PNHP

Republicans dismiss the uninsured, but what about the Democrats?

Republicans dismiss the uninsured, but what about the Democrats?

GOP Says Coverage For The Uninsured Is No Longer The Priority

By Julie Rovner
NPR, July 27, 2012
For decades, the primary goal of those who would fix the U.S. health system has been to help people without insurance get coverage. Now, it seems, all that may be changing. At least some top Republicans are trying to steer the health debate away from the problem of the uninsured.
Take this exchange between Fox News Sunday host Chris Wallace and Senate Minority Leader Mitch McConnell (R-Ky.) earlier this month, just after the Supreme Court upheld most of President Obama’s health law.
Wallace: “What specifically are you going to do to provide universal coverage to the 30 million people who are uninsured?”
McConnell: “That is not the issue. … The question is how can you go step by step to improve the American health care system? It is already the finest health care system in the world.”
But McConnell isn’t the only top Republican saying covering the uninsured should no longer be the top priority.
“Conservatives cannot allow themselves to be browbeaten by failing to provide the same coverage numbers as Obamacare,” Sen. Orrin Hatch, R-Utah, told a conference at the conservative American Enterprise Institute. “To be clear, it is a disgrace that so many American families go without health insurance coverage. But we cannot succumb to the pressure to argue on the left’s terms.”
“Every once in a while, the Republicans have rare moments of honesty. And so when they say that they don’t want to expand coverage, this is one of those rare moments,” says Ethan Rome, who runs Health Care for America Now, an advocacy group working to promote and defend the health care law.
“They look around and they see middle-class families and others in need, and what do they want to do? They want to give tax breaks to the super rich,” he says. “That’s who they are and what they do. And I think that’s why they’re starting to talk about how they don’t want to expand coverage. Because they at least want to be truthful about a couple of things. And those are the ways in which they want to abandon certain populations and be frank about it.”
http://www.npr.org/blogs/health/2012/07/27/157439331/gop-says-coverage-for-the-uninsured-is-no-longer-the-priority

So the Republicans contend that the problem of the uninsured “is not the issue,” but the Democrats have enacted a program that pretends to provide universal coverage when they are leaving 30 million uninsured. Who is being honest here?
Because the issue of national health insurance has been associated with liberal/progressive politicians, some have mistakenly assumed that Physicians for a National Health Program (PNHP) has aligned itself with the Democratic Party. This is a non sequitur.
PNHP is a 501(c)3 organization, and, as such, does not support any political candidate nor any political party.
More importantly, PNHP is a single issue organization, exclusively supporting a single payer national health program – an improved Medicare for all. Neither the Democratic Party nor the Republican Party supports single payer.
During the political season, it is tempting for single payer supporters to select a party that might be more open to single payer, and then to support candidates of that party in the election. But top down doesn’t work, as those who supported the Democrats can now see. The top rejected single payer.
We need a bottom up approach by joining together in coalitions, by educating the public, and by promoting grassroots efforts to bring a loud and clear single payer message to all would-be politicians, regardless of political affiliation. As individuals, we can support candidates that lead on the single payer issue, but as an organization, PNHP will lead on policy, not politics.

Medicare’s birthday: Open letter to the president and leadership

It’s Our Economy, July 29, 2012

This Open Letter was published to honor Medicare’s 47th birthday. It comes on the heels of the Supreme Court upholding the Affordable Care Act and increasing threats to Medicaid and Medicare. The letter argues for the expansion of Medicare to all people in the United States and sees Medicare as the solution, not the problem.

Open Letter to the President and Leadership from Health Professionals, Lawyers and Advocates for Medicare for All

July 30, 2012

Dear Mr. President, Secretary Sebelius, Majority Leaders Reid and Cantor, Speaker Boehner and Minority Leaders McConnell and Pelosi,

We write to you on the occasion of Medicare’s 47th birthday to share our deep concern about increasing threats to both Medicare and Medicaid and to urge the immediate expansion of Medicare to everyone in the United States followed by its improvement. The implementation of the Affordable Care Act is not the solution; when it is fully implemented tens of millions will be left without insurance, tens of millions more will be left without adequate insurance and the cost of health care will continue to skyrocket. Forty-seven years of experience proves that Medicare is not the problem, but is the solution to the health care crisis in America.

For many of the most vulnerable among us, Medicare and Medicaid are their last protection from financial and medical catastrophe. Unfortunately, these vulnerable patients are not represented in health policy discussions. Instead, policy is dictated by special interests profiting from our health care system, not by those depending upon it to stay alive.

We call upon you to end the partisan and corporate influences that replace the best medical interests of our patients with the financial interests of those whose primary need and goal is to maximize profit, not to promote prevention and assure patient care.

Health care costs more in America than it does anywhere else in the world. Among the industrialized nations, we rank at or near the bottom on almost every measure of public health. Millions of us have limited or no access to health care, resulting in tens of thousands of unnecessary deaths and hundreds of thousands of family bankruptcies; these consequences are not found in other industrialized nations. Our country is heading in the wrong direction. We need immediate action.

We need a health care system that provides access to every one of us, no matter how sick, poor, old, or unemployed we may be. We need reduced costs. We need improved health for all people in the United States, not just the most fortunate.

The recent Supreme Court decision on the Affordable Care Act unhappily codifies into law an approach that fails to meet any of these health care needs:

• At its best, the ACA will leave 30 million Americans without health coverage. Another 40 million will be under-insured and therefore at risk for financial catastrophe or death when they get sick. Both numbers will increase as states opt out of the Medicaid expansion.

• With no restriction on prices charged by insurance companies, many people will find even the lowest tier policies unaffordable. Others will be unable to afford deductibles, and with that unable to afford necessary care. And still more will be bankrupted by out-of-pocket expenses when they get sick.

• As Medicare spending decreases, out of pocket expenses will rise. Patients will be compelled to defer health care until they are desperately ill, further eroding public health in America.

• The ACA will not slow the soaring costs of American health care. These costs exact a terrible toll on our economy. Small businesses struggle to survive if they choose to provide benefits to their employees. Large businesses cannot compete in international markets. Entrepreneurs refuse to start new businesses for fear their families will lack access to health care.

Instead of relieving our families and businesses from higher costs and diminishing access, the ACA entrenches the worst aspects of our health care system:

• Private health insurance companies are enshrined as the only portal through which most patients can access health care. We already know that because of the current system of more than a thousand insurance plans, the associated administrative waste consumes 31% of total health care spending. If this administrative loss were invested in health care, we could provide comprehensive care to every person with no additional funding.

• The ACA reduces Medicare costs by paying providers less, a tactic encouraging providers to avoid Medicare patients.

• The Supreme Court decision on the ACA allows states to cut Medicaid enrollment and services without penalty, leaving millions of Americans with inadequate or no access to care.

• The ACA encourages continuation of inhumane cost-shifting to patients in the form of compulsory purchase of expensive policies, higher deductibles, and higher co-pays.

• Millions of people will remain dependent upon employer-sponsored private insurance for health care access, continuing the pattern of labor-management negotiations becoming battlegrounds.

America needs cost-effective universal health care as exists in every other industrialized country. No other nation uses our unique private insurance system which penalizes the sick by charging them more, by reducing their benefits, or by denying care altogether. None allow private insurance companies to place profit over coverage. All of them encourage health care by reducing or eliminating deductibles and co-pays. And all of them provide better care to more people for less money than we do.

Instead of greater privatization of our health care system, we implore you to immediately extend Medicare, our cherished national public insurance, to every person in the United States and then work to improve it. Making Medicare universal would:

• Insure health care access to every American regardless of health, wealth, age, or employment.

• Create the opportunity to fund health care with progressive taxes designed to spare struggling families and small businesses.

• Reduce costs of health care by eliminating the extraordinary and unnecessary administrative waste generated by the private health insurance industry.

• Increase the financial health of our families by sparing them the specter of bankruptcy if any member should have a serious accident or illness.

• Eliminate labor-management disputes over health care benefits.

• Reduce fraud by using consistent forms throughout the country.

• Allow patients to choose their physicians, rather than having insurance companies choose for them.

Medicare needs improvement to provide these benefits. An improved Medicare program should:

• Include every person in the United States, giving them all equal access and benefits.

• Cover all necessary medical, dental, vision, mental health and long-term care with little or no patient cost-sharing.

• Negotiate fair prices for pharmaceuticals, medical devices and health services.

• Remove for-profit health facilities.

• Create an appointed board of patients and health professionals to determine benefits and payments based on need and evidence, not on politics.

• Assure guaranteed access to health care for all communities by defining global operating budgets for health facilities with separate capital budgets to facilitate better health planning.

America’s multi-decade experiment with market-driven care which emphasizes protection of for-profit industries has devastated our families, crippled our businesses, smothered our economy, and stolen our health. The ACA is a continuation of this experiment and medical ethics dictate that this experiment must be stopped.

We can no longer tolerate having the highest health care costs with the worst outcomes in the industrialized world. Our own publicly funded health care systems (Medicare and the Veterans Administration) can and do provide better care at lower cost to even the most vulnerable patients.

We cannot rely either on our private insurance industry or the ACA to remedy our crisis. We implore you to immediately protect, improve, and expand Medicare. Every person in the United States needs and deserves access to health care.

With concern,

Henry L. Abrons, MD, Berkeley, California; Pippa Abston, MD PhD, Huntsville, Alabama; Garrett Adams, MD, Louisville, Kentucky; Patch Adams, MD, Urbana, Illinois; Kris Alman, MD, Portland, Oregon; Paul Bigman, Business Representative, IATSE Local 15, AFL-CIO, Seattle, Washington; Mindy Blaski, MD, Seattle, Washington; Paul Blaski, Seattle, Washington; Philip Caper, MD, Brooklin, Maine; Claudia Chaufan, MD, San Francisco, California; Andy Coates, MD, Albany, NY,  Mardge Cohen, MD, Boston, Massachusetts; Mary L. De Luca, MD, Albuquerque, New Mexico; Margaret Flowers, MD, Baltimore, Maryland; Elizabeth Frost, MD, Minneapolis, Minnesota; John Geyman, MD, Seattle, Washington; Leslie Hartley Gise, MD, Kula, Hawaii; Irene Gomez, Seattle, Washington; James S. Goodman, MD, Albuquerque, New Mexico; Jeoffry Gordon, MD, San Diego, California; Paul Gorman, MD, Portland, Oregon; Nancy Greep, MD, Los Angeles, California; Oliver Hall, JD, Washington, DC; Hedda L. Haning, MD, Charleston, West Virginia; Bruce Hector, MD, North Hills, California; David Himmelstein, MD, New York, New York; Paul Hochfeld, MD, Corvallis, Oregon; Michael Huntington, MD, Corvallis, Oregon; Dana Iorio, ARNP; Seattle, Washington; Joseph Q. Jarvis, MD, Salt Lake City, Utah; Jeffrey Kaplan, MD, Baltimore, Maryland; Stephen B. Kemble, MD, Honolulu, Hawaii; Jim Kratzer MD, MPH, Fresno, California; Don McCanne, MD, San Juan Capistrano; David McLanahan, MD, Seattle, Washington; George Martin, MD, Seattle, Washington; Samuel Metz, MD, Portland, Oregon; Russell Mokhiber, JD, Berkeley Springs, West Virginia; Kathleen Myers, DDS, Seattle, Washington; Eric Naumburg, MD, Columbia, Maryland; Clark Newhall, MD JD, Salt Lake City, Utah; Carol Paris, MD, Leonardtown, Maryland; George L. Pauk, MD, Phoenix, Arizona; Glenn Pearson, MD, Fort Collins, CO, Edward Pontius MD, Topsham, Maine  Julie Keller Pease, MD, Brunswick, Maine; Ellen Punyon, Retired School Principal, Seattle, Washington; Richard Quint, MD, MPH, San Francisco, California; George Randt, MD, Cleveland,Ohio; Helen Redmond, LCSW, New York, New York; Katie Robbins, Mailman School of Public Health, MPH, Class of 2014, New York, New York; Cecile Rose, MD, MPH, Denver, Colorado; Johnathan Ross, MD, Toledo, Ohio; Rick Saling, CWA (for ID only), Seattle, Washington; Gordon Schiff, MD, Boston, Massachusetts; Ann Settgast, MD, Minneapolis, Minnesota; Elias Shaya, MD, Baltimore, Maryland; Diljeet Singh, MD, Chicago, Illinois; William Skeen, MD, Oakland, California; Paul Y. Song, MD, Santa Monica, California; Nancy Hewitt Spaeth, RN, Seattle, Washington James Squire, MD, Seattle, Washington; Karen Green Stone, Small Business Owner, Bloomington, Indiana; Rob Stone, MD, Bloomington, Indiana; Arthur J. Sutherland, III, MD, FACC, Memphis, Tennessee; Bruce Trigg, MD, Albuquerque, New Mexico; William Ulwelling, MD, Albuquerque, New Mexico; Robert Vinetz, MD, Los Angeles, California; John V. Walsh, MD, Cambridge, Massachusetts; Li-hsia Wang, MD, Berkeley, California; Daniel P. Wirt, MD, Houston, Texas; Steffie Woolhandler, MD, New York, New York; Kevin Zeese, JD, Baltimore, MD.

http://itsoureconomy.us/2012/07/medicares-birthday-open-letter-to-the-president-and-leadership-from-health-professionals-lawyers-and-advocates-for-medicare-for-all/

Is "repeal and replace" real policy, or just a sound bite?

The health-care 'repeal and replace' hoax

By Jack Bernard
The Charleston Gazette, July 25, 2012

Charleston, W.Va. — “Repeal and replace!” That is a very catchy slogan indeed. Of course, any objective observer knows that it has very little chance of happening, but it still makes for a great sound bite.

Since 2007, the Democrats have had to override Republican Senatorial filibusters 36O times, far more than ever before. This concerns me for two reasons. First, using the filibuster thwarts democracy and may be unconstitutional. Second, excessively employing the filibuster sets a precedent for others to follow when they are in the minority.

Let’s assume a very unlikely Republican sweep occurs in 2012. Romney wins, the House stays Republican and the Senate goes for the GOP with 51 or 52 Senators. Chances are still slim that repeal will take place due to the filibuster rule. Eight or nine Democrats would have to jump ship and vote with the Republicans, my party, to repeal the law before it really has a chance to be fully implemented in 2014.

Will Rogers once stated: “I do not belong to any organized political party, I am a Democrat.” But, to a growing degree, that party is showing more solidarity in support of its positions. Why? Because moderates in both parties have been run out of office. Getting liberal Democrats to support a Republican repeal effort is highly improbable unless a compelling case can be made that what replaces it will meet with clear public support.

What should most concern my party’s leaders about its proposals is that they are unlikely to ever generate much backing from the voters. People may not approve of the insurance mandate, but that does not mean that they want the Ryan alternative: Medicare turned into a voucher program, with the risk shifted from the federal government to senior citizens. Or, that states and their taxpayers are going to happily accept the Medicaid program being turned into a block grant whereby in the long-term they have to cut services or enrollment unless they raise state taxes.

On the policy wonk side, these efforts are laughable. No systemic changes are entailed. These proposals merely shift the burden from the federal government to the elderly and the states. They do little to constrain cost increases through changes in the delivery and financing of care, unless you count forcing poorer, sicker old people to refrain from getting needed care due to the expense being dumped in their laps.

No, our current proposals fall flat politically and technically. But, do not despair, fellow Republicans. There is a solution that will get enough votes to repeal and replace: Medicare for All, with built-in cost controls. That is a way out, say my GOP friends. Not so.

Obama stole a well-established Republican idea from the 1990s to come up with Obamacare (the Affordable Care Act), which is really just Romneycare recycled. We can do the same to the Democrats by adopting their program, Universal Medicare.

Forget promoting the “free market, more competition” model. It clearly does not work in health care for a variety of reasons, including lack of comparative data and the way health care decisions are made by third parties, including the very concept of insurance.

A study recently looked at our health system versus other developed nations. One key finding is that our prices are out of control, causing our per capita costs to be far greater than elsewhere. The best way to control prices is a single-payer system, like they have in Canada and much of Europe.

Financing Universal Medicare is more straightforward than under the ACA. It can be done through payroll taxes, as Medicare and Social Security are now, with the burden split between workers and employers. There would be no insurance premiums, so the additional expense would be minimal. Plus, Medicare administrative costs are 3 percent, rather than 30 percent for the private insurers. More on Medicare for All can be found at the web site of the highly respected advocacy group Physicians for A National Healthcare Program, pnhp.org.

The Republican path to majority party status is clear. We just have to think out of the box and act decisively.

(Bernard is a retired senior executive, formerly with for-profit health-care firms, who has worked on planning and cost containment issues with several hospitals in West Virginia. He is currently a small business mentor and a Republican County Commissioner in Jasper County, Ga.)

http://wvgazette.com/Opinion/OpEdCommentaries/201207250065

Comment:  

By Don McCanne, MD

Although we seem to be locked in a highly partisan environment, Jack Bernard reminds us that mere sound bites, such as “repeal and replace,” get us nowhere if we do not back them up with sound policy. Since “repeal and replace” comes from his party (Republican) he is all the more credible when he delves into the policy implications of what that would really mean.

As the intensity of the political campaigns heat up, the sound bite on health reform has been simplified. Repeal and replace proved to be too complex because there is no clear replacement for the Affordable Care Act around which Republicans have coalesced.

In the recent past we have heard Republican proposals to voucherize Medicare (shifting risk to patients), block grant Medicaid (shifting risk to budget-constrained states), and sell private insurance across state lines (a race to the bottom in insurance benefits). Many Republican candidates have recognized that these measures are not popular, and in the absence of any other serious proposals on which they agree, they have reduced the sound bite to “repeal.”

Now where do they really stand on policy? The status quo was terrible, and the Affordable Care Act does have several beneficial features that are popular. Yet, even with the Affordable Care Act, we’ll hardly depart from the status quo since 30 million people will remain uninsured, and inadequate, low actuarial value plans will become the new standard. Do they really support repeal with a return to the status quo?

This is where Jack Bernard’s policy wonkery comes in. Maybe you can use partisan sound bites to get elected, but then once you are in charge, it is imperative that the severely dysfunctional health care financing system be replaced with one that actually works. So here the sound bite “replace” could be driving policy.

Many conservatives have said that we are going to end up with single payer anyway. Why is that? It’s that “improved Medicare for all,” a single payer system, is not simply a sound bite. It is a serious policy proposal that really would work for all of us.

Is “repeal and replace” real policy, or just a sound bite?

The health-care ‘repeal and replace’ hoax

By Jack Bernard
The Charleston Gazette, July 25, 2012

Charleston, W.Va. — “Repeal and replace!” That is a very catchy slogan indeed. Of course, any objective observer knows that it has very little chance of happening, but it still makes for a great sound bite.

Since 2007, the Democrats have had to override Republican Senatorial filibusters 36O times, far more than ever before. This concerns me for two reasons. First, using the filibuster thwarts democracy and may be unconstitutional. Second, excessively employing the filibuster sets a precedent for others to follow when they are in the minority.

Let’s assume a very unlikely Republican sweep occurs in 2012. Romney wins, the House stays Republican and the Senate goes for the GOP with 51 or 52 Senators. Chances are still slim that repeal will take place due to the filibuster rule. Eight or nine Democrats would have to jump ship and vote with the Republicans, my party, to repeal the law before it really has a chance to be fully implemented in 2014.

Will Rogers once stated: “I do not belong to any organized political party, I am a Democrat.” But, to a growing degree, that party is showing more solidarity in support of its positions. Why? Because moderates in both parties have been run out of office. Getting liberal Democrats to support a Republican repeal effort is highly improbable unless a compelling case can be made that what replaces it will meet with clear public support.

What should most concern my party’s leaders about its proposals is that they are unlikely to ever generate much backing from the voters. People may not approve of the insurance mandate, but that does not mean that they want the Ryan alternative: Medicare turned into a voucher program, with the risk shifted from the federal government to senior citizens. Or, that states and their taxpayers are going to happily accept the Medicaid program being turned into a block grant whereby in the long-term they have to cut services or enrollment unless they raise state taxes.

On the policy wonk side, these efforts are laughable. No systemic changes are entailed. These proposals merely shift the burden from the federal government to the elderly and the states. They do little to constrain cost increases through changes in the delivery and financing of care, unless you count forcing poorer, sicker old people to refrain from getting needed care due to the expense being dumped in their laps.

No, our current proposals fall flat politically and technically. But, do not despair, fellow Republicans. There is a solution that will get enough votes to repeal and replace: Medicare for All, with built-in cost controls. That is a way out, say my GOP friends. Not so.

Obama stole a well-established Republican idea from the 1990s to come up with Obamacare (the Affordable Care Act), which is really just Romneycare recycled. We can do the same to the Democrats by adopting their program, Universal Medicare.

Forget promoting the “free market, more competition” model. It clearly does not work in health care for a variety of reasons, including lack of comparative data and the way health care decisions are made by third parties, including the very concept of insurance.

A study recently looked at our health system versus other developed nations. One key finding is that our prices are out of control, causing our per capita costs to be far greater than elsewhere. The best way to control prices is a single-payer system, like they have in Canada and much of Europe.

Financing Universal Medicare is more straightforward than under the ACA. It can be done through payroll taxes, as Medicare and Social Security are now, with the burden split between workers and employers. There would be no insurance premiums, so the additional expense would be minimal. Plus, Medicare administrative costs are 3 percent, rather than 30 percent for the private insurers. More on Medicare for All can be found at the web site of the highly respected advocacy group Physicians for A National Healthcare Program, pnhp.org.

The Republican path to majority party status is clear. We just have to think out of the box and act decisively.

(Bernard is a retired senior executive, formerly with for-profit health-care firms, who has worked on planning and cost containment issues with several hospitals in West Virginia. He is currently a small business mentor and a Republican County Commissioner in Jasper County, Ga.)

http://wvgazette.com/Opinion/OpEdCommentaries/201207250065

Comment:  

By Don McCanne, MD

Although we seem to be locked in a highly partisan environment, Jack Bernard reminds us that mere sound bites, such as “repeal and replace,” get us nowhere if we do not back them up with sound policy. Since “repeal and replace” comes from his party (Republican) he is all the more credible when he delves into the policy implications of what that would really mean.

As the intensity of the political campaigns heat up, the sound bite on health reform has been simplified. Repeal and replace proved to be too complex because there is no clear replacement for the Affordable Care Act around which Republicans have coalesced.

In the recent past we have heard Republican proposals to voucherize Medicare (shifting risk to patients), block grant Medicaid (shifting risk to budget-constrained states), and sell private insurance across state lines (a race to the bottom in insurance benefits). Many Republican candidates have recognized that these measures are not popular, and in the absence of any other serious proposals on which they agree, they have reduced the sound bite to “repeal.”

Now where do they really stand on policy? The status quo was terrible, and the Affordable Care Act does have several beneficial features that are popular. Yet, even with the Affordable Care Act, we’ll hardly depart from the status quo since 30 million people will remain uninsured, and inadequate, low actuarial value plans will become the new standard. Do they really support repeal with a return to the status quo?

This is where Jack Bernard’s policy wonkery comes in. Maybe you can use partisan sound bites to get elected, but then once you are in charge, it is imperative that the severely dysfunctional health care financing system be replaced with one that actually works. So here the sound bite “replace” could be driving policy.

Many conservatives have said that we are going to end up with single payer anyway. Why is that? It’s that “improved Medicare for all,” a single payer system, is not simply a sound bite. It is a serious policy proposal that really would work for all of us.

Presbyterians, TIAA-CREF hear call to divest from private health insurance firms

By Katie Robbins
Healthcare not Wealthcare, July 27, 2012

In the midst of a fierce debate on the national level around the Supreme Court’s decision to uphold the Affordable Care Act, the Divestment Campaign for Health Care made its official debut. Its stated mission: “to expose how the health insurance industry puts the need for profit above the needs of patients and to escalate public support for total removal of the private health insurance companies from our nation’s health care.”

Leading advocacy organizations dedicated to single-payer health care are committed to pursuing a divestment campaign from private health insurance companies in order to transform the treatment of health care as a commodity into a basic human right for all people in the U.S.

“We are responsible for our investments, and particularly as health care workers and patients, we see the immorality of the private health insurance companies as they deny payment for care in order to create huge profits for shareholders,” says Dr. Rob Stone of Bloomington, Ind., a leader in the effort. “Those who stand for a just and equitable health care system must recognize the corrupting force of the private health insurance industry on our political process that costs tens of thousands of lives every year in addition to being a huge financial drain.”

The Presbyterian Church (USA) became the first major institution to take steps towards divestment from private health insurance.  On July 7, the church’s national assembly unanimously passed a resolution stating they will “evaluate the variance between church principles of universal access and affordability on the one hand and corporate objectives on the other. It will also assess the likelihood of significant change in corporate behavior.”

The resolution passed after moving testimony was delivered by Rev. Dr. Johanna W.H. van Wijk-Bos, the widow of the original author of the resolution, Rev. A. David Bos who passed away from a sudden case of pneumonia last year, stating before the committee:

“As he lay in the hospital, struggling with the oxygen mask provided to give his lungs the air they needed, he spoke haltingly what would be his last words on this earth: ‘How much will this cost?’  He died six days later. Three weeks after his death a representative from our health insurance company informed me in a telephone call that they rejected the claim to pay for my husband’s hospitalization and medical costs because of a ‘pre-existing condition.’”

Rev. Dr. van Wijk-Bos felt confident the work they had done would lead to full exposure of these corrupt companies because “corporate interests are incompatible with patient care.”

On the heels of this successful endorsement from the Presbyterian Church, activists gathered inside and outside the pension fund giant TIAA-CREF’s shareholder meeting in New York City to call attention to their holdings in private health insurance. Members of TIAA-CREF were shocked to learn that private health insurance companies are considered part of their socially responsible investment portfolio.

Sandy Fox, psychiatric social worker from Pittsburgh, received applause from the other attendees when she asked president and CEO Roger Ferguson Jr. about these holdings:

“How do you justify including health insurance companies – Cigna, Humana, Aetna, Coventry, and WellPoint – in CREF-Social Choice? Private health insurance companies add enormous cost but no value to health care. Furthermore, these companies violate 3 of the 5 social criteria for inclusion in the fund including:

1) NOT ‘devoted to human rights’;

2) NOT ‘dedicated to producing high-quality and safe products’; and

3) NOT ‘managed in an exemplary and ethical manner.’

…We come to you today to demand that you immediately divest from these ruthless companies.”

Shortly before the meeting, the Campaign launched a petition to TIAA-CREF calling for them to move their money out of private health insurance receiving nearly 2000 signers in just a few days.

The Divestment Campaign for Health Care calls upon all people of conscience to shed light on the duplicitous practices that continue in the private health insurance industry.   As the Campaign’s mission statement says: “We have nothing to lose. Health insurance companies have everything to lose as their stock prices drop and their influence wanes. Go to your religious organization, your union, your pension plan, your 401(k) adviser, your university endowment, your city council, your friends and neighbors, and tell them it’s time to get the health insurers out!”

Katie Robbins is a divestment activist and member of Healthcare-NOW! NYC and Healthcare for the 99%.

http://healthcarenotwealthcare.us/2012/07/27/health-care-workers-patients-lead-fight-for-divestment-from-corrupt-private-health-insurance-industry-presbyterian-church-and-tiaa-cref-hear-their-call/

Is "repeal and replace" real policy, or just a sound bite?

The health-care ‘repeal and replace’ hoax

By Jack Bernard
The Charleston Gazette, July 25, 2012
Charleston, W.Va. — “Repeal and replace!” That is a very catchy slogan indeed. Of course, any objective observer knows that it has very little chance of happening, but it still makes for a great sound bite.
Since 2007, the Democrats have had to override Republican Senatorial filibusters 36O times, far more than ever before. This concerns me for two reasons. First, using the filibuster thwarts democracy and may be unconstitutional. Second, excessively employing the filibuster sets a precedent for others to follow when they are in the minority.
Let’s assume a very unlikely Republican sweep occurs in 2012. Romney wins, the House stays Republican and the Senate goes for the GOP with 51 or 52 Senators. Chances are still slim that repeal will take place due to the filibuster rule. Eight or nine Democrats would have to jump ship and vote with the Republicans, my party, to repeal the law before it really has a chance to be fully implemented in 2014.
Will Rogers once stated: “I do not belong to any organized political party, I am a Democrat.” But, to a growing degree, that party is showing more solidarity in support of its positions. Why? Because moderates in both parties have been run out of office. Getting liberal Democrats to support a Republican repeal effort is highly improbable unless a compelling case can be made that what replaces it will meet with clear public support.
What should most concern my party’s leaders about its proposals is that they are unlikely to ever generate much backing from the voters. People may not approve of the insurance mandate, but that does not mean that they want the Ryan alternative: Medicare turned into a voucher program, with the risk shifted from the federal government to senior citizens. Or, that states and their taxpayers are going to happily accept the Medicaid program being turned into a block grant whereby in the long-term they have to cut services or enrollment unless they raise state taxes.
On the policy wonk side, these efforts are laughable. No systemic changes are entailed. These proposals merely shift the burden from the federal government to the elderly and the states. They do little to constrain cost increases through changes in the delivery and financing of care, unless you count forcing poorer, sicker old people to refrain from getting needed care due to the expense being dumped in their laps.
No, our current proposals fall flat politically and technically. But, do not despair, fellow Republicans. There is a solution that will get enough votes to repeal and replace: Medicare for All, with built-in cost controls. That is a way out, say my GOP friends. Not so.
Obama stole a well-established Republican idea from the 1990s to come up with Obamacare (the Affordable Care Act), which is really just Romneycare recycled. We can do the same to the Democrats by adopting their program, Universal Medicare.
Forget promoting the “free market, more competition” model. It clearly does not work in health care for a variety of reasons, including lack of comparative data and the way health care decisions are made by third parties, including the very concept of insurance.
A study recently looked at our health system versus other developed nations. One key finding is that our prices are out of control, causing our per capita costs to be far greater than elsewhere. The best way to control prices is a single-payer system, like they have in Canada and much of Europe.
Financing Universal Medicare is more straightforward than under the ACA. It can be done through payroll taxes, as Medicare and Social Security are now, with the burden split between workers and employers. There would be no insurance premiums, so the additional expense would be minimal. Plus, Medicare administrative costs are 3 percent, rather than 30 percent for the private insurers. More on Medicare for All can be found at the web site of the highly respected advocacy group Physicians for A National Healthcare Program, pnhp.org.
The Republican path to majority party status is clear. We just have to think out of the box and act decisively.
(Bernard is a retired senior executive, formerly with for-profit health-care firms, who has worked on planning and cost containment issues with several hospitals in West Virginia. He is currently a small business mentor and a Republican County Commissioner in Jasper County, Ga.)
http://wvgazette.com/Opinion/OpEdCommentaries/201207250065

Although we seem to be locked in a highly partisan environment, Jack Bernard reminds us that mere sound bites, such as “repeal and replace,” get us nowhere if we do not back them up with sound policy. Since “repeal and replace” comes from his party (Republican) he is all the more credible when he delves into the policy implications of what that would really mean.
As the intensity of the political campaigns heat up, the sound bite on health reform has been simplified. Repeal and replace proved to be too complex because there is no clear replacement for the Affordable Care Act around which Republicans have coalesced.
In the recent past we have heard Republican proposals to voucherize Medicare (shifting risk to patients), block grant Medicaid (shifting risk to budget-constrained states), and sell private insurance across state lines (a race to the bottom in insurance benefits). Many Republican candidates have recognized that these measures are not popular, and in the absence of any other serious proposals on which they agree, they have reduced the sound bite to “repeal.”
Now where do they really stand on policy? The status quo was terrible, and the Affordable Care Act does have several beneficial features that are popular. Yet, even with the Affordable Care Act, we’ll hardly depart from the status quo since 30 million people will remain uninsured, and inadequate, low actuarial value plans will become the new standard. Do they really support repeal with a return to the status quo?
This is where Jack Bernard’s policy wonkery comes in. Maybe you can use partisan sound bites to get elected, but then once you are in charge, it is imperative that the severely dysfunctional health care financing system be replaced with one that actually works. So here the sound bite “replace” could be driving policy.
Many conservatives have said that we are going to end up with single payer anyway. Why is that? It’s that “improved Medicare for all,” a single payer system, is not simply a sound bite. It is a serious policy proposal that really would work for all of us.

The health care 'repeal and replace' hoax

By Jack Bernard
The Charleston Gazette, July 26, 2012

CHARLESTON, W.Va. — “Repeal and replace!” That is a very catchy slogan indeed. Of course, any objective observer knows that it has very little chance of happening, but it still makes for a great sound bite.

Since 2007, the Democrats have had to override Republican Senatorial filibusters 360 times, far more than ever before. This concerns me for two reasons. First, using the filibuster thwarts democracy and may be unconstitutional. Second, excessively employing the filibuster sets a precedent for others to follow when they are in the minority.

Let’s assume a very unlikely Republican sweep occurs in 2012. Romney wins, the House stays Republican and the Senate goes for the GOP with 51 or 52 Senators. Chances are still slim that repeal will take place due to the filibuster rule. Eight or nine Democrats would have to jump ship and vote with the Republicans, my party, to repeal the law before it really has a chance to be fully implemented in 2014.

Will Rogers once stated: “I do not belong to any organized political party, I am a Democrat.” But, to a growing degree, that party is showing more solidarity in support of its positions. Why? Because moderates in both parties have been run out of office. Getting liberal Democrats to support a Republican repeal effort is highly improbable unless a compelling case can be made that what replaces it will meet with clear public support.

What should most concern my party’s leaders about its proposals is that they are unlikely to ever generate much backing from the voters. People may not approve of the insurance mandate, but that does not mean that they want the Ryan alternative: Medicare turned into a voucher program, with the risk shifted from the federal government to senior citizens. Or, that states and their taxpayers are going to happily accept the Medicaid program being turned into a block grant whereby in the long-term they have to cut services or enrollment unless they raise state taxes.

On the policy wonk side, these efforts are laughable. No systemic changes are entailed. These proposals merely shift the burden from the federal government to the elderly and the states. They do little to constrain cost increases through changes in the delivery and financing of care, unless you count forcing poorer, sicker old people to refrain from getting needed care due to the expense being dumped in their laps.

No, our current proposals fall flat politically and technically. But, do not despair, fellow Republicans. There is a solution that will get enough votes to repeal and replace: Medicare for All, with built-in cost controls. That is a way out, say my GOP friends. Not so.

Obama stole a well-established Republican idea from the 1990s to come up with Obamacare (the Affordable Care Act), which is really just Romneycare recycled. We can do the same to the Democrats by adopting their program, Universal Medicare.

Forget promoting the “free market, more competition” model. It clearly does not work in health care for a variety of reasons, including lack of comparative data and the way health care decisions are made by third parties, including the very concept of insurance.

A study recently looked at our health system versus other developed nations. One key finding is that our prices are out of control, causing our per capita costs to be far greater than elsewhere. The best way to control prices is a single-payer system, like they have in Canada and much of Europe.

Financing Universal Medicare is more straightforward than under the ACA. It can be done through payroll taxes, as Medicare and Social Security are now, with the burden split between workers and employers. There would be no insurance premiums, so the additional expense would be minimal. Plus, Medicare administrative costs are 3 percent, rather than 30 percent for the private insurers. More on Medicare for All can be found at the web site of the highly respected advocacy group Physicians for A National Healthcare Program, pnhp.org.

The Republican path to majority party status is clear. We just have to think out of the box and act decisively.

Bernard is a retired senior executive, formerly with for-profit health-care firms, who has worked on planning and cost containment issues with several hospitals in West Virginia. He is currently a small business mentor and a Republican County Commissioner in Jasper County, Ga.

http://wvgazette.com/Opinion/OpEdCommentaries/201207250065

The health care ‘repeal and replace’ hoax

By Jack Bernard
The Charleston Gazette, July 26, 2012

CHARLESTON, W.Va. — “Repeal and replace!” That is a very catchy slogan indeed. Of course, any objective observer knows that it has very little chance of happening, but it still makes for a great sound bite.

Since 2007, the Democrats have had to override Republican Senatorial filibusters 360 times, far more than ever before. This concerns me for two reasons. First, using the filibuster thwarts democracy and may be unconstitutional. Second, excessively employing the filibuster sets a precedent for others to follow when they are in the minority.

Let’s assume a very unlikely Republican sweep occurs in 2012. Romney wins, the House stays Republican and the Senate goes for the GOP with 51 or 52 Senators. Chances are still slim that repeal will take place due to the filibuster rule. Eight or nine Democrats would have to jump ship and vote with the Republicans, my party, to repeal the law before it really has a chance to be fully implemented in 2014.

Will Rogers once stated: “I do not belong to any organized political party, I am a Democrat.” But, to a growing degree, that party is showing more solidarity in support of its positions. Why? Because moderates in both parties have been run out of office. Getting liberal Democrats to support a Republican repeal effort is highly improbable unless a compelling case can be made that what replaces it will meet with clear public support.

What should most concern my party’s leaders about its proposals is that they are unlikely to ever generate much backing from the voters. People may not approve of the insurance mandate, but that does not mean that they want the Ryan alternative: Medicare turned into a voucher program, with the risk shifted from the federal government to senior citizens. Or, that states and their taxpayers are going to happily accept the Medicaid program being turned into a block grant whereby in the long-term they have to cut services or enrollment unless they raise state taxes.

On the policy wonk side, these efforts are laughable. No systemic changes are entailed. These proposals merely shift the burden from the federal government to the elderly and the states. They do little to constrain cost increases through changes in the delivery and financing of care, unless you count forcing poorer, sicker old people to refrain from getting needed care due to the expense being dumped in their laps.

No, our current proposals fall flat politically and technically. But, do not despair, fellow Republicans. There is a solution that will get enough votes to repeal and replace: Medicare for All, with built-in cost controls. That is a way out, say my GOP friends. Not so.

Obama stole a well-established Republican idea from the 1990s to come up with Obamacare (the Affordable Care Act), which is really just Romneycare recycled. We can do the same to the Democrats by adopting their program, Universal Medicare.

Forget promoting the “free market, more competition” model. It clearly does not work in health care for a variety of reasons, including lack of comparative data and the way health care decisions are made by third parties, including the very concept of insurance.

A study recently looked at our health system versus other developed nations. One key finding is that our prices are out of control, causing our per capita costs to be far greater than elsewhere. The best way to control prices is a single-payer system, like they have in Canada and much of Europe.

Financing Universal Medicare is more straightforward than under the ACA. It can be done through payroll taxes, as Medicare and Social Security are now, with the burden split between workers and employers. There would be no insurance premiums, so the additional expense would be minimal. Plus, Medicare administrative costs are 3 percent, rather than 30 percent for the private insurers. More on Medicare for All can be found at the web site of the highly respected advocacy group Physicians for A National Healthcare Program, pnhp.org.

The Republican path to majority party status is clear. We just have to think out of the box and act decisively.

Bernard is a retired senior executive, formerly with for-profit health-care firms, who has worked on planning and cost containment issues with several hospitals in West Virginia. He is currently a small business mentor and a Republican County Commissioner in Jasper County, Ga.

http://wvgazette.com/Opinion/OpEdCommentaries/201207250065

Revitalizing HMOs by relabeling them ACOs

Aurora Health Care And Aetna Form Accountable Care Collaboration, Offer New Commercial Health Care Products

Aetna
July 26, 2012

Aurora Health Care has joined with Aetna to bring employers a new type of commercial health plan designed to improve employees’ health care experience and health outcomes, while controlling costs. 

The Aurora Accountable Care Network offers a price guarantee to employers built upon a health care model that improves quality, outcomes and the patient experience. This type of price guarantee is possibly the first of its kind among accountable care models. Employers will see real savings in what they spend on health care as a result of improved patient outcomes and greater efficiencies.

Mark T. Bertolini, Aetna chairman, CEO and president, said, “We are building on our strong provider relationships to establish a nationwide accountable network that offers better care at a lower cost for everyone.  Aurora Health Care has revolutionized health care in Wisconsin. Aetna’s industry-leading care management programs and consumer tools together with Aurora’s outstanding patient care model will lead to a better overall health care experience.” 

“Aetna views accountable care organizations as a model for making health care work better for everyone,” said Bill Berenson, Aetna market president. “Aurora has demonstrated it can improve outcomes through how it integrates patient care and implements best practices. Together with Aurora, Aetna will offer more affordable and more personalized health benefits to Wisconsin employers and their employees. This is the future of health care.”  

The Aurora Accountable Care Network achieves this level of health care quality and personalized service through Aurora’s integrated system of more than 1,500 physicians, 15 hospitals and 160 clinics in eastern Wisconsin and northern Illinois.

http://www.aetna.com/news/newsReleases/2012/0726-Aetna-and-Aurora-Health-Care.html

Comment:

By Don McCanne, MD

Accountable care organizations (ACOs) are supposedly a new model of health care delivery systems which are designed to reduce health care spending while improving the quality of care. Aurora Health Care is an established integrated delivery system that recently has been approved by CMS to participate in the “shared savings” program authorized by the Affordable Care Act.

Supporters of this concept have assured us that these entities are distinctly different from HMOs. But are they?

Aurora Health Care has now joined with for-profit, private insurer Aetna as part of Aetna’s plan to “establish a nationwide accountable network that offers better care at a lower cost for everyone.”

That’s exactly what we heard during the managed care revolution when the HMO explosion took place, abandoning the model of pure integrated health systems (e.g., Kaiser Permanente), and instead establishing entities, whether composed of groups or networks, dominated by private insurers.

How can this be considered a new model when it appears to be the same old, same old. They haven’t even bothered to rearrange the deck chairs.

Single payer does not equal increased wait-times

By Dr. Aaron Carroll
The Incidental Economist, July 25, 2012

I can’t count the number of times I’ve been told this week that it’s just a “fact” that single payer systems lead to increased wait times. It appears that pointing out that this is not true is “rude”. So be it.

Let’s start with some simple facts. Wait times occur when there are too many patients and too few appointment slots. That can happen when there are too few doctors or when there are too many people who want appointments. So, yes, if you have a doctor shortage, you can get increased wait times. If the system wants to keep spending low by limiting visit slots, you can get increased wait times. If you increase the number of insured people dramatically, you will get increased wait times.

Note that any of those things can occur with or without a single payer system. They can occur with an entirely private system. If you massively decrease the number of uninsured, as the ACA will attempt to do, it’s entirely possible we will get wait times. This will happen whether people become insured through private insurance in the exchanges or through government insurance (Medicaid). The type of insurance is irrelevant. If there are way more patients calling for appointments, and the number of doctors is static, wait times will likely increase.

So if wait times are your main concern, then you’re likely against reducing the number of uninsured by any means. The outcome is the same.

None of this has anything to do with single payer.

Now it’s possible that single payer systems can lead to increased wait times. In Canada, they keep spending far below what we put out. They do so partially by spacing out visits for elective procedures and such. That’s a conscious decision, and it leads to some people waiting for elective care. But that’s an outcome of their financial conservatism, not the single payer system. Other countries (think France) don’t have the same issues with elective procedures because they spend more money. Our single payer system (Medicare) has far fewer spending restraints, and does not suffer from the wait time problem.

We could convert the entire country to Medicare tomorrow, increase the number of physicians, and have no wait times at all. We could convert the entire country to private insurance in a Switzerland-like system, make no changes to the number of physicians, and see wait times go through the roof. This really is a zombie idea.

http://theincidentaleconomist.com/wordpress/single-payer-does-not-equal-increased-wait-times/

Revitalizing HMOs by relabeling them ACOs

Aurora Health Care And Aetna Form Accountable Care Collaboration, Offer New Commercial Health Care Products

Aetna
July 26, 2012
Aurora Health Care has joined with Aetna to bring employers a new type of commercial health plan designed to improve employees’ health care experience and health outcomes, while controlling costs.
The Aurora Accountable Care Network offers a price guarantee to employers built upon a health care model that improves quality, outcomes and the patient experience. This type of price guarantee is possibly the first of its kind among accountable care models. Employers will see real savings in what they spend on health care as a result of improved patient outcomes and greater efficiencies.
Mark T. Bertolini, Aetna chairman, CEO and president, said, “We are building on our strong provider relationships to establish a nationwide accountable network that offers better care at a lower cost for everyone.  Aurora Health Care has revolutionized health care in Wisconsin. Aetna’s industry-leading care management programs and consumer tools together with Aurora’s outstanding patient care model will lead to a better overall health care experience.”
“Aetna views accountable care organizations as a model for making health care work better for everyone,” said Bill Berenson, Aetna market president. “Aurora has demonstrated it can improve outcomes through how it integrates patient care and implements best practices. Together with Aurora, Aetna will offer more affordable and more personalized health benefits to Wisconsin employers and their employees. This is the future of health care.”
The Aurora Accountable Care Network achieves this level of health care quality and personalized service through Aurora’s integrated system of more than 1,500 physicians, 15 hospitals and 160 clinics in eastern Wisconsin and northern Illinois.
http://www.aetna.com/news/newsReleases/2012/0726-Aetna-and-Aurora-Health-Care.html

Accountable care organizations (ACOs) are supposedly a new model of health care delivery systems which are designed to reduce health care spending while improving the quality of care. Aurora Health Care is an established integrated delivery system that recently has been approved by CMS to participate in the “shared savings” program authorized by the Affordable Care Act.
Supporters of this concept have assured us that these entities are distinctly different from HMOs. But are they?
Aurora Health Care has now joined with for-profit, private insurer Aetna as part of Aetna’s plan to “establish a nationwide accountable network that offers better care at a lower cost for everyone.”
That’s exactly what we heard during the managed care revolution when the HMO explosion took place, abandoning the model of pure integrated health systems (e.g., Kaiser Permanente), and instead establishing entities, whether composed of groups or networks, dominated by private insurers.
How can this be considered a new model when it appears to be the same old, same old. They haven’t even bothered to rearrange the deck chairs.

Stuart Butler on the 30 million uninsured

The New ACA Score And The Perils Of Letting Cost Estimates Drive Policymaking

by Stuart Butler
Health Affairs Blog, July 24, 2012

If you were expecting the Congressional Budget Office (CBO) recalculation of the Affordable Care Act (ACA) to rival the drama of the Supreme Court decision, you will have been disappointed.  But the new CBO re-estimate underscores the dangers of basing major policy changes on such forecasts.

While the Court caused political shockwaves by declaring the ACA’s “penalty” to be a “tax”, that in itself did not have major implications for the new score.  CBO projects a net reduction in total federal outlays of $84 billion over 10 years (the new total is $1,168 billion) and an increase in the uninsured of about 3 million, when compared with its earlier estimates.  Significant numbers, but not earth-shattering.  The Joint Committee on Taxation provided revenue estimates for the CBO forecast.

But CBO faced enormous challenges in estimating the impact of the ruling, and its seemingly precise estimate clouds the significant guesses it had to make.

The Challenge Facing CBO

Rather than the tax-not-penalty decision, the part of the Court’s ruling with the greatest budgetary implications concerned Medicaid.  It also gave CBO its biggest headache.  The Court struck down the provision requiring states to expand Medicaid coverage to households up to 133 percent of the poverty level.  So CBO had to figure how many states – indeed which states, given different Medicaid coverage pattern today in the states – would decline short-term federal funding for the expansion (what the Wall Street Journal called the “teaser rate”), knowing they would have to pay a portion of the cost in future years.  The governors of several states, including Texas, Florida and South Carolina, have already declared they would refuse the money.

So what could CBO do?  Take such declarations at face value?  Factor in a bit of politics, consult a political crystal ball, and predict what might actually happen in state houses next year? Give a range to show, say, the different effects of all states declining or all agreeing to expand Medicaid?

To compound the scoring challenge, CBO had to project what would happen to newly eligible Medicaid households in states that decline federal money to expand Medicaid.  Some, but not all, would be eligible for subsidies in the new ACA exchanges, depending on household income.  But how many would sign up (adding to subsidy costs, even though they would not have added to federal Medicaid costs)?

According to former CBO Director Douglas Holtz-Eakin, depending on your guess the potential range of budgetary effects would be large.  If the six states currently saying they will not expand Medicaid follow through with that threat, Holz-Eakin estimates the net budget impact would be $22-80 billion between 2014 (when the expansion occurs) and 2021.  But if all states decide the expansion is an offer they must refuse because of the long-term state cost, the impact could be as high $627 billion.

A False Sense Of Certainty

Faced with the uncertainty about state action, CBO declined to give a range (a bad thing).  Instead it avoided second-guessing states (arguably a good thing for people who wear green eyeshades rather than appear on political talk shows) and projected a number based on “the middle of the distribution of possible outcomes.” That’s defensible, in the same sense as a weather forecaster splitting the difference on the chances of thunderstorms next Friday, but it results in a seemingly precise number that is almost certainly wrong and yet gives a false sense of certainty to policymakers.

This case of CBO scoring highlights once again why it is so important for policy to be driven a bit less by budget estimators generating apparently precise numbers.  That leads to policies based on guesses needed for a computer algorithm rather than on judgment and public discourse about the nature and purpose of government.  But alas, Congress insists that CBO come up with one number for its deliberations, not a range or a zone of probability.  And so even though CBO wisely warns that its number “should not be viewed as representing a single definitive interpretation of how the ACA should or will be implemented in light of the Court’s decision,” regrettably it will be.

Posted response by Don McCanne:

The policies inherent in the Affordable Care Act do create uncertainty as to how many will remain uninsured. Nevertheless, the CBO projection of 30 million uninsured will be the number quoted in policy discussions, since it is the best we have, and it does provide a rough estimate of how short ACA falls in the goal of covering everyone.

To provide a perspective of the enormity of this policy failure, let’s assume that we chose a different set of policies that would cover the same total number of individuals, still leaving 30 million uninsured. Let’s say that we want to have 100 percent coverage in each state, beginning with the largest states since they would have the greatest health care burden in terms of the sheer numbers of patients. Let’s continue to cover 100 percent of each state until we run out of funds to pay for coverage for the last 30 million people – the residents of the least populated states.

Under such a policy, everyone would be covered except all of the residents of Alaska, Arkansas, Delaware, District of Columbia, Hawaii, Idaho, Kansas, Maine, Mississippi, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, Rhode Island, South Dakota, Vermont, West Virginia, and Wyoming.

Who could ever support such a ridiculous policy scheme? Yet since we have buried other ridiculous policies into a highly dysfunctional, fragmented, administratively wasteful ACA financing scheme, we are going to accept those policies as the best we can do? It’s okay to have 30 million uninsured as long as we don’t concentrate them in two-fifths of our states?

Stuart Butler implies that we need policies based on “judgment and public discourse about the nature and purpose of government.” If we were all sincere in such a discourse, and laid partisanship aside, we would end up with a decision to enact a single payer national health program that included everyone.

http://healthaffairs.org/blog/2012/07/24/the-new-aca-score-and-the-perils-of-letting-cost-estimates-drive-policymaking/

Comment:

By Don McCanne, MD

Stuart Butler has a valid point that the variables in the Affordable Care Act and its implementation are great enough that we cannot accurately predict the precise numbers of individuals who will remain uninsured. The information that the Congressional Budget Office relied on to come up with 30 million uninsured does give us a very rough estimate of the total, and enough confidence that we can say with certainty that at least tens of millions will remain uninsured.

So what is Stuart Butler’s point? He indicates that instead of using this precise number to establish policy, we should choose policies based on “judgment and public discourse about the nature and purpose of government.” Well, let’s use the less precise estimate of tens of millions uninsured. What then should be the role of government?

It is clear that the private sector has been incapable of insuring everyone, and that government involvement is required if universal coverage and access are to be our goals. It is also clear that the Affordable Care Act is not an adequate response on the part of government since that is what led to this e
stimate of the large numbers who will remain uninsured.

So what would Butler propose? In 1989, we thought we knew the answer when he coauthored the report from the Heritage Foundation which called for the principle that, “Every resident of the U.S. must, by law, be enrolled in an adequate health care plan to cover major health care costs,” and “The requirement to obtain basic insurance would have to be enforced,” and “If the family did not enroll… a fine might be imposed.” Yes, an individual mandate.

This did prove to be partisan since the concept was used in proposed Republican legislation designed to counter the health care reform proposal of Bill and Hillary Clinton. The Clinton effort fizzled, and the Republican proposals were never enacted. Little did we realize then that a couple decades later the partisan support for the individual mandate would flip from the Republicans to the Democrats.

In a USA TODAY op-ed this year, Butler indicated that his views had changed based on newer policy research, and that today the individual mandate “means the government makes people buy comprehensive benefits for their own good, rather than our original emphasis on protecting society from the heavy medical costs of free riders.” Sort of, you take care of your own needs but don’t turn to me for help when you can’t meet them – the perpetual conflict between individual responsibility and social solidarity.

He wrote, “health research and advances in economic analysis have convinced people like me that an insurance mandate isn’t needed to achieve stable, near-universal coverage. For example, the new field of behavioral economics taught me that default auto-enrollment in employer or nonemployer insurance plans can lead many people to buy coverage without a requirement.”

We know that default auto-enrollment does result in higher rates of participation, but we also know that an entirely voluntary program for purchasing our often unaffordable private health plans would leave far more uninsured than would the policies contained in the Affordable Care Act.

We should have that public discourse that Butler calls for – the one about what we, as a nation, want. Do we want absolutely everyone to be included in our health care system? Or do we want to continue with policies that provide the equivalent of covering everyone in the most populous states, but none of the residents of Alaska, Arkansas, Delaware, District of Columbia, Hawaii, Idaho, Kansas, Maine, Mississippi, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, Rhode Island, South Dakota, Vermont, West Virginia, and Wyoming?

Heritage Foundation: “A National Health System for America” 1/2/89
http://www.heritage.org/research/reports/1989/a-national-health-system-for-america

USA TODAY: “Don’t blame Heritage for ObamaCare mandate” by Stuart Butler
http://www.usatoday.com/news/opinion/forum/story/2012-02-03/health-individual-mandate-reform-heritage/52951140/1