PNHP

Expert talks about Obamacare to retiree group

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Expert talks about Obamacare to retiree group

By Ken Borsuk
Greenwich Time (Old Greenwich, Conn.), Aug. 19, 2015

While the battle over the Affordable Care Act might be finished in the courts, it still faces challenges, according to health-policy expert John Hughes.

Hughes, a professor of medicine at Yale University School of Medicine and director of medical care for the West Haven VA Medical Center, was the featured speaker at the Retired Men’s Association of Greenwich on Wednesday. He discussed the history and future of Obamacare, which was enacted in 2010 despite the opposition of congressional Republicans.

Hughes said the recent U.S. Supreme Court decision upholding the Affordable Care Act’s federal subsidies was the second time the country’s highest court has upheld the law.

“It is unlikely there will be any other legal challenges,” Hughes said. “Most people agree there’s no future in that, given the Supreme Court decisions. Any assaults on the Affordable Care Act are going to have to come from Congress and any changes are going to have to come from Congress.”

The Republican-led House of Representatives has unsuccessfully tried more than 40 times to defund Obamacare. Even though Republicans now control the Senate, PresidentBarack Obama would still be able to veto a legislative attempt to end his signature legislation, Hughes said.

“What happens in the next election will very much determine the future of the Affordable Care Act,” Hughes said. “It’s an interesting time to be alive.”

Hughes, during the question-and-answer period after his address, discussed the merits of a single-payer system similar to Canada’s. He said that despite some complaints from Canadians, they approve of the system and are angry over seeing ts misrepresented in the American media as forcing people to wait for medical care.

He said American doctors remain divided over the idea of a single-payer system in America.

“Doctors generally respond well to the idea of a single-payer system until you start talking about how exactly it will work,” Hughes said. “Then all of a sudden it’s not so popular. … Many would not be happy with having a single payer, but some of my colleagues in private practice at this point say the current system is nuts. We’re having to dance with these gorillas, these insurance organizations and these large consolidated hospital organizations. Maybe we should just dance with a single gorilla.”

Hughes said America is spending too much on health care, an issue which led to the topic of needing health care reform in the first place.

“Even though we are a wealthy country and we would expect to spend more on health care, we spend disproportionately more than any other country,” Hughes said. “It’s not just that we’re spending more money. We have been devoting a larger and larger proportion of our economy to health care. … This is a well-recognized phenomenon, and economists, no matter what stripe, agree that we are spending unsustainable amounts of money on health care.”

A full video of Hughes’ remarks will be posted online at www.greenwichrma.com.

http://www.greenwichtime.com/news/article/Expert-talks-about-Obamacare-to-RMA-6453870.php

Fundamental flaw of Republican health reform proposals

Scott Walker, Marco Rubio Propose ‘Plans’ to Replace Obamacare

By Jonathan Chait
New York Magazine, August 18, 2015

Today, Scott Walker and Marco Rubio have published plans — really, not so much plans as skeletal descriptions of planlike concepts — to replace Obamacare. Appealing to the general election requires them to promise something to compensate the victims of repeal. How will they fund that something? This is the basic problem that for decades has prevented Republicans from offering a health-care plan. Rubio and Walker show that they still have no answer.

The main reason people lacked insurance before Obamacare is that they did not have enough money to afford it. Some of those uninsured people had unusually high health costs. Some of them had unusually low incomes. Boiled down, Obamacare transferred resources from people who are rich and healthy to people who are poor and sick, so the poor and sick people can afford insurance.

Walker and Rubio are fairly clear about their plans for regulating the insurance market. They want to go back to the pre-Obamacare, deregulated system. They’d eliminate the requirements that insurance plans cover essential benefits, and let them charge higher prices to sicker customers. That’s good for people who have very limited medical needs (as long as they never obtain a serious medical condition, or have a family with somebody with a serious medical condition). It’s bad for people who have, or ever will have, higher medical needs.

Both Walker and Rubio promise to take care of people with preexisting conditions by creating separate “high-risk pools.” That is a special kind of insurance market for people with expensive medical conditions. As you may have guessed, insurance for people with expensive medical needs is, well, expensive. Making that insurance affordable therefore requires lots of subsidies from the government. Where would Walker and Rubio get the money for that? They don’t say.

Both Walker and Rubio propose to cut funding for Medicaid, but this doesn’t create much room to subsidize coverage, since Medicaid is already much cheaper than Medicare or private insurance. Republicans are willing to cut Medicaid because they’re generally willing to cut programs that focus on the very poor, but there’s not much blood to be drawn from this stone.

It is tempting to treat the lack of specifics in the Republican health-care plans as a problem of details to be filled it. But it is not a side problem. It is the entire problem. They will not finance real insurance for the people who have gotten it under Obamacare, nor will they face up to the actual costs they’re willing to impose on people. The party is doctrinally opposed to every available method to make insurance available to people who can’t afford it. They have spent six years promising to come up with an alternative plan, and they haven’t done it, because they can’t.

http://nymag.com/daily/intelligencer/2015/08/walker-rubio-obamacare-replacement-plans.html#jumpLink

***

Comment:

By Don McCanne, MD

Much has been written this week about the proposals of presidential candidates Gov. Scott Walker and Sen. Marco Rubio for replacing the Affordable Care Act (ACA or Obamacare) once it is repealed. Most articles discuss the few specifics of their proposals that they have provided, but Jonathan Chait’s stands out because he describes the underlying fundamental flaw common to all conservative proposals for reform: for everyone to have affordable access to health care, there must be a large transfer from the healthy to the sick and from the wealthy to those with lower incomes, and the conservative proposals fall far short on the size and direction of the transfers that are needed.

Chait exits the topic leaving ACA in place, but there is more to be said. Although ACA actually did expand the necessary transfers, it still falls short of what is needed, plus too many inequities are perpetuated. Patches to ACA would still leave in place the fundamentally flawed infrastructure, and the Republican replacements are even more fundamentally flawed because they would worsen the financial barriers to care, especially by failing to include adequate transfers in their models.

A much more efficient and equitable method of achieving the necessary transfers would be to enact a single payer national health program. If the Republicans really do want a better replacement for Obamacare, maybe they should seriously consider single payer.

PolitiFact accurate but misleading on Sanders’s claim of U.S. spending twice as much

Bernie Sanders repeats flawed claim about U.S. health care spending compared to other countries

By Will Cabaniss
PolitiFact, August 16, 2015

Democratic presidential candidate Bernie Sanders is on a campaign for “Medicare for all” — or at least something like it.

Sanders, an independent senator from Vermont who identifies as a socialist, told NBC’s Meet the Press moderator Chuck Todd to look at how much the country spends compared to the rest of the world as a reason for a single-payer system.

“We spend almost twice as much per capita on health care as do the people of any other country,” Sanders said.

It’s a striking claim, and one we heard from Sanders six years ago.

We rated the claim False then, and it’s still wrong now.

We looked at data from the Organization for Economic Cooperation and Development (OECD), widely cited by experts as an authoritative source for this information.

In 2007, the United States led the world in health care spending at $7,167 per capita, according to the OECD. Norway and Switzerland followed at $4,579 and $4,568, respectively.

The United States maintained its spending lead in the years that followed. But Sanders puts the difference too strongly when he says U.S. spending is “almost twice” per capita of “any other country.”

According to the OECD’s most recent data, U.S. spending grew to $8,713 per capita in 2013. Switzerland and Norway came in second and third at $6,325 and $5,862 per capita, respectively.

Had Sanders fine-tuned his talking point by claiming that the United States spends twice as much per capita as the average developed country, his statement would been accurate. Average per capita spending is less than $3,500 across the 32 countries listed in the OECD database. That’s 40 percent of what the United States spends per person.

Our ruling

Sanders said that “we spend almost twice as much per capita on health care as do the people of any other country.”

The United States spends more on health care per capita than other countries, but not always twice as much. Sanders’ comment suggests the United States outpaces all other countries more than it actually does. European countries with extensive social service networks aren’t so far behind the United States. 

We rate his statement False.

http://www.politifact.com/truth-o-meter/statements/2015/aug/16/bernie-s/bernie-sanders-repeats-flawed-claim-about-us-healt/

OECD Health Statistics 2015: http://www.oecd.org/els/health-systems/health-data.htm

***

Comment:

By Don McCanne, MD

Sen. Bernie Sanders told NBC’s Chuck Todd, “We spend almost twice as much per capita on health care as do the people of any other country.” You’ve probably heard, or thought you heard, similar statements from others, including some of the PNHP leadership. But this specific statement is technically incorrect.

Sanders did include the important specification that he was referring to “per capita” spending, but by specifying that our per capita spending was almost twice that of any other country, that would place the second highest spending country at slightly over half of our spending. That is not correct.

What he likely intended to say was, “We spend almost twice as much per capita on health care as the average of developed nations,” or, “… industrialized nations,” or, “… wealthy nations,” or, more specifically, “… as the average of all OECD nations.” PolitiFact indicates that such a statement would have been accurate.

Yet this statement still isn’t quite accurate. In 2013, the latest year for which we have full data, the United States spent $8713 per capita, whereas the OECD average was $3453 per capita. That is not “almost twice” the OECD average, but rather the United States is spending over TWO AND A HALF TIMES AS MUCH PER CAPITA as the average per capita spending of OECD nations (2.52 times as much).

PolitiFact rules, “Sanders’ comment suggests the United States outpaces all other countries (in spending) more than it actually does.” In fact, the United States outpaces the average per capita spending of other developed nations by even more than what Sanders intended to say.

Remember, THE UNITED STATES SPENDS TWO AND A HALF TIMES AS MUCH PER CAPITA ON HEALTH CARE AS THE AVERAGE PER CAPITA SPENDING OF ALL OECD NATIONS.

Chicago celebrates Medicare’s 50th anniversary

Medicare is as American as apple P.I.E (Protect, Improve, Expand).

By Anne Scheetz, M.D.
Illinois Single-Payer Coalition, Aug. 2, 2015

So proclaimed approximately 200 representatives of National Nurses United (NNU), the Illinois Single-Payer Coalition (ISPC), Physicians for a National Health Program (PNHP), Students for a National Health Program (SNaHP), and more than twenty Chicago labor and community groups on July 30, the 50th anniversary of Medicare and Medicaid.

Chanting slogans such as “Health care is a human right! Fight, fight, fight!” and “This system, let’s stop it! Our health is not for profit!” the crowd, led by disability/single-payer activists propelling wheelchairs, marched on the Chicago office of Humana, third largest health insurance company in Illinois, and the largest purveyor of Medicare Advantage Plans (MAPs).

There, medical student and SNaHP leader Scott Goldberg denounced the $22.9 billion overpayment Humana’s MAPs received from Medicare between 2011 and 2014–the excess over what traditional Medicare would have spent for the same patients. (Read the speech here.)

A delegation then entered the building and attempted to present an invoice for this amount to Humana. They were not received and left upon being told they were trespassing. Although Humana promised to send a representative to meet with the delegation outside, no one appeared. 

Returning to a nearby park, people ate apple pie supplied by NNU and listened to a series of inspiring speeches.

Susan Aarup for ISPC and Michael Grice (also an ISPC member) spoke about the importance of single-payer heath care for people with disabilities (read their speeches here and here.)

Katie Jordan of the Illinois Alliance for Retired Americans spoke about the important contribution of Medicare to seniors’ ability to retire with dignity (read her speech here).

Byron Sigcho of the Pilsen Alliance spoke about health care justice for immigrants (read his speech here).

Mack Julion, President, National Association of Letter Carriers, and Executive member of the Chicago Federation of Labor, spoke of the universally detrimental effect of health care costs on contract bargaining.

Rev. Wendy Witt, First United Methodist Church, Chicago Temple, spoke on behalf of the People’s Lobby, which works for economic justice including publicly funded and administered health care.

ISPC member N’Dana Carter spoke of the Chicago Mental Health Movement’s fight for access to public mental health clinics.

Victoria Crider of the South Side Trauma Center Campaign spoke about the fight for an adult trauma center in an area of Chicago that is at once a trauma care desert and a center of gun violence; and about the inability of residents of surrounding communities to access care at University of Chicago Medical Center because of financial barriers–a discrepancy that would be resolved by Medicare for all.

Jean Ross, NNU Co-president, spoke out of her personal experience as a nurse, as well as addressing attacks on Medicare by health insurance companies and politicians. Promising that nurses will do whatever it takes to prevent the suffering that these attacks would produce if successful, she concluded, “We will never acquiesce to a system based on the idea that some deserve more care than others.” Read her speech here.

Keynote speaker Dr. David Ansell of PNHP demanded that insurance companies be limited to insuring buildings and cars, not people’s health, and led the crowd in chants of “Everybody in, nobody out!”

Emily Henkels, PNHP national organizer, together with members of SNaHP, engaged the crowd in social media.

State Prepresentatives Mary Flowers (31) and Will Guzzardi (39) joined organizers on the stage at the conclusion of the program.

Flowers is the chief sponsor of the Illinois Universal Health Care Act, currently HB 108, which she first introduced in 2007. In 2008, she held hearings around the state on the need for Medicare for all, and she has re-introduced the bill in each subsequent General Assembly. The bill passed out of committee on February 18 of this year with the help of first-term representative Guzzardi, laying the foundation for continued organizing in the upcoming session.

Additional organizations that endorsed the event: Alliance for Community Services, Central Illinois Jobs with Justice, Champaign County AFL-CIO, Chicago ADAPT, Chicago Democratic Socialists of America, Chicago Jobs with Justice, Fox Valley Citizens for Peace and Justice, Health and Medicine Policy Research Group, IIRON, Northern Illinois Jobs with Justice, Progressive Democrats of America Illinois, Radical Public Health, Reclaim Chicago, and United Electrical Workers Western Region.

Members of still other organizations participated in the day, including Access Living, ADAPT of Chicago Productions, American Federation of Government Employees, Chicago Gray Panthers, Fearless Leading by the Youth, Friedman Place, Illinois Green Party, Illinois Media Progressives, Progress Center Illinois, and United Auto Workers Local 557.

Members of ISPC’s People with Disabilities Committee noted that the sign language interpreter (supported by ISPC) was very good; and that sound system and the wheelchair ramp to the stage worked well.

ISPC members signed up about 75 new supporters of single-payer health care.

While celebrating the past 50 years, organizers of this wonderful event see it as the foundation for a broader fight for single-payer health care in Illinois and nationally, and for continuing the struggle for social justice of which health care is one part.

ISPC members will follow up with newly identified supporters.

The collaborating organizations look forward to working together in the future. 

Next event: The national single-payer strategy conference, sponsored by Healthcare-NOW!, the Labor Campaign for Single Payer Healthcare, and One Payer States, with a simultaneous conference by PNHP, will meet in Chicago October 30 to November 1 (more information here). We hope to see you there!

http://www.ilsinglepayer.org/article/chicago-celebrates-medicares-50th-anniversary

Troubled multi-employer plans show need for single payer

By Anne Scheetz, M.D., and Hale Landes
Fox Valley Labor News, July 2, 2015

Multi-employer or Taft-Hartley plans — a “made-in-America” source of health coverage and other benefits for more than 20 million U.S. workers, retirees, and their families — are under serious threat.

The threat has two sources: the Affordable Care Act (ACA), and the fragmented, for-profit nature of the U.S. health care system, which the ACA reinforced, rather than corrected.

Some union leaders held up the multi-employer plans as a good model for health system reform. In contrast to private for-profit health insurance companies, the plans, by law, serve their members, not passive investors.

They are more efficient than the insurance companies, devoting less than 10 percent of their outlay to administrative expenses (and more than 90 percent to health care), as opposed to the insurance companies’ 15 to 20 percent.

They tend to have high actuarial value, covering on average 87 percent of enrollees’ health care expenses, as compared to 90 percent for the platinum plans (which most people cannot afford) offered on the insurance exchanges, and 60 percent for the bronze plans.

Needless to say, this recommendation was not adopted. On the contrary, the ACA not only left the for-profit insurance companies in charge of health care, but created new disadvantages for multi-employer plans.

Perhaps most importantly, the ACA does not allow low-income workers who are enrolled in multi-employer plans to qualify for the government subsidies that are available to low-income people who buy insurance from for-profit insurance companies on the insurance exchanges.

Multi-employer plans are nonetheless taxed to pay for the subsidies, just like the insurance companies whose customers can benefit from them.

The ACA presents numerous other challenges to multi-employer plans as well, such as the unfunded mandate to cover children up to age 26; and administrative burdens whose costs will shift money away from health care.

Still other challenges apply to all workers. Penalties for companies that don’t offer health insurance are much less than the cost of insurance, do not apply to those that employ less than 50 workers, and do not apply to part-time workers. Employers are responding by cutting the number of employees, cutting hours, and sending employees to the insurance exchanges, among other practices that harm workers and their families.

The so-called Cadillac tax, which penalizes plans with high premiums, or, in the case of the multi-employer plans, high benefit payments, will also hurt the plans, and will most hurt those plans with a large number of older and sicker enrollees.

The National Coordinating Committee for Multi-employer Plans and many unions have responded to the problems posed by the ACA by lobbying for various amendments, and a few have called for its repeal.

Yet, the plans face serious challenges — even without the ACA.

Costs throughout the health care system are escalating. The consolidation of hospitals and physician practices allows providers to drive up prices. Prices for specialty drugs are rising almost 20 times as fast as prices for conventional drugs, and the prices of even some old and standard drugs are increasing faster than the rate of inflation. Administrative costs are increasing — for the whole system, they now total at least $350 billion per year.

The question of who will pay these increasing costs — employers or workers — has become a frequent cause of contract disputes. At best, workers have sacrificed wage increases to pay for health care, and this trend will continue.

The increasing costs are a significant challenge to worker solidarity. Some workers are denied equal benefits based on hours of work or length of employment, weakening union strength just as it is most needed. As is happening throughout the health care system, the funds are shifting more costs to their enrollees through co-pays for some services, a policy that penalizes the sick and burdens most those earning the lowest pay.

Amending the ACA — a very difficult task, given its complexity, will not solve these problems. Even a health reform modeled on the multi-employer plans would not solve these problems.

The solution is a single-payer health care system, also called expanded and improved Medicare for all. This reform proposal is the only proposal to address all of the problems faced by the multi-employer plans and all workers.

Under a single-payer program, everyone is covered for all medical care with the single payer being the government. Its administrative simplicity is the principal source of cost containment (traditional Medicare’s administrative overhead is only 2 percent). Insurance company marketing, underwriting, profits, and outrageous executive compensation would be eliminated. Furthermore, since everyone would be in the same system, the single payer would also be the single buyer of drugs, medical equipment, and services, thus able to enforce reasonable prices.

Financing would be by a progressive tax. Those who have the most would pay the most, while everyone would receive the care they need when they need it.

In contrast to the current situation, which workers are pitted against each other, under a single-payer system, we will all have an interest in making that system better. A single-payer system promotes, rather than undermines, social solidarity.

Other benefits include free choice of providers, instead of the narrow networks that are now commonplace; no interruptions in coverage due to job changes, illness, or retirement; and a much more just workers’ compensation system.

A single-payer health care system is the only way to take health benefits off the bargaining table, leaving unions free to bargain over wages and working conditions.

Union support for a single-payer health care system is strong, although not yet universal. The website of Unions for Single Payer Health Care lists more than 600 labor groups that have endorsed the national single-payer bill, HR 676, the Expanded and Improved Medicare for All Act, whose chief sponsor is John Conyers of Michigan. The groups include more than 150 central labor councils from around the country; and 25 groups, including three labor councils, from Illinois.

Fifteen major unions and other labor groups support the Labor Campaign for Single-Payer, which works more on the state level. These include National Nurses United (NNU) for whom a single-payer health care system is an essential aspect of nurses’ professional obligation to advocate for their patients; Young Workers; the National Education Association (NEA); United Electrical, Radio, and Machine Workers (UE); and the Coalition of Labor Union Women (CLUW), among others.

At the 2014 AFL-CIO Convention, delegates affirmed their support for a single-payer system; and activists with the Labor Campaign challenged organized labor to “finish the job” of health care reform by making health care a human right.

On July 30 of this year, NNU will lead the celebration of Medicare’s 50th anniversary with the message: “Medicare – as American as apple PIE: Protect, Improve, Expand.”

Illinois’s single-payer bill, the Illinois Universal Health Care Act, currently HB 108, has been introduced in each General Assembly since 2007 by chief sponsor Mary Flowers of Chicago. Although it will not pass in the near future, it articulates the vision of the single-payer movement for the people of Illinois and the U.S., and serves as an educational and organizing tool. The Illinois Single-Payer Coalition and its Labor Outreach Committee work with local labor groups, as well as the national organizations toward a future guarantee for all people of access to all necessary health care, and of financial protection in the case of illness or injury.

Labor is surely the sector that can best lead the way to the solidarity expressed in the single-payer movement’s slogans: “Everybody in, nobody out,” and “One nation, one health plan.”

Anne Scheetz, M.D., is a member of Physicians for a National Health Program and a founding member of the Illinois Single-Payer Coalition. Hale Landes is a member of IBEW Local 134 and the Illinois Single-Payer Coalition.

Published in the FVLM print editions of June 25 and July 2, 2015.

http://foxvalleylabornews.com/

http://ilsinglepayer.org/article/troubled-multi-employer-plans-show-need-single-payer

Health care injustice for California’s high-needs children

California’s Plan To Absorb Medically Fragile Children Into Managed Care Proves Controversial

By Barbara Feder Ostrov and Anna Gorman
Kaiser Health News, August 17, 2015

When Kausha King’s son Christian was born with cerebral palsy, along with a seizure disorder and lung disease, doctors told her he would not live past the age of three. Today, Christian is 18, and although he cannot walk or speak, he is happy and thriving, King says.

King credits much of her son’s progress to a little-known state program known as California Children’s Services (CCS), which pays for specialized medical care for children with severe illnesses or birth defects.

Beginning next year, state officials essentially want to fold the $2 billion program, which serves an estimated 180,000 children younger than 21, into its vast system of Medi-Cal managed care.

But families like King’s, along with children’s advocates and pediatric medical centers, are strenuously opposed. They say Medi-Cal managed care hasn’t worked well for vulnerable populations and is particularly risky for fragile kids whose lives depend on access to highly specialized care.

“It feels like our children are going to be dumped in to this system that doesn’t even seem to be working for healthier children,” said King, who lives in Concord, Calif. and works as a liaison for families of children with special needs. “Children like Christian require a different level of support than your average child.”

At issue are two separate programs whose beneficiaries overlap. About 90 percent of children served by CCS also qualify for Medi-Cal, the public insurance program for low-income Californians. Medi-Cal covers their general medical care, while CCS covers services related to specific conditions such as spina bifida, cancer, cystic fibrosis and sickle cell disease.

CCS pays a fee for each service provided, whereas Medi-Cal increasingly is switching to a managed care approach, in which medical services are coordinated and covered under a single health plan for a fixed monthly payment.

Many parents and consumer advocates are skeptical. Similar transitions of elderly, disabled and child populations from traditional fee-for-service Medi-Cal into managed care programs have proved controversial.

These critics point to a scathing report from the California State Auditor in June, which found that the state could not assure that its Medi-Cal managed care networks were adequate and that thousands of calls to an ombudsman’s office went unanswered every month. They also refer to a lawsuit pending in Los Angeles, alleging disabled people were denied crucial medications, tests and treatment by Medi-Cal managed care plans.

(Ann-Louise Kuhns, president and CEO of the California Children’s Hospital Association) said the state’s proposal threatens children’s access to the pediatric specialists who are most familiar with them and their rare diseases.

“These (managed care) plans typically don’t have these specialty providers in their networks,” she said.

California’s Plan To Absorb Medically Fragile Children Into Managed Care Proves Controversial

***

Comment:

By Don McCanne, MD

The origins of California Children’s Services (CCS) (formerly Crippled Children’s Services) date back almost a century (1927). It has been a phenomenal program ensuring care for these children with special needs. Now the state wants to transfer these children into Medi-Cal managed care programs (Medicaid). Ouch!

CCS is part of the traditional culture of California health care. Children’s hospitals, academic institutions, specialists and sub-specialists are readily available to meet the needs of these unfortunate children, simply because it’s always been that way. Well, really more than that, because that is what they do. But no thought is ever given to turning these children away.

In contrast, Medi-Cal has been chronically underfunded and has one of the lowest payment rates in the nation. Many providers refuse to accept Medi-Cal patients (and they are “providers” when they let money issues trump their professional obligation to care for the infirm). Now it is even worse in that the Medi-Cal managed care organizations limit patient access to their own contracted networks. Experience to date suggests that these networks are inadequate for basic, primary care services, and access to more specialized services is much worse. 

California Department of Health Care Services director Jennifer Kent said that this is not about saving money, but rather that children can benefit by being managed in a system where the whole child is treated by one plan. But when the decision was made to transfer Medi-Cal patients to managed care programs it was about saving money, according to state announcements at that time.

CCS was all about getting the care that these children needed when they needed it. Medi-Cal managed care is about keeping patients away from “excessive” specialized care by coordinating their care through overworked primary care professionals who do not have the time nor expertise to meet many of the needs of these children with their complex disorders.

This should not to be construed as a statement condemning integrated health care. Just the opposite. Under a single payer system, our entire health care delivery system can be considered to be a single integrated system. Primary care provides an entry into a system in which the most appropriate care can be arranged – the best of integrated health care.

It was a wise move when the precursor of CCS was established early in the last century. It was a wise moved when they abandoned the label, “crippled.” It was a wise move when they perpetuated the program instead of folding it into California’s overworked and underfunded Medi-Cal program. But is was a terrible move when, for cost-saving reasons, they transferred Medi-Cal patients into managed care plans. Moving CCS patients into the same program is nothing short of tragic.

We need a single payer system so that we can get the bureaucrats and their private third party payers out of our way as we medically manage health care based on patient needs, rather than us managing health care dollars. Yes, we need public administrators to manage distribution of the funds, but we need to be free to advocate for our patients in a system designed to ensure access, not to prevent it.

Grateful West Virginians gathered in Shepherdstown to celebrate the 50th birthday of Medicare

Shepherdstown Chronicle, Aug. 7, 2015

Established in 1965, Medicare (along with Social Security), has been the foundation for health and financial well-being for Americans over 65. Medicare pays the greater part of medical bills for seniors and helps disabled people of all ages.

Medicare can be improved and made more cost-effective by expanding it to all Americans from birth to death. A bill before Congress, HR 676 (Expanded and Improved Medicare for All Act), provides coverage of all medically necessary services and adds dental, vision and hearing services, as well as long-term care.

HR 676 repairs the major flaws in our present Medicare system.

Currently, Medicare covers only 80 percent of doctors’ bills under Part B. Patients need supplemental insurance to pay the 20 percent that Medicare doesn’t cover.

Under the complex and confusing Medicare Part D prescription coverage, patients are often left with a large part of the bill. Patients needing chemotherapy often face bankruptcy. By law, Medicare is forbidden to negotiate for lower prices from drug companies.

So-called Medicare Advantage plans are saddled with all the difficulties of private insurance, restricting patients’ choice of doctors and what medicines are covered. They divert dollars from medical care to paperwork, insurance executives’ bonuses, and lobbying, costing the taxpayers more. Arranging referrals and deciphering arbitrary formularies waste doctors’ time. Patients still pay deductibles and copays.

HR 676 will dispense with these problems and reduce costs. By eliminating private insurance companies, replacing private insurance premiums with a fair tax, and by extending Medicare to everyone, we will get privately provided, publicly funded care.

Cries of “don’t touch my Medicare” are common. When are there calls for its repeal? So why not extend it to all by replacing private insurance and its overhead with medical care? Help all Americans enjoy the benefit of improved Medicare by contacting congressional representative with the message: support HR 676.

http://www.shepherdstownchronicle.com/page/content.detail/id/513386/Grateful-West-Virginians-gathered-in-Shepherdstown-to-celebrate-the-50th-birthday-of-Medicare-.html

Insurance lobby that fought Hillarycare and Obamacare now has sturdy bridges to Democrats

By Alec MacGillis 
Truthout, Aug. 16, 2015

When the former head of the U.S. government’s health insurance programs was hired in July to run a lobby that had spent tens of millions of dollars trying to derail Obamacare, it was more than just another spin of Washington’s revolving door.

Marilyn Tavenner, former administrator of the Centers for Medicare and Medicaid Services, became chief executive of America’s Health Insurance Plans, the industry’s main lobbying group, which is known as AHIP. As the latest of a half-dozen prominent architects and overseers of Obamacare to move into the health industry, her move signified growing ties between health insurers and Democrats despite battles over the Affordable Care Act.

The relationship has long been marked by ambivalence and tension. Tavenner’s predecessor at AHIP, Karen Ignagni, was a former Democratic staffer on Capitol Hill, but the insurance lobby led the way in defeating the Clinton health coverage plan in 1993 and secretly spent about $100 million to attack Obamacare even as it negotiated to make it palatable to the industry. More recently, as the law added millions to the insurance rolls and generated big profits for many companies, they have turned to defending it.

The connections may continue or strengthen if Hillary Clinton wins the Democratic nomination and the presidency. That’s because a Washington firm called the Dewey Square Group, which is closely identified with the Clinton campaign, was at the center of the industry’s efforts to win influence among Democrats — at a time when the two sides were sharply opposed.

Full story: http://www.truth-out.org/news/item/32352-insurance-lobby-that-fought-hillarycare-and-obamacare-now-has-sturdy-bridges-to-democrats#

Alec MacGillis covers politics for ProPublica.

Obama Administration Must Confront Monopoly Practices in the Health Insurance Industry

‘A single payer system is urgently needed to solve this catastrophic crisis for working people’

By Lawrence J. Hanley
The Huffington Post, Aug. 13, 2015

The flurry of recent merger announcements from the handful of remaining national health insurance providers is cause for alarm for all Americans.

The Affordable Care Act (ACA) has taken nearly full effect and it is clear that staggering annual increases in health insurance premium costs are still with us. The skyrocketing costs of health insurance and health care treatment are pushing working American families well past the breaking point. There is a limit to what working people can afford to pay for what should be a human right.

The most recent corporate advances down the road of health insurance monopolization are the announcements that the enormous Aetna intends to absorb rival Humana, and at the same time the Anthem corporate giant — formerly WellPoint — is maneuvering to swallow Cigna.

Should these latest anti-competitive takeover moves go unchallenged by the Obama Justice Department when there is little doubt that the trend of double digit premium increases will accelerate?

In many areas of the country today there are frequently only one or two health insurers available when workers try to grapple with the dramatically rising premiums and costs. Their frequently identical plan offerings and prices raise the obvious suspicion that the insurers have fixed prices and rigged market share somehow.

And while these latest insurance company combinations and practices will be scrutinized by some states, that level of review is uneven and forced on reluctant state insurance departments ill-equipped to deal with such enormous corporations and their armies of legal and lobbying representatives.

Must Confront Corporate Criminality

It is urgent that the Obama Administration act swiftly and decisively to confront corporate criminality.

The Department of Justice (DOJ) has recently awoken from its slumber on the antitrust front, and has begun preliminary moves to investigate the obvious price fixing of the major airlines. They are likewise reviewing the sale of the General Electric appliances division to the European Electrolux corporation. But while both of these are cases are critical to the restoration of some semblance of an antitrust enforcement policy, the potential damage to working people from greater monopolization of the key health insurance sector is incalculable.

Until the United States Congress finds the political will to abolish our costly and badly broken health insurance industry the monopoly racketeers must at least be confronted and restricted from free rein.

A single payer system is urgently needed to solve this catastrophic crisis for working people.

Until then it is imperative that the Obama Administration utilize its full DOJ resources to investigate and stop the trend towards complete monopolization in the health insurance industry. This action takes no act of Congress, but merely requires the political leadership to commit the Justice Department to enforce existing laws on an industry that has demonstrated its intention to defy the law and rob working people in the process.

Lawrence J. Hanley is international president, Amalgamated Transit Union in D.C., and member of the AFL-CIO’s Executive Council.

http://www.huffingtonpost.com/lawrence-j-hanley/obama-administration-must_1_b_7977552.html

Offering equal access for health care?

By Ann Troy, M.D.
Marin (Calif.) Independent Journal, Letters, July 8, 2015

Congress created Medicare 50 years ago to provide seniors with health care, giving them protection against financial ruin, and peace of mind.

All that was needed was proof of age and citizenship (or legal residency). It was so simple and straightforward that all seniors were enrolled in six months, in the pre-computer era — using index cards!

Congress could have and should have extended Medicare to cover all Americans, creating a single-payer system with the free choice of doctors and hospitals that seniors enjoy. Instead, it passed the hopelessly complex Affordable Care Act, with its malfunctioning websites and uneven coverage.

It has kept the wasteful and bureaucratic insurance industry in health care, wreaked havoc on the health care system, left millions uninsured, and millions more with woefully inadequate coverage.

It has also cost far more than simply extending Medicare.

It could be argued that by not extending Medicare to cover all Americans, the government is not providing equal protection under the law.

It is well known that people without insurance or with high deductibles wait longer to seek medical care, thus their illnesses or problems become more difficult to treat. They suffer more from injuries and disabilities, resulting in decreased productivity and poorer quality of life.

They face financial hardships or ruin (half of bankruptcies in the United States are due to medical debt). And, sometimes they die because they have no insurance (an estimated 50,000 every year).

Those with Medicare have more protection against the devastating effects of illness and injury, get more help overcoming or living with disabilities, and are protected against financial ruin.

“Equal protection” has been used, with some success, to improve access to education and, now, to allow same-sex couples to marry. It seems that an even stronger case can be made regarding access to health care — which is considered a right in every other developed nation.

http://www.marinij.com/opinion/20150707/marin-ij-readers-forum-for-july-8

Medicare at 50: Successes, shortcomings

By Louis Balizet, M.D.
Pueblo (Colo.) Chieftain, July 30, 2015   

Fifty years ago – on July 30, 1965 – President Lyndon Johnson signed Medicare into law.

Medicare’s 50th birthday seems a good time to reflect on the program’s successes, shortcomings and future.

First, Medicare’s successes:

  1. Medicare insures access to health care for more than 50 million Americans.
  2. Medicare has covered hundreds of millions since 1965.
  3. Medicare is popular – ranking with Social Security as the most valued government service.
  4. Medicare has shielded countless millions from financial ruin due to medical expenses – protection that, outside the Medicare population, 35 million Americans still lack.
  5. Medicare has sparked spectacular growth in hospitals, medical practices, pharmaceutical companies and medical device manufacturers.
  6. Medicare is efficient – it operates with an overhead of 2 percent, compared to 20 percent in private health insurance.
  7. Incidentally, Medicare ended segregation in over a thousand hospitals in the South, since its substantial benefits were withheld from institutions that maintained separate wards based on race.

But Medicare has its shortcomings:

  1. Medicare has become intertwined with the private health insurance industry, making health care overall much more complicated and expensive for its beneficiaries.
  2. Medicare has failed to address adequately the cost of medical care.
  3. Medicare’s benefits are too thin in many instances; people over 65 spend an average of 20 percent of their income on health care expenses.

What is Medicare’s future?

Despite its shortcomings, Medicare is still the best template for delivering health care to all Americans in the future, much more so than the Affordable Care Act:

  1. Medicare’s shortcomings are fixable (as opposed to the ACA’s baked-in problems). Medicare’s benefits can be broadened, eliminating the need for most, if not all, supplemental private insurance. The statutory prohibition against bargaining for drug prices with pharmaceutical companies can be repealed.
  2. Thus modified, Medicare could simply be expanded to cover all Americans, eliminating in the process the ACA, Medicaid, CHIP and private medical insurance. The age for eligibility for Medicare could be lowered from your 65th birthday to the day you are born.
  3. The idea of National Health Insurance is not a crazy or unattainable one. It is the norm in every developed country in the world but ours.

I practiced medical oncology in Pueblo between 1976 and 2013. Over that time, an ever-increasing number of my patients suffered as much from the financial burden of their cancer care as the cancer itself. In fact, 2 percent of all cancer patients file for bankruptcy. 

Thanks to Medicare, people over 65 are largely shielded from the tragedy of financial ruin from illness. Should this protection not be afforded to all Americans, regardless of age? 

Medicare should be improved, streamlined, then expanded to all Americans. By showing us the way out of our present complicated, unfair and exorbitantly expensive medical system, Medicare may yet enjoy its finest hour. 

Dr. Louis Balizet practiced medical oncology in Pueblo between 1976 and his retirement in 2013, first at the Southern Colorado Clinic, then at Rocky Mountain Cancer Centers. He is active in Physicians for a National Health Program, a physician group that advocates for universal single-payer health care.

www.chieftain.com

Do Amy Finkelstein and colleagues show that Medicaid has little value?

The Value of Medicaid: Interpreting Results from the Oregon Health Insurance Experiment

By Amy Finkelstein, Nathaniel Hendren & Erzo F.P. Luttmer
National Bureau of Economic Research, Working Paper 21308, June 2015

Abstract

We develop a set of frameworks for valuing Medicaid and apply them to welfare analysis of the Oregon Health Insurance Experiment, a Medicaid expansion for low-income, uninsured adults that occurred via random assignment. Our baseline estimates of Medicaid’s welfare benefit to recipients per dollar of government spending range from about $0.2 to $0.4, depending on the framework, with at least two-fifths – and as much as four-fifths – of the value of Medicaid coming from a transfer component, as opposed to its ability to move resources across states of the world. In addition, we estimate that Medicaid generates a substantial transfer, of about $0.6 per dollar of government spending, to the providers of implicit insurance for the low-income uninsured. The economic incidence of these transfers is critical for assessing the social value of providing Medicaid to low-income adults relative to alternative redistributive policies.

http://www.nber.org/papers/w21308

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Valuing Medicaid

By Harold Pollack, Bill Gardner & Timothy Jost
The American Prospect, July 26, 2015

How Valuable Is Medicaid?

An important recent paper by Amy Finkelstein, Nathaniel Hendren, and Erzo Luttmer, “The Value of Medicaid,” tries to determine how much it is worth, but in a narrow way whose baseline assumptions understate the value of the program. The authors use data from the Oregon Health Insurance Experiment. The experiment worked like this: Oregon had more poor and uninsured people than they could insure under Medicaid. So they held a lottery for who could apply for Medicaid coverage. Finkelstein and her colleagues realized that this lottery was in effect an experiment that would allow them to study the impact of Medicaid coverage on the previously uninsured.  Following a reasonable — but contestable — economic methodology, Finkelstein and colleagues estimated an equivalent dollar-value to the improved health observed among lottery winners. The authors then explored what happened to a dollar that was spent on providing Medicaid: Who actually benefited and by how much? And would recipients have been willing to pay for their Medicaid benefits if they had to?

The study’s major findings, widely reported in The Wall Street Journal, Vox, Forbes, and many other media outlets, can be summarized as follows:

  1. Uninsured people who get Medicaid only gained from 20 to 40 cents in value from each dollar spent by the government.
  2. A principal reason why the benefit of getting insured was so small is that when uninsured people received care, they typically paid only 20 cents on the dollar for those services. Safety-net providers, state or local government, friends, relatives, or someone else absorbed the remaining costs. When a recipient became insured, Medicaid paid some of these costs at the rate of about 60 cents per dollar.
  3. Because a large fraction of Medicaid expenditures financed care that recipients would have received anyway (for example, by leaving bad debt at hospitals), it is unclear whether recipients themselves would have been willing to pay the full costs of Medicaid.

While the Oregon Health Insurance Experiment was a well-designed study, too few of the study participants experienced serious medical conditions to investigate how Medicaid affected their health or quality of life. In addition, the experiment — and thus Finkelstein, Hendren, and Luttmer’s study — did not examine how Medicaid affected recipients’ families or the health-care institutions that care for low-income uninsured patients. Medicaid’s long-term benefits as an investment in infants and children were also beyond the scope of the Oregon experiment.

But perhaps the most important limitation of the study stems from an assumption that many readers would be unlikely to notice. Finkelstein and her colleagues placed a very low value — $25,000 — on a year of additional life for Medicaid beneficiaries. The typical threshold used in health services research is much larger, in recent studies far above $100,000 per additional year of (healthy) life. Yet because the median income of the Oregon study participants was about one-fourth of the median income in the United States, the researchers chose to value an additional life-year at about one-fourth of the usual threshold. This assumption powerfully frames everything that follows in this analysis. After all, if you start out by assuming that Medicaid beneficiaries’ lives are worth very little, you will find that it is not worth spending much money to prolong them.

Although Finkelstein, Hendren, and Luttmer’s baseline assumptions are methodologically defensible, they have radical implications that are rarely so bluntly applied in other domains of health-policy research. Choices about how to financially value the health of poor people relative to the health of others are inevitably both politically and morally freighted. It strains credulity, for example, to imagine American policymakers using this low a value for life when analyzing mammography, prostate cancer treatment, or implantable cardiac defibrillators for seniors.

The authors are careful not to make any normative statements based on these findings, but others such as Michael Cannon, Tyler Cowen, and John Graham have done so. They make two arguments: First, Medicaid is an inefficient way to benefit the poor. If a Medicaid dollar results in only 20 cents in benefit to a previously uninsured person, wouldn’t it be more efficient to simply give that person a dollar? And, second, Medicaid is actually a subsidy for people other than those it ostensibly helps.

We see matters rather differently. Economists have long understood that poor people would prefer cash to subsidized health insurance (especially if they can still get health care for free). So why does every developed country, including the United States, subsidize health insurance for the poor? Part of the reason is that those countries have broader moral and public-health criteria for thinking about health insurance and poor people’s lives. Universal health care expresses a commitment to the well-being of fellow citizens. Everyone should have access to a decent minimum of care; caring for others in distress is a primary expression of human solidarity.

http://prospect.org/article/valuing-medicaid

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Quotes from conservatives cited above:

Michael Cannon: “The (Finkelstein et al) trio found that Medicaid enrollees receive very little benefit from each dollar spent on Medicaid.”

Tyler Cowan:  “An implication of this is that the poor would be better off getting direct cash transfers.”

John Graham:  “Only 20 to 40 cents of Medicaid spending actually goes towards patients’ welfare.” 

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Comment:

By Don McCanne, MD

This NBER study by Amy Finkelstein and her colleagues on the value of Medicaid is important in that it is being used by conservatives to discredit Medicaid, giving fodder to opponents of this program. For that reason, it is important to understand the limitations of the narrow assumptions used in the study, and that is why the article by Harold Pollack and his colleagues is so important.

The Finkelstein article is challenging for the non-economist, but one assumption stands out as a basis for countering the claims of the conservatives who would use this to diminish support for Medicaid. That assumption in this study is that a year of life is worth about $25,000 for Medicaid beneficiaries when most studies assign a value closer to $125,000 per quality-adjusted life year ($100,000 to $150,000). When private insurance extends life by a year it is worth about five times what that same year of life would be worth for a low-income Medicaid beneficiary, so this study seems to assume. According to Pollack, et al., “… if you start out by assuming that Medicaid beneficiaries’ lives are worth very little, you will find that it is not worth spending much money to prolong them.”

Another bizarre line of reasoning is that much of the Medicaid money does not benefit the patient because it goes to physicians, hospitals, and Medicaid managed care organizations. The assumption seems to be that if the patient was not covered by Medicaid, the care would be provided anyway on a charity basis. Thus the patient does not receive any benefit from Medicaid because charity care and care under Medicaid are supposedly the same (not true), whereas the physicians and hospitals would benefit by receiving Medicaid income for what would otherwise be charity care. Would these conservatives seriously contend that private insurance provides little value for patients since the money goes to the physicians, hospitals and insurers and not to the patient? Of course not. Private insurance funds are used to purchase health care, providing considerable value for the patient. So how can they say that Medicaid funds are simply diverted to the health care delivery system, providing little value for the patient?

This is yet one more study to come out of the Oregon Health Insurance Experiment. The raw data in these studies are valid but the assumptions made and the interpretations extrapolated from them are being used to make claims such as, “Medicaid enrollees receive very little benefit from each dollar spent on Medicaid.” Medicaid saves lives, reduces suffering, and prevents financial hardship. That has real value.