National Health Program, Health Care for All, United for Single Payer and Health Care-NOW are single-payer advocacy groups maintaining chapters in Washington State and numerous other states across the country. Major proponents of these state bills are forging networking alliances with other social justice groups, funding research studies on the economic impact of state single-payer plans and pressing for the passage of H.R. 676, the national version of a universal single-payer plan.

At the federal level, H.R. 676, also known as the Expanded and Improved Medicare for All Act, was first introduced to the House of Representatives in 2003 and reintroduced again in 2009 and in 2011 by its author, Congressman John Conyers, Jr., D-MI. (Dennis Kucinich, D-OH, co-authored the bill.) At the time of its reintroduction in 2009, the bill had 88 co-sponsors. Congressman Conyers again reintroduced H.R. 676 on February 13, 2013. The bill currently has 46 co-sponsors.15

According to Quentin Young MD, a longtime advocate of universal health care, the “health-care-industrial-complex” has nearly 34% of our massive health care expenditures at its command to garner political influence and mount mass media campaigns to defeat the single-payer option.

Nevertheless, he maintains that polls show that the majority of the general public and conventionally trained physicians support a universal coverage system like single-payer.16

Physicians for a National Health Program of Western Washington, Health Care for All Washington and Health Care-NOW are a few single-payer advocate organizations in Washington State to contact for more information.17,18,19

Physicians for a National Health Program of Western Washington:
http://pnhpwesternwashington.org/
Health Care for All Washington:
http://www.healthcareforallwa.org/
Health Care-NOW:
http://www.healthcare-now.org/

If your congressperson is not already a co-sponsor, you can call or write him/her to see where he/she stands on this issue. Below is a link to Library of Congress Website that gives a list of H.R.676 co-sponsors http://beta.congress.gov/bill/113th-congress/house-bill/676/cosponsors20

Special Thanks To: Sherry Weinberg, MD, Don Bunger, Helen Thorsen CDP, Don Mitchell, MD, Jim Squire, MD, Marti Schmidt, JD, David McLanahan, MD, Kathleen Myers, DDS, Betty Capehart, Kathleen Randall, MA

References available here.

This article is the second of a three-part series. Part 3 of this article-“How Natural Medicine May Fare in the Universal Single-Payer Plans that Are Currently Being Proposed ” will discuss how natural medicine, naturopathic physicians and their patients could benefit from the implementation of single-payer health care plans that have been proposed with special emphasis on single-payer campaigns in Washington State.

Dr. Joie Meissner is a WANP member and primary care physician in Seattle’s Capital Hill area. Currently on the board of directors Physicians for a National Healthcare Program of Western Washington, her personal interests include food safety, securing a universal healthcare system and clinical research on multiple sclerosis at Bastyr University.

http://www.wanpnews.com/2013/07/25/single-payer-a-universal-plan-that-curbs-obscene-costs/

Large employers moving retirees to private exchanges

Time Warner Joins IBM in Health Shift for Retirees

By Spencer E. Ante
The Wall Street Journal, September 8, 2013

Media-company Time Warner Inc. plans to move its U.S. retirees from company-administered health plans to private exchanges, according to a person familiar with the matter. The company will allocate funds in special accounts that retirees can use to go shop for coverage, the person said.

The news comes as International Business Machines Corp. also plans to move about 110,000 of its own retirees off its company-sponsored health plan to a Medicare insurance exchange.

President Barack Obama’s health-care overhaul calls for such exchanges, which will go live next month, and employers are looking at similar, privately administered exchanges as an alternative to offering their own health plans.

Yet while these efforts are just ramping up—and creating a good deal of anxiety in the process—hundreds of thousands of retirees are already using exchanges to pick Medicare plans, and many more are likely to do so in the months ahead as companies look for ways to fix their health-care costs by moving to the “defined contribution” model they adopted for pensions years ago.

Extend Health, the Utah-based exchange owned by Towers Watson & Co. that IBM picked for its retirees, was founded in 2004 but has grown quickly recently as more employers have signed up.

Extend Health has signed up around 300 companies, and the pace is quickening. It had just three corporate customers at the end of 2007 and just 76 at the end of 2010. About a third have joined in this year alone.

Bryce Williams, managing director of Towers Watson Exchange Solutions, which runs Extend Health, said the exchange has moved more than 500,000 retirees over to its service. IBM will add to that total when it starts moving retirees over next year.

Instead of subsidizing retiree health premiums directly, IBM will give retirees an annual contribution through a health-retirement account that they can use to buy Medicare Advantage plans and supplemental Medicare policies on the exchange, as well as to pay for other medical expenses.

IBM retirees have a big incentive to pick insurance through plans offered by Extend Health: Retirees who are eligible but don’t enroll in a plan through Extend Health won’t receive the company contribution.

Extend Health said nearly 50 companies in the Fortune 500 have become clients, including Caterpillar Inc. and DuPont Co.

The approach was adopted for active employees last year by Sears Holdings Corp. and Darden Restaurants Inc.

http://online.wsj.com/article/SB10001424127887324549004579063170451763800.html

Comment:

By Don McCanne, M.D.

We already knew that employers were canceling retiree coverage in their company-administered health plans and switching to defined contribution approaches which place the risk of future health care increases onto the backs of their retirees. What is new is the acceleration of this shift by large employers who are taking the easy way out by using private insurance exchanges – a new intermediary that adds to the profound administrative waste already inherent in our health care system.

What is next? Sears Holdings and Darden have already adopted these defined contribution approaches for their active employees. When IBM, Time Warner, Caterpillar, DuPont, and the others that are sure to follow find that these new retiree programs are so successful in controlling the employers’ costs, how soon will it take them to shift their active employees into these plans? Even the union-negotiated plans are at risk since unions have lost much of their negotiating clout.

Middle-income Americans are already feeling the crunch. They realize that juggling cost-of-living, education expenses, defined contribution retirement funds, housing and transportation, and other costs is becoming much more difficult as the American Dream is being slowly chiseled away. They know that it is happening, but their lack of taking an activist stance seems to suggest that they don’t know what to blame it on.

Well, it’s pretty obvious. We have a government of, by and for the one percent. Unless the ninety-nine percent wake up, we’ll soon see virtual moats around their castles. In fact, just try to get close enough to knock on their doors today, and you’ll see what a private police state for the one percent is like.

Left behind: Stories from Obamacare’s 31 million uninsured

By Sarah Kliff and Lena H. Sun
Washington Post, Wonkblog, September 8, 2013

Every month, a hundred or so people crowd the lobby of the Arlington Free Clinic, clutching blue tickets to enter a health-care lottery. Uninsured and ailing, they hope to be among the two dozen who hit the jackpot and are given free care.

Some might think the lottery’s days are numbered, given that the insurance expansion under President Obama’s health-care law is taking effect in January. But clinic officials say the lottery will stay because demand for their services is likely to be as high as ever. “We will be business as usual,” said Nancy Sanger Pallesen, the clinic’s executive director.

The Affordable Care Act, the most sweeping health care program created in a half century, is expected to extend coverage to 25 million Americans over the next decade, according to the most recent government estimates. But that will still leave a projected 31 million people without insurance by 2023. Those left out include undocumented workers and poor people living in the 21 states, such as Virginia, that have so far declined to expand Medicaid under the statute, commonly called Obamacare.

“The law will cut the number of the uninsured in half,” said Matthew Buettgens of the Urban Institute. “This is an important development, but it certainly isn’t the definition of universal.”

As a result, while hospitals and other providers gear up to handle an influx of Americans who will be newly insured as of Jan. 1, many of the nation’s 1,000 free clinics, which cater to the uninsured and are financed mostly by private donations, are redoubling efforts to help those bypassed by the law. The trend shows both the limits of the law and the way it is affecting nearly every corner of the health-care system, sometimes in little-noticed ways.

Some of the free clinics are planning to step up their focus on undocumented workers, who won’t be permitted to buy insurance on the new online marketplaces and are expected to become a larger share of the uninsured. Other clinics, seeking to fill what they see as a major gap in the law, are considering offering free dental care.

Andre Sokol, a 59-year-old unemployed carpenter, is an example of someone who won’t be helped by the law and will continue to rely on the Arlington clinic, which, at an given time, provides care to about 1,600 people. He lost his health-care benefits when he left his job in the construction industry several years ago to care for his longtime girlfriend, who was diagnosed with ALS, and his mother, who was battling dementia. Two years ago, the women died within two months of each other. Sokol had no job, no income and no place to live.

In January, Sokol had quadruple bypass surgery at Virginia Hospital Center, which absorbed the costs. He didn’t qualify for Medicaid because Virginia doesn’t allow single men, no matter how poor, on Medicaid, unless they’re disabled. The state has one of the strictest eligibility standards in the country. That would change if the state expanded its program under the health law.

At the same time, Sokol’s income is too low to allow him to get federal subsidies to help pay for a private policy on the exchange. (The law assumed people with incomes below 100 percent of the poverty level, or about $11,500, would be covered by Medicaid, but many states balked at enlarging their programs after the Supreme Court said the expansions were optional.) Arlington Free Clinic officials said about half of their patients are in the same situation: They are below the poverty line but aren’t eligible either for Medicaid or subsidies to buy insurance.

After Sokol had surgery, the Arlington clinic agreed to take him on as a patient, as part of an agreement with Virginia Hospital Center. That agreement is one way people can become patients at the clinic; other patients come in by way of the lottery or via referrals from homeless and domestic-abuse shelters.

“Most of our members would love to go out of business and close their doors if there was a program that ended uninsurance,” Nicole Lamoureux Busby, executive director of the National Association of Free and Charitable Clinics, said. “But this isn’t universal health care. We’re not planning to see a dramatic decrease in our patients.”

Busby said that many of the clinics she works with are facing an additional hurdle with the health law: Convincing private donors that they will still play a crucial role after millions gain coverage.

“So many listen to the news and hear a 24-second sound bite that says everyone is getting coverage,” she said. “The donors may think we don’t need their funds.”

An analysis by the Kaiser Family Foundation predicted that the uninsured rate in Arlington County would fall from 12.4 to 7.4 percent after the health law is fully implemented in 2022. The foundation estimated that 14,000 people would remain without insurance, down from the 24,000 people currently lacking coverage.

The Arlington Free Clinic, which was founded in 1994, is staffed by doctors who volunteer their time when they aren’t at their regular jobs. To be eligible for the clinic, individuals must be over 18, live in Arlington County and earn less than 200 percent of the poverty line, or about $23,000 for an individual. They must also have been in the United States for at least a year.

On a recent Tuesday, the line for the lottery went around the block. It included a wide range of patients, including young children and the middle-aged who spoke English, Spanish, Arabic and Mandarin and other languages.

“I need a doctor for a lot of things,” said Ebtsam Ibrahim, a 46-year-old Egyptian woman and mother of four. She said she has had a toothache for two years but hasn’t seen a dentist because of the cost. She was trying for the third time to win the lottery.

Nazmun Nahar, a 33-year-old mother of three, arrived cradling her one-year-old daughter in her arms. She and her husband are Bangladeshi immigrants who became American citizens over a decade ago.

Because Nahar’s husband makes about $30,000 a year working at Subway, the family of five would likely qualify for generous subsidies to buy private health coverage under Obamacare. But like many of the lottery hopefuls, Nahar knew little about the law or how it would work.

“I just heard a little about it, but nobody explained it to me,” she said.

Jan Strucker, 59, was one of the few people who was aware of the new insurance marketplaces. A retired nurse, she lives on about $20,000 a year in worker’s compensation. She has serious health issues, and may soon need surgery. She figures she would be eligible for subsidies under the law. But that means she needs to wait until October to enroll, and coverage won’t kick in until January.

“This is ridiculous. This is shameful,” Strucker said. “And we’re only seven minutes from the White House.”

By mid-morning, the winning lottery tickets had been selected for 28 participants. A beaming Ibrahim, the Egyptian mother, was among the winners. A husband and wife from Russia also won one ticket that day. Each insisted that the other be the first to take advantage of the free health care, moving some clinic staff members to tears.

Lottery winners must go through an eligibility screening before their first appointment with a doctor, typically weeks later.

The other people who took par
t in the lottery, including Nahar and Strucker, went home empty-handed. Some will qualify for benefits under the health law. Others will likely return to the lottery, hoping to land a slot at the clinic.

Vidal Grajeda, 68, a retired painter and landscaper who previously won a spot through the lottery, was with his wife, Nicolasa Grajeda, 64, who took part in the lottery but did not win.

“I’m a patient and very grateful to the clinic,” he said. He doesn’t qualify for Medicare because he didn’t work long enough in the United States. At the clinic, he receives treatment for diabetes, high cholesterol, high blood pressure and knee problems. He asked the clinic’s director of clinical administration, Jody Steiner Kelly, whether the clinic will be open and working after Oct. 1, when people can start enrolling in coverage offered under Obamacare.

“Yes, the clinic will be here,” replied Kelly.

Luz Lazo contributed to this story.

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/09/08/left-behind-stories-from-obamacares-31-million-uninsured/