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Remembering Dr. Mary Allott Agna

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Remembering Dr. Mary Allott Agna

By YS News Staff
Yellow Spring News, Jan. 15, 2015

Mary Allott Agna passed away at home on Jan. 6. She was 90.

Mary was born on Sept. 18, 1924, in Alliance, Ohio, to Gwen and Guy Allott. She was so proud of being their daughter — her mother was one of the first registered nurses in the state of Ohio and helped nurse many young men at Camp Sherman through the flu epidemic of 1918. Her father was the mayor of Alliance and owned the local hardware store where she worked during the Great Depression, supporting many families through a barter system. Her father became blind as an adult and she and her mother were his eyes, allowing him to continue to be a productive and active person until his death. They climbed Mt. Katadin together and traveled extensively.

Mary attended Mt. Union College in Alliance and graduated from the University of North Carolina at Chapel Hill with a major in bacteriology. She became a physician, graduating from the University of Cincinnati Medical School in 1949. She met her husband, James W. Agna, at UC. They celebrated 65 years of marriage in September 2014. Theirs was a remarkable love and a devoted partnership. They led lives of service and dedication to social justice and change. They were in the U.S. Public Health Service in Burma (Myanmar) from 1951–53. Mary had her first of five children, Gwen Agna, there, in Rangoon in 1952. Four more children were added to the family: Jacob, Molli (Diebold), Brigitte and Tom. She and Jim moved their family to Haiti in 1958 and worked at the Hôpital Albert Schweitzer, in St. Marc.

The family established their home in Yellow Springs in 1959. Mary worked as a research assistant in anthropology at the Fels Institute for Human Development and also as a physician at the Yellow Springs Clinic. She then served as the Clark County health commissioner and after as the Greene County health commissioner, where she was responsible for instituting many progressive community health practices. During that time, she also served as clinical preceptor for the Department of Environmental Health at the University of Cincinnati (1965–70). The family moved to Cincinnati in 1970, where she and Jim joined the University of Cincinnati Medical School faculty. She became the assistant clinical professor of environmental health and community medicine at UC and the Assistant Health Commissioner for the Cincinnati Health Department (1970–74). She then served as the chief health officer for the Northern Kentucky District Health Department. In 1974, she secured a federal grant to start the first family medicine residency in the U.S. at the University of Cincinnati, where she became the assistant dean of the College of Medicine and associate professor of family medicine.

In 1979, Mary and Jim returned to live in Yellow Springs, where they both joined the Wright State University Medical School faculty. Mary was the associate professor and vice chairman of the department of family medicine, as well as the associate professor of community medicine and professor emeritus at Wright State. Mary was a member of the University of Cincinnati and the Wright State University Medical School Admissions Committees for 43 years, retiring from Wright State’s in 2013. During her years on the Wright State Admissions Committee, the number of women medical students rose to over 50 percent, in part due to Mary’s commitment to equal representation between men and women.

Mary was a lifetime member of the American Academy of Family Practice, member of the Greene County Medical Society, the Ohio Academy of Family Practice, the Ohio Public Health Council (1974–81 and 1989–96) and Phi Beta Kappa.

Mary served in many volunteer community roles in Cincinnati and in Yellow Springs, including as the chair of the Board of Trustees of Friends Care Center Long Range Planning Committee and the national Professional Advisory Committee of Coordinated Home Care. She was instrumental in making sure the elderly nationwide had the option of living out their final days in their homes, where she did. She volunteered at Planned Parenthood clinics, reflecting her commitment to women’s reproductive rights and advocacy for low-income and underserved women. She and Jim are lifelong members of Physicians for National Health Care Program, being committed to universal health care for all. They were active in the civil rights movement and were one of the families in Yellow Springs who welcomed an African-American student, Sam Taylor, to their family in 1960 so he could attend John Bryan High School when the high school in Farmville, Va., closed rather than integrate.

In her retirement, Mary taught knitting to Yellow Springs High School students and was active in the Council on Aging and the Yellow Springs Senior Center. She was a member of the Yellow Springs Shakespeare Club and the Unitarian Universalist Fellowship of Yellow Springs. She was an avid reader of books and of the New York Times, The Nation and The New Yorker.

Mary will be remembered as someone who always delighted in other people’s company and for her joie de vivre (she loved the French language, too). Mary was so kind, warm and humble. She did not suffer cruelty or hypocrisy. Over the years, she and Jim loved to entertain family and friends with Burmese curry dinners and cookouts. She was a lover of nature, opera, and all things Native American. Mary’s great lifelong passion was horses. She grew up with them, remembering all by name and personality. Her last horse, Kizzie (Kismet), a Tennessee Walker, lived at the Funderburg farm, where she rode every day through her early 80s. She taught many to ride and to respect horses, most especially her children and grandchildren.

Mary’s professional and volunteer accomplishments were legion. But by far, her and Jim’s greatest achievement, in their eyes, is their family. They all gathered to celebrate her 90th birthday in September and published a book of her letters and memoirs in honor of the occasion. She is survived by her husband, James; daughters Gwen (Tom Marantz), Molli (Steve Diebold) and Brigitte (Andrew LaCroix); sons Jake (Patty Tobias) and Tom; grandchildren Nell Marantz (Alex Smith) and Kate Marantz, Eve Ackil (Dan Ackil) and Mae Agna, Chad, Paige Diebold Babb (Brian Babb), Faye and Jake Diebold and James Wasihun Agna LaCroix; great-grandchildren Esme Fielder Smith-Marantz and Lila Mae Ackil and many dear friends. Jim, her children and her grandchildren were so proud of her, of her accomplishments and of being a part of her family.

The family wishes to thank Teresa Bondurant for her loving care, the care assistants at Arcadia Home Care, Hospice of the Miami Valley, Dr. Pam von Matthiessen and Friends Care Center. In lieu of flowers, donations in her memory can be made to Physicians for a National Health Program 29 E. Madison, Suite 1412, Chicago, IL 60602 or Yellow Springs Community Foundation, P.O. Box 55, Yellow Springs, OH 45387. 

Mary Allott Agna

Majority still support single-payer option, poll finds

By Sarah Ferris
The Hill, January 19, 2015

More than five years after the single-payer system was scrapped from ObamaCare policy debates, just over 50 percent of people say they still support the idea, including one-quarter of Republicans, according to a new poll.

The single-payer option – also known as Medicare for all – would create a new, government-run insurance program to replace private coverage. The system, once backed by President Obama, became one of the biggest casualties of the divisive healthcare debates of 2009.

The idea remains extremely popular among Democrats, with nearly 80 percent in support, according to the poll, which was shared first with The Hill by the Progressive Change Institute.

“There is a hunger in America for big progressive ideas,” spokesperson TJ Helmstetter wrote in a statement. “The state of our union is progressive, and the president would be smart to give America the big, popular, progressive economic ideas that people have been crying out for.”

Another proposed idea under ObamaCare – the public option – also retains wide approval.

Only 13 percent of people said they opposed the public option, which would give individuals the choice of buying healthcare through Medicare or private insurers.

The Progressive Change Institute, which is a sister organization of the million-member Progressive Change Campaign Committee, has long supported the public option, which Helmstetter said would “level the playing field for consumers and dilute the power of insurance companies.”

The approach was also an initial part of Obama’s reform plan, though it was attacked by both parties on the Hill and was ultimately rejected in favor of a new, government-funded healthcare system based on subsidies.

At the time, Democrats leading the negotiations were accused of caving into corporate interests, while Obama was accused of “selling out.”

As recently as 2009, Obama has also said he is a proponent of the single-payer system, which remains far more controversial among policy experts.

The poll was comprised of 1,500 likely voters and was conducted this month by the firm GBA Strategies.

http://thehill.com/policy/healthcare/229959-majority-still-support-single-payer-option-poll-finds

Single Payer: It’s What the People Want

New poll shows majority of Americans support such a system

By Andrea Germanos
Common Dreams, Jan. 20, 2015

A majority of Americans support a single-payer, Medicare-for-all healthcare system, a new poll shows.

The results showed that just over 50 percent of the 1,500 likely voters surveyed indicated support for a single-payer system. Almost 80 percent of Democrats supported such a plan, while 25 of Republicans did.

The findings were first shared with The Hill by the Progressive Change Institute, an arm of the Progressive Change Campaign Committee.

The new poll comes on the heels of Vermont Governor Peter Shumlin’s abandoning what was seen as a trailblazing plan to create a single-payer healthcare system in his state. The move was derided by Dr. Andrew D. Coates, immediate past president of Physicians for a National Health Program, who said, “Vermonters throughout the state understand that an equitable health care system must be truly universal and must remove all financial barriers to medically necessary care. They recognize that a public single payer is an essential incremental step toward these goals.”

“The time for a single-payer system is now. Our patients in every state urgently need it,” Coates added.

That sentiment is widely shared.

Dr. James Burdick, Professor of Surgery at Johns Hopkins University School of Medicine, wrote in May that a single-payer system “is now recognized by many in the U.S. as the best solution for our health care problems.”

Larry Smith, one of the subjects of Michael Moore’s 2007 documentary film SiCKO, focused on the system’s economic benefits, writing last month: “Single-payer health care reform (some call it improved and expanded Medicare for all for life) isn’t just good for those folks under 65 who aren’t yet on Medicare. Single-payer financing for our health care system isn’t just good for public budgets and business bottom lines. Single-payer health care reform would allow most of us to spend a lot less than we do now on health care costs.”

As Donna Smith, Larry’s wife and indefatigable single-payer advocate has stressed, making a change to single-payer would also uproot the current system which she describes as a profit-driven healthcare “cartel.”

“If we had an improved and expanded Medicare-for-all for life system, financed through a public, single-payer model, our system would be just that—our health care system. We would be the ones making sure that good health care access and fairly negotiated pricing was done in the best interests of us all. Until then, we are at the mercy of the health care cartel that is so powerful that it currently controls almost one-fifth of the U.S. economy,” she wrote.

Single-payer supporter Senator Bernie Sanders (I-Vt.) agrees: “The goal of real health-care reform must be high-quality, universal coverage in a cost-effective way—with an emphasis on disease prevention. We must ensure, to as great a degree as possible, that the money we put into health coverage goes to the delivery of health care, not to paper-pushing, astronomical profits and lining CEOs’ pockets.”

Andrea Germanos is a staff writer at Common Dreams.

This work is licensed under a Creative Commons Attribution-Share Alike 3.0 License

http://www.commondreams.org/news/2015/01/20/single-payer-its-what-people-want

What would Martin Luther King, Jr. say about the Oxfam brief?

Second Convention of the Medical Committee for Human Rights, March 25, 1966

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” — Dr. Martin Luther King, Jr.

http://www.huffingtonpost.com/amanda-moore/martin-luther-king-health-care_b_2506393.html

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Oxfam, Issue Brief, January 19, 2015

Global wealth is increasingly being concentrated in the hands of a small wealthy elite. These wealthy individuals have generated and sustained their vast riches through their interests and activities in a few important economic sectors, including finance and pharmaceuticals/healthcare. Companies from these sectors spend millions of dollars every year on lobbying to create a policy environment that protects and enhances their interests further.

*  In 2014, the richest 1% of people in the world owned 48% of global wealth, leaving just 52% to be shared between the other 99% of adults on the planet.1 Almost all of that 52% is owned by those included in the richest 20%, leaving just 5.5% for the remaining 80% of people in the world.

*  The very richest of the top 1%, the billionaires on the Forbes list, have seen their wealth accumulate even faster over this period. In 2010, the richest 80 people in the world had a net wealth of $1.3tn. By 2014, the 80 people who top the Forbes rich list had a collective wealth of $1.9tn; an increase of $600bn in just 4 years, or 50% in nominal terms. The wealth of these 80 individuals is now the same as that owned by the bottom 50% of the global population, such that 3.5 billion people share between them the same amount of wealth as that of these extremely wealthy 80 people. In 2010, it took 388 billionaires to equal the wealth of the bottom half of the world‟s population; by 2014, the figure had fallen to just 80 billionaires.

*  In 2014 there were 1,645 people listed by Forbes as being billionaires. This group of people is far from being globally representative. Almost 30% of them (492 people) are citizens of the USA.

*  Between 2013 and 2014 billionaires listed as having interests and activities in the pharmaceutical and healthcare sectors saw the biggest increase in their collective wealth. Twenty-nine individuals joined the ranks of the billionaires between March 2013 and March 2014 (five dropped off the list), increasing the total number from 66 billionaires to 90, in 2014 making up 5% of the total billionaires on the list. The collective wealth of billionaires with interests in this sector increased from $170bn to $250bn, a 47% increase and the largest percentage increase in wealth of the different sectors on the Forbes list.

*  During 2013, the pharmaceutical and healthcare sectors spent more than $487m on lobbying in the USA alone. This was more than was spent by any other sector in the US, representing 15% of $3.2bn total lobbying expenditures in 2013. In addition, during the election cycle of 2012, $260m was spent by this sector on campaign contributions. Twenty-two of the 90 pharmaceutical and healthcare billionaires are US citizens.

http://www.oxfam.org/sites/www.oxfam.org/files/file_attachments/ib-wealth-having-all-wanting-more-190115-en.pdf

Comment:

By Don McCanne, MD

In 1966, Martin Luther King, Jr. famously noted that injustice in health care was the most shocking and inhumane form of inequality. The Oxfam brief issued today – Martin Luther King, Jr. Day – gives some insight as to how well we are fulfilling his dream of social justice for all. We are seeing exponential increases in wealth inequality and the fastest expansion of that inequality is in the pharmaceutical and health care sectors.

Are we still learning from him, or have we given up?

Why do we need to improve Medicare?

Medicare at 50 — Origins and Evolution

By David Blumenthal, M.D., M.P.P., Karen Davis, Ph.D., and Stuart Guterman, M.A.
The New England Journal of Medicine, January 14, 2015

Many Americans have never known a world without Medicare. For 50 years, it has been a reliable guarantor of the health and welfare of older and disabled Americans by paying their medical bills, ensuring their access to needed health care services, and protecting them from potentially crushing health expenses. However, as popular as Medicare has become, Congress created the program only after a long and deeply ideological struggle that still reverberates in continuing debates about its future.

Future Challenges

Medicare is a much larger, more comprehensive, and more complex program than it was in 1965. In its response to cost and quality concerns, it has also become much more assertive in trying to improve the performance of the national health care system. For much of its history, Medicare just paid bills. Now, it has joined private-sector insurers in the effort to manage care as well.

Despite these changes, however, Medicare continues to face major challenges, which will be discussed in more detail in part two of this series. Perhaps the most important of these challenges is its cost. Growth in Medicare spending per beneficiary has slowed sharply in recent years, and although that slowdown is projected to continue over the next few years, the growth in total program spending is projected to outpace that in the overall economy as the retiring baby-boom generation increases the number of beneficiaries. This will put more pressure not only on Medicare finances but also on the federal budget, with Medicare spending projected to rise as a share of federal revenues from 17% in 2014 to 27% in 2050 and to approach 40% by the end of the century.

The current structure of Medicare is anachronistic and unnecessarily complex. Most employers offer their employees a comprehensive benefit package that includes hospital care, physician services, and prescription drugs. Medicare, in contrast, offers its beneficiaries fragmented coverage, with separate parts for each of these services. As a result of its substantial deductibles and the lack of a ceiling on out-of-pocket costs, most beneficiaries purchase supplemental private insurance to cover gaps in Medicare. Low-income beneficiaries, unable to afford care provided through substantial cost sharing in Medicare, can enroll in Medicaid to obtain help in paying Medicare premiums and out-of-pocket costs, but each state has its own income and asset rules. As a result, the complexity of the current insurance system for the elderly becomes truly startling. This complexity frustrates efforts to coordinate care for the sickest and frailest patients and to create an understandable and consistent set of incentives for providers.

Despite the importance of Medicare in improving its beneficiaries’ access to care, the program does have substantial limitations in coverage. These limitations result in large out-of-pocket payments for the most vulnerable beneficiaries. Although Medicare covers some rehabilitation services and limited home care, it does not pay for extended long-term services and supports, a gap that surprises many elderly persons and their families when they need such care. Medicaid does cover these benefits but only for the poorest elderly. The role of Medicare in addressing growing societal needs for long-term services remains uncertain.

These and other issues suggest that preserving and strengthening Medicare over the next 50 years will continue to require active, wise, and humane policy development. Such a task would be a challenge for the federal government under any circumstances but particularly if the current intense partisan divisions persist.

http://www.nejm.org/doi/full/10.1056/NEJMhpr1411701

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Comment:

By Don McCanne, MD

Although Medicare is the most popular health insurance program in the nation, it still has some serious deficiencies. As an example, 27 percent of Medicare beneficiaries spend more than 20 percent of their income for out-of-pocket health care expenses.

There are two pressing reasons why efforts should be made to strengthen Medicare. The most obvious is that current Medicare beneficiaries should have at least the level of financial security and health security that citizens of other nations receive through their health care financing systems.

The other reason is that Medicare is thought by many to be a natural model for a national health program that covers everyone. It is important that the model be improved so that we can do away with wasteful and inefficient supplementary programs such as Medigap coverage, retiree health benefits, Medicare Advantage plans, and Part D drug plans, and, while we are at it, eliminate the financial barriers of cost sharing that impair access to care. Once we have an improved Medicare we can combine it with the other important features of a single payer national health program, finally realizing our dream of an expanded and improved Medicare for all.

For those who wish to be reminded of the key features of single payer that should be combined with an improved Medicare, a brief list is at this link:

https://www.pnhp.org/resources/key-features-of-single-payer

Single-payer system would free $375 billion for health care

By Isaiah J. Poole
Campaign for America’s Future, Jan. 15, 2015

A new study has put a price tag on how much more the United States pays in health care costs because it has chosen not to adopt a single-payer system: $375 billion.

That figure, in a report published this week in the online journal BMC Health Services Research, represents the excess administrative costs imposed by our private billing and insurance system in 2012. It would have been enough, the report said, to provide every uninsured American with health coverage and upgrade coverage for millions of others who are carrying inadequate, bare-bones policies.

“We could provide everyone with good care and remove the complex and onerous cost-sharing that we have in the current system,” said James G. Kahn, senior author of the study and a researcher at the Philip R. Lee Institute for Health Policy Studies at University of California at San Francisco, in an interview with OurFuture.org.

“Not to put too fine a point on it, but by spending this money on health care, we could save lives,” he said.

The report, which also includes input from physicians and health policy researchers from the City University of New York School of Public Health and Harvard Medical School, said that the United States spent a total of $471 billion in medical billing paperwork and insurance-related red tape.

A single-payer system, they estimate, would eliminate 80 percent of that cost.

The finding not only serves to underscore the extent to which the Affordable Care Act has only tinkered around the edges of the health care system, when in fact a full rethinking of how we deliver health care is needed, but it is fodder for a rebuke of the conservative “repeal and replace” mantra, which would double down on the Rube Goldberg private insurance system and leave patients even more vulnerable to its complexities and costs.

Giving patients more “skin in the game” by requiring them to shoulder more of the health care cost burden would simply prompt people to not get the health care they need at those times when they are in a position to make a decision, Kahn said. Especially during emergencies, when health care costs are typically highest, “there is no evidence at all that the skin-in-the-game strategy is a way to control health care costs.”

Kahn points out that there is “a critical mass” of Americans who support movement toward a single-payer system, and there are groups of health care experts who are working to educate the public about the remaining work that needs to be done to offer Americans a health care system that provides universal coverage and is cost-efficient. 

“If I and my colleagues can document in stark terms the ways we are wasting money – that is more than $1 trillion over three years – that will convince people that we really need to achieve that change, even though at the moment it seems tough,” he said.

For more, including an audio of the interview described above, click here: http://ourfuture.org/20150115/single-payer-system-would-free-375-billion-for-health-care-audio

Group pushes for single-payer health care system

Under a single-payer system, the government would cover all health care costs

By Tiffany Chan
22News – WWLP (Boston), Jan. 15, 2015

Health care isn’t just expensive for you; it’s costing the state billions of dollars each year. That’s why some state lawmakers are pushing for a single-payer system.

“Who can understand their hospital bill today? I can’t. We can get over that, get simple, get responsive and make sure health care works for the people,” said former gubernatorial candidate Dr. Donald Berwick.

Dr. Berwick met with state lawmakers to stress the need for change in the health care system,

arguing that the current system is far too expensive and complicated. Berwick hopes the state will move toward a single-payer health care system instead. Under a single-payer system, the government would cover all health care costs.

Advocates didn’t specify how the state would fund a single-payer system or how much it would cost, but say overall the measure would lower costs for families.

Ture Turnbull, executive director of MassCare said, “The cost to the state will be adjusted, but the actual individual, family and business will pay less in health care with a single-payer.”

It would to be quite awhile before Massachusetts could adopt a single-payer system.

Berwick says they’ll have to convince the public and state lawmakers that it’s a good idea, but he believes it’s possible: “It’s a big ask, but I think this state can do it and I’d love to see us be the model for the nation.”

Opponents of single payer are concerned with having a government-run health care system.

See more, including video, here: http://wwlp.com/2015/01/15/group-pushes-for-single-payer-health-care-system/

Over 60 million still face medical-related financial difficulties

The Rise in Health Care Coverage and Affordability Since Health Reform Took Effect

By Sara R. Collins, Petra W. Rasmussen, Michelle M. Doty, and Sophie Beutel
The Commonwealth Fund, January 15, 2015

Abstract 

New results from the Commonwealth Fund Biennial Health Insurance Survey, 2014, indicate that the Affordable Care Act’s subsidized insurance options and consumer protections reduced the number of uninsured working-age adults from an estimated 37 million people, or 20 percent of the population, in 2010 to 29 million, or 16 percent, by the second half of 2014. Conducted from July to December 2014, for the first time since it began in 2001, the survey finds declines in the number of people who report cost-related access problems and medical-related financial difficulties. The number of adults who did not get needed health care because of cost declined from 80 million people, or 43 percent, in 2012 to 66 million, or 36 percent, in 2014. The number of adults who reported problems paying their medical bills declined from an estimated 75 million people in 2012 to 64 million people in 2014.

Conclusion

For the first time since it was launched in 2001, the Commonwealth Fund Biennial Health Insurance Survey has found significant declines in the number and share of U.S. adults who lack health insurance. The survey also finds evidence to suggest that the coverage gains are allowing working-age adults to get the health care they need while reducing their level of financial burden because of medical bills and debt.

But, while there were minor improvements reported by insured adults in cost-related access and medical bill problems, rates of these problems remain high, especially among adults with low incomes. Prior Commonwealth Fund survey results have found that the increasing size and prevalence of high deductibles and copayments in private health plans, including employer-based plans, is leading many people with low and moderate incomes to avoid or delay needed health care. Excessive cost-sharing for Americans across all insurance types could jeopardize improvements in access to care and medical bill burdens documented in the survey.

States’ decisions to reject the Medicaid expansion have left large numbers of the poorest Americans in the country without health insurance. Since the survey was fielded in July, one additional state has expanded its program, seven others are in discussions to move to forward, and still others may follow their lead this year.

http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2015/jan/1800_collins_biennial_survey_brief.pdf

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Comment:

By Don McCanne, MD

The media reports on the new Commonwealth Fund study are celebrating the reduction in the numbers who remain uninsured and the reductions in the financial consequences of being uninsured, supposedly proving that the Affordable Care Act is working. What is difficult to celebrate is confirmation that there are still 66 million people who did not get needed health care because of cost, and there are 64 million people who still reported problems paying their medical bills.

Rather than celebrating a modest improvement in the statistics we should be be using this report to condemn the gross inadequacies of the Affordable Care Act that leave in place the financial barriers that have negatively impacted over 60 million people, and have the potential to have the same negative impact on tens of millions more should they incur a need to access the health care system.

For those who say, “But this is working,” it is not working for the vast majority for whom our prior system fell cruelly short. Continuing this highly flawed experiment constitutes unethical experimentation when we know that a single payer system with full prepaid financing will remove the financial barriers and hardships that are perpetuated by the Affordable Care Act.

When you have a forest fire, you don’t pull out the candle snuffers; you call in the tankers. Likewise, when our health care financing system is leaving tens of millions broke and without adequate care, you don’t tweak what we have; you mobilize a powerful system that actually would work – an improved and expanded Medicare for all.

Single payer reform would eliminate financial barriers to medical care

By Vanessa Van Doren and Joshua Niforatos
The Plain Dealer (Cleveland), Letters, Jan. 15, 2015

In her Jan. 15 Sun News column, “Medicaid expansion not healthy for individuals, government: Sarah Bevins, Libertarian Party of Ohio,” Sarah Bevins argued for complete cessation of all government safety-net healthcare programs that provide life-saving medical care to the poorest Americans. She believes a free-market healthcare system will improve access to care and reduce costs despite evidence to the contrary.

Even with Medicare, Medicaid and CHIP covering vulnerable citizens, 44,000 people die each year due to lack of health insurance. Medical bills are the leading cause of bankruptcy in the U.S., even for those with health insurance.

Bevins incorrectly attributes paperwork hurdles to Medicaid when in fact these hurdles exist because of the rules and red tape that are a result of multiple insurers.

Single Payer Reform is a solution to these problems. Every resident of the U.S. would be enrolled in an improved Medicare that covers all necessary medical care. Over $300 billion yearly in savings will be obtained by transitioning to a public payer. Patients will no longer face financial barriers to care and would regain free choice of doctor and hospital.

Ohioans need to decide if they want a free-market model that benefits only the affluent of society, or if they want a healthcare model that is known to work and provides improved and expanded care for all.

Van Doren and Niforatos are medical students at Case Western Reserve University School of Medicine and co-founders of a student chapter of Physicians for a National Health Program.

http://blog.cleveland.com/letters/2015/01/medicaid_letter_to_the_editor_1.html

Co-ops reflect the callous deception of Congress

CO-OP (Consumer Operated and Oriented Plan) Health Plans under the Affordable Care Act

PNHP, Quote of the Day, July 18, 2011

From the comment by Don McCanne:

The proposed rule has now been released for the establishment of CO-OPs under the Affordable Care Act. The CO-OPs are private, nonprofit organizations that sell insurance, like HMOs and PPOs, under the same rules as the other private insurers. The most important difference is that a CO-OP is controlled by a board of directors that is elected by the individuals enrolled in the CO-OP.

These are new organizations, and, as such, require a new infusion of capital to meet the reserve requirements for future claims. These are the same requirements that have been established by the states for other private insurers already competing in the marketplace.

Private, for-profit insurers have the capability of establishing start-up costs and solvency reserves by selling shares of stock. Since the CO-OPs are nonprofit, they don’t have this resource to tap. Recognizing this, the Affordable Care Act included provisions for government loans for start-up costs and other loans for solvency (reserve funds for future claims). It is important to understand that these are not grants but are loans that must be repaid, with interest, within five years for start-up loans and fifteen years for solvency loans.

Think about that. The CO-OPs are required to compete with the private insurers under the same terms, while having the additional requirement of paying back these loans. Since their only revenue source is premiums for the insurance they are selling, these loan costs that their competitors don’t have will have to be recovered through higher premiums. Under these terms, how could they possibly compete with the private insurers?

There are many other issues. How long would it take to establish a critical threshold of enrolling enough members to create a viable entity? Since it is likely that the CO-OPs would be subject to adverse selection (enrolling a larger share of patients with greater health care needs), there would be further upward pressure on their premiums (death spiral) since current risk adjustment tools do not recover the full excess losses (as if health care is a “loss”).

It’s too bad. CO-OPs should have offered us the opportunity to establish altruistic health care organizations. Instead, the politicians bent over backwards not only to keep the government out of these programs, but also to protect the private insurers’ marketplace by being sure that the CO-OPs were not allowed a fair playing field by saddling them with insurmountable debt.

We needed a seat at the table.

https://www.pnhp.org/news/2011/july/co-op-consumer-operated-and-oriented-plan-health-plans-under-the-affordable-care-act

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Health Insurance Startup Collapses In Iowa

By Clay Masters, Iowa Public Radio
NPR/Kaiser Health News, January 14, 2015

CoOportunity Health has failed. The Affordable Care Act set aside funding for health care co-ops, to enable the organizations to compete in places where there aren’t many insurers. CoOportunity Health was the second largest co-op in the country in terms of membership, and one of the largest in terms of the federal funding it received.

But then CoOportunity hit a kind of perfect storm, says Peter Damiano, director of the University of Iowa’s public policy center. First, the co-op had to pay a lot more medical bills than those in charge expected.

“CoOportunity Health’s pool of people was larger than expected, was sicker than expected,” Damiano says. “So their risk became much greater than the funds that were available,”

When the Obama administration in late 2013 allowed people to keep the insurance plan they already had, many customers happy with Wellmark stayed put. Damiano says this meant many of the customers who flocked to CoOportunity tended to be… people with expensive health problems who’d had trouble paying for insurance before, in the market Wellmark dominated.

“It was always going to be a challenging market to try to reach,” says Damiano, “and on top of that, the whole idea of co-ops was relatively new and experimental. But it was to try to create competition, on that private sector approach,” says Damiano.

According to Nick Gerhart, Iowa’s insurance commissioner… the co-op thought it was going to get more federal money. “On December 16 around 4 o’clock we were informed they weren’t going to get any further funding,” he says. “Nothing was pulled — it just wasn’t extended further.”

“Ours was the second largest in the country, so you’ve got to look at it that way.” Gerhart says. “If the second largest can’t make it, how viable are the other ones? I don’t know. But at the end of the day they didn’t have enough capital to support 120,000 members.”

http://kaiserhealthnews.org/news/health-insurance-startup-collapses-in-iowa/

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Comment:

By Don McCanne, MD

Those of us who watched closely as the health care reform process unfolded were outraged by many of the decisions made by the members of Congress. As single payer supporters we were denied a seat at the table. Regardless, we still tried to inform the process but we were routinely ignored. “What you guys want is just not politically feasible.”

Look what I wrote July 18, 2011: “It’s too bad. CO-OPs should have offered us the opportunity to establish altruistic health care organizations. Instead, the politicians bent over backwards not only to keep the government out of these programs, but also to protect the private insurers’ marketplace by being sure that the CO-OPs were not allowed a fair playing field by saddling them with insurmountable debt.”

Now look at what happened to CoOportunity – the second largest co-op in the country. Not only did they enroll patients with greater health care needs, as we predicted, but the government loans were inadequate to maintain its viability. The success in enrolling large numbers of members accelerated the demise of this co-op, but what about the others? With the premiums they receive, how will they be able to pay for the health care services of a higher risk population plus service their loans at the same time – loans that competing private insurers do not have to face?

It isn’t that we didn’t know how to design a proper health care financing program. We clearly did – single payer. What is tragic is that the Affordable Care Act was designed to take special care of the private insurance industry while supposedly showing some vague, deceptive semblance of improving access and affordability for the patients served, though caring for patients was certainly a lower priority than catering to the private insurers.

With 30 million people being left uninsured, and with the establishment of a new insurance standard of unaffordable under-insurance, our members of Congress sure did a crappy job – not just crappy but far worse – it was callous and inhumane.

The Affordable Care Act in 2015 — where do we stand?

By Louis Balizet, M.D.
Health News Colorado, Jan. 12, 2015

The beginning of the new year seems a logical time to review the Affordable Care Act and to speculate on its future. In 2014, we saw the start of the exchanges and Medicaid expansion, the end of Vermont’s attempt to expand coverage beyond the ACA, and continued legal challenges aimed at killing the ACA piecemeal. What do all these portend for 2015?

Approximately 6 million previously uninsured Americans obtained health insurance coverage last year through federal and state exchanges, with the federal exchange accounting for most of the sign-ups.

Exchange performance for 2015 policies is smoother overall than last year’s chaotic debut, but it is unclear at the present time how many more people will be enrolled. Early returns suggest the increase will be modest.

Colorado’s exchange is beset by the recent mass exodus of upper-echelon management and concerns about financial viability when federal support expires at the end of this year. Nationwide, most policies sold in 2014 were of low actuarial value (bronze or silver), exposing policyholders to out-of-pocket expenses up to $6,000 apiece.

Most would agree, however, that being underinsured is preferable to being uninsured. Medicaid expansion provided coverage for an additional 4 million, a figure that could have been 2 million higher were it not for the opt-out opportunity handed Republican governors by the Roberts Court in 2012.

Pennsylvania elected to expand Medicaid for 2015, using an attenuated version; 100,000 have signed up so far. Arkansas may rescind its 2014 Medicaid expansion, withdrawing coverage from over 200,000 people. Arizona’s planned 2015 expansion is being held up by Republican legislators’ legal maneuvers.

The most populous states to refuse Medicaid expansion, Texas and Florida, remain obdurate. Thus, it is unlikely that significantly more people will be covered by Medicaid in 2015 than were in 2014.

While states largely concentrated in the old Confederacy took every opportunity to shield its citizens from the perceived evils of the ACA by declining Medicaid expansion and state exchanges, liberal Vermont headed in the opposite direction.

Reflecting a decade of preparation by single-payer advocates and led by unabashedly pro-single payer Gov. Peter Shumlin, Vermont attempted to fashion universal coverage for its residents through Green Mountain Care. This government-run enterprise aimed at replacing private insurance with comprehensive (platinum-level plus) tax-supported benefits.

Last month, however, Shumlin pulled the plug on the project, citing unacceptably high levels of taxation that would have been needed to fund benefits. The Vermont attempt to provide universal coverage was doomed to failure, however, because it was nowhere near a single-payer system.

Green Mountain Care would have had to co-exist with large private employer plans, Medicare, Tricare, the V.A.; it could not solve the conundrum of how to cover Vermonters working out-of-state and out-of-staters working in Vermont.

Vermont therefore could not avail itself of economies available only with national single-payer universal health care: single-source purchasing of pharmaceuticals, global budgeting for hospitals, and reduction of system administrative overhead from insurance company levels (20 percent) to Medicare levels (2 percent). Absent these savings, taxes required for financing far exceed insurance premiums avoided.

The Affordable Care Act faces an existential threat this year that dwarfs challenges it has faced so far. It is looking down the barrel of a gun held by the Supreme Court thanks to a critical ambiguity in the hastily written 2010 bill.

Opponents to the ACA argued in King v. Burwell that language in the bill, and resultant Act, restrict insurance subsidies to those policies purchased through the state exchanges only, eliminating subsidies for policies purchased, as most were, through the federal exchange.

The Fourth Circuit Court disagreed, much to the temporary relief of ACA supporters, but the Roberts Court in November agreed to hear the plaintiffs’ appeal of the Fourth Circuit Court’s decision. If the Supreme Court throws out subsidies in the federal exchange (used by 36 states), millions would likely exit the insurance market on very short notice

Quite apart from the widespread suffering this would cause, the resultant actuarial nightmare could cause the ACA to collapse, taking smaller, newer and more vulnerable insurance companies with it.

No one really knows what the elimination of subsidies in the federal exchanges would mean, but references to Armageddon are popular.

If the Affordable Care Act survives King v. Burwell, it will probably cover a few more million this year, assuming a slight increase in Medicaid expansion and modest improvement in the function of the exchanges. This would leave at least 35 million Americans without health care coverage, a figure that is unlikely to change much in future years.

Will this be acceptable to our country?

If not, or if the ACA is crippled in June by the Roberts Court, where do we go from here?

The Vermont debacle instructs us, not that single-payer universal health care is impossible, but rather that it has to be done on a national rather than on a state-by-state basis.

We might want to take another look at Medicare for all. It would be immune from legal assault, given its reliance on taxes rather than a complicated cobbled-together mixture of mandates, insurance premiums and subsidies. If it performs anywhere near as well as Canada’s Medicare (its name for single payer universal health care), it could gradually reduce health care spending as a percentage of GNP toward sustainable (12 to 13 percent) levels, while improving overall health outcomes by eliminating financial barriers to health care.

Political opposition to Medicare for all would appear to be insurmountable now, with anti-government fervor ascendant in Washington and health care industry profits and clout increasing relentlessly.

The Affordable Care Act at one time seemed to be single-payer advocates’ worst night nightmare – not enough to cover everyone, but enough to defuse interest in fundamental reform. If it stalls out or blows up, however, the ACA might prompt a look at alternatives, of which there is only one.

Louis Balizet, M.D., is a recently retired oncologist from Pueblo. He’s a member of the advocacy group, Physicians for a National Health Program, and a leader of Health Care for All Colorado. This article is a slightly revised version of the original.

Opinions expressed in Health News Colorado represent the views of the individual authors.

http://www.healthnewscolorado.org/2015/01/12/opinion-the-affordable-care-act-in-2015-where-do-we-stand/

Gottfried, Perkins say time is right for single-payer health care

By Matthew D’Onofrio
The Legislative Gazette (Albany, N.Y.), Jan. 13, 2015

For two decades, Assemblyman Richard Gottfried, D-Manhattan, has been calling on his fellow lawmakers to pass legislation that would provide universal health care for all New Yorkers.

To cap off a series of statewide hearings that began in November, the Assembly Health Committee — chaired by Gottfried — held a hearing on the Health Care Act on Tuesday in Albany where doctors, health care advocates, union leaders, and clergy discussed the need for a health care system that simplifies the billing system for treatment.

“New Yorkers deserve better,” said Gottfried, the bill’s sponsor. “We deserve to be able to go to the doctor when we need to, without worrying about if we can afford it. We deserve not to worry when we get a medical bill or an insurance statement we can’t figure out. We deserve health coverage for all of us, at a price based on our abilities to pay, not what the market will bear.”

Gottfried says the Health Act would save billions of dollars yearly by eliminating unnecessary insurance company overhead and administrative costs that doctors incur when dealing with insurance companies including premiums, deductibles, co-pays, restricted provider networks and out-of-network charges. New Yorkers would have the independence to choose their doctors and other providers based on ability to pay. The program will be fully accountable, eliminating the ‘local share’ of Medicaid.

“Your health is your wealth,” shouted Perkins, the Senate sponsor, to the dozens of supporters who filled the Well of the Legislative Office Building. “Your health is your wealth,” the supporters responded.

Leaders of various organizations such as the New York State AFL-CIO, New York State Nurses Association, the New York State Academy of Family Physicians, 1199SEIU United Healthcare Workers East, New York State United Teachers and Citizen Action of New York were present.

“Passing single-payer health care would be an essential step in ensuring that every New Yorker, regardless of his or her income level, has access to affordable and quality health care, while saving tax payers millions,” said Sen. Gustavo Rivera, who was at the rally. “It’s common sense.”

www.legislativegazette.com/Articles-Top-Stories-c-2015-01-13-90454.113122-Gottfried-Perkins-say-time-is-right-for-singlepayer-health-care.html

Health insurance paperwork wastes $375 billion

By Dan Mangan
CNBC.com, Jan. 13, 2015

And you thought your bills were out of control.

The United States health-care system wastes an estimated $375 billion annually in billing and insurance-related paperwork that could be saved if the nation moved from a “multipayer” health coverage system to a “single-payer” system run by the government, a new study says.

That dollar figure, tied to getting people, insurance companies and governments to pay for health-care services provided, equals almost 15 percent of total national health-care spending.

“We all sort of suspected there was quite a big number, but when we came down to the actual figure it was certainly revealing,” said Aliya Jiwani, health policy researcher and lead author of the report, which was published by the journal BMC Health Services Research.

Jiwani said that while “the administrative costs have been an issue” in the health-care world for years, “the fixes that have been put in place have only aggravated the issue.”

In fact, the paper notes that “administrative costs as a percentage of total care health care spending more than doubled from 1980 to 2010.”

The authors of the paper write that the savings from eliminating trillions of dollars in administrative waste over the years “could cover all of the uninsured” people currently in the U.S. if a single-payer system were adopted. They estimate the cost of covering all of the roughly 40 million Americans still lacking health insurance would be equal to just about half of the $375 billion in projected savings.

The balance of those savings, they write, could “upgrade coverage for the tens of millions who are under-insured.”

While the paper identified a very big number of wasted dollars, it remains a big question of whether that could lead to a single-payer system anytime soon.

Full, much longer story: http://www.cnbc.com/id/102330504#