PNHP

Time for Medicare-For-All

Time for Medicare-For-All

By Bob Balhiser
Independent Record (Helena, Mont.), Letters, March 9, 2013

Health insurance companies are parasites that add no value whatsoever to our health care system!

I have a Medicare supplement plan and my wife has a high deductible ($5,950) individual plan. The same company writes both policies. Rates for my plan are regulated by Medicare while hers are not regulated at all. Here are recent increases for both types of health insurance plans: rates for my Medicare Supplement increased 9.2 percent from 2011 to 2012, and 9 percent from 2012 to 2013. During the same time period, my wife’s private health insurance premium rose 15.5 percent and 20.7 percent respectively. We can hardly wait until she becomes eligible for Medicare so we can quit feeding this parasitic company.

The example above demonstrates why we should rid our country of private health insurers and implement a single-payer system such as Improved Medicare-For-All. Granted, opponents of single payer health care will be the first to call it “socialized medicine,” but nothing could be further from the truth. Instead, Medicare-For-All might more properly be described as “socialized health insurance” wherein private sector doctors, hospitals and pharmacies are paid by a single insurer called Medicare.

What are the potential savings from Medicare-For-All done right? Well, the U.S. pays 18 percent of Gross Domestic Product for health care, while other advanced countries with “socialized health insurance” pay an average of 11 percent GDP. That 7 percent GDP difference in our economy would amount to a savings of $1 trillion annually. So, let’s do something that should appeal to Republicans and Democrats alike. Let’s implement Medicare-For-All and apply all the savings toward national debt reduction. How’s that for a win/win solution?

Bob Balhiser resides in Helena, Mont.

http://helenair.com/news/opinion/readers_alley/time-for-medicare-for-all/article_728cc2ce-8911-11e2-a4af-001a4bcf887a.html

Analysis of Pennsylvania's single payer proposal

The Pennsylvania Health Care Plan: Impact and Implementation

By Gerald Friedman, Ph.D., Professor of Economics, University of Massachusetts – Amherst
March 5, 2013

Executive Summary

Pennsylvania is on an unsustainable economic path.  Health care costs are absorbing a growing share of personal income. Between 1991 and 2009, spending on health care in the Commonwealth increased by $60 billion, rising nearly twice as fast as state income. Little of this increased spending can be attributed to improvements in health care. Instead, the fastest growth has been in administration and billing operations… while a growing number of Pennsylvanians are without adequate health insurance or access to needed care.
 
The Pennsylvania Health Care Plan (PHCP) would put the state on a sustainable path by controlling health care costs while giving all citizens access to quality health care. It would establish a single-payer system to finance health care — paying for all necessary medical care including hospital care, visits to doctors / nurses, occupational and physical therapy, prescription drugs, medical devices, medically necessary nursing home care and home health care. By reducing administrative costs and anti-competitive market practices, the PHCP could save $33 billion in 2014, almost 23% of existing medical spending. These savings would allow the expansion of coverage to all Pennsylvania residents while still saving over $17 billion, or $1,335 per person.
 
The PHCP would be funded by a 10% payroll tax paid by employers and a 3% levy on income paid by recipients. The shift from insurance premiums and out-of-pocket expenses to taxes linked with income would lower health care spending for over 80% of Pennsylvanians.

Businesses and local governments would also benefit, saving on payroll costs as well as the premiums paid to cover the “administrative costs” associated with private health insurance. By lowering payroll costs, the PHCP would make Pennsylvania businesses more competitive, producing an additional 120,000 – 200,000 new jobs.

(Legislation to be introduced March 19 in the Pennsylvania Senate as SB 400)

http://healthcare4allpa.org/wp-content/uploads/2013/03/EISExecutiveSummary.pdf

Full report (38 pages)
http://healthcare4allpa.org/wp-content/uploads/2013/03/EconomicImpactStudy3513.pdf

Comment:

By Don McCanne, M.D.

Another single payer study… another result that makes single payer the imperative. Are we slow learners? Or what?

Pa. study proves single payer will save $17 billion annually and cover everybody in state

By Chuck Pennacchio
OpEd News, March 11, 2013

A single-payer health care plan will save Pennsylvania families, businesses and tax payers $17 billion annually while providing comprehensive health care to all, according to an economic impact study released today.

Commissioned by Health Care for All PA, a statewide non-profit organization, the study was conducted by University of Massachusetts – Amherst professor of economics Gerald Friedman, Ph.D.

It compares the cost of the current for-profit health insurance model in Pennsylvania under which provider choice is limited and health services are rationed by health insurance companies to that of a consumer-driven health care system which gives people freedom to choose their own doctors, hospitals and health care providers.

The legislation to create this single-payer system will be re-introduced in the Pennsylvania Senate (Senate Bill 400) on March 19 by Senator Jim Ferlo. The name of this state-based, consumer-driven health care system will be The Pennsylvania Health Care Plan.

Some of the important advantages of The Pennsylvania Health Care Plan are:

* Comprehensive coverage for every resident of Pennsylvania, including dental, vision, mental health and prescription drug services;

* Eliminates the need for hospitals to absorb the cost of care for the uninsured;

* Reduces bureaucracy for private physicians resulting in reduced administrative costs and improved compensation for private physicians;

* Reduces or eliminates health insurance over-costs for small business, allowing for more job creation, greater reinvestment of profits, and reduced workers’ compensation costs.

* Radically reduces the total cost of health care to levels more consistent with costs in the rest of the industrialized world.

A one-page Executive Summary along with the full text of the Economic Impact Study is available here.

Please spread the word. Contact your friends and legislators. Help us with donations for advertising and speaker transportation costs. Health care for all IS possible in Pennsylvania, but only if we demand it.

Read the entire study here.

Chuck Pennacchio is executive director of Health Care for ALL PA.

http://www.opednews.com/articles/Study-proves-that-single-p-by-Chuck-Pennacchio-130311-711.html

New York: Gottfried, Perkins introduce universal health care bill

By Clara A. Smith
The Legislative Gazette (Albany, N.Y.), March 11, 2013

Assemblyman Richard Gottfried and Sen. Bill Perkins have unveiled a bill that, if adopted, would create a new single-payer health plan called New York Health.

The health plan, designed to provide widespread health care for all New Yorkers, would provide health coverage regardless of employment, wealth, age, income or any other factor. The plan would replace private insurance coverage with universal coverage for all New Yorkers.

“Health care should be a right, not a privilege,” said Gottfried, the Assembly Health Committee chair. “Coverage should be driven by the needs of patients, not insurance companies and stockholders. You and your doctor work to keep you healthy. New York Health will pay the bill.”

Coverage for health care would be publicly funded under the new health plan and would include a benefits package more inclusive than most health plans currently offered. Instead of patients and employers paying deductibles, premiums and co-pays, coverage would be funded through a graduated tax on income, based on ability to pay, according to the sponsors of the legislation.

“There would be two basic sources of revenue; one would be a payroll tax that would be paid primarily by employers that would be on all payroll income and progressively graduated so that higher wage and [salary] earning employees would pay a higher percentage than lower,” Gottfried said at a press event announcing the introduction of the bill. “The second revenue source would be a surcharge on the state income tax on taxable interest dividends, capital gains … that is important because our wealthiest earners in our society, their wealth doesn’t come from a salary, it comes from interest in dividends and capital gains.”

Perkins, in a letter advocating for the bill that was sent to fellow Senate members, describes current federal health care as having made improvements over the years but unfortunately still gives insurance companies too much control of “our health and our wallets.” He said that currently patients and their doctors are forced to figure out what is covered under insurance companies while trying to get reimbursed.

“Health care should be about health, not profit,” Perkins said at the press event. “For some this may be a new issue, but this issue has been around for years and it’s time has come. In fact, it has more than come. I have always advocated that your health is your wealth and I am proud to sponsor this bill.”

The bill, (A.5389/S.2078) notes that all New Yorkers would be covered for “medically necessary services,” such as preventative, specialist and primary care; mental health; dental; reproductive health care; medical supply costs and prescription drugs.

“Right now, five New Yorkers die every day due to lack of health care and many go bankrupt from medical bills. That is unacceptable and inhumane,” said Laurie Wen, executive director of Physicians for a National Health Program. “A universal, publicly financed health care system would save lives [and] money. It’s a win-win situation for patients, physicians and our economy.”

All New Yorkers under the plan would choose a primary care practitioner or other provider of their choice to “provide care coordination.” This move is meant to help patients get the care and follow-up attention they need so they can successfully navigate the new health plan system.

“New Yorkers — as individuals, employers and taxpayers — have experienced a rapid rise in the cost of health care and coverage in recent years,” as stated in a sponsor memo submitted by Perkins. “This increase has resulted in a large number of people without health coverage.

“Businesses have also experienced extraordinary increases in the costs of health care benefits for their employees. An unacceptable number of New Yorkers have no health coverage and many more are severely underinsured.”

In 2009, The New York State Department of Health and Department of Insurance, based on a study by the Urban Institute, released a report that declared single-payer plans the “most cost-effective way to provide health care to all New Yorkers.”

“Single-payer health care is just, simple, clear and efficient,” Dr. Paul Sorum of Albany Medical Center said at the press event. “We ask the state legislature and the governor to save the physicians and patients of New York state to allow the physicians to take care of patients not insurance companies, to be a beacon for the rest of the country, to lead us into universal single-payer health care.”

If passed, this bill would be the second of its kind enacted in the United States. Vermont, in 2011, enacted legislation called “Green Mountain Care” that is set to create the first functional single-payer health care system within the next several years.

Gottfried clarified at the event that if the bill is passed it will take a few years for New York to get the proper systems ready to implement the plan ready.

The bill is currently co-sponsored by 83 other legislators.

http://www.legislativegazette.com/Articles-Top-Stories-c-2013-03-11-82933.113122-Gottfried-Perkins-introduce-universal-health-care-bill.html

Would busting up our consolidated health care market lower prices?

No Competition: The Price Of A Highly Concentrated Health Care Market

By Diane Archer
Health Affairs Blog, March 6, 2013

As health care costs swell, the private insurance system that covers most working Americans is in crisis. Americans are paying higher and higher premiums for increasingly threadbare coverage, and employers are getting out of the business of providing health care altogether. Rising costs cannot be attributed purely to improving technology or increasing operating costs for providers, because Medicare has controlled per capita spending more effectively than commercial insurers that provide employer-sponsored coverage.

Rather, commercial insurers cannot contain costs because the pricing mechanism for medical services is broken. When it comes to health care, competition simply isn’t working.

Prices in the private sector are out of control. On average, private insurers pay 25 percent more than Medicare for physician services and 30 percent more for hospital care. What’s more, both public and private sector payment rates for doctors in America are far and away the highest in the world, and research suggests that these high rates are among the principal reasons health care is so much more expensive in this country than elsewhere.

These international gaps are much wider in the private sector. For instance, private payments for an office visit in the United States cost 70 percent more than those abroad, while public payments are 27 percent higher.

Rather than being influenced by competition, health care prices are largely set by insurers and providers with monopoly power to maximize profits. Big hospital chains and provider groups dominate most local markets and extract extremely high rates from dominant insurers, which are motivated by fear of losing market share if they fail to attract these providers to their networks.

Commercial health plans have little bargaining power when they negotiate prices with monopolistic providers. In fact, even insurance industry lobbyists admit that private health plans cannot hold down the cost of health care. Insurers choose instead to adapt to this non-competitive environment.

So what is to be done?

The Patient Protection and Affordable Care Act (“ACA”) will for the first time guarantee the overwhelming majority of Americans access to good coverage, a huge step forward.  But it expands coverage mostly by relying on the dysfunctional private insurance market. There is no evidence that the newly created exchanges will exert any downward pressure on prices, given the experience of private plans to date.

Congress needs to recognize that players in the private health care marketplace will continue to set excessive rates until they are stopped. These exorbitant rates are not only hurting working people, they are also driving up Medicare costs and imposing a massive burden on taxpayers and the federal government. Doctors and hospitals are conditioned to expect higher and higher rates and demand higher payments from public programs.

Congress has three options to rein in runaway prices: It can use Medicare-style techniques to set rates or rate ceilings in the commercial marketplace, including in the new health insurance exchanges, just as every other developed nation does. It can give people under 65 the choice of a public health insurance plan that works like Medicare, competes against the private health plans, and brings down costs. Or it can do both.

Over the long-term, the federal government might be able to address the broken pricing mechanism by enforcing antitrust laws more aggressively than before to break up monopolies in health care markets. But it is worth remembering that even heavily regulated insurance markets – such as Medicare Advantage or the exchange system in Massachusetts – have not been particularly successful at controlling costs. The simple fact is that the array of existing incentives for commercial insurers does not tend to drive down prices. Given the direction of commercial insurance, relying on the current version of “competition” is destined to jeopardize access to health care for millions of working Americans while driving public spending upward.

http://healthaffairs.org/blog/2013/03/06/no-competition-the-price-of-a-highly-concentrated-health-care-market/

Comment:

By Don McCanne, M.D.

The increase in anti-competitive consolidation of hospitals and physician groups is thought to be contributing to our high health care spending, especially since private insurers have been very feeble price negotiators in this concentrated market. Does that mean that we need the government trust busters to step in to introduce more competition in health care?

As Noble laureate Kenneth Arrow demonstrated a half century ago, there are many reasons that merely busting up consolidated health systems could never lead to a functioning competitive market in health care. Besides, the cost escalation has always been with us, long before the more intense consolidation efforts began. As far as the wish to achieve lower prices through competition, we can forget about competing hospitals, competing physician groups, competing accountable care organizations, and, especially, competing private insurance plans.

As far as what we should do, Diane Archer suggests either extending Medicare’s administered pricing function to private insurers as well, or providing a Medicare-like plan that competes with the private insurers, or both.

During the debate over the “public option,” we explained how merely adding another insurance option, even though government-run, to our highly dysfunctional, fragmented system of financing health care would have very little impact on achieving our goals of universality, equity, efficiency, and affordability.

Although government-administered pricing has been effective for Medicare, using it for private insurers also would fall short of these goals since the dysfunctional system would still remain in place. Even combining price controls and a public plan option together would still be inadequate, for the same reasons.

So what should we do? Instead of continuing to apply patches to our current system, we should replace it with an improved Medicare that makes health care affordable for all of us. There would be no need for public option plans, nor for government rate setting of private insurance, if we got rid of the overpriced and inefficient market of private health plans.

Could this be the year for single-payer health care?

By Casey Seiler
Times Union (Albany, N.Y.), Capitol Confidential blog, March 7, 2013

Probably not — but that didn’t stop Assemblyman Richard Gottfried from rolling out the latest version of his perennial bill establishing a statewide single-payer health care system, a structure often shorthanded by advocates nationwide as “Medicare for all.”

Backed by nurses, physicians, anti-poverty activist Mark Dunlea and a clutch of his fellow Democratic lawmakers, Gottfried discussed the bill at a Thursday news conference.

The Manhattan Democrat’s legislation, A.5389, has 73 co-sponsors in his chamber — though Speaker Sheldon Silver is not among them — and about a dozen in the Senate, where the measure is now carried by Bill Perkins. (Until this year, Tom Duane served as its Senate sponsor.)

Even though the nation is only beginning to implement the federal Affordable Health Care Act, Gottfried said the Empire State shouldn’t have to wait years before seeing where it falls short. “Federal health care reform has done a lot of good, but it still leaves us in the hands of insurance companies,” Gottfried said. “New York can do better.”

The New York Health Act would replace all private insurance coverage with comprehensive, universal coverage for every New Yorker, he explained.

“It would save the billions of dollars that we now spend on insurance company administrative costs. … You and your doctor would work to keep you healthy. New York Health would pay the bill with funding from broad-based revenue based on ability to pay,” Gottfried said.

The two sources of revenue: a progressive payroll tax paid for primarily by employers with contributions by workers, and a surcharge on investment income. It would also require the demise of the health insurance industry in New York — a transformation business groups view as only slightly better than the apocalypse.

The bill’s only appearance on the floor of the Assembly was in 1992, when it passed before being promptly ignored by the Republican-controlled state Senate.

“In the intervening years, as Gilda Radner said, ‘It’s always something,’” Gottfried said. “People who would have been focused on single-payer for a couple of years were focused on the Clinton health plan. Then people here in New York were focused on managed-care reforms and for many years fighting against drastic cuts in Medicaid that were on the table. And then for the last several years people were focused on getting health care reform enacted in Washington. Now that federal health care reform is done and people can now assess what good it has done and what it has left undone, I think we are really ready to refocus on single-payer.”

He called it a “superb year” to reconsider the plan. Perkins said that this appeared to be a good year for progressive legislation — an apparent reference to Gov. Andrew Cuomo’s new emphasis — but struck a realistic tone.

“Listen, let’s be for real: There are a lot of monied interests that are involved in this,” Perkins said. “The privatized model is about profit; it’s about paying for policies that do not necessarily speak to the best interests of the community, to the best interests of people. And therefore, to some extent it measures how valuable this is — because there’s so much effort over the years to prevent (the bill) from even getting to daylight.”

Advocates have been cheered by the passage of a single-payer bill in Vermont, although the Green Mountain State won’t be able to implement its system until at least 2017, at which point it will have to seek extensive federal approvals before moving forward. Gov. Peter Shumlin has commented that his state’s move is especially valuable because Vermont’s relatively small population makes it a better lab for a single-payer system. New York, in contrast, is one of the most populous states in the nation.

Casey Seiler is Capitol bureau chief for the Times Union.

For the text above and a link to a video of the press conference:
http://blog.timesunion.com/capitol/archives/180979/could-this-be-the-year-for-single-payer-health-care/

'Bitter pill' should prompt lawmakers to back Medicare for all

By Timothy Shaw, M.D.
The Capital Times (Madison, Wis.), Letters, March 11, 2013

Steven Brill’s recent Time magazine article “Bitter Pill: Why Medical Bills Are Killing Us,” rightly portrays our American health care system as a mess. Health care has become an unaffordable business monopoly that benefits the medical community and corporations the most, and patients the least.

But before the right-wing media starts spinning the fantasy that this mess is “Obamacare,” I want to emphasize that this is NOT Obamacare. Speaking at an AFL-CIO event in 2003, then Sen. Obama advocated for a single-payer plan. But in 2010, President Obama had to settle for the Patient Protection and Affordable Care Act. While it has some excellent provisions in it, it still leaves in place a dysfunctional, employer-based, for-profit health care system which is the cause of the problems elucidated in Brill’s article.

PPACA, as written, was influenced by over 3,000 special-interest lobbyists — doctors, health insurers, big PHARMA, hospital systems, etc. Influenced by special-interest money, Congress dropped the public option, and when eight caring doctors and nurses rose to speak at a congressional hearing in favor of an affordable single-payer system, they were arrested.

Some of our elected leaders speak in disfavor of labor unions, but encourage and are funded by the excessively greedy and profitable union of doctors, insurers, hospitals and big PHARMA.

Our elected leaders should live up to their oath of office and “promote the general welfare” by expanding our Medicare system to ALL citizens equally by voting for H.R. 676 “Expanded and Improved Medicare for All Act.”

Dr. Timothy Shaw resides in Fitchburg, Wis.

http://host.madison.com/ct/news/opinion/mailbag/timothy-shaw-lawmakers-should-vote-for-h-r-medicare-for/article_5c2aa076-98bd-5b62-8dfe-2d423a74e22c.html

Would busting up our consolidated health care market lower prices?

No Competition: The Price Of A Highly Concentrated Health Care Market

By Diane Archer
Health Affairs Blog, March 6, 2013
As health care costs swell, the private insurance system that covers most working Americans is in crisis. Americans are paying higher and higher premiums for increasingly threadbare coverage, and employers are getting out of the business of providing health care altogether. Rising costs cannot be attributed purely to improving technology or increasing operating costs for providers, because Medicare has controlled per capita spending more effectively than commercial insurers that provide employer-sponsored coverage.
Rather, commercial insurers cannot contain costs because the pricing mechanism for medical services is broken. When it comes to health care, competition simply isn’t working.
Prices in the private sector are out of control. On average, private insurers pay 25 percent more than Medicare for physician services and 30 percent more for hospital care. What’s more, both public and private sector payment rates for doctors in America are far and away the highest in the world, and research suggests that these high rates are among the principal reasons health care is so much more expensive in this country than elsewhere.
These international gaps are much wider in the private sector. For instance, private payments for an office visit in the United States cost 70 percent more than those abroad, while public payments are 27 percent higher.
Rather than being influenced by competition, health care prices are largely set by insurers and providers with monopoly power to maximize profits. Big hospital chains and provider groups dominate most local markets and extract extremely high rates from dominant insurers, which are motivated by fear of losing market share if they fail to attract these providers to their networks.
Commercial health plans have little bargaining power when they negotiate prices with monopolistic providers. In fact, even insurance industry lobbyists admit that private health plans cannot hold down the cost of health care. Insurers choose instead to adapt to this non-competitive environment.
So what is to be done?
The Patient Protection and Affordable Care Act (“ACA”) will for the first time guarantee the overwhelming majority of Americans access to good coverage, a huge step forward.  But it expands coverage mostly by relying on the dysfunctional private insurance market. There is no evidence that the newly created exchanges will exert any downward pressure on prices, given the experience of private plans to date.
Congress needs to recognize that players in the private health care marketplace will continue to set excessive rates until they are stopped. These exorbitant rates are not only hurting working people, they are also driving up Medicare costs and imposing a massive burden on taxpayers and the federal government. Doctors and hospitals are conditioned to expect higher and higher rates and demand higher payments from public programs.
Congress has three options to rein in runaway prices: It can use Medicare-style techniques to set rates or rate ceilings in the commercial marketplace, including in the new health insurance exchanges, just as every other developed nation does. It can give people under 65 the choice of a public health insurance plan that works like Medicare, competes against the private health plans, and brings down costs. Or it can do both.
Over the long-term, the federal government might be able to address the broken pricing mechanism by enforcing antitrust laws more aggressively than before to break up monopolies in health care markets. But it is worth remembering that even heavily regulated insurance markets – such as Medicare Advantage or the exchange system in Massachusetts – have not been particularly successful at controlling costs. The simple fact is that the array of existing incentives for commercial insurers does not tend to drive down prices. Given the direction of commercial insurance, relying on the current version of “competition” is destined to jeopardize access to health care for millions of working Americans while driving public spending upward.
http://healthaffairs.org/blog/2013/03/06/no-competition-the-price-of-a-h…

The increase in anti-competitive consolidation of hospitals and physician groups is thought to be contributing to our high health care spending, especially since private insurers have been very feeble price negotiators in this concentrated market. Does that mean that we need the government trust busters to step in to introduce more competition in health care?
As Noble laureate Kenneth Arrow demonstrated a half century ago, there are many reasons that merely busting up consolidated health systems could never lead to a functioning competitive market in health care. Besides, the cost escalation has always been with us, long before the more intense consolidation efforts began. As far as the wish to achieve lower prices through competition, we can forget about competing hospitals, competing physician groups, competing accountable care organizations, and, especially, competing private insurance plans.
As far as what we should do, Diane Archer suggests either extending Medicare’s administered pricing function to private insurers as well, or providing a Medicare-like plan that competes with the private insurers, or both.
During the debate over the “public option,” we explained how merely adding another insurance option, even though government-run, to our highly dysfunctional, fragmented system of financing health care would have very little impact on achieving our goals of universality, equity, efficiency, and affordability.
Although government-administered pricing has been effective for Medicare, using it for private insurers also would fall short of these goals since the dysfunctional system would still remain in place. Even combining price controls and a public plan option together would still be inadequate, for the same reasons.
So what should we do? Instead of continuing to apply patches to our current system, we should replace it with an improved Medicare that makes health care affordable for all of us. There would be no need for public option plans, nor for government rate setting of private insurance, if we got rid of the overpriced and inefficient market of private health plans.

Bills calls for 'Medicare for all'

Assemblyman Gottfried urges single-payer health care system for state

By Casey Seiler
Albany Times-Union, March 8, 2013

ALBANY — Enacting a massive state takeover of the cost of health care for every New Yorker might seem like a heavy lift even in a deep-blue state like New York.

But that didn’t stop Assemblyman Richard Gottfried from rolling out the latest version of his perennial bill establishing a statewide single-payer health care system, a structure often shorthanded by advocates as “Medicare for all.”

Backed by nurses, physicians, anti-poverty activist Mark Dunlea and a clutch of his fellow Democratic lawmakers, Gottfried discussed the bill at a Thursday news conference.

The Manhattan Democrat’s legislation has 73 co-sponsors in his chamber — though Speaker Sheldon Silver is not among them — and about a dozen in the Senate, where the measure is carried by Bill Perkins, D-Harlem.

Even though the nation is only beginning to implement the federal Affordable Health Care Act, Gottfried said the Empire State shouldn’t have to wait years before seeing where it falls short. “Federal health care reform has done a lot of good, but it still leaves us in the hands of insurance companies,” Gottfried said. “New York can do better.”

The New York Health Act would replace all private insurance coverage with comprehensive, universal coverage for every New Yorker, he said.

“It would save the billions of dollars that we now spend on insurance company administrative costs. … You and your doctor would work to keep you healthy. New York Health would pay the bill with funding from broad-based revenue based on ability to pay,” Gottfried said.

The two sources of revenue: a progressive payroll tax paid for primarily by employers with contributions by workers, and a surcharge on investment income. It would also require the demise of the health insurance industry in New York — a development business groups view as only slightly preferable to the end of the world.

The bill’s only appearance on the floor of the Assembly was in 1992, when it passed before being promptly ignored by the Republican-controlled state Senate.

“In the intervening years, as Gilda Radner said, ‘It’s always something,'” Gottfried joked, referring to the late “Saturday Night Live” player.

“People who would have been focused on single-payer for a couple of years were focused on the Clinton health plan,” he continued. “Then here in New York people were focused on managed-care reforms and, for many years, fighting against drastic cuts in Medicaid that were on the table. And then for the last several years people were focused on getting health care reform enacted in Washington. … I think we are really ready to refocus on single-payer.”

Perkins struck a realistic tone about the bill’s chances, as well as its ultimate value.

“Listen, let’s be for real: There are a lot of monied interests that are involved in this,” Perkins said. “The privatized model is about profit; it’s about paying for policies that do not necessarily speak to the best interests of the community, to the best interests of people. And therefore, to some extent it measures how valuable this is — because there’s so much effort over the years to prevent (the bill) from even getting to daylight.”

 http://www.timesunion.com/local/article/Bills-calls-for-Medicare-for-all-4338038.php#ixzz2MzAGVaL9

Only 2% of individual plans meet "essential health benefit" requirements

Almost No Existing Health Plans Meet New ACA Essential Health Benefit Standards

By Kev Coleman
HealthPocket, March 7, 2013

Given that health insurance plans will have to meet new minimum coverage standards starting in 2014, HealthPocket examined the current marketplace of individual health plans to measure the market disruption that will occur as these plans are replaced by plans compliant with the new standards.

Our research took the Affordable Care Act’s Essential Health Benefits as our starting point. The Essential Health Benefits are the minimum categories of health insurance coverage that every qualified health plan must have starting January 1, 2014. HealthPocket then examined 11,100 individual health plans across the United States to see how many plans had coverage in each of the Essential Health Benefit categories.

The data shows that there will be a near complete transformation of the individual and family health insurance market starting in 2014. Less than 2% of the existing health plans in the individual market today provide all the Essential Health Benefits required under the Affordable Care Act (ACA).

On average, the health plans provided 76% of the ACA’s Essential Health Benefits. Benefits such as hospitalization, emergency care, and ambulatory services (such as visits to a primary care doctor or specialist) were covered by almost all plans in one form or another. A more detailed analysis of our results revealed that the missing 24% of Essential Health Benefits were concentrated around a few categories.

Dental and vision care for children was the least likely of the Essential Health Benefits to be provided in base benefits for a health insurance plan. Only one out of four plans nationally had these benefits within their base coverage. Looking at these benefits at a more granular level revealed that only 8% of plans provided coverage for dental check-up services. Maternity coverage was nearly as infrequent as pediatric dental and vision coverage. Two thirds of health plans did not offer their beneficiaries prenatal, delivery, and postnatal healthcare coverage. Substance Use Disorder Coverage was frequently absent in health insurance coverage as well. Only half of plans covered inpatient and outpatient services for substance use issues (e.g. alcohol or drug addiction). Mental health coverage was slightly better with six out of ten plans covering inpatient and outpatient treatment.

Implications for Health Insurance Premiums?

One of the questions raised by the results of this study is whether the coverage expansion required by the ACA will cause premiums to rise in 2014. Although the answer to that question is beyond the scope of this study, premiums could rise due to a combination of factors, including:

* The closing of the coverage gap as described in this study

* Guarantee issue provisions that will allow people with pre-existing medical conditions to enroll in health plans

* ACA actuarial value requirements on the maximum out-of-pocket costs that can be charged to beneficiaries

http://www.healthpocket.com/healthcare-resources/few-existing-health-plans-meet-new-aca-essential-health-benefit-standards#.UTnodq4tb3V

Comment:

By Don McCanne, M.D.

One of the problems that needed to be addressed by the Affordable Care Act (ACA) was the fact that health plans in the individual market have very skimpy benefits – benefit packages that were designed by private insurers who were attempting to keep their premiums competitive. This study confirms the extent of the inadequacies of these plans.

In response, ACA included a mechanism to require a minimum basic level of essential health benefits (EHB). The expansion of the benefits to be covered, along with guaranteed issue to those with preexisting disorders, and placing a maximum on out-of-pocket costs, will all result in significantly higher premiums for plans offered in the individual market. That is in spite of the fact that many will still find the benefits to be deficient, and will still face large out-of-pocket costs because of the low actuarial values of the plans that most people will select.

Even with subsidies, these plans will be expensive. And for those who do not qualify for subsidies? Maybe those potential purchasers would finally see the wisdom of establishing an equitable public system of financing health care through progressive taxes – a single payer national health program. They certainly aren’t going to like what they are going to get under ACA.

Only 2% of individual plans meet "essential health benefit" requirements

Almost No Existing Health Plans Meet New ACA Essential Health Benefit Standards

By Kev Coleman
HealthPocket, March 7, 2013
Given that health insurance plans will have to meet new minimum coverage standards starting in 2014, HealthPocket examined the current marketplace of individual health plans to measure the market disruption that will occur as these plans are replaced by plans compliant with the new standards.
Our research took the Affordable Care Act’s Essential Health Benefits as our starting point. The Essential Health Benefits are the minimum categories of health insurance coverage that every qualified health plan must have starting January 1, 2014. HealthPocket then examined 11,100 individual health plans across the United States to see how many plans had coverage in each of the Essential Health Benefit categories.
The data shows that there will be a near complete transformation of the individual and family health insurance market starting in 2014. Less than 2% of the existing health plans in the individual market today provide all the Essential Health Benefits required under the Affordable Care Act (ACA).
On average, the health plans provided 76% of the ACA’s Essential Health Benefits. Benefits such as hospitalization, emergency care, and ambulatory services (such as visits to a primary care doctor or specialist) were covered by almost all plans in one form or another. A more detailed analysis of our results revealed that the missing 24% of Essential Health Benefits were concentrated around a few categories.
Dental and vision care for children was the least likely of the Essential Health Benefits to be provided in base benefits for a health insurance plan. Only one out of four plans nationally had these benefits within their base coverage. Looking at these benefits at a more granular level revealed that only 8% of plans provided coverage for dental check-up services. Maternity coverage was nearly as infrequent as pediatric dental and vision coverage. Two thirds of health plans did not offer their beneficiaries prenatal, delivery, and postnatal healthcare coverage. Substance Use Disorder Coverage was frequently absent in health insurance coverage as well. Only half of plans covered inpatient and outpatient services for substance use issues (e.g. alcohol or drug addiction). Mental health coverage was slightly better with six out of ten plans covering inpatient and outpatient treatment.
Implications for Health Insurance Premiums?
One of the questions raised by the results of this study is whether the coverage expansion required by the ACA will cause premiums to rise in 2014. Although the answer to that question is beyond the scope of this study, premiums could rise due to a combination of factors, including:
* The closing of the coverage gap as described in this study
* Guarantee issue provisions that will allow people with pre-existing medical conditions to enroll in health plans
* ACA actuarial value requirements on the maximum out-of-pocket costs that can be charged to beneficiaries
http://www.healthpocket.com/healthcare-resources/few-existing-health-pla…

One of the problems that needed to be addressed by the Affordable Care Act (ACA) was the fact that health plans in the individual market have very skimpy benefits – benefit packages that were designed by private insurers who were attempting to keep their premiums competitive. This study confirms the extent of the inadequacies of these plans.
In response, ACA included a mechanism to require a minimum basic level of essential health benefits (EHB). The expansion of the benefits to be covered, along with guaranteed issue to those with preexisting disorders, and placing a maximum on out-of-pocket costs, will all result in significantly higher premiums for plans offered in the individual market. That is in spite of the fact that many will still find the benefits to be deficient, and will still face large out-of-pocket costs because of the low actuarial values of the plans that most people will select.
Even with subsidies, these plans will be expensive. And for those who do not qualify for subsidies? Maybe those potential purchasers would finally see the wisdom of establishing an equitable public system of financing health care through progressive taxes – a single payer national health program. They certainly aren’t going to like what they are going to get under ACA.

Teachers, colleges getting early lesson in Obamacare

By Eric Zorn
Chicago Tribune, March 5, 2013

They jokingly refer to themselves as “road scholars,” the part-time, often itinerate employees who teach the majority of the classroom hours at community colleges.

Without their willingness to work for modest pay, tuition at these colleges would be out of reach for many of those looking to put a foot on the first rung of secondary education.

And now some of these instructors are finding themselves among the first to be ensnared by a requirement of Obamacare — the Affordable Care Act — as their employers are planning to cut their teaching hours to make sure they don’t qualify for health care benefits under the new law.

Friday morning, adjunct professors and their supporters are planning a protest rally during an Illinois Council of Community College Presidents meeting in Lombard to urge leaders of the state’s community colleges to “Keep the ‘care’ in the Affordable Care Act,” as their promotional flier puts it.

Here’s the problem: Starting next year, Obamacare will require companies that employ more than 50 full-time workers to provide health insurance to employees who work 30 or more hours a week, or else pay a fine.

But what’s an “hour” for a college teacher? Depending on the subject matter, level of interaction with students and other factors, one hour in the classroom can require two, three or more hours of preparation, grading, conferences and so on.

“How do we account for all that time? How do we measure it?” asks David Baime, senior vice president for governmental relations for the American Association of Community Colleges, which represents 1,167 institutions nationwide. “With almost 70 percent of our (classroom) credits now taught by adjuncts, the colleges are extremely concerned about how the law will be interpreted and the extra costs they might get hit with.”

The Internal Revenue Service will hold a public hearing April 23 in Washington on this issue to attempt to sort out the concerns of the colleges and give them better guidance. But many schools are already planning out the 2013-14 school year, and some are erring on the side of caution, pre-emptively altering schedules and throwing some teachers into a panic.

Oakton Community College, with campuses in Des Plaines and Skokie, last month announced it would be cutting the hours of certain particularly active adjunct teachers starting this summer in order to make sure they won’t qualify as full-time employees under the Obamacare threshold when it kicks in.

Oakton’s marketing manager Janet Spector Bishop estimates 50 or fewer of the roughly 400 adjunct faculty members will lose hours when the somewhat complicated formula is applied.

Oakton’s Adjunct Faculty Association union President Barbara Dayton puts the number at 85.

Whichever number is correct, here’s the problem these teachers face: They’re already at the low end of the pay scale — a typical adjunct teaching two classes that meet four hours a week might make $8,000 for a semester, with no job benefits — and now they’re being told they’re going to make even less money right when the law will compel them to buy insurance.

“It’s a double whammy,” said Bill Silver, an Illinois Education Association union representative who’s helping organize Friday’s rally. “They’ll be earning 30 to 70 percent less money, then being told to go buy their (health) insurance on the exchanges.”

Students, he said, will see either fewer class offerings or classes being taught by less experienced part-timers.

Ideally, Silver said, all community colleges would offer health care benefits for their part-timers.

An administrative memo at Oakton said the additional costs associated with Obamacare stood to be “several million dollars” depending on how the law is ultimately applied. And this, of course, could result in higher tuitions, larger class sizes or both.

Either way, it looks like students lose.

And this is probably just the first example of the many similar issues that will arise as the big, clumsy law tries to blend the private, employer-provided insurance model with the idea of near-universal medical coverage.

Yet another lesson in Single-payer 101.

Comment on this column at chicagotribune.com/zorn