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BC/BS of Minnesota dumps broad networks

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BC/BS of Minnesota dumps broad networks

Minnesota Blues’ decision to alter ACA plans mirrors stampede to narrow networks

By Bob Herman
Modern Healthcare, June 24, 2016

Blue Cross and Blue Shield of Minnesota is cutting back its participation in the state’s Affordable Care Act insurance exchange next year after losing nearly $300 million in the individual market in 2015.

However, the large Blues insurer is not completely exiting the state-based marketplace. Fully withdrawing has its consequences: Federal law bars insurers from re-entering the marketplaces for five years, assuming they discontinue all types of individual policies.

Instead, Blue Cross and Blue Shield of Minnesota is dropping health plans with the broadest networks sold on and off the exchange and will push people toward its narrower HMO option called Blue Plus, according to the Star Tribune.

Blue Cross and Blue Shield of Minnesota’s decision is not unprecedented and has been embraced by other insurers around the country. The Blues plans in Illinois, New Mexico and Texas—all of which are owned by Health Care Service Corp., a giant Chicago-based company that has lost billions of dollars on ACA plans—abandoned their broad-network exchange plans in favor of the narrow-network HMOs.

Dropping broad-network plans can also be seen as a controversial risk dump for insurers. The sickest people who cost the most to insure often chose plans with higher monthly premiums to gain access to broader provider networks and fewer out-of-pocket costs. In Minnesota next year, those people may opt to buy those plans with other carriers, immediately benefiting the Blues’ bottom line while redirecting the insurance risk elsewhere.

http://www.modernhealthcare.com/article/20160624/NEWS/160629943

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Comment:

By Don McCanne, M.D.

The individual insurance market has always been unstable. The struggles insurers face are not only how they can make their products more effective and accessible to more individuals, but especially how they can ensure that revenues exceed expenditures. So what can we learn from the response of Blue Cross and Blue Shield of Minnesota to unfavorable market conditions?

Most importantly, they are dumping risk onto other insurers. That places a burden on the other insurers which then translates to even higher premiums, higher cost sharing, fewer benefits, or any combination of these for individuals already enrolled in the other insurance risk pools. That’s not good.

In order to maintain a presence in the market, they are continuing to offer its narrow network HMO option. Those who transfer into that plan will have more limited choices of health care providers, perhaps losing coverage for their current health care professionals and institutions. That’s not good.

This instability in coverage is a defining feature of private health insurance plans. The insurers will always continue to introduce innovations as they compete for an advantage in the marketplace. When their products appeal to people who have greater health care needs, their model doesn’t work, and they pull out. What is working now is passing more costs onto the patients through greeter cost sharing, and limiting access to care by narrowing the networks of covered providers. That’s not good.

What seems obvious is that we have selected the wrong intermediary for financing health care. The private insurers function with a business need requiring costly administrative excesses, and they have a need to conform their products to meet business goals rather than patient service goals. That’s not good.

What would work best for patients would be a single payer national health program – an improved Medicare for all. But the Republicans are opposed, and the Democratic platform committee just voted to exclude single payer from their platform, and no other political party has enough traction to prevail in the elections. That’s not good.

Even though the Medicare for all concept remains popular, it seems that we will not have single payer in the foreseeable future. Churchill and others have said that a democracy is the worst form of government other than all of the others, but sometimes you wonder.

Medicare, an effective program that needs expansion

By Jack Bernard
The Atlanta Journal-Constitution, June 24, 2016

I have been amazed at the number of negative Medicare-for-all attack pieces printed in various respected papers over the last few months, making me wonder why primarily liberal economists would be attacking a program that progressives have been trying to enact since Truman.

The underlying implication is that the current private system is more effective than a federal government run single-payer model. As a Republican former elected official with a very conservative spending record, I too believe in eliminating governmental waste and in utilizing the private sector when it is more effective.

Therefore, my record makes some citizens surprised when I advocate for Medicare for all. Objectively, the U.S. healthcare system is and has been severely broken. Despite our spending far more per capita, our country is far behind all developed democracies, which scoff when our politicians make the false claim that we have the best healthcare in the world.

For example, the National Research Council and Institute of Medicine recently commissioned a panel of experts to compare our health with that of 16 other developed nations. We ranked poorly, on the bottom in several key areas! The NRC/IM report stated that our health care is “inaccessible or unaffordable” with “lapses in the quality and safety of care”.

The nations with the lowest cost and best outcomes have comprehensive universal health insurance, either: A.) the government provides direct care (like England or the “socialist” VA here); B.) there is a public utility model (like Denmark and France); or C.) there is single-payer (like Canada, with Medicare covering everyone).

Despite the demagoguery, options “B” and “C” do not represent a government takeover of health care delivery. These options eliminate private-sector insurance company marketing and administrative costs, and big pharma price gouging, directing that money into patient care rather than paying for bureaucracy and multimillion-dollar CEO salaries.

Medicare, the U.S.’s national health care insurance for the disabled and those over 65, has under 3 percent overhead costs (Canada is under 2 percent). Private insurance companies complained because the Affordable Care Act (ACA) required them to get down to 20 percent, or pay a fine.

You will notice that the list of options used by other nations does not include an “Obamacare” model, with dozens of private insurance companies offering a multitude of confusing, expensive plans. In fact, the ACA is a direct descendant of the private insurance plan model derived by the conservative Heritage Foundation as an alternative to “Clinton Care” in the 1990s. That overly complex model became “Dolecare,” which then became “Romneycare.” Oddly, the ACA was then passed by Democrats.

For the ACA to function at all, everyone has to buy insurance, which is the main complaint of the public. Older, sicker folks can afford their premiums only because younger, healthier folks must also pay their premiums. No insurer is going to accept long-term losses, which currently appear to be rising. Insurers will simply raise premiums or get out of the business, as several are currently doing.

The best alternative to the ACA is expansion of Medicare. Americans know and like the program. Few object to paying for Medicare each month versus private insurance premiums.

Taxpayers are beginning to see the benefits of single-payer versus the ACA. In May, Gallup reported that “58 percent of U.S. adults favor the idea of replacing the law with a federally funded healthcare system that provides insurance for all Americans.”

For the most part, it can be funded in much the same way as Social Security, through a payroll tax, with additional funding coming from a variety of other sources. More detail on this subject can be found on the Physicians for a National Health Program website (www.pnhp.org).

A recent study by Dr. Gerald Friedman of the University of Massachusetts found that substantial annual savings can be achieved via single-payer. When combined with the spending reality of other developed countries, this fact should be enough to get our elected officials to objectively examine expanding Medicare, rather than simply attacking the idea due to raw politics.

But Republicans just continue to repeat their worn-out talking points about our current system being perfect — so long as we repeal the ACA. The Democrat front-runner is little better, supporting the ACA but having no clear plan to cover the 27 million Americans still without coverage or the millions more with inadequate insurance.

Given that special interest groups are making billions from our broken system, and contributing heavily to both parties to keep health insurance private, the real question is “will politicians in both parties ever have the courage to act?” If not, this nation is headed towards medical bankruptcy while still failing to insure its taxpayers

Jack Bernard, the first director of health planning for Georgia, has been an executive with several national health care firms. A Republican, he’s a former chairman of the Jasper County Commission.

http://www.myajc.com/news/news/opinion/medicare-an-effective-program-that-needs-expansion/nrmsZ/

Medical Student Prescribes Remedy Our Sick System Needs

By Emily Kirchner
Common Dreams, June 24, 2016

I am a fourth year medical student. I’ve dreamed about being a physician since I was in sixth grade. For a long time, my deepest hopes were to get into college, be accepted by a medical school, and maintain the grades and test scores needed to keep me there.  My clinical rotations have taken me to hospitals across the state of Pennsylvania – from Pittsburgh’s North Side to North Philadelphia with stops in rural and suburban communities in between. Now I’m less than a year away from obtaining my medical degree.

Despite many hours of study and months on the hospital wards, I don’t feel any closer to practicing the kind of medicine I’ve always dreamed about than when I watched my first episode of “ER.”

That’s because I now understand that I won’t be able to take care of patients the way they – or I – would like.

How so? Although we’re living in a time and place where we have more ways than ever before to treat illness, our health care system is broken. It’s clear to me that the current system is set up to make profits for corporate shareholders, not to keep people healthy.

Right now, we are paying exorbitantly – the highest per capita expenditure in the world – for a health care system that leaves too many people out. Even after the Affordable Care Act is fully implemented, 28 million people will still be uninsured in 2026, according to the Congressional Budget Office.

Further, the specter of under-insurance, where insured individuals’ out-of-pocket medical costs are more than 10 percent of their income, is rising. Premiums, deductibles and co-pays are going up, deterring people from seeking needed care and exposing them to the danger of medical bankruptcy.

This very expensive system is also ineffective. I met a patient who first lost her energy, then her appetite, then her hair, and then her insurance in the middle of cancer treatment. She finally lost her oncologist because the latter did not accept Medicaid.

I’ve met parents who guiltily admit they can’t afford their own medicine and use their children’s inhalers when they can’t breathe. I’m trained to ask if patients are taking their medicines and then to follow up: “Do you ever have trouble affording your medications?”

I’ve watched the extent of insurance coverage determine treatment decisions for patients injured in car accidents. Or whether a patient with mental health problems gets treated at all.

So today I’m pouring my energy into a new dream: to practice medicine in a health care system where everyone gets covered for all medically necessary care. I want to help bring about a single-payer, national health insurance program.

This is not pie in the sky. Last month, the nonprofit Physicians for a National Health Program released “Beyond the Affordable Care Act: A Physicians’ Proposal for Single-Payer Health Care Reform” in the pages of the American Journal of Public Health. The proposal is endorsed by more than 2,200 physicians in all specialties.

Under the proposal, everyone will be covered by a publicly financed, nonprofit national health program, or NHP, for both outpatient and inpatient care, as well as rehabilitation, mental health services, long-term care, dental care, and prescriptions.

And it’s affordable. By replacing our redundant, complex private insurance bureaucracy with a single, nonprofit, streamlined program, we’ll reap savings of roughly $500 billion a year. That’s enough to improve and expand coverage to all – i.e. to eliminate the problems of uninsurance and under-insurance, and eliminate all co-pays and deductibles – without any increase in total health care spending.

The new system will be able to rein in costs. Much like we currently fund fire departments, the NHP will pay global, lump-sum budgets to hospitals, clinics, and nursing homes, rather than charging for each aspirin tablet.

Physicians will be paid based on a fee-for-service schedule covering all patients or by salary. The NHP, as a single buyer, will negotiate prices with drug companies, just like other countries already do, reaping additional savings.

We can finance this program by combining all current sources of government health spending, which already accounts for 64.3 percent of the country’s health bill, with modest new taxes based on ability to pay. Ninety-five percent of all households would save money, according to one study.

This is not a government take-over; this is the people reclaiming control over their own health care. This is the only way to keep everyone healthy, and to do it efficiently.

This is the plan I want for my patients, for my family, for myself. Based on recent polls showing solid majority support for “Medicare for All,” I’m obviously not alone. We should implement this remedy without delay.

Emily Kirchner is a medical student at Lewis Katz School of Medicine at Temple University. She is a student member of the Board of Directors of Physicians for a National Health Program, and is also active in Students for a National Health Program.

http://commondreams.org/views/2016/06/24/medical-student-prescribes-remedy-our-sick-system-needs

NHS under Brexit, and what it means for the U.S.

What would Brexit mean for the NHS?

By Denis Campbell
The Guardian, June 14, 2016

Alongside the economy and immigration, the NHS has emerged as a key battleground in the EU debate. That is because the leave campaign decided early on to deploy the health service as a core argument in their plea to voters. Leave leaders Boris Johnson and Michael Gove have said consistently since campaigning began in April that Brexit could free up up to £8bn extra a year to spend on the NHS.

Leaving the EU would not, however, provide more money to spend on the NHS, according to the Institute of Fiscal Studies. “Rather, it would leave us spending less on public services, or taxing more, or borrowing more.”

Labour has dismissed the leave campaign’s claim of a bigger NHS budget as “misleading, simplistic and complete and utter nonsense”. Its own analysis concludes that a post-Brexit economic slump could force the government to cut the Department of Health’s budget by £10.5bn – the equivalent of every hospital in England having to shed 1,000 nurses and 155 doctors.

And last week, Tory MP and former GP Sarah Wollaston defected from the Vote Leave campaign saying its claim that Brexit would unlock up to £350m a week for the NHS “simply isn’t true”.

https://www.theguardian.com/society/2016/jun/14/brexit-nhs-health-social-care-disabled-people-eu-referendum

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Pharma, researchers, NHS face uncertainty after Brexit win

By Helen Collis
Politico, June 24, 2016

Britain’s Brexit result today ignites a long period of uncertainty in the health sector, on the relocation of the European Medicines Agency, on staffing the National Health Service and on funding research.

http://www.politico.eu/article/pharma-researchers-nhs-face-uncertainty-after-brexit-win/

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EU referendum: Nigel Farage backtracks on Vote Leave’s ‘£350m for the NHS’ pledge hours after result

By Jon Stone
Independent, June 24, 2016

Nigel Farage has disowned a pledge to spend £350 million of European Union cash on the NHS after Brexit.

The Ukip leader was asked on ITV’s Good Morning Britain programme whether he would guarantee that the money pledged for the health service during the campaign would now be spent on it.

Speaking on the morning of the referendum result he however said he had never made any such pledge.

When it was pointed out that Vote Leave emblazoned the £350 million claim onto the side of a tour bus and drove it around the country, Mr Farage said: “It wasn’t one of my adverts – I can assure you! I think they made a mistake in doing that.

http://www.independent.co.uk/news/uk/politics/eu-referendum-result-nigel-farage-nhs-pledge-disowns-350-million-pounds-a7099906.html

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Comment:

By Don McCanne, M.D.

There was certainly no uniformity of opinion on what impact Brexit might have on their National Health Service. Now that the results are in, we still will not know until the destabilization begins to settle down.

So what is the most likely outcome? The basic structure of their revered health system will likely remain intact, but it may be subjected to tweaking, the nature of which will depend on the ideology prevalent in the political environment after the shakeup occurs, already beginning with the announcement that Conservative Prime Minister David Cameron will resign.

What impact will this have on health care reform in the United states? Virtually none. The probable Democratic presidential nominee has said that she will perpetuate the current system, adding minor beneficial tweaks. The probable Republican presidential nominee will likely accept the recommendations in the white paper released by the House Republicans which basically proposes perpetuating the current system with tweaks that they consider to be beneficial from a conservative perspective.

Bernie Sanders and colleagues are attempting to shift the Democratic platform to a position of support for a single payer national health program – Medicare for All – but Hillary Clinton has already made it very clear that she would not support such a change.

We can sympathize with the difficulties faced by the Europeans as they work out the Brexit problems and what is to follow. But if we are to learn from this, we must understand how important it is to be informed on public policy and then to elect politicians who will carry out a pledge to make our nation work well for all of us. We don’t seem to be doing that now. We do not have the prospect of a Usexit since we have nowhere to go.

What can we do about high drug prices?

New Directions in Health Care Podcast: Controlling Rising Drug Costs

By Sandy Hausman
The Commonwealth Fund, June 22, 2016

Prescription drug spending, a significant driver of overall health care costs, has been rising rapidly over the last few years. This episode explores the reasons for higher drug prices, including the introduction of new high-value medications, potentially inefficient research and development, and a lack of price regulation. Producer Sandy Hausman interviews Commonwealth Fund President David Blumenthal, M.D., Duke-Margolis Center for Health Policy Director Mark McClellan, M.D., and Johns Hopkins University School of Public Health Professor Gerard Anderson about the underlying causes and potential solutions.

At Johns Hopkins University’s School of Public Health, Professor Gerard Anderson argues government should more aggressively regulate drug prices.

“There are no rules. There’s no legislation. You just basically, as a drug company, have the ability to set the price, and if the government has given you a monopoly – and that’s what a patent is – then there are no competitors for your drug, and so you can charge essentially whatever you want. You don’t have to worry that a lot of people won’t have access to the drug, because you’re going to make a lot of money on a few people, and that’s exactly what happens.”

He adds that even generic drug makers may be charging too much.

“Five drugs companies—and soon it will be four—in the generic drug industry control over half of the market, and the reason why generic drugs have been inexpensive in the past is pure price competition. They’re selling exactly the same product. That’s what a generic drug is, but they’re selling it on the basis of price competition, but if there’s not a lot of competitors, then you don’t get very good price competition.”

But Mark McClellan warns against the imposition of price controls, since they may limit patient access to certain medications.

“In the United Kingdom, which has significantly lower drug prices than the United States, there is a government body set up that reviews whether or not the price set by a manufacturer is worth it for certain kinds of patients, and in some patients makes a decision that the price is not worthwhile. That’s negotiating leverage. That means that unless the price comes down, people don’t have as much access to the drug.”

As that debate continues, Dr. Blumenthal says the federal government has found some ways to negotiate for better prices.

“The Veterans Administration and the Department of Defense negotiate drug prices and have the statutory authority to set an upper limit on drug prices — that is the lowest amount that any single purchaser can get from a drug company, and there are other drug price controls that are imposed, for example, by states on behalf of their Medicaid programs. When you put California and New York together — two blue states that often pioneer with these kinds of new programs — those are big parts of the national market.”

Podcast link:
http://www.commonwealthfund.org/interactives-and-data/multimedia/podcasts/new-directions-in-health-care/drug-costs

Transcript link:
http://www.commonwealthfund.org/~/media/files/multimedia/podcasts/drug-prices.pdf

***

Comment:

By Don McCanne, M.D.

As usual, Professor Gerard Anderson is right again. Between patents for brand products and consolidation in the generic market, drug prices are out of control. He argues that the government should more aggressively regulate prices.

You may remember Anderson as coauthor with Uwe Reinhardt et al. of the classic Health Affairs article, “It’s the Prices, Stupid.”

Mark McClellan argues that government involvement in setting drug prices risks impairing access to higher priced drugs, but it is the excessive prices in the United States that creates much greater access problems because of the lack of affordability.

David Blumenthal points out that the Veterans Administration, the Department of Defense, and some state Medicaid programs have been effective in limiting drug prices, thus the government does have the potential to play a very important role in combating price gouging by the pharmaceutical industry.

And, of course, with a well designed, government funded and administered single payer system our drug costs would be brought down to reasonable, fair levels – for all of us, collectively.

Thousands rally as 22,000 miners are threatened with cut off of health benefits

UMWA Plans March on Washington

Unions for Single Payer Health Care, June 20, 2016

LEXINGTON, KY — Over 5,000 miners rallied here last Tuesday to protest health benefit cuts threatened to happen before the end of the year. Responding to the call of their union, United Mine Workers of America (UMWA), miners came from seven states to gather at the convention center. Some arrived with walkers, canes, wheel chairs, and oxygen tanks, giving tangible evidence of the toll on human health inflicted by the mining industry.

The UMWA reports that 22,000 retired union miners, widows or dependents would lose health care benefits at the end of the year if federal legislation they are backing isn’t enacted this year. Retirement benefits are also at risk.

UMWA President Cecil Roberts told those assembled that union miners had spent their lives working in dangerous places to provide America’s electricity and steel and make it the most prosperous nation on earth.

“We have stood up for America, and it’s time America stood up for us!” said Roberts, “America owes us, and we will collect on that debt!”

Union miners said the promise of good health care and pensions dates to 1946, when the federal government promised benefits in resolving a labor dispute.

Roberts Calls for March on Washington with Civil Disobedience

Roberts announced at the rally that union members will march on Washington D.C. later this year and risk being arrested if that’s what it takes. He told miners to go home and find at least five others that would be willing to rally at the nation’s capital.

The UMWA is calling for passage of legislation in Congress, Senate Bill 1714 and House Resolution 2403, which would redirect existing appropriations to ensure health care benefits for retirees whose companies have gone bankrupt in the last 4 years, as well as prevent the UMWA pension fund from collapsing. The Lexington Herald-Leader endorsed the proposed bills.

Solidarity Action:

Contact your two senators and ask them to support S 1714 and your representative and ask him/her to support HR 2403. Call the US Capitol Switchboard (202) 224-3121 and ask for your congresspersons by name.

This coal miners’ crisis is further testimony that collective bargaining power alone is insufficient to resolve the health care problem for unions and workers. Workers and the nation must have a legislative solution. If we are to protect and improve health care for workers, the labor movement must lead the battle for national single payer health care. 

HR 676, a national single payer bill, would improve Medicare and expand it to everyone. It includes all medically necessary care including dental and drugs with no co-pays and no deductibles. It was introduced by Congressman John Conyers (D-MI) and has 62 co-sponsors. If your union has not yet endorsed this bill, please do so!

Endorse HR 676:

The sample resolution is here: http://unionsforsinglepayer.org/tools/sample_resolution

Build the movement to make it happen!

Issued by:

All Unions Committee for Single Payer Health Care–HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551
 
Email: nursenpo@aol.com
http://unionsforsinglepayer.org
https://www.facebook.com/unionsforsinglepayer

Letter: Health overhead

By Dr. Loren A. Crown
The Commercial Appeal, June 22, 2016

COVINGTON, TENN. — The writer of the June 19 letter “Single-payer answer” correctly pointed out problems with the current system (i.e., profit-driven insurers, the pharmaceutical industry and providers) resulting in our nation seeing a decrease in longevity, a health care ranking behind 36 other nations, and yet a No. 1 cost rating.

I would add that while Medicare has a 1 to 2 percent overhead expense, the current system results in approximately a 20 percent overhead (health care executives, stock dividends, duplication, etc.).

Single-payer access could eliminate this and leave funds for the 15 percent who have no coverage or marginal coverage without increasing the health care budget.

http://www.commercialappeal.com/opinion/letters-to-the-editor/Letter-Health-overhead-383900731.html

Republicans offer only detrimental tweaking to our health care system

A Better Way to Fix Health Care

By Speaker Paul Ryan
abetterway.speaker.gov, June 22, 2016

Our Principle

In a confident America, everyone has access to quality, affordable health care.

Our Challenge

Obamacare is making things worse by the day. It drives up premiums and deductible costs for individuals, families, and businesses. It forces people off the plans they like. It fuels waste, fraud, and abuse. And it cannot be fixed. Its knot of regulations, taxes, and mandates cannot be untangled. Obamacare must be fully repealed so we can start over and take a new approach.

Our Vision

Over the years, House Republicans have put forward hundreds of ideas to improve health care, ranging from targeted proposals to full alternatives to Obamacare. This is the first time we are unifying these efforts into a single health care plan.

This isn’t a return to the pre-Obamacare status quo. And it isn’t just an attempt to replace Obamacare and leave it at that. This is a new approach. It’s a step-by-step plan to give every American access to quality, affordable health care.

Our plan recognizes that people deserve more patient-centered care, not more bureaucracy. That means more choices, not more mandates. You should have the freedom and the flexibility to choose the care that’s best for you. Insurers should compete for your business, and treat you fairly—no matter what. You and your family should have access to the best life-saving treatments in the world. And as you get older, Medicare should give you more choices too. At every step, you should be in the driver’s seat. This is a better way.

A Better Way to Fix Health Care – Snapshot (3 pages):
http://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-Snapshot.pdf

A Better Way: Health Care – Policy Paper (37 pages):
http://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-PolicyPaper.pdf

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Comment:

By Don McCanne, M.D.

As their vision states, the House Republicans have organized their previous concepts on health care reform into a single policy paper. It is heavy on rhetoric that is deceptive and bordering on dishonesty in that their proposals are cloaked in language suggesting that these are beneficial policies when many of them are actually detrimental.

The report includes a rehash of familiar proposals: health savings accounts, selling insurance across state lines, association health plans, medical liability, Medicaid block grants, and converting Medicare to a premium support program. There is really not much new here.

But what is missing are the details that would allow for an objective analysis of the impact were these polices converted into legislation. However, it is easy to translate their rhetoric into what they are really proposing: they would reduce the role of the federal government in financing health care, shifting responsibilities to the states and especially to the the markets, while sharply increasing the financial burden on patients.  Since more of the responsibility for paying for health care would shift to the individual, it is likely that the greatest impact would be to significantly impair access to health care due to financial barriers, especially the lack of cash on hand.

Just one example of their rhetoric:

“Currently under Medicare, for example, beneficiaries and physicians (and other providers) are not allowed to agree to a different treatment regimen for a Medicare covered service. Our plan would develop a personalized care demonstration program that would give beneficiaries and health care professionals the ability to voluntarily enter into an arrangement for items and services outside of the Medicare system. While participating in this voluntary demonstration project, Medicare beneficiaries would still retain their Medicare benefits. With the proper oversight, this is a common-sense approach to giving our seniors the opportunity to make medical financing decisions with their physicians without direct interference from Washington. These freedoms can also help to ensure that Medicare beneficiaries maintain the access to health care professionals they deserve by increasing flexibility and thus the number of physicians who participate in Medicare.”

Sounds great – freedom to purchase the care you want instead of that dictated by the federal government. No, that isn’t the point. The policy they advocate for here is to allow physicians to charge Medicare patients full fees for authorized services. That currently is not allowed unless a physician totally opts out of the Medicare program – not a practical consideration for most physicians. Why do they have this rule? Without it a two-tiered Medicare program would be created – a concierge tier for the wealthy, and an underfunded welfare program for the rest of us.

But how about a little perspective here? The Republicans propose repealing the Affordable Care Act and then replacing it with slight variants of many of the policies contained in the act. They leave in place most of the health care financing infrastructure: Medicare, Medicaid, employer-sponsored plans, individual plans with public and private exchanges, and private payment. They merely tweak the existing system. The tweaks cause private insurance to become even less effective in providing financial security; the profound administrative waste is perpetuated, and oversight of the outrageous pricing in health care is reduced.

We’ve already had enough of this. It’s time – past time – to demand reform that works, that would make health care affordable for everyone who needs it. It’s time for a single payer national health program – an improved Medicare for all.

PNHP note: Physicians for a National Health Program is a nonpartisan educational organization. It neither supports nor opposes any candidate for public office.

Some Democrats Aren’t Giving Up on Universal Health Care

By Mary Ellen McIntire
Morning Consult, June 20, 2016

Democrats should push for universal health coverage ahead of the November election, several health care advocates urged the committee drafting the Democratic National Committee’s platform at a recent session focused on health policy.

Their liberal health care proposals echo a similar theme from an environment-themed session the same day, in which activists criticized DNC members for not pushing harder on climate change.

The hearing was part of a series of regional events held by the Democratic Platform Drafting Committee “designed to engage every voice in the party.”

Too many people are still uninsured six years after the passage of the Affordable Care Act, said many of the advocates who spoke before the committee in Phoenix on Friday. Still more are underinsured, they said, and people are struggling to pay for rising premiums and to afford prescription drugs.

While most of the witnesses speaking to the platform committee acknowledged the Affordable Care Act as a step forward toward ensuring health coverage for more people, some fault lines appeared among the party. Supporters of Sen. Bernie Sanders (I-Vt.) pointed out the shortfalls of the law, suggesting that it gets in the way of a single-payer system. Sanders hasn’t yet officially conceded the presidential primary race in his pursuit of influencing the party’s platform.

“It’s a national disgrace that we don’t provide health care for everyone,” said RoseAnn DeMoro, director of National Nurses United, which endorsed Sanders.

The Department of Health and Human Services says the ACA expanded health coverage to roughly 20 million Americans. The uninsurance rate fell to 9.1 percent last year, according to the National Health Interview Survey, though millions are still without coverage.

More than 50 percent of Americans now favor a single-payer health care system, DeMoro said. A Kaiser Family Foundation poll in December put that figure at 58 percent.

The current system, as an industry, isn’t fixable, she argued. “It’s very difficult to take a system that has profit in it, and this is what we find in the ACA, where so much money is taken out of the system and then think that we’re going to be able to resolve that piecemeal,” she said.

Rep. Barbara Lee (D-Calif.), a member of the drafting committee, said Democrats in Congress fought hard for a single payer or public option system while crafting the health law. They lost that fight because of Republican and industry pushback. States now have the option of adopting their own single-payer system if they choose. Coloradans will vote on such a ballot initiative in November.

Single-payer health care is the most effective route to universal coverage, argued Stephanie Woolhandler, co-founder of Physicians for a National Health Program. Government spending on health programs would initially rise, but it would later be offset by a reduction in premiums and out-of-pocket costs, she said. A Medicare buy-in or public option wouldn’t work as effectively because the system would not realize the same administrative and drug-cost savings available through a single-payer system.

“I think we, like the nurses, feel you just can’t pretend we’ve solved the problem here with the Affordable Care Act,” Woolhandler said. “What we have now is not a solution. We still have people dying. We still have people not getting care.”

Drug costs, which have come under significant political pressure in this election cycle, were another focus of the witnesses speaking to the drafting committee. Patients need relief from rising drug costs more quickly than the ACA is allowing, said Daniel Martinez, president of AARP Arizona. He wants to require drugmakers to explain how they are pricing products and create a new tax credit for people that are providing health care to relatives.

Kitty Kennedy, of the Arizona Alliance for Retired Americans, suggested that allowing safe importation of drugs from abroad could make it easier for Americans to afford prescription drugs. Hillary Clinton, the presumptive Democratic nominee, supports that idea. Oddly enough, that idea has also been floated by presumptive GOP nominee, Donald Trump.

https://morningconsult.com/2016/06/20/some-democrats-arent-giving-up-on-universal-health-care/?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=30825191&_hsenc=p2ANqtz-_hX9w5lbBVSq_jv_9s8LQ8Ji7DQ3dnUpHqnL8ZK_OTuKTMgEW3qCYVmBgQpm9eJEo2JDqC9Qzb7aumN6okR7nO74eSkA&_hsmi=30825191

PNHP note: Physicians for a National Health Program is a nonpartisan educational organization. It neither supports nor opposes any candidate for public office.

Health care financial insecurity is at a record low, but…

In U.S., Healthcare Insecurity at Record Low

By Jeffrey M. Jones and Nader Nekvasil
Gallup, June 20, 2016

Fewer Americans reported not having enough money in the past 12 months to pay for necessary healthcare and/or medicines for themselves or their families than at any point since Gallup and Healthways began tracking this metric in 2008. From 2008 through 2013, the percentage of Americans who experienced difficulty in the past 12 months affording healthcare and medicine was fairly steady, hovering near the average of 18.7%. Since then, the average has been 16.4%, including the new quarterly low of 15.5% in the most recent quarter.

Gallup_Health_Insecurity

The increase in the percentage of Americans having health insurance is likely a key reason why fewer Americans are struggling to pay for healthcare. Generally, those without health insurance are at least three times more likely to report not having enough money for healthcare/medicine than their counterparts with health insurance. In the most recent quarter, 41.8% of the uninsured said they had struggled to pay for healthcare costs, compared with 12.3% of those with insurance.

Bottom Line

Although roughly one in six Americans report having times in the past year when they were unable to afford the healthcare or medicine they needed, this is down significantly from just three years ago. The expansion of health insurance coverage to millions more Americans under the Affordable Care Act is likely a major factor in the decline of healthcare insecurity, demonstrating a concrete benefit of the law.

At the same time, there are growing concerns that health insurance costs are set to rise in many parts of the country, as insurers and states adjust to the new healthcare market. These increases would mostly affect Americans who do not qualify for a health insurance subsidy under the Affordable Care Act.

http://www.gallup.com/poll/192914/healthcare-insecurity-record-low.aspx

***

Comment:

By Don McCanne, M.D.

The headlines reporting the results of this Gallup survey are celebrating the decline in health care insecurity (e.g., “Fewer Americans Are Having Trouble Paying Health Care Bills, Gallup Finds” – Kaiser Health News). Although any improvement is always good news, a 17 percent decline in health care insecurity is not much to celebrate (declining from 18.7% to 15.5%). Filling the glass less than one-fifth full is disappointing when we could have had a full glass.

The graph in the article shows a very modest decline, but even it is deceptive since it is truncated. The bottom of the graph is cut off at 10% and the top at 24%, but imagine showing the range at 0% to 100%. The curve would look quite flat, demonstrating visually how unimpressive the gain is.

Although it is shameful that 41.8% of the uninsured are struggling with medical bills, 12.3% of those who are insured still face health care insecurity, and many of the insured who are not have simply been fortunate enough to not require a significant amount of health care. So having insurance is not working well for many of those who do need health care.

The health care insecurity described refers only to medical bills; it does not refer to other costs of illness such as lost income. But a well designed single payer system with first dollar coverage for all essential health care services could virtually eliminate medical bills (though a person might still be responsible for charges for services and products that might not be appropriate for a taxpayer financed system). Removing financial barriers is a crucial step toward improving health care access.

Let’s enact single payer. Then we can celebrate.

Letter: Single-payer answer

By Dr. Arthur J. Sutherland III
The Commercial Appeal, June 19, 2016

MEMPHIS — Your June 12 guest column by BlueCross BlueShield CEO J.D. Hickey was a lot of crying about how BCBS cannot afford to cover Tennessee patients in their marketplace insurance plans in 2017 (“Marketplace model means high costs in Tenn”). But what he didn’t say was that the insurance industry is part of the problem.

The U.S. is the only developed country in the world that does not have a national health insurance program. We have a market-based system that has become the most expensive in the world because of the excessive costs and waste involved with private insurers and suppliers.

We are ranked 37th in the world in the quality of health care delivery in spite of having an abundance of resources (e.g. highly trained health care providers, plenty of hospital beds and sophisticated technology).

The political process is moving toward a major modification of the health care system. Public health experience instructs us that a single-payer national health insurance plan can heal the dysfunctional contemporary system and spare us the vagaries, often cruel, of marketplace gambles.

If Medicare was improved and changed, everyone would be automatically covered for all necessary medical services. The savings of a single-payer system would amount to $400 billion in administrative waste redirected to care, with no net increase in health spending.

Patients would be allowed free choice of their doctors and hospital. Premiums and out-of pocket costs would be replaced with progressive income and wealth taxes. Ninety-five percent of Americans would pay less for health care than they do now.

http://www.commercialappeal.com/opinion/letters-to-the-editor/Letter-Single-payer-answer-383519801.html

Steffie Woolhandler, M.D., M.P.H., Briefs Democratic Platform Committee on Single Payer

Testimony in support of single-payer national health insurance

By Steffie Woolhandler M.D., M.P.H., M.A. (Hon., Harvard)
FACP Prof. of Public Health, City University of New York at Hunter College
Lecturer (formerly Professor) in Medicine, Harvard Medical School
Adjunct Clinical Professor of Medicine and Staff Physician,
Albert Einstein College of Medicine
Democratic Platform Drafting Committee Hearing, June 17, 2016

PNHP note: the following testimony, and subsequent dialogue with members of the drafting committee, can be viewed below, or on the C-SPAN website.

I am a primary care doctor and professor of medicine and health policy. In 1986, I co-founded the non-partisan organization Physicians for a National Health Program, whose 20,000 members advocate for single payer reform.

Our proposals for single payer reform have appeared in the New England Journal of Medicine, The Journal of the American Medical Association, and most recently in the American Journal of Public Health. That proposal and references for my statements appear in my written testimony.

1. The ACA has not solved the health care crisis. About 30 million Americans are uninsured today. And 25 million would remain uninsured even if all states were to accept the Medicaid expansion.

2. Millions more have such hollowed-out coverage that they can’t afford care. Deductibles on employer-sponsored plans increased 255% between 2006 and 2015. Deductibles in the ACA’s exchange Silver plans average $3,064.

My research with Elizabeth Warren, when we were both professors at Harvard, found that medical problems were a cause of 62% of all personal bankruptcies. The majority of the medically bankrupt had private insurance that failed to protect them. This year, the Consumer Financial Protection Bureau reported that unpaid medical bills are by far the most common debts sent to collection agencies.

3. Many Americans have been forced into insurance that limits their choice of doctors and hospitals, often excluding leading cancer centers and teaching hospitals. Medicare for All would assure everyone a free choice of doctor and hospital. 

4. Health inequality is on the rise. Today, the wealthiest American men live, on average, 15 years longer than the poorest. Meanwhile, the life expectancy gap has fallen in Canada. Overall, Canadians and Europeans now live 2 to 3 years longer than Americans.

5. Single payer systems in these nations provide first dollar coverage, while spending about half as much per person as we do.

6. The economic numbers on single payer add up. At the outset, government health spending would rise, but would be fully offset by reductions in premiums and out-of-pocket costs. Over the longer term, single payer reform would be less inflationary than our current market-based system. (Markets are designed to expand, and they do, especially when they’re heavily subsidized.)

Single payer would save about $3.3 trillion on insurance overhead over the next decade by replacing private health insurers, whose overhead averages 12%, with a single public insurer with overhead of 2-3%, as in the traditional Medicare program or Canada’s single payer.

Single payer reform would also slash the paperwork that insurers inflict on doctors and hospitals, saving another $2.75 trillion over 10 years. Doctors would send all bills to one place using a simple billing form, and hospitals would stop sending bills. Instead, they’d be paid negotiated lump-sum budgets – much as we pay fire departments. Administration consumes 25% of hospital budgets in the U.S., vs. 12%, in Canada and Scotland.

Overall, a single payer reform would save more than $6 trillion on paperwork over the next decade, enough money to cover all of the uninsured, and to upgrade coverage for those of us with insurance.

7. A single payer reform could save an additional $2 trillion over ten years by using its leverage as a monopsony buyer to drive down drug prices.  This strategy has allowed Europeans and Canadians (as well as the VA) to get drugs at half–price. 
 
8. A Medicare buy-in or public option will not work. It would improve choices for some Americans but fail to garner most of the administrative or drug savings available through single payer. Moreover, as in the Medicare Advantage program, overall costs would go up because private insurers would cherry pick the healthiest patients, shunting expensive and unprofitable patients to the public option. We have already seen this dynamic at work in the collapse of the non-profit insurance coops under the ACA. In insurance competition, good guys finish last.

9. Single payer is popular. Most doctors, like other Americans, now favor national health insurance, and according a recent Gallup survey, the public now greatly prefers it to Obamacare.

10. In summary, single payer reform is the only route to affordable and sustainable universal coverage. The Democratic Party cannot pretend that minor tweaks to our failing health care system will fix it.

Additional Written Testimony and Documentation for the Democratic Party Platform Committee

By Steffie Woolhandler, M.D., M.P.H.

1. The full text of the recent physicians’ proposal for single payer health care reform is available at https://www.pnhp.org/nhi.

2. My estimates of single payer savings on insurance overhead are based on the following sources. According to the National Health Expenditure Accounts, private insurers’ overhead in 2016 was 12.5% of total premium (see: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/nhe60-24.zip). In contrast, according to the Medicare Trustees, overhead in the traditional Medicare program is less than 3% (see: https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/reportstrustfunds/downloads/tr2015.pdf), and overhead in Canada’s single payer program, which streamlines administration by paying hospitals global budgets, is 1.8% (see: https://www.cihi.ca/sites/default/files/document/nhex_trends_narrative_report_2015_en.pdf).

3. The large administrative savings for doctors and hospitals under single payer have been well documented (see, for instance my studies in the New England Journal of Medicine at: http://www.nejm.org/doi/full/10.1056/NEJMsa022033#t=article, and in BMC  Health Services Research at: http://www.ncbi.nlm.nih.gov/pubmed/25540104). Every serious analyst of single payer reform has acknowledged these savings (for a summary of studies of the cost of single payer reform see: https://www.pnhp.org/facts/single-payer-system-cost), including the Congressional Budget Office, the Government Accountability Office, the Lewin Group (a consulting firm owned by UnitedHealth Group).

As my international research team found, U.S. hospitals spend one-quarter of their total budgets on billing and administration, more than twice as much as hospitals spend in single payer systems like Canada’s or Scotland’s (see: http://content.healthaffairs.org/content/33/9/1586.abstract). Similarly, U.S. physicians, who must bill hundreds of different insurance plans with varying payment and coverage rules, spend two to three times as much as our Canadian colleagues on billing (see: http://www.nejm.org/doi/full/10.1056/NEJMsa022033).

4. Nations with national health insurance programs that negotiate drug prices pay about half as much for prescription drugs as Americans (see: http://content.healthaffairs.org/content/32/4/753.abstract).

5. Implementing a single payer program would disrupt the private insurance industry, but would not disrupt the smooth functioning of hospitals, clinics, doctors’ offices and other medical providers. The rollout of Medicare in 1965 caused no disruption, contrary to predictions of disaster (see: http://www.huffingtonpost.com/steffie-woolhandler/medicares-history-belies-_b_9245484.html), and the start-up of single payer systems in Canada and Taiwan went smoothly. Interestingly, when Medicare started up, there was little society-wide increase in the utilization of medical services. Between 1964 (before Medicare) and 1966 (the year when Medicare was fully functioning) there was no increase in the total number of doctor visit in the U.S.; Americans averaged 4.3 visits per person in 1964 and 4.3 visits per person in 1966. Instead, the number of visits by poor seniors went up, while the number of visits by healthy and wealthy patients went down slightly. The same thing happened in hospitals. There were no waiting lists, just a reduction in the utilization of unneeded elective care by wealthier patients, and the delivery of more care to sick people who needed it. A similar phenomenon occurred in Canada (see: http://www.nejm.org/doi/full/10.1056/NEJM197311292892206).

6. According to a 2016 Gallup survey (available at: http://www.gallup.com/poll/191504/majority-support-idea-fed-funded-healthcare-system.aspx?g_source=Politics&g_medium=newsfeed&g_campaign=tiles), 58% of Americans favor (and only 37% oppose) “replacing the ACA with federally funded healthcare system.” Among those who favor either keeping the ACA or replacing it with a federally funded system, 64% prefer single payer vs. 32% who prefer the ACA – a 2:1 margin. Moreover, 27% of those who want to repeal the ACA and say they favor replacing it with a federally funded system. Strikingly, while only 16% of Republicans support keeping the ACA in place, 41% favor a federally funded health care system.

PNHP note: Physicians for a National Health Program is a nonpartisan educational organization. It neither supports nor opposes any candidate for public office.