PNHP

Uwe Reinhardt – No “simple” health reform

Uwe Reinhardt – No “simple” health reform

No Such Thing as ‘Simple’ Health Reform

By Uwe Reinhardt
The New York Times
January 29, 2010

Even before Senator-elect Scott Brown’s stunning victory in the Massachusetts special election, there was no shortage of advice on simpler approaches to health reform that the president and his Congressional allies could have used in place of the bills now before Congress.

Although the current reform bills undoubtedly are burdened with many tangential items, one can easily underestimate how quickly any kind of health reform will become complex.

(He quotes Peggy Noonan who advocates for “small, discrete steps” such as “a simple bill that mandated insurance companies offer coverage without respect to previous medical conditions.”)

In the eyes of people unfamiliar with economics, the step she (like others before her) proposes may seem small.

She seems completely unaware that, to be implemented, that step has to be accompanied by (1) a mandate to be insured or, at the least, very powerful financial incentives to be insured. And if government imposes such a mandate on citizens, it must be ready (2) to subsidize low-income families in the acquisition of the mandated insurance. Already we have a bill requiring many pages.

(He quotes from Sen. Tom Coburn’s summary of his bill calling for guaranteed coverage, and affordable premiums through risk adjustment.)

The European systems Mr. Coburn has in mind are the Swiss and Dutch health systems, because we are referred to a paper on these systems.

It should be noted that the Dutch and especially the Swiss systems are subject to heavy government regulation — far heavier than is foreseen in the Senate health reform bill passed in late December.

For example, health insurance is mandatory in both countries. Both countries prescribe purely community-rated insurance premiums which, unlike the Senate bill, cannot take the age of the insured into account. And both countries extend sizable public subsidies toward the purchase of private health insurance.

In short, as Senator Coburn’s bill illustrates, “simply” to pass a bill that imposes community rating on health insurers, as Ms. Noonan suggests, is anything but simple. It opens a veritable Pandora’s box of additional, required legislation which, once fully fleshed out, would pretty much constitute the core of the insurance-reform bill currently in the Senate bill.

http://economix.blogs.nytimes.com/2010/01/29/no-such-thing-as-simple-health-reform/

Posted response of Don McCanne, San Juan Capistrano, CA (Response #23)

Once Congress decided to build on our existing, fragmented, dysfunctional system of financing health care, it became necessary to create the complex legislation that was generated in both the House and the Senate, precisely because of the reasons Prof. Reinhardt describes.

Congress and the administration began with the most expensive system in existence and then attempted to apply social insurance principles to our hybrid model, allegedly with the goal of covering everyone with a system with sustainable spending. The health policy literature is replete with simulations and real-life studies demonstrating that this is by far the most expensive model of reform, and it falls short on universality, equity, and efficiency.

The least expensive and most effective models are a government-owned health service (socialized medicine, not America’s first choice), or a bona fide social insurance program used to finance the largely private health care delivery system. Although there is no perfect system, a government social insurance program (like Medicare) does have an advantage over social insurance programs using a market of private plans in that administrative costs are lower and mechanisms to moderate spending increases are more effective. Also, the Swiss and Dutch private insurance-based programs still leave uninsured about 1.5 percent of their populations.

President Obama this week told the nation that he was eager to see a better approach to cover everyone and bring down costs, though in his prior comments he has revealed that he already knows how to do that. And what is that?

During this break in the negotiations on reform, we really should take a serious look at an improved Medicare program that would cover everyone. It is the least expensive model of reform. It has the greatest administrative efficiency. It would truly cover everyone automatically. And even for those who do not support social solidarity, it would finally control our intolerable growth in health care spending through the proven mechanism of a single payer monopsony.

Thanks for the question, Mr. President

Letter to the Editor
New York Times

To the Editor:

President Obama’s State of the Union address had a high point when he pledged that anyone with a “better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know.”

Thank you, Mr. President. The answer is the reform supported by 65 percent of the public and even 59 percent of physicians. It’s remarkably simple, and the nation has already had 44 years of successful experience with it in financing health care for our elderly and the totally disabled.

It is, of course, Medicare-for-all, single-payer, not-for-profit national health insurance. Its superiority lies in excluding profit-seeking insurance companies and Big Pharma from controlling and undermining our health system. This is your answer, Mr. President.

Quentin Young
Chicago, Jan. 28, 2010

The writer, a doctor, is national coordinator of Physicians for a National Health Program.

http://www.nytimes.com/2010/01/29/opinion/l29obama.html

Uwe Reinhardt – No "simple" health reform

No Such Thing as ‘Simple’ Health Reform

By Uwe Reinhardt
The New York Times
January 29, 2010
Even before Senator-elect Scott Brown’s stunning victory in the Massachusetts special election, there was no shortage of advice on simpler approaches to health reform that the president and his Congressional allies could have used in place of the bills now before Congress.
Although the current reform bills undoubtedly are burdened with many tangential items, one can easily underestimate how quickly any kind of health reform will become complex.
(He quotes Peggy Noonan who advocates for “small, discrete steps” such as “a simple bill that mandated insurance companies offer coverage without respect to previous medical conditions.”)
In the eyes of people unfamiliar with economics, the step she (like others before her) proposes may seem small.
She seems completely unaware that, to be implemented, that step has to be accompanied by (1) a mandate to be insured or, at the least, very powerful financial incentives to be insured. And if government imposes such a mandate on citizens, it must be ready (2) to subsidize low-income families in the acquisition of the mandated insurance. Already we have a bill requiring many pages.
(He quotes from Sen. Tom Coburn’s summary of his bill calling for guaranteed coverage, and affordable premiums through risk adjustment.)
The European systems Mr. Coburn has in mind are the Swiss and Dutch health systems, because we are referred to a paper on these systems.
It should be noted that the Dutch and especially the Swiss systems are subject to heavy government regulation — far heavier than is foreseen in the Senate health reform bill passed in late December.
For example, health insurance is mandatory in both countries. Both countries prescribe purely community-rated insurance premiums which, unlike the Senate bill, cannot take the age of the insured into account. And both countries extend sizable public subsidies toward the purchase of private health insurance.
In short, as Senator Coburn’s bill illustrates, “simply” to pass a bill that imposes community rating on health insurers, as Ms. Noonan suggests, is anything but simple. It opens a veritable Pandora’s box of additional, required legislation which, once fully fleshed out, would pretty much constitute the core of the insurance-reform bill currently in the Senate bill.
http://economix.blogs.nytimes.com/2010/01/29/no-such-thing-as-simple-health-reform/

Posted response of Don McCanne, San Juan Capistrano, CA (Response #23)
Once Congress decided to build on our existing, fragmented, dysfunctional system of financing health care, it became necessary to create the complex legislation that was generated in both the House and the Senate, precisely because of the reasons Prof. Reinhardt describes.
Congress and the administration began with the most expensive system in existence and then attempted to apply social insurance principles to our hybrid model, allegedly with the goal of covering everyone with a system with sustainable spending. The health policy literature is replete with simulations and real-life studies demonstrating that this is by far the most expensive model of reform, and it falls short on universality, equity, and efficiency.
The least expensive and most effective models are a government-owned health service (socialized medicine, not America’s first choice), or a bona fide social insurance program used to finance the largely private health care delivery system. Although there is no perfect system, a government social insurance program (like Medicare) does have an advantage over social insurance programs using a market of private plans in that administrative costs are lower and mechanisms to moderate spending increases are more effective. Also, the Swiss and Dutch private insurance-based programs still leave uninsured about 1.5 percent of their populations.
President Obama this week told the nation that he was eager to see a better approach to cover everyone and bring down costs, though in his prior comments he has revealed that he already knows how to do that. And what is that?
During this break in the negotiations on reform, we really should take a serious look at an improved Medicare program that would cover everyone. It is the least expensive model of reform. It has the greatest administrative efficiency. It would truly cover everyone automatically. And even for those who do not support social solidarity, it would finally control our intolerable growth in health care spending through the proven mechanism of a single payer monopsony.

Uwe Reinhardt – No “simple” health reform

No Such Thing as ‘Simple’ Health Reform

By Uwe Reinhardt
The New York Times
January 29, 2010

Even before Senator-elect Scott Brown’s stunning victory in the Massachusetts special election, there was no shortage of advice on simpler approaches to health reform that the president and his Congressional allies could have used in place of the bills now before Congress.

Although the current reform bills undoubtedly are burdened with many tangential items, one can easily underestimate how quickly any kind of health reform will become complex.

(He quotes Peggy Noonan who advocates for “small, discrete steps” such as “a simple bill that mandated insurance companies offer coverage without respect to previous medical conditions.”)

In the eyes of people unfamiliar with economics, the step she (like others before her) proposes may seem small.

She seems completely unaware that, to be implemented, that step has to be accompanied by (1) a mandate to be insured or, at the least, very powerful financial incentives to be insured. And if government imposes such a mandate on citizens, it must be ready (2) to subsidize low-income families in the acquisition of the mandated insurance. Already we have a bill requiring many pages.

(He quotes from Sen. Tom Coburn’s summary of his bill calling for guaranteed coverage, and affordable premiums through risk adjustment.)

The European systems Mr. Coburn has in mind are the Swiss and Dutch health systems, because we are referred to a paper on these systems.

It should be noted that the Dutch and especially the Swiss systems are subject to heavy government regulation — far heavier than is foreseen in the Senate health reform bill passed in late December.

For example, health insurance is mandatory in both countries. Both countries prescribe purely community-rated insurance premiums which, unlike the Senate bill, cannot take the age of the insured into account. And both countries extend sizable public subsidies toward the purchase of private health insurance.

In short, as Senator Coburn’s bill illustrates, “simply” to pass a bill that imposes community rating on health insurers, as Ms. Noonan suggests, is anything but simple. It opens a veritable Pandora’s box of additional, required legislation which, once fully fleshed out, would pretty much constitute the core of the insurance-reform bill currently in the Senate bill.

http://economix.blogs.nytimes.com/2010/01/29/no-such-thing-as-simple-health-reform/

Posted response of Don McCanne, San Juan Capistrano, CA (Response #23)

Once Congress decided to build on our existing, fragmented, dysfunctional system of financing health care, it became necessary to create the complex legislation that was generated in both the House and the Senate, precisely because of the reasons Prof. Reinhardt describes.

Congress and the administration began with the most expensive system in existence and then attempted to apply social insurance principles to our hybrid model, allegedly with the goal of covering everyone with a system with sustainable spending. The health policy literature is replete with simulations and real-life studies demonstrating that this is by far the most expensive model of reform, and it falls short on universality, equity, and efficiency.

The least expensive and most effective models are a government-owned health service (socialized medicine, not America’s first choice), or a bona fide social insurance program used to finance the largely private health care delivery system. Although there is no perfect system, a government social insurance program (like Medicare) does have an advantage over social insurance programs using a market of private plans in that administrative costs are lower and mechanisms to moderate spending increases are more effective. Also, the Swiss and Dutch private insurance-based programs still leave uninsured about 1.5 percent of their populations.

President Obama this week told the nation that he was eager to see a better approach to cover everyone and bring down costs, though in his prior comments he has revealed that he already knows how to do that. And what is that?

During this break in the negotiations on reform, we really should take a serious look at an improved Medicare program that would cover everyone. It is the least expensive model of reform. It has the greatest administrative efficiency. It would truly cover everyone automatically. And even for those who do not support social solidarity, it would finally control our intolerable growth in health care spending through the proven mechanism of a single payer monopsony.

'There is a better health plan, Mr. President'

Medicare-for-All doctors available for comment on State of the Union speech

FOR IMMEDIATE RELEASE:
Jan. 28, 2010

Contact:
Margaret Flowers, M.D.
Steffie Woolhandler, M.D., M.P.H.
David Himmelstein, M.D.
Oliver Fein, M.D.
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org

Rising to President Obama’s challenge to others in his State of the Union address that they come up with a better approach to health care reform than his own, physicians who advocate for a single-payer program stepped forward this morning to again make the case for their alternative, which they say has solid public support.

Among them is Dr. Margaret Flowers, a pediatrician and congressional fellow for Physicians for a National Health Program, an organization of 17,000 physicians who support a single-payer system, who is traveling to the White House today to deliver an open letter to the president calling on him to meet with her and other Medicare-for-All advocates.

Also speaking out today are Drs. Steffie Woolhandler and David Himmelstein, co-founders of PNHP, primary care physicians in Cambridge, Mass., and professors at Harvard Medical School, who provided commentary in a blog in today’s New York Times.

In her letter to Obama, Flowers notes how surprised she and others were when single-payer advocates were excluded from the early stages of the discussions on health reform. Flowers was one of several physicians, nurses and reform advocates who were arrested at Senate Finance Committee hearings last spring for standing up and asking in a dignified way why the Medicare-for-All option was “off the table.”

Flowers writes: “I am asking you to meet with me because the solution is simple. Remove all of the industries who profit off of the American health care catastrophe from the table. Replace them with those who are knowledgeable in designing health systems and who are without ties to the for-profit medical industries. And then allow them to design an improved Medicare-for-All national health system.”

Flowers then itemizes the advantages of adopting such a system, saying that it would cover everyone, save thousands of lives, relieve medical debt, control costs, help the economy, and restore the physician-patient relationship. Obama himself is on record noting only a single-payer plan would provide universal coverage: “The truth is unless you have what’s called a single-payer system in which everyone’s automatically covered, you’re probably not going to reach every single individual.”

The full text of Flowers’ letter is available here, and the blog commentary by Woolhandler and Himmelstein is available here.

All three, plus several other physicians, are available for comment on the president’s speech last night.

Physicians for a National Health Program is an organization of 17,000 doctors who advocate for single-payer national health insurance. To contact a physician-spokesperson near you, visit www.pnhp.org/stateactions or call (312) 782-6006.

‘There is a better health plan, Mr. President’

Medicare-for-All doctors available for comment on State of the Union speech

FOR IMMEDIATE RELEASE:
Jan. 28, 2010

Contact:
Margaret Flowers, M.D.
Steffie Woolhandler, M.D., M.P.H.
David Himmelstein, M.D.
Oliver Fein, M.D.
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org

Rising to President Obama’s challenge to others in his State of the Union address that they come up with a better approach to health care reform than his own, physicians who advocate for a single-payer program stepped forward this morning to again make the case for their alternative, which they say has solid public support.

Among them is Dr. Margaret Flowers, a pediatrician and congressional fellow for Physicians for a National Health Program, an organization of 17,000 physicians who support a single-payer system, who is traveling to the White House today to deliver an open letter to the president calling on him to meet with her and other Medicare-for-All advocates.

Also speaking out today are Drs. Steffie Woolhandler and David Himmelstein, co-founders of PNHP, primary care physicians in Cambridge, Mass., and professors at Harvard Medical School, who provided commentary in a blog in today’s New York Times.

In her letter to Obama, Flowers notes how surprised she and others were when single-payer advocates were excluded from the early stages of the discussions on health reform. Flowers was one of several physicians, nurses and reform advocates who were arrested at Senate Finance Committee hearings last spring for standing up and asking in a dignified way why the Medicare-for-All option was “off the table.”

Flowers writes: “I am asking you to meet with me because the solution is simple. Remove all of the industries who profit off of the American health care catastrophe from the table. Replace them with those who are knowledgeable in designing health systems and who are without ties to the for-profit medical industries. And then allow them to design an improved Medicare-for-All national health system.”

Flowers then itemizes the advantages of adopting such a system, saying that it would cover everyone, save thousands of lives, relieve medical debt, control costs, help the economy, and restore the physician-patient relationship. Obama himself is on record noting only a single-payer plan would provide universal coverage: “The truth is unless you have what’s called a single-payer system in which everyone’s automatically covered, you’re probably not going to reach every single individual.”

The full text of Flowers’ letter is available here, and the blog commentary by Woolhandler and Himmelstein is available here.

All three, plus several other physicians, are available for comment on the president’s speech last night.

Physicians for a National Health Program is an organization of 17,000 doctors who advocate for single-payer national health insurance. To contact a physician-spokesperson near you, visit www.pnhp.org/stateactions or call (312) 782-6006.

There is Still Time For Real Reform, Listen to the American People

Open Letter to President Obama on Health Care Reform

By Margaret Flowers, M.D.
Op-Ed News
January 28, 2010

President Barack Obama|
1600 Pennsylvania Avenue
Washington, D.C. 20500

Dear President Obama,

I was overjoyed to hear you say in your State of the Union address last night:

“But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know.”

My colleagues, fellow health advocates and I have been trying to meet with you for over a year now because we have an approach which will meet all of your goals and more.

I am a pediatrician who, like many of my primary care colleagues, left practice because it is nearly impossible to deliver high quality health care in this environment. I have been volunteering for Physicians for a National Health Program ever since. For over a year now, I have been working with the Leadership Conference for Guaranteed Health Care/ National Single Payer Alliance. This alliance represents over 20 million people nationwide from doctors to nurses to labor, faith and community groups who advocate on behalf of the majority of Americans, including doctors, who favor a national Medicare-for-All health system.

I felt very optimistic when Congress took up health care reform last January because I remember when you spoke to the Illinois AFL-CIO in June, 2003 and said:

“I happen to be a proponent of a single-payer universal health care program.” (applause) “I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care cannot provide basic health insurance to everybody. And that’s what Jim is talking about when he says everybody in, nobody out. A single-payer health care plan, a universal health care plan. And that’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.”

And that is why I was so surprised when the voices of those who support a national single-payer plan/Medicare for All were excluded in place of the voices of the very health insurance and pharmaceutical industries which profit off the current health care situation.

There was an opportunity this past year to create universal and financially sustainable health care reform rather than expensive health insurance reform. As you well know, the United States spends the most per capita on health care in the world yet leaves millions of people out and receives poor return on those health care dollars in terms of health outcomes and efficiency. This poor value for our health care dollar is due to the waste of having so many insurance companies. At least a third of our health care dollars go towards activities that have nothing to do with health care such as marketing, administration and high executive salaries and bonuses. This represents over $400 billion per year which could be used to pay for health care for all of those Americans who are suffering and dying from preventable causes.

The good news is that it doesn’t have to be this way. You said that you wanted to “keep what works” and that would be Medicare. Medicare is an American legacy of which we can feel proud. It has guaranteed health security to all who have it. Medicare has lifted senior citizens out of poverty. Health disparities, which are rising in this nation, begin to disappear as soon as patients reach 65 years of age. And patients and doctors prefer Medicare to private insurance. Why, our Medicare has even been used as a model by other nations which have developed and implemented universal health systems.

Mr. President, we wanted to meet with you because we have the solution to health care reform. The United States has enough money already and we have the resources, including esteemed experts in public health, health policy and health financing. Our very own Dr. William Hsiao at Harvard has designed health systems in five other countries.

I am asking you to meet with me because the solution is simple. Remove all of the industries who profit off of the American health care catastrophe from the table. Replace them with those who are knowledgeable in designing health systems and who are without ties to the for-profit medical industries. And then allow them to design an improved Medicare-for-All national health system. We can implement it within a year of designing such a system.

What are the benefits of doing this?

* It will save tens of thousands (perhaps hundreds of thousands) of American lives each year, not to mention the prevention of unnecessary suffering.

* It will relieve families of medical debt, which is the number one cause of bankruptcy and foreclosure despite the fact that most of those who experienced bankruptcy had health insurance.

* It will relieve businesses of the growing burden of skyrocketing health insurance premiums so that they can invest in innovation, hiring, increased wages and other benefits and so they can compete in the global market.

* It will control health care costs in a rational way through global budgeting and negotiation for fair prices for pharmaceuticals and services.

* It will allow patients the freedom to choose wherever they want to go for health care and will allow patients and their caregivers to determine which care is best without denials by insurance administrators.

* It will restore the physician-patient relationship and bring satisfaction back to the practice of medicine so that more doctors will stay in or return to practice.

* It will allow our people in our nation to be healthy and productive and able to support themselves and their families.

* It will create a legacy for your administration that may someday elevate you to the same hero status as Tommy Douglas has in Canada.

Mr. President, there are more benefits, but I believe you get the point. I look forward to meeting with you and am so pleased that you are open to our ideas. The Medicare-for-All campaign is growing rapidly and is ready to support you as we move forward on health care reform that will provide America with one of the best health systems in the world. And that is something of which all Americans can be proud.

With great anticipation and deep respect,

Margaret Flowers, M.D.
Maryland chapter, Physicians for a National Health Program

http://www.opednews.com/articles/There-is-Still-Time-For-Re-by-Margaret-Flowers–100127-703.html

Did Obama Move Health Care Forward?

Going Down the Same Old Tunnel

By Steffie Woolhandler and David Himmelstein
Room for Debate Blog, New York Times
January 28, 2010

Having surrendered in advance to the private insurers and drug companies who profit from our dysfunctional health financing system, President Obama and the Democrats who lead Congress couldn’t rally the American people to support their woeful plan against Republican attacks.

In the end, the Democrats’ back room deals produced a scheme reminiscent of the ones crafted by Mitt Romney (in Massachusetts, 2006) and Richard Nixon (Washington, 1972) – but even less effective than those.

A simple single payer program could save $400 billion annually on insurance-related bureaucracy and profits, and tens of billions more by driving down drug prices. That’s more than enough to cover the uninsured and to upgrade coverage for insured Americans, without increasing health spending.

But the Democrats’ efforts to appease insurers and pay off the pharmaceutical industry made covering the uninsured unaffordable. Once they’d rejected single payer (and its savings on useless bureaucracy), the Democrats could only offer unpalatable funding options; stick consumers with ever-higher health costs, raise taxes, or drain money from care. In the end, the Democrats chose all three.

Their individual mandate would force millions to pay private insurers’ outrageous premiums for coverage so skimpy that a major illness would still lead to bankruptcy. (And if you currently have coverage you don’t like, they’d force you to keep it). They added a steep excise tax on workers lucky enough to still have good coverage. And their massive Medicare cuts included a plan to take billions from already-strapped public hospitals (and other safety net providers) and give it to private insurers. In sum, the Democrats asked middle class Americans to pay more, and get little in return.

The president can regain his footing by reconnecting with the hopes of Americans who elected him and rejecting the sordid corporate compromises that signify Washington politics as usual. A single-payer, Medicare-for-All reform would lower costs, cover the uninsured, and upgrade coverage for most insured Americans. Leading a crusade for such a plan, he’d mobilize vast popular support; enough to overwhelm Republican obstructionism. But instead, he seems intent on looking for light at the end of the same old tunnel.

During his campaign, President Obama declaimed that he’d back single payer – if we were starting from scratch. One thing’s clear from the recent Massachusetts election upset: it’s time to start from scratch.

Steffie Woolhandler  is a professor of medicine and David Himmelstein is an associate professor of medicine, both at Harvard Medical School. They are co-founders of Physicians for a National Health Program.

http://roomfordebate.blogs.nytimes.com/2010/01/28/did-obama-move-health-care-forward/#steffie

President Obama is eager to see a better approach

State of the Union Address

President Barack Obama
The White House
January 27, 2010
But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know.  (Applause.)  Let me know.  Let me know.  (Applause.)  I’m eager to see it.
http://www.whitehouse.gov/the-press-office/remarks-president-state-union-address

And…

Illinois AFL-CIO

Barack Obama
June 30, 2003
I happen to be a proponent of a single payer universal health care program. (applause) I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care cannot provide basic health insurance to everybody. And that’s what Jim is talking about when he says everybody in, nobody out. A single payer health care plan, a universal health care plan. And that’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.
https://pnhp.org/news/2008/june/barack_obama_on_sing.php

Well?

SilverSneakers benefit for Medicare Advantage plans

Blue Shield of California to Offer Award-Winning Fitness Program to Medicare Beneficiaries in San Bernardino

Blue Shield of California
January 18, 2010

Blue Shield of California announced today that it will expand its contract with Healthways, Inc. to offer the SilverSneakers® Fitness Program to Blue Shield Medicare Advantage members in San Bernardino County. SilverSneakers, which Blue Shield already offers in Los Angeles and Orange counties, is the nation’s leading exercise program for older adults.

Using the SilverSneakers premier network, Blue Shield of California members get access to a variety of participating fitness and wellness facilities throughout the country, including such popular locations as Curves® and Bally Total Fitness®. Many sites offer amenities such as exercise equipment, treadmills and free weights, and the signature SilverSneakers fitness classes.

https://www.blueshieldca.com/bsc/newsroom/pr/sneakers_011810.jhtml

SilverSneakers: http://www.silversneakers.com/Home.aspx

Comment: 

By Don McCanne, MD

Healthways SilverSneakers is a membership fitness program for seniors provided as a free benefit by many Medicare Advantage programs throughout the nation. It is not a benefit that is allowed in the traditional Medicare program.

We certainly applaud seniors who participate in programs designed to maintain physical fitness and general wellness. But there are two features of this program that should outrage taxpayers.

1) These programs are funded by government overpayments made to the private Medicare Advantage plans. Though some of the overpayments are used for additional benefits, much is wasted in excessive administrative costs and profits. Not only should taxpayers object to the waste, they should also object to a program that provides extra benefits limited to private plan enrollees but not available to those in the traditional Medicare program. If the extra benefits are appropriate, then all Medicare beneficiaries should receive them. If they are not appropriate, then no taxpayer funds should be used for these benefits. In either case, the overpayments directed to the private plans should either be redistributed amongst all Medicare beneficiaries or retained in our Medicare reserves. Regardless, the private Medicare Advantage plans should be eliminated as the wasteful intermediaries that they’ve proven to be.

2) Which of our seniors would find the SilverSneakers program to be an attractive benefit? Obviously only the healthiest without infirmities that would prevent them from participating in the exercise programs. SilverSneakers is being selectively marketed to the healthiest, lowest-cost seniors, even though their private plans are being paid much more than we spend taking care of patients in the traditional Medicare program which includes a disproportionate share of chronically ill patients. The taxpayers take care of the sick, while they doubly overpay the private plans to take care of the lower-cost healthier individuals.

The Republicans are feigning outrage by protesting that the proposal before Congress would “cut Medicare spending” by partially reducing some of the overpayments to the Medicare Advantage plans. Well, the Democrats actually are wrong. In a brave show of timidity, they suggest tweaking the Medicare Advantage overpayments, when they should show the temerity to throw those crooks out and use the funds to improve benefits in the traditional Medicare program.

While they’re at it, they should throw out the crooks running the rest of the private plans, and establish an improved Medicare program for all of us.

What about the seniors who would lose their SilverSneakers membership? They can buy a program directly from Curves or Bally Total Fitness, thereby eliminating both the SilverSneakers and the Medicare Advantage middlemen. Or better yet, they can organize their own fitness groups and continue to exercise – for free!

SilverSneakers benefit for Medicare Advantage plans

Blue Shield of California to Offer Award-Winning Fitness Program to Medicare Beneficiaries in San Bernardino

Blue Shield of California
January 18, 2010
Blue Shield of California announced today that it will expand its contract with Healthways, Inc. to offer the SilverSneakers® Fitness Program to Blue Shield Medicare Advantage members in San Bernardino County. SilverSneakers, which Blue Shield already offers in Los Angeles and Orange counties, is the nation’s leading exercise program for older adults.
Using the SilverSneakers premier network, Blue Shield of California members get access to a variety of participating fitness and wellness facilities throughout the country, including such popular locations as Curves® and Bally Total Fitness®. Many sites offer amenities such as exercise equipment, treadmills and free weights, and the signature SilverSneakers fitness classes.
https://www.blueshieldca.com/bsc/newsroom/pr/sneakers_011810.jhtml
SilverSneakers: http://www.silversneakers.com/Home.aspx

Healthways SilverSneakers is a membership fitness program for seniors provided as a free benefit by many Medicare Advantage programs throughout the nation. It is not a benefit that is allowed in the traditional Medicare program.
We certainly applaud seniors who participate in programs designed to maintain physical fitness and general wellness. But there are two features of this program that should outrage taxpayers.
1) These programs are funded by government overpayments made to the private Medicare Advantage plans. Though some of the overpayments are used for additional benefits, much is wasted in excessive administrative costs and profits. Not only should taxpayers object to the waste, they should also object to a program that provides extra benefits limited to private plan enrollees but not available to those in the traditional Medicare program. If the extra benefits are appropriate, then all Medicare beneficiaries should receive them. If they are not appropriate, then no taxpayer funds should be used for these benefits. In either case, the overpayments directed to the private plans should either be redistributed amongst all Medicare beneficiaries or retained in our Medicare reserves. Regardless, the private Medicare Advantage plans should be eliminated as the wasteful intermediaries that they’ve proven to be.
2) Which of our seniors would find the SilverSneakers program to be an attractive benefit? Obviously only the healthiest without infirmities that would prevent them from participating in the exercise programs. SilverSneakers is being selectively marketed to the healthiest, lowest-cost seniors, even though their private plans are being paid much more than we spend taking care of patients in the traditional Medicare program which includes a disproportionate share of chronically ill patients. The taxpayers take care of the sick, while they doubly overpay the private plans to take care of the lower-cost healthier individuals.
The Republicans are feigning outrage by protesting that the proposal before Congress would “cut Medicare spending” by partially reducing some of the overpayments to the Medicare Advantage plans. Well, the Democrats actually are wrong. In a brave show of timidity, they suggest tweaking the Medicare Advantage overpayments, when they should show the temerity to throw those crooks out and use the funds to improve benefits in the traditional Medicare program.
While they’re at it, they should throw out the crooks running the rest of the private plans, and establish an improved Medicare program for all of us.
What about the seniors who would lose their SilverSneakers membership? They can buy a program directly from Curves or Bally Total Fitness, thereby eliminating both the SilverSneakers and the Medicare Advantage middlemen. Or better yet, they can organize their own fitness groups and continue to exercise – for free!

Message from Massachusetts

By Marcia Angell, MD
Former editor-in-chief, New England Journal of Medicine | Senior Lecturer, Harvard Medical School
Huffington Post, January 21, 2010

Well, that was a game-changer! But don’t misinterpret it (and don’t blame Martha Coakley’s lackluster campaign). Scott Brown’s victory was not about the principles of either party, nor was it about the size of government, nor even about health reform, except indirectly. It was about disillusionment and anger with government.

When Obama became president, there was a euphoric sense that we really would see “change you can believe in.” Yes, there were unrealistic expectations — in the words of John Stewart’s “senior black correspondent,” a belief in “miracle Negroes,” even though they’re “just guys.” But for the most part, people did not expect overnight solutions. What they counted on was that Obama would set to work keeping his campaign promises, and do so in a forthright and transparent way.

So what happened? Right out of the chute, he signaled that there might be very little change. After appointing the usual Goldman Sachs crowd as advisors, he showered money on Wall Street unconditionally, while doing relatively little for people who were losing their houses and jobs. Nor did he do much for the states, whose budget woes people feel directly and are a big part of what happened on Tuesday. He did some good things, of course, but they were mostly small and on the margins.

And the campaign promises? We still have both wars raging, with about the same number of troops, just re-distributed from Iraq to Afghanistan. We still have Guantanamo, we still have indefinite imprisonment without charges, and we almost certainly still have torture. As for transparency, there’s still not much of it. And the federal deficit continues to climb, despite the lack of palpable relief for Main Street. Not everyone knows all of this, or cares, but some people know each of these things, and together, they add up to a lot of disillusioned people.

As for health care, not many of the angry voters understand all the provisions of the Senate bill (who does?). But they do know that Obama has “pissed away” a year on it, as Theda Skocpol says, much of it devoted to obsequious courting of the likes of Ben Nelson and Joe Lieberman and Olympia Snow. That raised real questions about his abilities as a leader. And most people under 65 know that the reform would require them to buy commercial insurance, a prospect nearly everyone dislikes. Finally, they almost certainly have some inkling that the bill was written by lobbyists. After all, last spring the White House hosted a highly publicized photo-op and jamboree with the health industries, at which they pledged to work together.

Liberals are wrong to think that opposition to health reform is a rejection of big government. If health reform consisted of extending Medicare to everyone, people would be delighted. There are millions of 64-year-olds out there who can hardly wait to be 65. (And if the government created lots more jobs, they would be delighted by that, too.)

It’s not the size of government; it’s how well it works and on whose behalf. Many people no longer trust Obama to work in their interests, or even to tell the truth. They vote for Republicans mainly because they’re the only other game in town. But I don’t think that means they subscribe to Republican principles. In Massachusetts, Republicans constitute about 11 percent of voters, and I doubt whether that number will increase by much. People are rejecting both parties in droves and becoming independents, because they no longer believe government works for them, no matter which party is in charge. The same dynamic that swept Obama into office might well sweep him out.

It’s also mistake to lump all the protesters together as Sarah Palin yahoos. There are many of those, of course, but in addition there are many people who, even if they’re confused enough to vote Republican, have legitimate concerns, not all of them the same — including Ron Paul libertarians who want out of Iraq and Afghanistan, deficit hawks who worry about saddling their kids with more debt, and ordinary people who are just worried or desperate and don’t see any relief coming from government.

If they don’t draw the wrong lessons from the Scott Brown debacle, the Democrats might still recover. The problem is not that Obama tried to do too much, but that he compromised away his principles.

http://www.huffingtonpost.com/marcia-angell-md/message-from-massachusett_b_432074.html