PNHP

National Day of Action for Medicare's 46th Anniversary: Medicare is the solution to the fiscal crisis, not its problem

National Day of Action for Medicare's 46th Anniversary: Medicare is the solution to the fiscal crisis, not its problem

Healthcare-NOW!

FOR IMMEDIATE RELEASE:
July 27, 2011

CONTACT:
Katie Robbins: National Organizer, Healthcare-NOW!. 330-618-6379, katie@healthcare-now.org.
Donna Smith: Community Organizer/Legislative Advocate, California Nurses Association/National Nurses United. 773-617-4493, donnas@calnurses.org.

Philadelphia, PA – As Washington stalls over reaching a deal on the debt ceiling, residents across the country point to a solution to our health and fiscal crisis: “Improved Medicare-for-all.” The Medicare program will celebrate its 46th anniversary this Saturday, July 30, and events are planned from coast-to-coast to honor the nation’s most popular social insurance program, as well as call for its preservation and expansion.

In deals being made over increasing the debt ceiling, cuts to Medicare, along with Medicaid and Social Security, have been discussed by both Republicans and Democrats. The false claims that Medicare costs are out of control leads Americans to believe that Medicare itself is an unsustainable program, when the truth is that Medicare costs themselves are not rising – it is healthcare costs as a whole that have become unsustainable.

“The real problem is the soaring costs of health care that lie beneath Medicare,” said Robert Reich, former Secretary of Labor under President Bill Clinton. “They’re costs all of us are bearing in the form of soaring premiums, co-payments, and deductibles. Medicare offers a means of reducing these costs – if Washington would let it.”i

An enormous amount of waste in our healthcare system comes from propping up the for-profit health insurance companies resulting in one out of every three healthcare dollars goes to administration, billing, advertising, CEO salaries and profits, while leaving most Americans uninsured or under-insured. Conversely, Medicare – acting as single payer by collecting all healthcare fees and paying out all healthcare costs for the elderly and the disabled – has a modest overhead of only 3 percent.ii

Healthcare-NOW!, a national advocacy organization for universal single-payer healthcare, knows that the solution to our nation’s deficit will not be found by cutting our vital social insurance programs. Rather, the solution lies in a national single-payer system or Medicare-for-all. This would greatly control sky-rocketing health costs, and reduce administrative waste, medical errors and unnecessary medical procedures and tests, as well as allow the government to use its enormous bargaining power to negotiate lower rates with hospitals and pharmaceutical companies. A national single-payer healthcare system would save $400 billion a year in overall health costs.iii

“We don’t have a fiscal problem in this country, we have a priority problem,” said Katie Robbins, Healthcare-NOW! National Organizer. “Healthcare-NOW! calls for responsible government that uses our healthcare dollar wisely and equitably, not a government that sacrifices human needs for political theater.”

As Congress and the White House hold working-class Americans’ needs hostage, thousands of Healthcare-NOW! members and supporters have organized more than 40 actions at Congressmembers’ offices and community centers in over 20 states to tell them Medicare is the solution – not the problem.

In honor of Medicare’s 46th, Healthcare NOW! members from across the country submitted videos detailing their personal experiences with the broken healthcare system. Phyllis Myers of Detroit stated, “When you have to spend $1000 for a supply of medication for one month…it is really harsh.”

“I have multiple sclerosis and need a medication in order to have a full and productive life,” said Roger Starcher of Charlotte, NC. “Aetna has consistently denied this medication and refuses to pay for it. That’s why I support Medicare-for-all in America.”

Healthcare-NOW is joined by many allied organizations including Physicians for a National Health Program, Progressive Democrats of America and National Nurses United in calling attention to Medicare’s anniversary and the Medicare-for-all solution.

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*To see the video submissions by Phyllis Myers, Roger Starcher and dozens more, please visit our website at http://www.healthcare-now.org/campaigns/single-payer-rally/why-i-want-medicare-for-all/.

*For a complete listing of events nationwide, visit http://www.healthcare-now.org/takeaction/events-calendar/

i Reich, R. (2011, July 23). Medicare Is the Solution, Not the Problem. Reader Supported News. Retrieved from http://www.readersupportednews.org/opinion2/272-39/6724-medicare-is-the-solution-not-the-problem

ii Woolhandler, S., M.D., M. P. H., Campbell, T., M.H. A. & Himmelstein, D. U., M.D. (2003). Costs of Health Care Administration in the United States and Canada. The New England Journal of Medicine, 349. Retrieved from https://pnhp.org/publications/nejmadmin.pdf

iii See above (Costs of Health Care Administration in the United States and Canada).

Medigap Medical Loss Ratio Improvement Act

Rep. Stark, Sen. Kerry Introduce Bill to Provide Medicare Beneficiaries Better Value for Their Medigap Premium Dollars

Congressman Pete Stark
Press Release, July 26, 2011

Today, Rep. Pete Stark (D-CA) and Sen. John Kerry (D-MA) introduced the Medigap Medical Loss Ratio Improvement Act. The legislation improves consumer protections in the Medigap marketplace by raising the minimum percentage of premium dollars that must go toward medical care, not executive compensation or administrative costs. This percentage is called the medical loss ratio (MLR).

Under current law, Medigap insurers are required to meet an MLR of only 65 percent in the individual marketplace and 75 percent in the group market. The Medigap Medical Loss Ratio Improvement Act would require Medigap insurance plans to spend at least 85 percent of every premium dollar on medical care in the group market and 80 percent in the individual market.

http://www.stark.house.gov/index.php?option=com_content&view=article&id=2260:press-release-stark-kerry-introduce-bill-to-provide-medicare-beneficiaries-better-value-for-their-medigap-premium-dollars&catid=82:press-releases-2011&Itemid=62

And…

The Hill
July 26, 2011

The insurance industry opposes Kerry and Stark’s bill.

The healthcare law’s MLR requirements didn’t extend to Medigap because it’s a form of supplemental coverage, said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans.

As supplements, Medigap plans collect lower premiums than comprehensive policies, but the administrative costs aren’t necessarily lower. Extending the 80 to 85 percent MLR standards to Medigap would disrupt coverage with which seniors are satisfied, Zirkelbach said.

http://thehill.com/blogs/healthwatch/health-insurance/173623-aarp-backs-bill-to-extend-new-rules-on-insurers-spending

Comment: 

By Don McCanne, MD

Medigap policies are private plans that supplement Medicare coverage. They are quite popular because of the exposure that Medicare beneficiaries have to relatively high out-of-pocket expenses. They also represent one of the worst values in private insurance because of their very low medical loss ratios (a low percentage of of the premiums collected is spent on actual health care).

Rep. Pete Stark and Sen. John Kerry have introduced the Medigap Medical Loss Ratio Improvement Act (HR 2645 and S 1416) to bring the Medigap medical loss ratios up to the same level as other private plans under the Patient Protection and Affordable Care Act. Individual Medigap plans will have to spend at least 80 percent of the premium on health care, and group Medigap plans at least 85 percent.

To no surprise, the insurance industry is opposed, and understandably so. In order to calculate the supplemental benefits to be paid under the Medigap plans, the insurers must still process all services, most of which are paid by Medicare, thereby involving the same administrative effort as comprehensive plans. Also, their marketing costs are similar to their comprehensive private plans. Thus their administrative costs and profits are proportionately much higher considering the small amount paid out in supplemental benefits.

The insurers are really in a bind. They can’t reduce their administrative services, yet, because the plans are only supplements, they can’t pay out much more in benefits. Requiring the same medical loss ratios as apply to comprehensive plans would likely destroy the Medigap model, and insurers would have to withdraw these plans.

That would be good since these plans are such a terrible value no matter how you cut it. But we have to keep in mind why these plans exist. Medicare benefits are inadequate, leaving beneficiaries exposed to excessive costs. To eliminate this wasteful private industry of Medigap plans, the appropriate solution would be to reduce or preferably eliminate the out-of-pocket cost sharing of Medicare.

Although that reintroduces the “moral hazard” issue of “free” health care, other nations have shown that comprehensive “free” health care can be provided at much lower costs than ours. If we’re going to talk about morality, then we should ask, what is moral about injecting an expensive, superfluous, worthless industry into our health care?

This legislation is important because it identifies the problem of excessive administrative waste, which adds even more to our very high health care costs. But rather than this bill, we really do need an improved Medicare for all.

Proponents pitch single-payer health care at Framingham State forum

By Scott O’Connell
The MetroWest Daily News (Framingham, Mass.), July 27, 2011

FRAMINGHAM, Mass. — Four members of a panel at Framingham State University last night gave their pitch for a single-payer health care system in the state, saying it would streamline administration, make care more widely available and potentially save billions of dollars.

But not everyone was swayed, including one audience member who said a switch to single payer would limit access to health care.

In a single-payer system, a version of which was recently passed in Vermont, health care would be paid for by one entity, most likely the government but also potentially a private company. That single payer would be responsible for collecting money for health coverage, like through a payroll tax, and then pay for all state residents’ health care bills.

Framing last night’s presentation is an ongoing effort on Beacon Hill to pass legislation enacting a single-payer system in the state. A chief sponsor of one of those bills, Sen. Jamie Eldridge, D-Acton, who was also one of the four panel speakers, said about one-fourth of legislators support it.

Eldridge and the other panel members – UMass Amherst economics professor Gerald Friedman, business owner Alex Robbins, and Ben Day, executive director of single-payer advocacy group Mass-Care – said it will take a coordinated grassroots effort to build enough support for a single-payer system even in Massachusetts, which broke new ground for states by making health insurance mandatory for residents in 2006.

The panel said that while the state’s reform and the subsequent passage of federal health care reform a year ago expanded access to health care, it hasn’t made it more affordable.

“Now we’re looking at phase two,” said Rep. Tom Sannicandro, D-Ashland, the moderator of last night’s forum, which he said was intended to “get the discussion out there” on single-payer health care.

Panel members said the single-payer system, already adopted by many developed nations around the world, makes health care more affordable by reducing the amount of administrative work that bogs down America’s existing hybrid public, private system. By having a single payer like the government responsible for all health coverage costs, physicians will be able to focus more on care, and patients won’t have to be stressed by the process of dealing with an insurance company, they said.

Friedman said he believes a switch to single payer could save as much as $8 billion in health care costs in the state, and lower the average per person cost from $7,000 to $6,000.

“The money’s there on the street, waiting for us to pick it up,” he said.

Robbins, who owns William Henry Furniture in Cambridge with his wife, said a single-payer system could spare small companies like his from the annual squeeze of rapidly rising employee health care costs.

“We’re paying twice as much for health care than 10 years ago, but the coverage is half of what it used to be,” he said.

One audience member, Paul Pietro of Southborough, who said he works at Mid-State Insurance, said the single-payer system ultimately won’t do anything to control costs, though, as long as health care providers and doctors continue to drive the current system of delivery of care. Mid-State is an insurance broker from Worcester.

“I don’t see that happening at all,” Pietro said. “If you had single payer, you’d be rationing, and the quality of care is going to come down significantly.”

Some other questions posed to the panel by audience members also insinuated that a move to single care ultimately would only replace premiums with a tax bill from the government.

After the presentation, though, some audience members said they’re ready for a change. Mel Warshaw of Framingham said last night’s show of support for the measure could be a step in that direction.

“It tells me that there’s a movement in Massachusetts to do this,” he said. “I’m very much in support of it.”

Read more: http://www.metrowestdailynews.com/archive/x633529445/Proponents-pitch-single-payer-health-care-at-Framingham-State-forum#ixzz1TJXBfq2B

Medigap Medical Loss Ratio Improvement Act

Rep. Stark, Sen. Kerry Introduce Bill to Provide Medicare Beneficiaries Better Value for Their Medigap Premium Dollars

Congressman Pete Stark
Press Release, July 26, 2011

Today, Rep. Pete Stark (D-CA) and Sen. John Kerry (D-MA) introduced the Medigap Medical Loss Ratio Improvement Act. The legislation improves consumer protections in the Medigap marketplace by raising the minimum percentage of premium dollars that must go toward medical care, not executive compensation or administrative costs. This percentage is called the medical loss ratio (MLR).

Under current law, Medigap insurers are required to meet an MLR of only 65 percent in the individual marketplace and 75 percent in the group market. The Medigap Medical Loss Ratio Improvement Act would require Medigap insurance plans to spend at least 85 percent of every premium dollar on medical care in the group market and 80 percent in the individual market.

http://www.stark.house.gov/index.php?option=com_content&view=article&id=2260:press-release-stark-kerry-introduce-bill-to-provide-medicare-beneficiaries-better-value-for-their-medigap-premium-dollars&catid=82:press-releases-2011&Itemid=62

And…

The Hill
July 26, 2011

The insurance industry opposes Kerry and Stark’s bill.

The healthcare law’s MLR requirements didn’t extend to Medigap because it’s a form of supplemental coverage, said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans.

As supplements, Medigap plans collect lower premiums than comprehensive policies, but the administrative costs aren’t necessarily lower. Extending the 80 to 85 percent MLR standards to Medigap would disrupt coverage with which seniors are satisfied, Zirkelbach said.

http://thehill.com/blogs/healthwatch/health-insurance/173623-aarp-backs-bill-to-extend-new-rules-on-insurers-spending

Medigap policies are private plans that supplement Medicare coverage. They are quite popular because of the exposure that Medicare beneficiaries have to relatively high out-of-pocket expenses. They also represent one of the worst values in private insurance because of their very low medical loss ratios (a low percentage of of the premiums collected is spent on actual health care).

Rep. Pete Stark and Sen. John Kerry have introduced the Medigap Medical Loss Ratio Improvement Act (HR 2645 and S 1416) to bring the Medigap medical loss ratios up to the same level as other private plans under the Patient Protection and Affordable Care Act. Individual Medigap plans will have to spend at least 80 percent of the premium on health care, and group Medigap plans at least 85 percent.

To no surprise, the insurance industry is opposed, and understandably so. In order to calculate the supplemental benefits to be paid under the Medigap plans, the insurers must still process all services, most of which are paid by Medicare, thereby involving the same administrative effort as comprehensive plans. Also, their marketing costs are similar to their comprehensive private plans. Thus their administrative costs and profits are proportionately much higher considering the small amount paid out in supplemental benefits.

The insurers are really in a bind. They can’t reduce their administrative services, yet, because the plans are only supplements, they can’t pay out much more in benefits. Requiring the same medical loss ratios as apply to comprehensive plans would likely destroy the Medigap model, and insurers would have to withdraw these plans.

That would be good since these plans are such a terrible value no matter how you cut it. But we have to keep in mind why these plans exist. Medicare benefits are inadequate, leaving beneficiaries exposed to excessive costs. To eliminate this wasteful private industry of Medigap plans, the appropriate solution would be to reduce or preferably eliminate the out-of-pocket cost sharing of Medicare.

Although that reintroduces the “moral hazard” issue of “free” health care, other nations have shown that comprehensive “free” health care can be provided at much lower costs than ours. If we’re going to talk about morality, then we should ask, what is moral about injecting an expensive, superfluous, worthless industry into our health care?

This legislation is important because it identifies the problem of excessive administrative waste, which adds even more to our very high health care costs. But rather than this bill, we really do need an improved Medicare for all.

Medicare for All: Fair, Frugal, and Inclusive

By Johnathon Ross, M.D.
CommonDreams, July 26, 2011

For 30 years I’ve been teaching young doctors how to practice primary care medicine at a center-city clinic in Toledo. Every day we witness heart-wrenching scenes right out of a Charles Dickens novel — scenes that illustrate the cruelty, arbitrariness and absurdity of our health care “system.”

Imagine for a moment a 64-year-old, low-income and uninsured man whose condition requires hospitalization and specialty care. Due to the likely cost of his treatment, he and his family could soon be facing bankruptcy. As if the physical suffering were not enough, he’s now grappling with a terrible financial crisis.

Right next to him is another patient with the same condition and of similarly modest means. However, because he’s 65 and enrolled in Medicare, he’s able to get dignified and relatively hassle-free care, without the worry of a financial shipwreck. He can go to the doctor and hospital of his choice, get treated and not face overwhelming medical bills.

Two patients, two very different stories — all because one person just happened to have been born a year earlier than the other.

Medicare, whose 46th anniversary will be observed July 30, has been a lifesaver for millions of elderly and severely disabled Americans. It’s been a major pillar of financial security for our nation’s families. And yet there are those in Congress today who would weaken or even dismantle it in the name of “fiscal responsibility.”

The Medicare program has many virtues. It has created incentives for hospitals and doctors to improve the quality of care. It has produced better cost control than the private sector, despite giving patients freedom to see any doctor and go to any hospital.

The cost of administering the program is in the 1.3 percent to 3 percent range, much less than the 12-14 percent range typical of big employer-based private plans, and the 25-30 percent overhead associated with individual plans.
 
Given these strengths, Medicare should have been the model for health reform. Instead, in passing the Affordable Care Act, Congress added a third floor to house with a crumbling foundation. That crumbling foundation is our inefficient, wasteful private-insurance-based system of financing health care.

Private insurers make money by screening out the sick, denying claims and raising premiums. They cause us to waste enormous amounts of money on excess paperwork and bureaucracy — their own paperwork and the paperwork they inflict on hospitals, patients and doctors like me. An estimated 31 cents of every health care dollar goes toward administration in U.S. health care, at least half of it unnecessary.

It doesn’t have to be this way. Our nation needs to enact a single-payer national health insurance program, an improved Medicare for all.

Instead of the being saddled with the mean-spirited, wasteful and exclusionary insurance arrangements we have now, an improved Medicare for all program would be fair, frugal and inclusive.

By replacing the private insurers with a single, streamlined, publicly financed system that handled all bills, we’d recapture about $400 billion annually that’s currently spent on unnecessary paperwork — enough to provide comprehensive coverage to all the uninsured and to improve coverage for the rest of us.

Such a system could negotiate pharmaceutical prices like the Veterans Administration does, lowering drug costs by about 40 percent. The same principle would apply to other supplies and services, helping us rein in costs.

The burden of rising health care costs on businesses would be sharply reduced, thereby enhancing the competitiveness of U.S. products overseas. Lowering out-of-pocket health costs would leave more money for discretionary spending that stimulates the economy.

Alarmingly, the budget deficit is prompting some in Washington to talk about cutting Medicare or delaying eligibility to age 67. That would be exactly the wrong direction in which to go. Medicare is the victim of rising health costs, not its cause.

It’s not too late to do the right thing. We should celebrate Medicare’s birthday by improving it and expanding it to all. The new system will save lives, save money and will place our nation on a path to become one of the best health systems in the world — something of which we can all be proud.

Johnathon Ross, M.D., M.P.H., is past president of Physicians for a National Health Program (www.pnhp.org) and an executive committee member of the Single Payer Action Network in Ohio (www.spanohio.org).

http://www.commondreams.org/view/2011/07/26-8

Medicare beneficiaries struggle with drug plans

Medicare beneficiaries struggling with prescription drug coverage

By Julian Pecquet
The Hill, July 25, 2011

Five years after the launch of Medicare prescription drug coverage, many beneficiaries are still struggling to sign up, according to a new report from the Medicare Rights Center.

The report highlights how hard it is for beneficiaries to choose among “a multitude of plans that have different benefit structures, pharmacy networks, formularies and rules for accessing benefits.”

“This report reinforces what we hear time and again on our helpline,” center President Joe Baker said in a statement. “The Part D plan selection process is enough to make many beneficiaries and their loved ones throw up their arms in surrender. People simply want to be able to find and enroll in the drug plan that is right for them, without getting stuck in a morass of indistinguishable plan options.”

http://thehill.com/blogs/healthwatch/medicare/173345-medicare-beneficiaries-struggle-with-prescription-drug-coverage

Comment: 

By Don McCanne, MD

“People simply want to be able to find and enroll in the drug plan that is right for them, without getting stuck in a morass of indistinguishable plan options.” No. People simply want to have the drugs that they need when they need them.

The Part D drug plan should have been created as a straightforward benefit of Medicare. The program should have been funded equitably through the tax system, and the benefit should have been simply to be able to obtain necessary drugs whenever prescribed. But no.

Congress decided to interject a separate, expensive, administratively complex industry into the picture – a market of competing drug plans. Not only do these entities waste resources, they establish even more barriers to access to the drugs patients need – barriers such as formulary exclusions, tiering of drugs, prior authorization requirements, exclusion of pharmacies from the plan networks, not to mention the complexities of trying to select from a hodgepodge of plans with widely different characteristics.

The obvious solution would be to establish a single payer national health program in which pharmaceuticals are a full, unencumbered benefit. That’s as obvious as, say, when you need the debt limit raised, you simply vote to raise the debt limit. But Congress doesn’t seem to be capable of making obvious choices.

In praise of Medicare

By Samuel Metz, M.D.
The Oregonian, July 26, 2011

Medicare turns 46 this week and there is much to celebrate. Medicare assures health care for seniors who might otherwise find health care inaccessible. It saves our government money. It makes the lives of our seniors better.

Two concepts inspired Medicare. First, seniors require more care than younger Americans. Second, seniors usually live on less income; many survive only on Social Security. This combination renders seniors extremely vulnerable to losing their savings, homes or lives from easily treatable diseases.

And Medicare provides good care. American life expectancy at birth ranks 30th in the world. We remain 30th for the rest of our lives — until we reach 65. Then, our rank rises until we reach 14th at 80. We can thank the remarkable access to health care provided by Medicare.

Every industrialized nation guarantees health care for seniors. Indeed, we are unhappily distinctive in being the only industrialized nation that does not guarantee care for everyone else, as well. Medicare restores us to a civilized status.

Before Medicare, only 40 percent of nonworking seniors had health insurance, and of those with coverage, private insurance paid for less than 10 percent of their hospital bills. The principle of insuring only the healthy who consume little care and avoiding the sick has always driven our private insurance industry. No insurance company can make money by offering the same comprehensive, affordable coverage to seniors as Medicare, so they don’t offer it. Our experience with Medicare Advantage, an effort to privatize parts of Medicare, resulted in our government spending $17 billion more for the same benefits available through Medicare. Our private insurance industry was in no hurry to insure seniors before Medicare started. They are in no hurry now. Medicare revolutionized health care access for seniors.

Why is Medicare expensive? Simply, health care for seniors will always cost more than that of healthier, younger Americans. And costs are rising in every health care system around the world, not just Medicare. The United States is doubly cursed because our costs are rising faster and are already twice as expensive as other countries. Though hard to believe, Medicare is a leader in fighting cost increases. Private insurance industry costs are rising nearly twice as fast as those of Medicare. And when it comes to administrative expenses, private insurance is 10 times higher than Medicare. In fact, if the single payer financing of Medicare were applied to citizens of all ages, we would save $350 billion annually, more than enough to provide comprehensive health care to every American.

Medicare is good for our seniors and good for our country. It provides health care far more affordably and efficiently than our private insurance industry. It saves our country hundreds of billions of dollars in administrative overhead. And if we expand Medicare to cover younger, healthier Americans, we would all get more care at less cost.

Medicare: Celebrate it, protect it, improve it, and expand it. We need more Medicare, not less.
 
Portland physician Samuel Metz is a member of Physicians for a National Health Program and a founding member of Mad As Hell Doctors.

http://www.oregonlive.com/opinion/index.ssf/2011/07/medicare_at_46.html

Medicare beneficiaries struggle with drug plans

Medicare beneficiaries struggling with prescription drug coverage

By Julian Pecquet
The Hill, July 25, 2011

Five years after the launch of Medicare prescription drug coverage, many beneficiaries are still struggling to sign up, according to a new report from the Medicare Rights Center.

The report highlights how hard it is for beneficiaries to choose among “a multitude of plans that have different benefit structures, pharmacy networks, formularies and rules for accessing benefits.”

“This report reinforces what we hear time and again on our helpline,” center President Joe Baker said in a statement. “The Part D plan selection process is enough to make many beneficiaries and their loved ones throw up their arms in surrender. People simply want to be able to find and enroll in the drug plan that is right for them, without getting stuck in a morass of indistinguishable plan options.”

http://thehill.com/blogs/healthwatch/medicare/173345-medicare-beneficiaries-struggle-with-prescription-drug-coverage

“People simply want to be able to find and enroll in the drug plan that is right for them, without getting stuck in a morass of indistinguishable plan options.” No. People simply want to have the drugs that they need when they need them.

The Part D drug plan should have been created as a straightforward benefit of Medicare. The program should have been funded equitably through the tax system, and the benefit should have been simply to be able to obtain necessary drugs whenever prescribed. But no.

Congress decided to interject a separate, expensive, administratively complex industry into the picture – a market of competing drug plans. Not only do these entities waste resources, they establish even more barriers to access to the drugs patients need – barriers such as formulary exclusions, tiering of drugs, prior authorization requirements, exclusion of pharmacies from the plan networks, not to mention the complexities of trying to select from a hodgepodge of plans with widely different characteristics.

The obvious solution would be to establish a single payer national health program in which pharmaceuticals are a full, unencumbered benefit. That’s as obvious as, say, when you need the debt limit raised, you simply vote to raise the debt limit. But Congress doesn’t seem to be capable of making obvious choices.

Impact of single payer on physician income in Canada

The Impact of Single-Payer Health Care on Physician Income in Canada, 1850–2005

By Jacalyn Duffin, MD, PhD
American Journal of Public Health, July 2011

Over nearly 60 years, into the 21st century, physician income grew at a rate of increase that outpaced that of other Canadians. Since 1958 through the advent of medicare, until at least 1992 and probably into the present, physicians, as a professional category, were the top earners in the country.

In 2005, US doctors earned about five-and-a-half times the US GDP per capita; Canadian doctors earned about four times their country’s GDP per capita.

The observation that Canadian physicians are paid less than their American counterparts invites us to ask, what do Canadians “get” in exchange for paying their physicians less than their American counterparts? A 1990 study showed that, although per capita expenditures on health in the United States were higher than those in Canada, the actual number of services was fewer. In other words, Canadian citizens were getting more and spending less.

From this research, we observe that even when the readjustments resulting from various policy and payment alterations are taken into account, Canadian medicare did not lead to a loss in physician income. Rather, physician incomes grew more quickly than those of other Canadians and are considerably greater. In short, the medical-income argument against moving toward a Canadian-style system is feeble.

The universal, single-payer system has been good not only for Canadians but also for their doctors.

http://ajph.aphapublications.org/cgi/content/abstract/101/7/1198

Comment: 

By Don McCanne, MD

The experience with single payer in Canada has revealed that not only were physicians’ incomes not harmed, physicians remain the top earners in the country. This article should allay the fears of U.S. physicians who would like to see us achieve a health care system that ensures quality health care for all but who remain apprehensive that their incomes might be adversely affected. As this report states, “The universal, single-payer system has been good not only for Canadians but also for their doctors.”

Messing With Medicare

By PAUL KRUGMAN
New York Times, July 24, 2011

At the time of writing, President Obama’s hoped-for “Grand Bargain” with Republicans is apparently dead. And I say good riddance. I’m no more eager than other rational people (a category that fails to include many Congressional Republicans) to see what happens if the debt limit isn’t raised. But what the president was offering to the G.O.P., especially on Medicare, was a very bad deal for America.

Specifically, according to many reports, the president offered both means-testing of Medicare benefits and a rise in the age of Medicare eligibility. The first would be bad policy; the second would be terrible policy. And it would almost surely be terrible politics, too.

The crucial thing to remember, when we talk about Medicare, is that our goal isn’t, or at least shouldn’t be, defined in terms of some arbitrary number. Our goal should be, instead, to give Americans the health care they need at a price the country can afford. And throwing Americans in their mid-60s off Medicare moves us away from that goal, not toward it.

For Medicare, with all its flaws, works better than private insurance. It has less bureaucracy and, hence, lower administrative costs than private insurers. It has been more successful in controlling costs. While Medicare expenses per beneficiary have soared over the past 40 years, they’ve risen significantly less than private insurance premiums. And since Medicare-type systems in other advanced countries have much lower costs than the uniquely privatized U.S. system, there’s good reason to believe that Medicare reform can do a lot to control costs in the future.

In that case, you may ask, why didn’t the 2010 health care reform simply extend Medicare to cover everyone? The answer, of course, is political realism. Most health reformers I know would have supported Medicare for all if they had considered it politically feasible. But given the power of the insurance lobby and the knee-jerk opposition of many politicians to any expansion of government, they settled for what they thought they could actually get: near-universal coverage through a system of regulation and subsidies.

It is, however, one thing to accept a second-best system insuring those who currently lack coverage. Throwing millions of Americans off Medicare and pushing them into the arms of private insurers is another story.

Also, did I mention that Republicans are doing all they can to undermine health care reform — they even tried to undermine it as part of the debt negotiations — and may eventually succeed? If they do, many of those losing Medicare coverage would find themselves unable to replace it.

So raising the Medicare age is a terrible idea. Means-testing — reducing benefits for wealthier Americans — isn’t equally bad, but it’s still poor policy.

It’s true that Medicare expenses could be reduced by requiring high-income Americans to pay higher premiums, higher co-payments, etc. But why not simply raise taxes on high incomes instead? This would have the great virtue of not adding another layer of bureaucracy by requiring that Medicare establish financial status before paying medical bills.

But, you may say, raising taxes would reduce incentives to work and create wealth. Well, so would means-testing: As conservative economists love to point out in other contexts — for example, when criticizing programs like food stamps — benefits that fall as your income rises in effect raise your marginal tax rate. It doesn’t matter whether the government raises your taxes by $1,000 when your income rises or cuts your benefits by the same amount; either way, it reduces the fraction of your additional earnings that you get to keep.

So what’s the difference between means-testing Medicare and raising taxes? Well, the truly rich would prefer means-testing, since they would end up sacrificing no more than the merely well-off. But everyone else should prefer a tax-based solution.

So why is the president embracing these bad policy ideas? In a forthcoming article in The New York Review of Books, the veteran journalist Elizabeth Drew suggests that members of the White House political team saw the 2010 election as a referendum on government spending and that they believe that cutting spending is the way to win next year.

If so, I would respectfully suggest that they are out of their minds. Remember death panels? The G.O.P.’s most potent political weapon last year — the weapon that caused a large swing in the votes of older Americans — was the claim that Mr. Obama was cutting Medicare. Why give Republicans a chance to do it all over again?

Of course, it’s possible that the reason the president is offering to undermine Medicare is that he genuinely believes that this would be a good idea. And that possibility, I have to say, is what really scares me.

http://www.nytimes.com/2011/07/25/opinion/25krugman.html

Single-payer system is the only answer

By David Moynahan, M.D.
Letters, Tallahassee Democrat, July 14, 2011

Re “Progressives have debt-reduction ideas, too” (Eugene Robinson, July 11).

I was heartened to see yet another article in support of single-payer health care. All the railing against “Obamacare” is just a distraction from our currently failing health care system, and “Obamacare” is hardly any better than the old system.

Those advocates of “Leave My Healthcare Alone” aren’t admitting to themselves that as “their” plan keeps getting more expensive or offering fewer benefits, they too might get squeezed out. Every day, more employers are opting out of providing health care, adding to the number of uninsured Americans. The uninsured seek only the most expensive health care (emergency room or catastrophic) for which they can’t pay, and the hospitals add those losses to their costs for everyone else.

So those with insurance pay for everyone else already. Single-payer systems around the world provide better (yes, better, by every measurable outcome) health care for half the cost. We need to wake up and demand true health care reform. Advocates of the status quo are like a ship’s passengers who demand that the captain stay on course and that the band keep playing instead of repairing a bad leak in the sinking USS Health Care.

David Moynahan, M.D., practices family medicine in Crawfordsville, Fla.

Why Medicare Is the Solution — Not the Problem

By Robert Reich
Robert Reich’s blog, July 22, 2011

Not only is Social Security on the chopping block in order to respond to Republican extortion. So is Medicare.

But Medicare isn’t the nation’s budgetary problems. It’s the solution. The real problem is the soaring costs of health care that lie beneath Medicare. They’re costs all of us are bearing in the form of soaring premiums, co-payments, and deductibles.

Medicare offers a means of reducing these costs — if Washington would let it.

Let me explain.

Americans spend more on health care per person than any other advanced nation and get less for our money. Yearly public and private healthcare spending is $7,538 per person. That’s almost two and a half times the average of other advanced nations.

Yet the typical American lives 77.9 years – less than the average 79.4 years in other advanced nations. And we have the highest rate of infant mortality of all advanced nations.

Medical costs are soaring because our health-care system is totally screwed up. Doctors and hospitals have every incentive to spend on unnecessary tests, drugs, and procedures.

You have lower back pain? Almost 95 percent of such cases are best relieved through physical therapy. But doctors and hospitals routinely do expensive MRI’s, and then refer patients to orthopedic surgeons who often do even more costly surgery. Why? There’s not much money in physical therapy.

Your diabetes, asthma, or heart condition is acting up? If you go to the hospital, 20 percent of the time you’re back there within a month. You wouldn’t be nearly as likely to return if a nurse visited you at home to make sure you were taking your medications. This is common practice in other advanced countries. So why don’t nurses do home visits to Americans with acute conditions? Hospitals aren’t paid for it.

America spends $30 billion a year fixing medical errors – the worst rate among advanced countries. Why? Among other reasons because we keep patient records on computers that can’t share the data. Patient records are continuously re-written on pieces of paper, and then re-entered into different computers. That spells error.

Meanwhile, administrative costs eat up 15 to 30 percent of all healthcare spending in the United States. That’s twice the rate of most other advanced nations. Where does this money go? Mainly into collecting money: Doctors collect from hospitals and insurers, hospitals collect from insurers, insurers collect from companies or from policy holders.

A major occupational category at most hospitals is “billing clerk.” A third of nursing hours are devoted to documenting what’s happened so insurers have proof.

Trying to slow the rise in Medicare costs doesn’t deal with any of this. It will just limit the amounts seniors can spend, which means less care. As a practical matter it means more political battles, as seniors – whose clout will grow as boomers are added to the ranks – demand the limits be increased. (If you thought the demagoguery over “death panels” was bad, you ain’t seen nothin’ yet.)

Paul Ryan’s plan – to give seniors vouchers they can cash in with private for-profit insurers — would be even worse. It would funnel money into the hands of for-profit insurers, whose administrative costs are far higher than Medicare.

So what’s the answer? For starters, allow anyone at any age to join Medicare. Medicare’s administrative costs are in the range of 3 percent. That’s well below the 5 to 10 percent costs borne by large companies that self-insure. It’s even further below the administrative costs of companies in the small-group market (amounting to 25 to 27 percent of premiums). And it’s way, way lower than the administrative costs of individual insurance (40 percent). It’s even far below the 11 percent costs of private plans under Medicare Advantage, the current private-insurance option under Medicare.

In addition, allow Medicare – and its poor cousin Medicaid – to use their huge bargaining leverage to negotiate lower rates with hospitals, doctors, and pharmaceutical companies. This would help move health care from a fee-for-the-most-costly-service system into one designed to get the highest-quality outcomes most cheaply.

Estimates of how much would be saved by extending Medicare to cover the entire population range from $58 billion to $400 billion a year. More Americans would get quality health care, and the long-term budget crisis would be sharply reduced.

Let me say it again: Medicare isn’t the problem. It’s the solution.

[This is drawn from a post I did in April, also before current imbroglio.]

http://robertreich.org/post/7941066493