PNHP

To mark Medicare anniversary, lawmakers and advocates rally for expansion of program to include every American

To mark Medicare anniversary, lawmakers and advocates rally for expansion of program to include every American

U.S. Rep. John Conyers, U.S. Sen. Bernie Sanders, others push for single-payer health care system

By Public Citizen (news release)
July 31, 2013

WASHINGTON – To mark the 48th anniversary of Medicare, congressional lawmakers and consumer advocates today called for Medicare to be expanded to provide health insurance to all Americans and highlighted a new study showing that a Medicare-for-all, or single-payer, system would save enough money to cover all of the 44 to 50 million uninsured Americans.

Participants in a rally outside the U.S. Capitol included U.S. Rep. John Conyers (D-Mich.), U.S. Sen. Bernie Sanders (I-Vt.), other members of the Congressional Progressive Caucus and representatives from Public Citizen, Physicians for a National Health Program, Labor Campaign for Single Payer Healthcare, Kentuckians for Single Payer Healthcare, Health Care Now! and All Unions Committee for Single Payer Health Care–HR 676. The event was preceded by a congressional briefing about the cost savings of a Medicare-for-all system and followed by lobby visits.

Although the Affordable Care Act (ACA) is designed to ensure that many more Americans are covered by the time the plan is fully implemented, a single-payer system would achieve far greater savings than the ACA, which maintains the role of the costly and wasteful private insurance industry. It also would be less complicated to put into place because it is already in place for Americans over 65 in the form of Medicare.

“The solution to our nation’s health care crisis isn’t cutting Medicare,” said Robert Weissman, president of Public Citizen. “It’s strengthening Medicare and expanding it to cover everyone. A Medicare-for-all, single payer system will ensure that every American is covered as a matter of right, and will save hundreds of billions of dollars by eliminating costs imposed by the wasteful private insurance industry.”

The new study, done by Gerald Friedman, professor of economics at the University of Massachusetts Amherst and released today by Physicians for a National Health Program, shows that upgrading the nation’s Medicare program and expanding it to cover people of all ages would yield more than a half-trillion dollars in efficiency savings in its first year of operation, enough to pay for high-quality, comprehensive health benefits for all residents of the United States at a lower cost to most individuals, families and businesses.

Under the single-payer system envisioned by “The Expanded & Improved Medicare For All Act” (H.R. 676), the U.S. could save $592 billion – $476 billion by eliminating administrative waste associated with the private insurance industry and $116 billion by reducing drug prices – in 2014.

“The evidence is clear,” said Dr. Robert Zarr, a Washington pediatrician and national board member of Physicians for a National Health Program, “An improved Medicare-for-all program is the most equitable and cost-effective way to assure that everyone, without exception, gets high-quality care. As a doctor who sees hard-pressed patients every day, I can tell you that the need for fundamental health care reform has never been greater.”

Savings from a single-payer plan would be more than enough to fund $343 billion in improvements to the health system such as expanded coverage, improved benefits, enhanced reimbursement of providers serving indigent patients, and the elimination of co-payments and deductibles. The savings also would fund $51 billion in transition costs such as retraining displaced workers and phasing out investor-owned, for-profit delivery systems.

Medicare was signed into law on July 30, 1965. H.R. 676, introduced into the 113th Congress by Conyers and 37 initial co-sponsors, would establish a single authority responsible for paying for medically necessary health care for all residents of the United States.

“Access to quality, affordable health care is more than just a moral imperative,” said Conyers. “It is a basic human right. The Affordable Care Act was a first step in reforming our broken health care system, but it cannot be the last. Until our coverage is truly universal, I will continue to fight – alongside groups like Public Citizen – for single-payer health care that will deliver quality health care to all Americans.”

“It is long past time that we recognize health care is a right, not a privilege,” said Sanders. “It boggles the mind that today, in America, we do not guarantee high-quality, affordable health care for all of our people. I am proud that Vermont is leading the nation in working to establish a single-payer health care system to provide better care at less cost.”

“Medicare-for-all is the high road solution to the fiscal crisis impacting all levels of government,” said Mark Dudzic, national coordinator of the Labor Campaign for Single Payer Healthcare. “Instead of solving this crisis on the backs of working people, Dr. Friedman’s study shows how we can save hundreds of billions of dollars while making quality health care a birthright for everyone in America.”

www.citizen.org

http://yubanet.com/usa/To-Mark-Medicare-Anniversary-Lawmakers-and-Advocates-Rally-for-Expansion-of-Program-to-Include-Every-American.php#.UflbzazrIng

Study: Single-Payer Health System Feasible, Could Save $1.8 Trillion in 10 Years

By Bob Herman
Becker’s Hospital Review, July 31, 2013

A new study shows that expanding Medicare to every American citizen would not only achieve universal coverage and trillions in savings, but it’s also feasible to implement based on legislation that has already been proposed.

Gerald Friedman, PhD, a professor of economics at the University of Massachusetts at Amherst, released his study today in Washington, D.C., at a congressional briefing. The basis of Dr. Friedman’s research is HR 676 — the Expanded and Improved Medicare for All Act — which is a bill introduced by Rep. John Conyers Jr. (D-Mich.) in February that would establish a single-payer health care program. The bill has been proposed for 11 straight years.

In his study, Dr. Friedman said if Rep. Conyers’ bill were signed into law, the expansion of Medicare could “paradoxically” save the U.S. health care system $592 billion in 2014 alone. The main savings would come from slashing “administrative waste” in the private health insurance industry and using the government’s bargaining power to obtain cheaper pharmaceuticals, according to the report. Over the next decade, the study suggested savings could reach $1.8 trillion.

Under HR 676, a single-payer system would be financed through several factors: increasing the personal income tax on the top 5 percent of income earners, instituting a progressive tax on payroll and self-employment, taxing capital gains and other unearned income, instituting a 0.5 percent tax on stock trades and other “progressive tax” financing efforts, according to the study.

The results of implementing the legislation, Dr. Friedman said, would be “expanded coverage, improved benefits, enhanced reimbursement of providers serving indigent patients and the elimination of copayments and deductibles in 2014.” The savings would also go toward retraining displaced health care workers for new healthcare roles and converting investor-owned, for-profit healthcare organizations into nonprofit systems.

“This analysis shows that it is possible to reform the U.S. health financing system to make it more efficient and equitable,” the study concludes. “On top of the enormous administrative savings of single payer, the savings from effective cost-control would make it possible to provide universal coverage and comprehensive benefits to future generations at a sustainable cost.”

Single-payer health care bills have generally been opposed by Republicans and others in the past. According to a 2008 study in the Annals of Internal Medicine, 59 percent of physicians support legislation to establish a single-payer system. Several industrialized countries have also had established single-payer or universal healthcare systems for at least 30 years, including the United Kingdom, Canada, Australia, Sweden and Norway.

http://www.beckershospitalreview.com/racs-/-icd-9-/-icd-10/study-single-payer-health-system-feasible-could-save-1-8-trillion-in-10-years.html

Fulfilling the Promise of Medicare

By Rep. John Conyers and Robert Weissman
The Huffington Post, July 30, 2013

“We can say this of Medicare: By honoring the fundamental humanity, which is the spirit of democracy, it is a triumph of rightness in America.”

Nearly five decades after President Lyndon Johnson spoke those words as he signed Medicare into law, it is time to honor the fundamental humanity of all Americans by ensuring that each and every one of us has a right to health care — irrespective of our wealth or income — by improving and expanding Medicare so that it covers all Americans.

The benefits that Medicare has brought to older Americans are almost boundless. Millions of Americans have lived longer, more productive, healthier lives because of the medical care they received under this program. Many would have incurred financial ruin, suffered needlessly, and died prematurely without Medicare.

Despite these incredible gains, there are those who want to end close to 50 years of progress in the name of ideological dogma. They oppose the thought of the federal government running anything so vehemently that they want to end Medicare as we know it. These zealots would turn Medicare into a voucher program, cutting benefits and effectively denying millions the medical care they need.

Others propose raising the Medicare eligibility age and similar measures to reduce the government’s Medicare bill — not by controlling health care costs, but by making the elderly pay more. Those proposals, too, are misguided.

Medicare does face cost pressures. The solution is not to take from older Americans, but to end the program’s subsidies and giveaways to Big Pharma and private insurance companies.

Nearly five decades after its enactment, here’s what we know: Medicare saves money by eliminating all the waste associated with the for-profit insurance industry. And Medicare provides coverage to everyone eligible. In stark contrast, the for-profit insurers condition care on ability to pay … and then still try to deny care to those who have paid.

That’s five decades of evidence that indicates the solution to our nation’s healthcare crisis isn’t cutting Medicare. It’s strengthening Medicare and expanding it to cover everyone.

However the Affordable Care Act ultimately plays out, we know two things for certain: Millions of Americans will remain uncovered and the for-profit insurance industry will remain in charge of prices and life-and-death treatment decisions. As President Obama once stated, the only way to ensure everyone is covered is with Medicare-for-All, a single-payer system.

Medicare-for-All would save $350 billion a year in administrative costs, waste and profits — savings would be used to cover everyone. Everyone would have free choice of a doctor. Americans would never have to fight with their insurance company ever again.

The richest country in the history of humanity has a moral obligation to cover all of its inhabitants with health care coverage. We believe health care is a right, and should not be treated as a benefit reserved for the privileged.

It’s past time for an American health care system that provides universal coverage of all medically necessary services at a fraction of the cost of our current fractured system. The way to do that is to enact H.R. 676, the “Expanded and Improved Medicare for All Act,” which will create a single-payer health care system similar to those in almost every other industrialized country.

Today, as we celebrate Medicare’s birthday, we urge Congress to fulfill Medicare’s promise and enact single-payer legislation and provide Medicare for All.

Representative John Conyers represents Michigan’s 13th Congressional District in the U.S. House of Representatives. Robert Weissman serves as the President of Public Citizen.

http://www.huffingtonpost.com/john-conyers/fulfilling-the-promise-of_b_3676992.html

Friedman analysis of HR 676: Medicare for All would save billions

‘Medicare for All’ would cover everyone, save billions in first year: new study

Physicians for a National Health Program
July 31, 2013

Upgrading the nation’s Medicare program and expanding it to cover people of all ages would yield over a half-trillion dollars in efficiency savings in its first year of operation, enough to pay for high-quality, comprehensive health benefits for all residents of the United States at a lower cost to most individuals, families and businesses.

That’s the chief finding of a new fiscal study by Gerald Friedman, a professor of economics at the University of Massachusetts, Amherst. There would even be money left over to help pay down the national debt, he said.

Friedman says his analysis shows that a nonprofit single-payer system based on the principles of the Expanded and Improved Medicare for All Act, H.R. 676, introduced by Rep. John Conyers Jr., D-Mich., and co-sponsored by 44 other lawmakers, would save an estimated $592 billion in 2014. That would be more than enough to cover all 44 million people the government estimates will be uninsured in that year and to upgrade benefits for everyone else.

“No other plan can achieve this magnitude of savings on health care,” Friedman said.

His findings were released this morning [Wednesday, July 31] at a congressional briefing in the Cannon House Office Building hosted by Public Citizen and Physicians for a National Health Program, followed by a 1 p.m. news conference with Rep. Conyers and others in observance of Medicare’s 48th anniversary at the House Triangle near the Capitol steps.

https://pnhp.org/news/2013/july/%E2%80%98medicare-for-all%E2%80%99-would-cover-everyone-save-billions-in-first-year-new-study

Funding HR 676: The Expanded and Improved Medicare for All Act: How we can afford a national single-payer health plan

By Gerald Friedman, Ph.D.
July 31, 2013

Executive Summary

The Expanded and Improved Medicare for All Act, HR 676, introduced into the 113th Congress by Rep. John Conyers Jr. and 37 co-sponsors, would establish a single authority responsible for paying for medically necessary health care for all residents of the United States.

Under the single-payer system created by HR 676, the U.S. could save an estimated $592 billion annually by slashing the administrative waste associated with the private insurance industry ($476 billion) and reducing pharmaceutical prices to European levels ($116 billion). In 2014, the savings would be enough to cover all 44 million uninsured and upgrade benefits for everyone else. No other plan can achieve this magnitude of savings on health care.

Specifically, the savings from a single-payer plan would be more than enough to fund $343 billion in improvements to the health system such as expanded coverage, improved benefits, enhanced reimbursement of providers serving indigent patients, and the elimination of co-payments and deductibles in 2014. The savings would also fund $51 billion in transition costs such as retraining displaced workers and phasing out investor- owned, for-profit delivery systems.

Health care financing in the U.S. is regressive, weighing heaviest on the poor, the working class, and the sick. With the progressive financing plan outlined for HR 676 (below), 95% of all U.S. households would save money.

HR 676 (Section 211, Appendix 2) specifies a financing plan for single-payer that includes
• Maintaining current federal financing for health care
• Increasing personal income taxes on the top 5% of income earners
• Instituting a modest tax on unearned income
• Instituting a modest and progressive tax on payroll, self-employment
• Instituting a small tax on stock and bond transactions

The following progressive financing plan would meet the specifications of HR 676:
• Existing sources of federal revenues for health care
• Tax of 0.5% on stock trades and 0.01% tax per year to maturity on transactions in bonds, swaps, and trades
• 6% high-income surtax (applies to households with incomes > $225,000)
• 6% tax on unearned income from capital gains, dividends, interest, profits, and rents
• 6% payroll tax on top 60% of income earners (applies to incomes over $53,000, tax paid by employers)
• 3% payroll tax on the bottom 40% of income earners (applies to incomes under $53,000, tax paid by employers)

HR 676 would also establish a system for future cost control using proven-effective methods such as negotiated fees, global budgets, and capital planning. Over time, reduced health cost inflation over the next decade (“bending the cost curve”) would save $1.8 trillion, making comprehensive health benefits sustainable for future generations.

https://pnhp.org/system/assets/drupal/Funding%20HR%20676_Friedman_7.31.13_proofed.pdf

Comment:

By Don McCanne, M.D.

This is the report that single payer advocates have been waiting for. Economics Professor Gerald Friedman of the University of Massachusetts at Amherst has provided us with an analysis of the financing of John Conyers’ HR 676: The Expanded and Improved Medicare for All Act. The results are quite impressive, especially considering the comprehensiveness of the HR 676 reforms. Dr. Friedman’s report will be invaluable in our advocacy for a single pager national health program.

The analysis shows that we really can provide everyone with comprehensive health care without causing a financial hardship for anyone. This is made possible by depending on progressive tax policies. Since it is likely that the opposition will become apoplectic when they see the proposed taxes, we should be prepared to explain why progressive tax policies to fund health care are a good thing rather than a bad thing.

Let’s begin with two fundamental principles: 1) All of us should have the health care that we need, and 2) Obtaining health care should not ever result in financial hardship. Having health problems is enough without adding the financial penalties of paying for health care simply because of having the misfortune of being sick or injured.

Our audience is not those who disagree with these principles. We will never be able to satisfy them. Rather we need to address those who agree but cringe and withdraw when they see a recommendation for TAXES!

We need to keep in mind that we are not working with the spending baseline that we had when we began to advocate for single payer a couple decades ago. (They should have listened to us then!) Health costs are now a much larger percentage of our economy. Health care costs for the average working family of four are now over $22,000, when median household income is about $50,000. It is now impossible to meet the goal of providing affordable health care for everyone without making the wealthy pay more than the rest of us. Financing must be progressive it we are to meet our goals.

The Affordable Care Act (ACA) has included several policies that do increase the progressivity of financing, but it depends on an administratively wasteful, fragmented system that is the source of many of the problems in health care today. Many who cannot afford their allocated share will still pay too much, and many more will not even receive the care that they should have merely because of the dysfunctional financing method perpetuated by ACA. In contrast, the administrative simplicity of progressive taxes ensures an equitable method of financing care, making it affordable for everyone.

For those who say that we can’t afford the taxes, remind them that the taxes displace much of our current spending for health care. Because of the efficiencies of the single payer model of financing, the amount that we would spend in increased taxes for health care is less than the amount we would s
ave in recovering the administrative and clinical waste of our current system. Not only will we be paying less in taxes than the excessive amount that we are currently paying for our dysfunctional system, the payment will become much more transparent so that we finally would know what health care really costs us. Much of the costs are hidden today.

People often think that health care costs are what they or their employers pay in private insurance premiums, plus out-of-pocket expenses. In fact, in 2012 we paid only about $884 billion in private insurance premiums, though our total national health expediters were about $2,831 billion. It is that other $1,947 billion of relatively hidden health care costs that we are already paying that will be more transparent under a public tax system. When you think of these numbers, you can better understand why the proposed taxes seem to be so high.

Rather than fixating on just the taxes proposed in HR 676, it is much more important to look at the change in income that each person faces as a result of these tax policies. Use the link above to access Professor Friedman’s report and go to Figure 2. The bar graph and its explanation in the note below should be studied carefully to understand the changes.

The four bars on the left represent the bottom four quintiles of household income – 80 percent of the population. The four bars on the right represent the top 20 percent. The fifth bar, representing those with incomes from the 80th to the 95th percentile have an average household income of $216,922. Yet they and also those with incomes below them – 95  percent of all households – will see an INCREASE in their net income in spite of what they may perceive to be onerous taxes. It is only the top 5 percent that will be paying more in taxes than they will be receiving in health care benefits.

Okay. That’s fair for most of us, but is it really fair for those with incomes of a half million dollars or more – especially for those with average incomes of $3 million or even $166 million? Remember that wealth has moved upwards with high income individuals benefiting from the increased productivity of the workers, while workers’ incomes have remained flat. This massive, unfair upward shift of income and wealth screams out for justice. Progressive tax policies are precisely what we need to correct this injustice. HR 676 does exactly that – not only ensuring health care for everyone, but finally making it affordable for everyone while establishing public policies to slow the financial drain that the wealthy have placed upon the rest of us.

The Koch brothers and the Walton family may not like this proposal, but it’s not like we’re taking away their mansions or their personal jets. They’ll never miss the money that HR 676 would divert to taxes. Even those with a current $500,000 after tax income will see their net income reduced to about $460,000. They may whine, but if they are honest with themselves, they would have to agree that they really won’t see any significant differences in their lifestyles either. Some of them will even think that it is worth it if it ensures that absolutely everyone finally has the right to affordable health care.

We can have an Expanded and Improved Medicare for All if we simply dispense with our irrational tax phobia.

‘Medicare for All’ would cover everyone, save billions in first year: new study

Economist says Canadian-style, single-payer health plan would reap huge savings from reduced paperwork and from negotiated drug prices, enough to pay for quality coverage for all – at less cost to families and businesses

FOR IMMEDIATE RELEASE
July 31, 2013

Contact:
Mark Almberg, communications director, (312) 782-6006, mark@pnhp.org

Upgrading the nation’s Medicare program and expanding it to cover people of all ages would yield more than a half-trillion dollars in efficiency savings in its first year of operation, enough to pay for high-quality, comprehensive health benefits for all residents of the United States at a lower cost to most individuals, families and businesses.

That’s the chief finding of a new fiscal study by Gerald Friedman, a professor of economics at the University of Massachusetts, Amherst. There would even be money left over to help pay down the national debt, he said.

Friedman says his analysis shows that a nonprofit single-payer system based on the principles of the Expanded and Improved Medicare for All Act, H.R. 676, introduced by Rep. John Conyers Jr., D-Mich., and co-sponsored by 45 other lawmakers, would save an estimated $592 billion in 2014. That would be more than enough to cover all 44 million people the government estimates will be uninsured in that year and to upgrade benefits for everyone else.

“No other plan can achieve this magnitude of savings on health care,” Friedman said.

His findings were released this morning [Wednesday, July 31, 11 a.m. EDT] at a congressional briefing in the Cannon House Office Building hosted by Public Citizen and Physicians for a National Health Program, followed by a 1 p.m. news conference with Rep. Conyers and others in observance of Medicare’s 48th anniversary at the House Triangle near the Capitol steps. A copy of Friedman’s full report, with tables and charts, is available here.

Friedman said the savings would come from slashing the administrative waste associated with today’s private health insurance industry ($476 billion) and using the new, public system’s bargaining muscle to negotiate pharmaceutical drug prices down to European levels ($116 billion).

“These savings would be more than enough to fund $343 billion in improvements to our health system, including the achievement of truly universal coverage, improved benefits, and the elimination of premiums, co-payments and deductibles, which are major barriers to people seeking care,” he said.

Friedman said the savings would also fund $51 billion in transition costs such as retraining displaced workers from the insurance industry and phasing out investor-owned, for-profit delivery systems.

Over the next decade, the system’s savings from reduced health inflation (“bending the cost curve”), thanks to cost-control methods such as negotiated fees, lump-sum payments to hospitals, and capital planning, would amount to an estimated $1.8 trillion.

“Paradoxically, by expanding Medicare to everyone we’d end up saving billions of dollars annually,” he said. “We’d be safeguarding Medicare’s fiscal integrity while enhancing the nation’s health for the long term.”

Friedman said the plan would be funded by maintaining current federal revenues for health care and imposing new, modest tax increases on very high income earners. It would also be funded by a small increase in payroll taxes on employers, who would no longer pay health insurance premiums, and a new, very small tax on stock and bond transactions.

“Such a financing scheme would vastly simplify how the nation pays for care, restore free choice of physician, guarantee all necessary medical care, improve patient health and, because it would be financed by a program of progressive taxation, result in 95 percent of all U.S. households saving money,” Friedman said.

Friedman’s findings are consistent with other research showing large savings from a single-payer plan. Single-payer fiscal studies by other economists, such as Kenneth E. Thorpe (2005), have arrived at similar conclusions, as have studies conducted by the Congressional Budget Office and the General Accountability Office in the early 1990s. Other studies have documented the administrative efficiency and other benefits of Canada’s single-payer system in comparison with the current U.S. system.

Friedman’s research was commissioned by Physicians for a National Health Program, a nonprofit research and educational organization of more than 18,000 doctors nationwide, which wanted to find out how much a single-payer system would cost today and how it could be financed.

“Funding H.R. 676:  The Expanded and Improved Medicare for All Act – How we can afford a national single-payer health plan in 2014,” by Gerald Friedman, Ph.D., Department of Economics, University of Massachusetts, Amherst.

Montana government clinic: Maybe single payer is aiming too low

Montana's State-Run Free Clinic Sees Early Success

By Dan Boyce
NPR, July 30,2013

A year ago, Montana opened the nation’s first clinic for free primary healthcare services to its state government employees. The Helena, Mont., clinic was pitched as a way to improve overall employee health.

A year later, the state says the clinic is already saving money.

(Government employees still have their) normal health insurance provided by the state. But at the clinic, (there are) no co-pays, no deductibles. It’s free.

That’s the case for the Helena area’s 11,000 state workers and their dependents. With an appointment, patients wait just a couple minutes to see a doctor.

“For goodness sakes, of course the employees and the retirees like it, it’s free,” says Republican State Sen. Dave Lewis.

He and others faulted then-Gov. Brian Schweitzer for moving ahead with the clinic last year without approval of the state legislature, although it was not needed.

Now, Lewis is a retired state employee himself. He says, personally, he does like going there, too.

The state contracts with a private company to run the facility and pays for everything — wages of the staff, total costs of all the visits. Those are all new expenses, and they all come from the budget for state employee healthcare.

Even so, division manager Russ Hill says it’s actually costing the state $1,500,000 less for healthcare than before the clinic opened.

“Because there’s no markup, our cost per visit is lower than in a private fee-for-service environment,” Hill says.

Physicians are paid by the hour, not by the number of procedures they prescribe like many in the private sector. The state is able to buy supplies at lower prices.

Bottom line: a patient’s visit to the employee health clinic costs the state about half what it would cost if that patient went to a private doctor. And because it’s free to patients, hundreds of people have come in who had not seen a doctor for at least two years.

Montana recently opened a second state employee health clinic in Billings, the state’s largest city. Others are in the works.

http://www.npr.org/2013/07/30/206654000/montanas-state-run-free-clinic-sees-early-success

Comment:

By Don McCanne, M.D.

Let’s see. This Montana state-run free clinic is government owned, the physicians are salaried, there are no deductibles or co-pays, employees and retirees including Republicans like it, and it costs the state “about half what it would cost if that patient went to a private doctor.” Wow!

The single payer model of social insurance usually calls for a government-run insurance program that pays for our largely private health care delivery system, with all of its inefficiencies and inequities. But what if it paid for a government owned and financed health care delivery system similar to this Montana clinic, but with government ownership expanded throughout the entire delivery system.

Instead of just aiming for the goal of a single payer social insurance program, we could have a program of socialized medicine – government ownership of the delivery system. Considering that it is a much lower cost system with which everyone is happy, is that such a bad idea?

Shumlin administration gears up for the nitty-gritty of single payer

By Andrew Stein
Vtdigger.org, July 29, 2013

Gov. Peter Shumlin put Vermont on a path to creating the nation’s first single payer health care system when he signed Act 48 in 2011. But since then, his administration has made little progress up that mountain, drawing questions and accusations from the far political left and right about the governor’s sincerity.

Now, Shumlin and his team are beginning to shift gears, planning the implementation of a publicly funded, universal health care system. In the past two months, the administration has moved two of its policy heavyweights to the fifth floor Office of Health Care Reform — right around the corner from where the governor sits.

Michael Costa, former policy director at the Tax Department, took the elevator up to his new office at the beginning of June. He is charged with figuring out how to finance a single payer system with tax dollars.

David Reynolds, a co-architect of the Affordable Care Act and a former health policy adviser to Sen. Bernie Sanders, joined the team in July. He is tasked with bringing the moving parts of a single payer system together.

Costa and Reynolds join Robin Lunge, director of Health Care Reform, who helped craft the single payer legislation and has overseen the administration’s health care policy initiatives since July 2011.

“This shows that we’re serious,” said Secretary of Administration Jeb Spaulding. “But that’s not why we’re doing this. We’re doing this because we are serious.”

Shumlin doesn’t flinch when questioned about the proposal’s vulnerable points, like shifting more than a billion dollars in health insurance dollars to the tax sector.

“I am bound and determined to pass the first sensible single payer health care system in the country, and that’s going to be the most ambitious policy lift in Vermont history,” Shumlin said on Monday. “So, obviously, we’re going to gear up our staff and engage Vermonters from all walks of life.”

For the past two years, Shumlin’s top health care team has been focused on creating and implementing a new web-based insurance market for more than 100,000 Vermonters. The exchange, called Vermont Health Connect, is slated to open Oct. 1. Then, on Jan. 1, 2014, Vermonters buying health insurance individually or through businesses with 50 or fewer employees will be legally required to purchase plans on this market.

The exchange is not the single payer system the administration has in mind. It is a market that is being created in accordance with the Affordable Care Act, aka Obamacare. To deviate from these federal regulations and implement a single payer health care system, Vermont will need a federal waiver from the secretary of Health and Human Services. But, under federal law, states are not eligible for the waiver until 2017.

This past legislative session, the administration was supposed to submit to the Legislature a financing plan for funding a universal health care system with public dollars. The plan was called for in Act 48, which became statute.

The financing plan, however, did not arrive on legislators’ desks. The administration said it would be premature to propose specific taxes and that the Legislature should focus on passing necessary laws for the imminent insurance exchange.

What did come was a road map of sorts for drawing up a financing plan. It was created by the University of Massachusetts, which estimated the state would need to raise roughly $1.6 billion in public dollars to finance a single payer system.

Some critics of the study say that it’s an underestimate of the overall cost to the public. But Costa says this study is crucial for developing a single-payer financing plan.

“I am developing a specific financing plan for Green Mountain Care, and we will have that to the Legislature in January 2015,” he said. “When I read Act 48 and the UMass report, I basically see who is covered, what is covered and how much this costs. For the next 18 months, my role is to take the ‘how much’ and design several different ways that you could pay for it and look at what are the impacts on employers, individuals and Vermont’s economy.”

Green Mountain Care

Green Mountain Care is the name of the publicly financed plan that is proposed in Act 48. To get there, Lunge says the administration had to cooperate with federal law.

“Our first step in moving towards Green Mountain Care and payment and delivery system reform was to start with the Affordable Care Act, and so a significant portion of our time and efforts and focus has had to be on the Affordable Care Act,” she said. “As we get closer to that being live and up and running, our focus is shifting to the bigger picture, long-term goals.”

Act 48 is explicit: Green Mountain Care would provide “affordable, high-quality, publicly financed health care coverage for all Vermont residents.”

Specifically, Lunge said, “It would provide coverage for doctor’s visits, hospital stays, preventative care, prescription drugs, all of the services that will be covered through all of the plans in Vermont Health Connect.” She added that Green Mountain Care would use a sliding scale for deductibles and co-pays based on residents’ incomes.

Shumlin says he is adamant that Green Mountain Care is applied universally — that includes teachers and state workers.

“Everybody in,” he said. “This is what we envision: No more health care premiums; public financing instead. Contracting out to one of our insurers to adjudicate the claims. We don’t want to be an insurance company. This means having a health care system where the health care follows the individual as a result of their residency in the state of Vermont, not where they work.”

One of the largest pieces to this puzzle is the business community. In 2011, Harvard economist William Hsiao recommended an 11 percent employer tax to fund a single payer system. The proposal was extremely unpopular among many of the state’s largest employers.

“Businesses are one of the many sectors that have so much to win if we get this right and so much to lose if we don’t,” Shumlin said. “One of the biggest challenges for businesses large and small is the unsustainable rise in costs of health care, which gobbles up our dollars faster than we can make them.”

Shumlin’s Business Council

In April, the governor organized a group of 20 business leaders from across the state to meet with him in off-the-record sessions about financing options for a single payer system.

The council’s representatives span the gamut of Vermont’s businesses, from IBM executive Janette Bombardier to Onion River Sports owner Andrew Brewer to Ken Perine, CEO of the National Bank of Middlebury.

David Coates is chair of the council. He heads the Vermont Long Term Disaster Recovery Group and is a former partner of
KPMG LLP, the auditing firm.

“It seems to me that business is extremely important for health care, and, as you know, businesses provide a lot of it,” Coates said. “At the end of the day, if this is going to have a very negative impact on businesses, then it will have a very negative impact on jobs and the economy.”

The group has met twice thus far and Coates says the members are waiting for the financing plan from Costa. He says his team won’t be devising financing mechanisms, but, rather, will react to the administration’s proposals.

“The hurdle in my opinion will be what is the cost and how will it impact these businesses’ bottom lines,” he said. “If those things come in in a positive way, then I don’t think there will be a hurdle whatsoever.”

But while thousands of Vermonters are keeping a close eye on the administration’s financing plan, one key official says he is focusing on how to make the rest of the system work.

David Reynolds

When David Reynolds founded Vermont’s first network of Federally Qualified Health Centers in 1976, he says insurance wasn’t the chief issue.

“Coverage alone does not equate to access,” Reynolds said. “Before I started Northern Counties, people in the Northeast Kingdom had health insurance, but they didn’t have a place to use it.”

Reynolds says a single payer system is about much more than financing, and it’s his task to make the system mesh. On the state government side of things, he is charged with greasing the wheels of state bureaucracies so that they work together.

“You need to have the workforce; you need to have integrated systems; you need to have more integration of mental and physical health; and those are the things I’m working on,” he said.

Reynolds left Northern Counties Health Care Inc. in 2007 to become U.S. Sen. Bernie Sanders’ senior policy adviser for health. When he said goodbye to Northern Counties, the network included six federally qualified health centers, two dental clinics and a home health and hospice division.

Working with Sanders, he pushed for progressive policies in Washington.

“David was the lead negotiator, researcher, and drafter of legislation to advance the senator’s priorities in health care,” Sanders’ spokesman Jeff Frank said. “He was involved in the drafting of the first national single payer bill introduced in the United States Senate.”

Reynolds says that one of his token achievements in Washington was helping to negotiate the creation of the 2017 waiver in the Affordable Care Act — the very waiver that would allow Vermont to deviate from the law to set up a single payer system.

“When the president gave up on not proposing single payer or a public option, that (waiver) was a compromise to get the votes of the more liberal members,” he said. “I call the Affordable Care Act the ‘private health insurance preservation act.’”

In 2011, he returned to Vermont to work on implementing Act 48.

“Having come from the dysfunctionality of Congress, working for Bernie Sanders, this is just remarkable to see,” he said. “People are really dedicated to this task.”

http://vtdigger.org/2013/07/29/shumlin-administration-gearing-up-for-the-nitty-gritty-of-single-payer/

Medicare has proved itself after 48 years

By Rob Stone, M.D.
The Herald-Times (Bloomington, Ind.), July 30, 2013

Who is the most popular health insurer in America? Not Anthem Blue Cross. It’s Medicare. And what insurer is the most efficient? Medicare again, operating at only 1.4 percent overhead, while the private insurers strain to meet the Affordable Care Act maximum overhead of 20 percent.

While the Affordable Care Act struggles to be born, it’s worth looking again at how well Medicare works. Last year the respected journal Health Affairs published a study showing how Medicare performs better than private health insurance plans.

According to the report, “Medicare beneficiaries are less likely to have cost-related access problems, high premium and out-of-pocket health care expenses as a share of income, and financial problems because of medical bills. And compared to non-elderly adults with employer-based coverage, Medicare beneficiaries are more likely to have access to a medical home – a primary care provider who knows their medical history well, is accessible, and helps coordinate their care,” and are “far more likely to report excellent quality of care.”

Medicare is not perfect and needs improvement, but it performs far better than the best of the private plans – the employer-sponsored health plans. Individual and small group plans have even worse performance. The Health Affairs article concluded, “Medicare is doing a better job than employer-sponsored plans at fulfilling the two main purposes of health insurance: ensuring access to care and providing financial protection.”

In my work as a physician I see it every day – patients under the Medicare eligibility age of 65 struggling to find affordable insurance, or fighting with their insurance company when they try to make a claim, or driven to bankruptcy by impossibly high deductible payments. But if they can hang on until they reach Medicare age, then they can finally get the care they need, without the hassles. “Pre-existing conditions” are not an issue. You can pick the hospital and doctor of your choice.

We need to celebrate and protect Medicare, a uniquely American approach to health care. Somehow Congress in their infinite wisdom decided 48 years ago that we should have a universal health care system for everyone over 65, but that the rest of us were on our own.

Don’t let the politicians privatize Medicare or raise the eligibility age. Some want to turn Medicare into a voucher program and shift more costs to seniors, a terrible idea. Medicare is the victim of skyrocketing health care costs, not the cause.

Medicare may not be perfect, but Americans with Medicare are far happier than those with private insurance. Medicare has been a leader in keeping costs down. Medicare already insures the people with the greatest health care needs: people over 65 and the disabled.

Happy Birthday, Medicare! It’s time for everyone to be able to see a doctor when they are sick, to have access to preventative care, and to not face financial ruin when they have to go to the hospital. We should improve and expand Medicare to cover everyone. Everybody In – Nobody Out. We all deserve health care.

Dr. Rob Stone is director of Hoosiers for a Commonsense Health Plan. He lives in Bloomington.

http://www.heraldtimesonline.com/news/opinion/medicare-has-proved-itself-after-years/article_0289bbec-3b3f-5e03-a45f-d47d60a88fc0.html

Happy 48th birthday, Medicare

By Rep. John Conyers Jr.
The Hill, July 29, 2013

As I reflect on my 48 years in Congress, at the positive policies created and those that have had not so positive effects, the enactment of Medicare is a bold highlight.

I voted for its original passage out of the House during my first summer as a congressman, during a time that was very different from the America of today. Prior to Medicare’s creation, only half of older adults had health insurance, with coverage often unavailable or unaffordable to the other half because of limited incomes and policies that cost nearly three times as much for the elderly than the young.

Medicare’s positive impact was more than just extending medical coverage to more than 19 million elderly citizens in its first year. A significant requirement of its implementation was provider compliance with Title VI of the then recently passed Civil Rights Act of 1964.

Almost overnight, this requirement effectively brought an end to segregation in hospitals.

Less than a decade after its creation, Medicare underwent a notable expansion in coverage, when eligibility expanded to include disabled persons receiving cash benefits under the Social Security disability program and persons with end-stage renal disease. Nearly a half century later, Medicare serves 50 million elderly Americans annually. The majority of these individuals would otherwise very likely have no health insurance.

Medicare’s coverage and benefits have extended countless years of qualify life to those receiving its medical care. I am encouraged to see that awareness of these results has brought action to reform the healthcare system and further expand coverage to more Americans. With the passage and upcoming implementation of the Affordable Care Act (ACA), an additional 30 million Americans currently uninsured will be able to access medical care at a reasonable price. While I fully support the progress the reform law is bringing, I believe there is more we can do to ensure medical access for every American.

I believe Medicare For All is the answer, which is why I have introduced and advocated for since 2003 a publicly funded, privately distributed insurance program, H.R. 676. Even with the expansion of access that ACA will provide, there will still be those who fall through the gaps or who struggle to pay for the costs of medical care. This would not be the case under a single-payer program like H.R. 676.

Each year, Medicare’s birthday creates a wonderful opportunity to come together and work in a constructive way advocating for transitioning our for-profit and costly healthcare system to a high-quality, simple and cost-effective Medicare For All program.

Americans are frustrated with exorbitant and rising healthcare costs, and many have a deep mistrust of private health insurance companies. The for-profit medicine model has resulted in rationed care and created undue stress and financial hardships for millions of Americans across the nation. Americans are smart — they know improved public health insurance works in other countries. They also know that our own Medicare program, although not perfect, is a proven and efficient method for providing healthcare to America’s seniors.

As we celebrate Medicare’s birthday today, it is suitable to pause and remember the signing of the Medicare Act, which took place at the Truman Library in Independence, Mo., on this day, 48 years ago, and what Lyndon Johnson said: “No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings they have so carefully put away over a lifetime so that they might enjoy dignity in their later years.”

By enacting H.R. 676, this could be the reality for every single American.

John Conyers Jr., D-Mich., has represented Michigan in the House of Representatives since 1965. He is ranking member on the Judiciary Committee.

http://thehill.com/opinion/op-ed/314193-happy-48th-birthday-medicare-#ixzz2aXQ2YRDS

Let’s celebrate Medicare

By Jessica Schorr Saxe, M.D.
The Charlotte (N.C.) Observer, July 29, 2013

Just after her 65th birthday, a patient limped into my office and apologized for not having shown up in months. She had not been able to afford a visit. Now on Medicare, she was able to address her medical problems. Within a month, she had seen her kidney doctor and an orthopedist. Within a few more weeks, she would have the knee replacement that had been recommended years before. A previously “noncompliant patient,” she was keeping all her appointments – now that she could afford them.

As the nation notes the 48th birthday of Medicare today, let us celebrate what we have achieved. But let us ponder this as well: This patient – and my many other pre-senior citizen patients with medical needs – would have been better off with coverage earlier. Maybe her kidney failure would not have progressed. She was lucky to have a job she could do while “hobbling around,” she says. Others can’t work due to pain and can’t get surgery because they are unemployed and uninsured.

Access to health care for all

The real celebration of this important milestone would be to improve Medicare and extend it, providing access to health care for all.

Consider these facts:

•  According to a study by the Commonwealth Fund, elderly individuals on Medicare were more satisfied than people with private insurance. (Only 8 percent rated their Medicare as fair or poor compared to 20 percent for employer-sponsored insurance and 33 percent for individual policies).

•  Medicare patients were less likely to have access problems due to cost (23 percent as compared to 37-39 percent for private insurance) and had fewer medical bill problems (21 percent and 39 percent respectively).

•  Traditional Medicare is more efficient with its 1.4 percent overhead (according to the Centers for Medicare and Medicaid Services) as compared to 12-25 percent for private insurance.

•  Lack of health insurance accounts for 45,000 deaths annually in the United States. Behind these statistics are 45,000 human beings whose lives might have been saved had they received medical care.

•  While the Affordable Care Act will reduce the number of uninsured, a recent survey showed that in 2016 about 30 million people, 80 percent of whom are U.S. citizens, would still be uninsured. In North Carolina, that number will be 1,268,000 (which could drop to 790,000, if N.C. lawmakers were to accept the Medicaid expansion).

Improved Medicare for all would be financed by a single-payer system in which one public entity would pay the bills, while the delivery of medical care would remain largely private. The program would eliminate all co-pays and deductibles, and be funded by equitable taxes amounting to less than what most people pay today for insurance premiums and out-of-pocket expenses. The billions of dollars in savings in administrative costs and negotiated drug costs would be more than adequate to provide universal coverage as well as improved services.

Do you think that extending Medicare to all is a liberal fantasy?

GOP doctor pushes ‘single payer’

Dr. David May, the gun-toting Republican chair of the Board of Governors of the American College of Cardiology, recently wrote an article advocating a single-payer system. He notes that it would save money, promote choice, provide transparency in costs, capture data that would allow to us improve outcomes, and allow physicians – rather than insurance companies – to be in charge of health care. He concludes that our current system is un-American and that his proposal is “quite Republican.”

This is a month to celebrate freedom. July 4 marked the anniversary of freedom for Americans from tyranny. Let’s end the month celebrating the freedoms that Medicare gives our seniors: the ability get needed medical care with less risk of financial devastation.

How much better it would be if we extended that freedom to all!

Jessica Schorr Saxe is a Charlotte physician and chair of Health Care Justice, the local chapter of Physicians for a National Health Program. hcjusticenc@gmail. com

Read more here: http://www.charlotteobserver.com/2013/07/29/4199327/lets-celebrate-medicare.html#storylink=cpy

Consider universal care

By Aldebra Schroll, M.D.
Chico (Calif.) News & Review, Letters, July 25, 2013

On July 30, the Medicare program will mark its 48th birthday.

Medicare is the national single-payer health insurance plan that covers the elderly and disabled. It was enacted to ensure financial stability as people aged.

Today, Medicare guarantees health care to more than 50 million Americans. A study from the journal Health Affairs found that those enrolled in Medicare had fewer problems obtaining affordable medical care and higher satisfaction scores than those in private plans. They were also less likely to file bankruptcy due to medical expenses.

Overall, Medicare patients report greater satisfaction and security than those enrolled in private plans. A universal Medicare-for-all plan could guarantee these benefits to everyone. Learn more at www.pnhp.org.

Dr. Aldebra Schroll resides in Chico.

http://www.newsreview.com/chico/letters-for-july-25-2013/content?oid=10773510

A happy 48th to Medicare

By Laurence S. Jacobs, M.D.
Santa Fe New Mexican, July 27, 2013

On Tuesday, Medicare will be 48 years old. It covers more than 50 million Americans — those older than 65 and the disabled. It has improved financial security for the elderly and disabled and reduced health disparities related to race and socioeconomic status. Medicare recipients go to the doctor and the hospital of their choice, not to a restricted panel of caregivers. Medicare operates on an overhead of about 2 percent, compared with private insurers’ overheads from 12 percent to more than 20 percent. Medicare does have its flaws: It doesn’t cover vision or hearing problems, and the drug program (Part D) has the insane congressional restriction that it cannot negotiate with pharmaceutical manufacturers over medication costs, the way Veterans Affairs can. That’s why the VA spends 40 percent less for the same drugs.

An improved Medicare for all would make terrific sense. Low overhead, a single set of approved forms (not a separate one for each insurer, as is now the case), no outrageous CEO salaries, no marketing or advertising costs, first dollar coverage without copayments or deductibles, no restrictions on choice of doctor or hospital. All medically approved tests and treatments would be covered, and there would be no issue of physicians refusing to see certain classes of patients because of poorly paying insurance. Funding, from progressive taxes, would cost individuals less than they now pay in premium, copay, deductible and out-of-pocket expenses. Finally, Medicare as the only payer would be able to negotiate robustly over prices of drugs, medical devices and hospital bills.

Medicare recipients are happier with their health insurance, have fewer problems with access to care and delays in payment, and are more likely to have a medical home with a primary care provider who knows them well than are people with private health insurance.

Severe illness has extraordinary consequences in the U.S. Some 62 percent of personal bankruptcies are largely due to medical expenses, and three-quarters of those bankrupted had health insurance in place prior to illness. Those policies did not offer financial protection, which is one of the main purposes of insurance. Many low-income people go without insurance because of its high cost. The consequences are awful; it’s been estimated that approximately 45,000 people die in this country annually because of lack of insurance, associated with delay or deferral of needed care. An improved Medicare for all would eliminate these consequences.

So why don’t we have Medicare for all? Because insurers, drug companies and associated entrenched interests lobby our Congress intensely to preserve their huge profits, and because of ideologues’ lies about government intrusion into health care. Actually, it’s the private insurance companies that intrude into medical decision-making and deny expensive coverages, not for medical reasons but to maximize profits and restrict access to care by contracting with ever-smaller panels of physicians.

Medicare for all would simply be a payment mechanism. Ask current Medicare recipients whether the program interferes with their care in any way.

We need to eliminate our crazy patchwork of insurance coverages, which leads to the estimated $400 billion in administrative overhead we now annually waste, and, like every other developed nation, we need to find a way to offer comprehensive health insurance to all our residents. The best way to accomplish this goal is to improve and expand our Medicare program, by making its coverage truly comprehensive medical and by enrolling everyone. That would make the birthday of Medicare a truly happy one for our entire population.

Dr. Laurence S. Jacobs, an emeritus professor of medicine at the University of Rochester School of Medicine and Dentistry and a member of Physicians for a National Health Program, calls Santa Fe home part of the year.

http://www.santafenewmexican.com/opinion/my_view/article_5a8a6096-e06d-5a40-ad98-c933bac6495d.html