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Healthcare is a Human Right Campaign comes to Calvert, Md.

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Healthcare is a Human Right Campaign comes to Calvert, Md.

By Amanda Scott
Southern Maryland Newspapers Online, July 17, 2013

In an effort to bring a universal health care system to Maryland, local chapters throughout the state have been following the footsteps of a successful grassroots campaign by the same name in Vermont.

On Saturday, the Healthcare is a Human Right (HCHR)-Maryland Calvert County Chapter held its inaugural “Healthcare Speakout” at the Calvert Library Prince Frederick to share the movement’s grassroots efforts to achieve universal health care for all Marylanders.

“We’re pushing to start seeing health care as a right — not a commodity,” said Sergio Espana, the state HCHR organizer.

The statewide campaign for universal health care began in December and has since gained traction in several counties where local chapters have been initiated, including Frederick, Howard, Baltimore, Montgomery, Calvert and Carroll counties. According to Healthcare-Now of Maryland’s website, the Maryland chapter of Physicians for a National Health Program and Healthcare-Now of Maryland partnered to create a “Health Care is a Human Right” campaign in Maryland.

In 2011, Vermont was the first state to adopt a universal health care system after the Vermont Workers’ Center launched the grassroots Healthcare is a Human Right Campaign in 2008 in the state. According to the HCHR Vermont website, citizens in Maryland, California, Oregon, New York and Maine are using strategies from Vermont’s campaign.

Stephen Wallace, a member of the Calvert County chapter, said Saturday the campaign is not political.

“It’s not a left or right thing. It’s about people. It’s about people’s health,” Wallace said, adding that people’s concerns about health care “just shouldn’t be there.” Those anxieties, he said, demonstrate that “the [health care] system isn’t working.”

According to Healthcare-Now of Maryland, a universal health care system would create a single-payer, publicly-financed, privately-delivered system that covers all Marylanders.

During Saturday’s “Healthcare Speakout,” four members of the Calvert County chapter shared stories of their experiences with the “broken” system and their hope for a new, universal, single-payer system.

Calvert County chapter member Brandon Johnson of Lusby said that after he and other members of his family had several medical issues, the medical bills “stacked up,” and his parents had to file for bankruptcy.

“That’s flawed. There’s no reason anybody should have that problem,” Johnson said.

Fellow chapter member Liam Fletcher of Prince Frederick said the stories he hears from other people about health care “just makes me sad.”

Fletcher said the movement is about “not putting profit above people,” like he said insurance companies will do.

Robert Wells, another chapter member from Prince Frederick, said, “We have to get rid of the profit-driven system” and the greed, so that everyone can get basic medical care.

“No one deserves to make a profit off of other people’s suffering,” Bobby Morrison, a chapter member from Huntingtown, said.

A universal system, member Cory Johnson said during Saturday’s presentation, would eliminate co-pays, deductibles and insurance hassles.

Cory Johnson also explained that there are many myths about such a system, such as: it can’t happen; it will never work; publicly-funded health care is too expensive and less effective; the government will choose doctors and make medical decisions; and it’s a “socialized” system.

“So, it’s not just the point that the system is bad for those who don’t have [insurance]. It’s also bad for those who do have it,” Cory Johnson said.

According to HCHR-Maryland, under the Affordable Care Act, there will still be more than 436,000 Maryland residents without health care. In 2012, according to Saturday’s presentation, there were 802,000 uninsured Maryland residents, accounting for 13.8 percent of the total population.

In 2010 in Maryland, there were an estimated 15,000 medical bankruptcy claims, according to the presentation. In its first year, a universal health care system in Maryland would save the state an estimated $7 billion, or 15 percent of existing health care spending, by reducing administrative costs and anti-competitive marketing practices, according to the presentation.

In addition, HCHR-Maryland claims the U.S. spends more money on health care than any other country and is less effective. A universal health care system could save the country more than $570 billion annually if implemented nationally, according to the presentation.

To increase awareness of the campaign in Calvert County, the chapter plans to host more “Healthcare Speakouts” and go door-to-door to meet with residents.

http://www.somdnews.com/article/20130717/NEWS/130719299/1074/healthcare-is-a-human-right-campaign-comes-to-calvert&template=southernMaryland

TIAA-CREF shareholders meeting hears call to divest from ‘unethical’ private health insurers

Shareholder’s comments provoke response from company’s president

News release, Healthcare-NOW!, July 17, 2013

CHARLOTTE, N.C. – Having suffered an earlier rejection by the leadership of TIAA-CREF of a shareholders resolution calling on the huge, nonprofit investment company to divest its funds from private health insurance firms because of the latter’s “unethical behavior,” a spokesperson for the divestment group took the microphone at the organization’s annual meeting Tuesday and urged just such a course of action.

Shareholder Sandra Fox, speaking on behalf of herself and others who have appealed to TIAA-CREF to divest its holdings in WellPoint and other giant health insurers, said such firms are not managed in an “exemplary and ethical manner” – a criterion for inclusion in the company’s portfolio – and therefore should be scrapped.

Going into to the meeting, Fox said: “The practices of these companies are anything but socially responsible. They make money by denying coverage, raising premiums, and increasing co-pays and deductibles, deterring patients from seeking care. Their everyday operations result in high overhead expenses, spiraling health care costs, worsening health, premature loss of life, and bankruptcy of countless Americans.”

Speaking from the floor to her fellow shareholders, she reiterated those points and stressed that the big health insurers have been repeatedly cited and fined by regulatory bodies and the courts for improper, unethical conduct.

Roger Ferguson, president and CEO of TIAA-CREF, who chaired the meeting, acknowledged Fox’s comments and said her group’s efforts had already made an impact. Ferguson said MSCI, its vendor for rating companies, had downgraded the stock of two health insurance companies based on the information her group had provided. He did not name which two companies they were.

Ferguson also said the dialogue on this issue would continue.

TIAA-CREF is one of the nation’s top financial services companies. It manages retirement, life insurance and other funds for people in academic, medical, faith-based and cultural fields. Its annual meeting was held Tuesday at its gated office complex in Charlotte.

Fox, a longtime social worker who lives in Pittsburgh, cited the findings of Harvard Medical School research and the congressional testimony of insurance industry whistleblowers to support her charge that private health insurers are not serving the public interest, but in fact are doing serious harm.

She is part of a larger national movement, the Divestment Campaign for Health Care, which is supported by Healthcare-NOW!, the national single-payer health care advocacy organization, and whose website is HealthCareNotWealthfare.us.

On their website, the group says the private companies should be replaced by a single-payer, improved-Medicare-for-all system, which “would provide excellent coverage to all by taking the private health insurance companies out of the equation and putting the needs of patients before profit.”

Pioneer Accountable Care Organizations disappoint

Pioneer Accountable Care Organizations succeed in improving care, lowering costs

Centers for Medicare and Medicaid Services, July 16, 2013

Today, the Centers for Medicare & Medicaid Services (CMS) announced positive and promising results from the first performance year of the Pioneer Accountable Care Organization (ACO) Model, including both higher quality care and lower Medicare expenditures.  Made possible by the Affordable Care Act, the Pioneer ACO Model encourages providers and caregivers to deliver more coordinated care for Medicare beneficiaries. This model, launched by the CMS Innovation Center, is part of the Affordable Care Act’s efforts to realign payment incentives, promoting high quality, efficient care for Medicare beneficiaries.  ACOs, including the Pioneer ACO Model and the Medicare Shared Savings Program, are one way CMS is providing options to providers looking to better coordinate care for patients and use health care dollars more wisely.

“These results show that successful Pioneer ACOs have reduced costs for Medicare and improved the quality of care for their patients,” said CMS Administrator Marilyn Tavenner.  “The Affordable Care Act has given us a wide range of tools to realign payment incentives in Medicare and Medicaid, and these efforts are already paying off.”

http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-Releases/2013-Press-Releases-Items/2013-07-16.html

And…

A Pillar of Obamacare’s Cost-Saving Effort Falls Short

By Devin Leonard
Bloomberg Businessweek, July 16, 2013

It’s no secret that the Obama administration’s effort to roll out health-insurance exchanges in every state is turning out to be more challenging than expected. Its campaign to lower health costs isn’t faring any better. On Tuesday, the Centers for Medicare and Medicare Services announced middling first-year results for the administration’s highest profile cost-control effort: the Pioneer Accountable Care Organization Model.

Obamacare supporters have long promised that Accountable Care Organizations — groups of hospitals and doctors that tend to large flocks of Medicare patients, with an eye toward keeping them out of the hospital — would be integral to bringing down the nation’s health-care costs. ACOs are supposed to come up with innovative ways of keeping patients in better shape by focusing on preventive measures while saving money in the process. Under the plan, the ACOs themselves are to be rewarded with the share of the savings they generate.

Thirty-two health care provider groups signed up for the pioneer program intended to promote the new model, but the Centers for Medicare and Medicare Services said Tuesday that only 13 of them generated enough savings to qualify for a cut. Two participants actually lost money instead.

The news wasn’t all bad. The pioneers produced better-than-average results on cholesterol control for diabetes patients. “Overall, we are very excited about the results,” Patrick Conway, chief medical officer for the Centers for Medicare and Medicare Services, told the Wall Street Journal. But a significant percentage of the pioneers weren’t so thrilled, and nine are slated to exit the program.

It’s much too soon to call the pioneer program a failure. It’s also premature to say the ACO model is one that will save vast amounts sums of money. That hasn’t stopped some of the law’s staunchest supporters, who might want to temper their rhetoric after Tuesday’s report.

http://www.businessweek.com/articles/2013-07-16/a-pillar-of-obamacares-cost-saving-effort-falls-short

And…

Pioneer ACOs Year One: On The Path To A Learning Health Care System

By Douglas Hastings
Health Affairs Blog, July 17, 2013

The Pioneer Model should be seen as part of a crucial phase of testing alternative payment and delivery models in an effort to achieve greater value in health care.  One year’s results should not be seen as a definitive outcome or leading to a dispositive conclusion, but rather as a valuable source for learning.

The participating providers are required to be both financially and clinically integrated.  The ACOs must, among other core attributes, have an effective governance and leadership structure, have the ability to apply evidence-based medicine and care coordination processes, meet quality measures, have a savings distribution formula, develop a robust electronic health record infrastructure, and, importantly, be able to effectively engage patients in their care and their health.

ACO skeptics clearly remain.  Among the doubts and cautions that have been raised are that ACOs will drive insufficient change in physician behavior and patient engagement, result in insufficient savings, create a specialist (and thus patient) backlash, suffer from lack of agreement over measures and metrics, and drive up prices due to consolidation.  These are legitimate concerns.  But such concerns should not mean that the testing should slow down.  Rather, in my view, it should accelerate, given some early positive results and the ongoing cost and quality challenges faced by our health care system.

http://healthaffairs.org/blog/2013/07/17/pioneer-acos-year-one-on-the-path-to-a-learning-health-care-system/

Comment:

By Don McCanne, M.D.

The Pioneer Accountable Care Organizations (ACOs) were already existing health care organizations that were selected as potentially exemplary models that could show the rest of the nation how well ACOs can work to achieve higher quality at lower costs. We now have a report from CMS of the initial “successes” of this model. Although the rhetoric from CMS is quite rosy, most reporters were not impressed, as the Bloomberg Businessweek response demonstrates.

Considering the added administrative hassle, the savings were negligible, with only 13 of the 32 organizations saving enough to receive “shared savings” from CMS, and 2 actually lost money.

Even the supposed quality gains were unimpressive since they represented only 15 measurements which the organizations were told in advance would be used to determine whether or not they met quality standards. These teach-to-the-test gains can hardly represent the overall quality status of each organization.

It is time for our policy makers to stop wishing that the ACO model is the nirvana of health policy and get on with endorsing a proven model of enhancing quality while controlling costs – a single payer national health program – a model that would have the additional benefit of actually covering everyone.

Tempering P4P expectations

An Examination of Pay-for-Performance in General Practice in Australia

By Jessica Greene Ph.D.
Health Services Research (HSR), August 2013

This study examines the impact of Australia’s pay-for-performance (P4P) program for general practitioners (GPs).

There was a short-term increase in diabetes testing and cervical cancer screens after program implementation. The increase, however, was for all GPs. Neither signing onto the program nor claiming incentive payments was associated with increased diabetes testing or cervical cancer screening.

http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12033/abstract

And…

The Effect of Pay-for-Performance in Nursing Homes: Evidence from State Medicaid Programs

By Rachel M. Werner M.D., Ph.D., R. Tamara Konetzka Ph.D., Daniel Polsky Ph.D.

Medicaid-based P4P in nursing homes did not result in consistent improvements in nursing home quality. Expectations for improvement in nursing home care under P4P should be tempered.

http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12035/abstract

Comment:

By Don McCanne, M.D.

More evidence that pay-for-performance (P4P) does not improve quality nor reduce costs.

Single payer does.

Insurers will continue to skirt regulations

Insurers Seek Right Balance of Risk, Reward

By Anna Wilde Mathews
The Wall Street Journal, July 14, 2013

In the insurance business, some customers are more desirable than others—and insurers will be seeking to woo them in preparation for the health law’s new marketplaces.

Customers not only bring revenue in the form of the premiums they pay. They also come with costs, since the insurer will be on the hook for medical expenses. Traditionally, that has made healthier people the best insurance risk. Insurers often could decline to sell plans to people with health problems, or charge them more.

Now, the health law is changing the rules of the game. Under its requirements, insurers must sell plans to all comers, and the rates can’t be tied to customers’ health. Less obviously, the law includes mechanisms that are designed to ensure that individual companies aren’t punished if they draw a mix of sicker consumers.

Young and healthy people will still be needed to help balance out the costs of sicker customers. But, in addition, some people who weren’t sought after in the past may become profitable because of the law’s payment structure. Among them: people who have chronic conditions such as diabetes, but who can keep their diseases managed and avoid big costs such as hospital visits, said Shubham Singhal, a director at consulting firm McKinsey & Co. That is because insurers can be paid more to cover consumers based on their diagnoses.

Since insurers can no longer pick and choose their customers, they will employ a range of subtler tools, including marketing campaigns and carefully designed plans aimed at the customers the insurers most want.

“They want to attract the right risk,” said Siva Namasivayam, chief executive of SCIO Health Analytics Inc. His firm helps insurers identify customer types, such as “entry-level singles” and “healthy baby boomers,” each with projections on likely costs. The firm pinpoints, by ZIP Code, where the different types tend to live, so the insurer can target its marketing geographically.

Highmark Inc., a Pittsburgh, insurer, said it has around 100 targeted campaigns aimed at particular types of consumers, including recent college graduates and retirees not yet eligible for Medicare. It sends walk-in tractor-trailers to college campuses and sets up booths at community events such as charity walks. “We have to be more one-to-one than we were historically,” said Steven Nelson, a senior vice president at Highmark.

Blue Cross & Blue Shield of Rhode Island also plans to aim at certain populations, including young men. Last year, the insurer promoted one of its low-cost plans with a campaign that included posters on the walls of men’s bathrooms in bars. “You don’t need beer goggles to fall in love with this health plan,” one slogan said.

http://online.wsj.com/article/SB10001424127887323300004578559371986794206.html

Comment:

By Don McCanne, M.D.

One of the great advantages of the Affordable Care Act was that it would finally bring an end to insurance company chicanery in which they were able to selectively insure more profitable healthy individuals while keeping the more costly sick individuals out of their plans.  At least, that’s what the new requirements for guaranteed issue (they must sell the plans to everyone, not only the healthy) and community rating (they cannot charge higher rates for the sick) were supposed to do. But insurers have a much larger bag of tricks.

Although insurers can no longer reject applicants who fail medical underwriting standards, they have learned to selectively market their plans to healthier populations, and they will continue to do so. They intensify their targeting to younger, healthier individuals while avoiding marketing to higher cost individuals. As this article indicates, an industry has arisen to help insurers select their targets for marketing, based on the health of selected groups or on the average health in geographical regions (ZIP Codes). This adds yet more administrative costs to our system already tremendously overburdened with administrative waste.

Not only do insurers market selectively to the healthier, they also are taking advantage of risk adjustment. Since insurers who take on clients with greater medical problems are paid more through these adjustments, it is to their advantage to include individuals with unfavorable diagnoses but whose health care needs are actually quite minimal. An individual might technically be diagnosed as a diabetic but require very little care, and yet the insurer can receive adjustments that are designed for a more severe diabetic with multiple complications. So it is to their advantage to enroll patients with just a touch of bad disease. They are already doing this in the private Medicare Advantage plans.

If an insurer misjudges and ends up with higher cost risk pools, they can no longer dump only those with greater needs, but they can pull their plans from the regions where they are experiencing high spending.

Insurers are masters at innovation. No matter how many laws and regulations they face, they will always find other ways to work the system. That’s just plain old good business. And that is the problem. We don’t want our health care defined by what is good for the industry; we want it defined by what is good for patients. We won’t get that until we establish our own public system dedicated to the primacy of patients.

And about that Blue Cross & Blue Shield of Rhode Island campaign that included posters on the walls of men’s bathrooms in bars with the slogan, “You don’t need beer goggles to fall in love with this health plan.” Although there are ten categories of essential health benefits, insurers are allowed flexibility within each category. Those young men would be well advised to read their plans carefully to see if they exclude sexually transmitted diseases and injuries while intoxicated. Insurers know no boundaries.

Make Medicare available to all

By Laurence S. Jacobs, M.D.
Democrat and Chronicle (Rochester, N.Y.), July 15, 2013

On July 30, Medicare will be 48 years old. It covers over 50 million Americans — those over 65 and the disabled.

Medicare has improved financial security for the elderly and disabled, and reduced health disparities related to race and socioeconomic status. Medicare recipients go to doctors and hospitals of their choice, not to a restricted panel of caregivers. Medicare has overhead costs of about 2 percent, compared with private insurers’ overheads from 12 percent to over 20 percent.

Medicare does have its flaws; it doesn’t cover vision or hearing problems, and the drug program (Part D) has the insane congressional restriction that it cannot negotiate with pharmaceutical manufacturers over medication costs, the way the Veterans Administration can. That’s why the VA spends 40 percent less for the same drugs.

An improved Medicare for all would make terrific sense. Low overhead, a single set of approved forms (not a separate one for each insurer, as is now the case), no outrageous CEO salaries, no marketing costs, first dollar coverage without co-payments or deductibles, no restrictions on choice of doctor or hospital. All medically approved treatments would be covered, and there would be no issue of physicians refusing to see certain classes of patients because of poorly paying insurance coverage.

Funding, from progressive taxes, would cost people less than they now pay in premium, co-pay, deductible, and out-of-pocket expenses. Further, employers would be rid of health care costs, which impair their global competitiveness. Finally, Medicare as the only payer would be able to negotiate robustly over prices of drugs, medical devices, and hospital bills.

Medicare recipients are happier with their health insurance, have fewer problems with access to care, delays in payment, and the like, and are more likely to have a medical home with a primary care provider who knows them well than are people with private health insurance.

So, why don’t we already have Medicare for all? Because of intense lobbying by those who profit from the status quo, and because of lies by ideologues about government intrusion into health care. It’s the private insurance companies that intrude into medical decision-making, deny expensive care to maximize profits, and restrict access to care.

Medicare for all would simply be a payment mechanism. Ask current Medicare recipients whether the program interferes with their care in any way. Like other developed nations, we need to find a way to offer comprehensive health insurance to all residents. The best way to do this is to improve and expand our Medicare program by making its coverage truly comprehensive, and by enrolling everyone. That would make the birthday of Medicare a truly happy one for all.

Dr. Jacobs is a retired professor of medicine at the University of Rochester School of Medicine and Dentistry.

http://www.democratandchronicle.com/article/20130714/OPINION02/307140021/Guest-essay-Make-Medicare-available-to-all-Jacobs

Pause in honor of Medicare

By Richard Propp, M.D.
Times Union (Albany, N.Y.), July 12, 2013

At this time of year I usually start thinking about the passage of Medicare in July of 1965. How in the world did President Johnson decide to take on Congress to approve such a huge program for seniors? To sum it up, it was just the right thing to do. Why?

A personal story may help. In 1965 I was chief medical resident at Albany Hospital under Professor Richard Beebe. He allowed us to moonlight. I worked in Ravena in the practice of Drs. Mosher and LeFevre. Our elderly patients often had no money for their office visits or medicines. Sometimes they might leave a chicken on Mrs. Mosher’s back door. These folks were forced to rely on charity but had no real access to quality care. It just wasn’t right.

After Medicare was implemented in 1966, there were changes in medicine. Medicare Part A paid for hospital stays and also paid medical residents a better wage. Part B reimbursed outpatient care at 80 cents on the dollar and physicians flourished.

Later on, the disabled and those with kidney failure and ALS were covered as was Hospice care. Why? It was the right thing to do.

Some conservatives have always hated this government program for the elderly along with the program for the poor, Medicaid, that was enacted at the same time. They say that government should not be responsible for any health care. And even now they would privatize Medicare by turning it over to insurance companies through vouchers. You and I, through our Congress and our President, have so far beaten back these efforts. Why did we organize to fight for Medicare? Because it was the right thing to do.

And so, as July 30 approaches, it is proper that we pause to remember the signing of the Medicare Act, which took place at the Truman Library in Independence, Mo., on that day. Here is what Lyndon Johnson said: “No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings they have so carefully put away over a lifetime so that they might enjoy dignity in their later years.”

We honor Presidents Truman, Kennedy and Johnson and their staffs for their foresight and work that sustains our grandparents, parents, children, and generations yet unborn. Harry Truman proposed a national health plan in 1945. John Kennedy had health care on his agenda when he was assassinated in 1963. Lyndon Johnson carried their causes to fruition. And we will celebrate this historic achievement with a Medicare 48th birthday party at noon in West Capitol Park in Albany on Wednesday, July 31. Join us! It’s the right thing to do.

Then we will continue the struggle to improve and expand Medicare for all, as a right. We will do this to obey the ethics of all faiths that instruct us to “love your neighbor as yourself.” It’s the right thing to do.

Dr. Richard Propp lives in Albany and is chair of Capital District Alliance for Universal Healthcare, which he co-founded.

http://www.timesunion.com/local/article/Pause-in-honor-of-Medicare-4662918.php

How human resilience reveals an unnecessarily cruel system

By Andrew D. Coates, M.D., F.A.C.P.
WAMC Northeast Public Radio, July 12, 2013

Recently one of my patients, someone in a very frail state, insisted upon discharge the next day, over my objections. The patient’s spouse was facing cancer and now was the time to be at home, not in the hospital.

But the next day, to my surprise, the patient requested continued hospitalization, not discharge. I probed, thinking that my patient had begun to grapple with the limits upon daily function that illness had imposed.

No, I learned, time together as a couple remained paramount to my patient, no matter what the personal risks. Something else had intervened.

The cancer treatment drugs prescribed for the patient’s partner, I learned, were too expensive. A mail order arrangement made the drugs more affordable, but now a problem with the delivery had delayed the treatment.

My patient’s spouse needed to be home to wait for the delivery, or perhaps to find out where the drugs might be, in hopes of keeping on the treatment schedule.

Instead, the patient’s spouse arrived at the hospital to insist upon the discharge plan.The patient’s partner had decided to delay resolving the problem with the cancer medications.

My patient in turn told the spouse that a rehab stay after the hospital had begun to sound like a better idea. The patient idea was not to burden their spouse, with cancer, with further tasks of bodily care at home.

As I spoke with each of them I further learned that they were afraid they would not be able to afford of the costs of transfer and treatment for post-hospital rehabilitation. As much as they feared being separated, they also feared financial ruin, and had just had the bitter experience of unaffordable costs of cancer drugs.

The stress and anxiety upon this couple was enormous. Yet I was awed by their love, their drive to see things through together as partners.

I was reminded of O. Henry’s classic story “The Gift of the Magi,” in which he sells his watch to buy her a comb for her beautiful hair and she sells her hair to buy him a chain for his magnificent watch.

But in this modern, real-life moment, all sentimentality was dashed, for the situation was not a redeeming tragedy, but a cruel farce, in which all of us seemed trapped.

Here were two people, each with serious, life threatening illness, each sacrificing themselves for the other — needlessly. The cruelty of this system is underscored by our knowledge that the stress of advanced illness can increase the risk of death in the spouse.

We could so easily afford to provide in-home therapies that would preserve and restore personal dignity, in addition to help heal. In reality, home therapies are not affordable or often don’t even exist.

We have state-of-the-art cancer treatments, but the costs of all drugs have been pushed onto individuals relentlessly. In reality, patients delay and forgo necessary care because of the costs of drugs.

We should all find a deep sense of shame and outrage to think that we live in a society where our seniors, people whose lifelong personal sacrifices won the description the “Greatest Generation,” are forced to make these kinds of choices.

Our society has plenty of resources to provide all necessary medical care to this couple. But we have not organized our health system to do it.

Where are the doctors? Where is the spirit of caregiving? We may be awed and inspired by the human resilience of our patients, but we work in a system that fails to serve them, fails us in our own mission.

Our profession has an obligation to change the entire culture and system of caregiving. Our heroic patients and our caregiving colleagues are counting upon us to do it.

Dr. Andrew Coates practices internal medicine in upstate New York. He is president of Physicians for a National Health Program.

You can listen to Dr. Coates’ radio broadcast here: http://www.wamc.org/post/andrew-coates-how-human-resilience-reveals-unnecessarily-cruel-system

What is best health care coverage for part-time workers?

Wegmans cuts health benefits for part-time workers

By Samantha Maziarz Christmann
The Buffalo News, July 10, 2013

Et tu, Wegmans?

The Rochester-based grocer that has been continually lauded for providing health insurance to its part-time workers will no longer offer that benefit.

Until recently, the company voluntarily offered health insurance to employees who worked 20 hours per week or more. Companies are required by law to offer health insurance only to full-time employees who work 30 hours or more per week.

Wegmans employs roughly 1,433 full-time employees and 4,304 part-time employees in the Buffalo Niagara region.

Several Wegmans employees confirmed part-time health benefits had been cut and said the company said the decision was related to changes brought about by the Affordable Care Act.

However, part-time employees may actually benefit from Wegmans’ decision, according to Brian Murphy, a partner at Lawley Benefits Group, an insurance brokerage firm in Buffalo.

“If you have an employee that qualifies for subsidized coverage, they might be better off going with that than a limited part-time benefit,” Murphy said.

That’s because subsidized coverage can have a lower out-of-pocket cost for the insured employee while also providing better benefits than an employer-paid plan.

Under the Affordable Care Act, part-time employees are not eligible for health insurance subsidies if their employer offers insurance.

“It’s a win-win. The employee gets subsidized coverage, and the employer gets to lower costs,” Murphy said.

“As a private company, we don’t share specifics of our employee benefits programs. It’s a given that health care reform will result in some changes to our benefits program, but it will not change our commitment to meeting the needs of our employees,” Wegmans said in a statement.

http://www.buffalonews.com/apps/pbcs.dll/article?AID=/20130710/BUSINESS/130719892/1003

Comment:

By Don McCanne, M.D.

The best coverage for part-time workers? Well, for part-time workers and for everyone else, it would be a single payer national health program. But we don’t have that. So, before we can enact an improved Medicare for everyone, what would be the best way to cover part-time workers under the Affordable Care Act?

During the reform process, the plight of the part-time worker remained an important consideration in trying to design a near-universal system (which it didn’t turn out to be). Part-time workers tend to have very low wages making it impossible to purchase decent insurance on their own, and yet their family incomes are often just barely high enough that they do not qualify for Medicaid.

Congress decided to continue to rely heavily on employer-sponsored health plans for coverage. The problem with part-time workers is that most employers either provided them with no coverage at all, or, if they did, the coverage was often so spartan that it was almost worthless. Although it was decided to require all but the smallest employers to provide employee coverage or face financial penalties, legislators yielded to larger employers who wanted part-time employees to be exempt. The threshold qualifying as part-time was set at 30 hours.

Think of all of the occupations in which flexible, part-time positions are ideal. Large retail sellers, supermarket chains, restaurant and fast food chains, hospitality services, and so forth, serve as examples. Labor costs are a great concern for these employers, and they have struggled with the concept of trying to meet the high costs of adequate health benefit programs.

But look at the opportunity they have with the 30 hour threshold. They no longer have to feel guilty about providing only worthless plans or no plans at all. Under the Affordable Care Act, the government is going to provide part-time employees subsidies inversely related to income, supposedly allowing these people to buy more comprehensive coverage through the exchanges. Employers can walk away, and these employees will get a better deal from the government.

Although it may be a better deal, it’s still not such a hot prospect. Even with subsidies for both premiums and out-of-pocket expenses, these low income individuals will still not be able to afford their portion of the costs and will face financial hardship as a result.

So these employers will be relieved of their responsibility of paying for health care coverage for their part-time employees, and the taxpayers will pick up the tab. Although there are important reasons for bringing an end to employer-sponsored coverage, it is unfair to give these employers special breaks, especially when considering that several members of the Walton family are near the top of the billionaires list. We should pay more taxes so that they can collect more billions?

No. This “win-win,” wherein “the employee gets subsidized coverage, and the employer gets to lower costs,” is a loser for health care equity and justice. As said at the start, we need a single payer national health program.

Problems with Affordable Care Act show need for single-payer system

By Toni Vafi
St. Louis Post-Dispatch, July 11, 2013

As promises of the Affordable Care Act continue to wither, the delay of the employer mandate is cause for more disappointment. Initially there was promise of average savings of $2,500 per family annually and visions of a public option. Universal coverage was assured and the oft-stated “if you like your employer based insurance, you can keep it” was evidence that we weren’t going socialist. These were a few of the goodies we expected under the Patient Protection and Affordable Care Act.

What happened? Gone are the $2,500 savings and the public option. Cost control wasn’t part of the ACA. The public option bothered insurance companies, so it was out. Of 60 million uninsured, the ACA will leave at least 30 million still without coverage, and the employer mandate delay will now surely increase the implementation burden on the exchanges, which might not be ready to go by Oct. 1.

Not to worry. Employers that have been unable to come up with a plan over the past four years are mainly employers of lower wage and temporary workers. These workers might receive subsidized plans on the exchanges. According to the Post-Dispatch (“Delay in health care law raises questions,” July 4), some employers expect to save millions during this one-year delay, millions to be picked up by the taxpayers. Most of the 30 million newly insured will be exchange or Medicaid clients, also to be funded in full or subsidized by the federal government. While I never begrudge the use of federal funds for health care, I do begrudge this elaborate plan giving insurance companies a third of those federal funds to shuffle paper and deny care, while earning huge profits for themselves.

If medical care is to be funded by tax dollars, let’s skip the hogwash and go directly to a single-payer system, which saves billions and provides equitable care for all.

http://www.stltoday.com/news/opinion/mailbag/letters-to-the-editor/problems-with-affordable-care-act-show-need-for-single-payer/article_8265fb30-b93e-5235-b7a4-4eab45811972.html

The State of US Health: Older but Sicker

The State of US Health, 1990-2010

By US Burden of Disease Collaborators
JAMA, July 10, 2013

Objectives

To measure the burden of diseases, injuries, and leading risk factors in the United States from 1990 to 2010 and to compare these measurements with those of the 34 countries in the Organisation for Economic Co-operation and Development (OECD) countries.

Design

We used the systematic analysis of descriptive epidemiology of 291 diseases and injuries, 1160 sequelae of these diseases and injuries, and 67 risk factors or clusters of risk factors from 1990 to 2010 for 187 countries developed for the Global Burden of Disease 2010 Study to describe the health status of the United States and to compare US health outcomes with those of 34 OECD countries.

Results

US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010; during the same period, HALE (healthy life expectancy) increased from 65.8 years to 68.1 years. The diseases and injuries with the largest number of YLLs (years of life lost due to premature mortality) in 2010 were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury. Age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls. The diseases with the largest number of YLDs (years lived with disability) in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. As the US population has aged, YLDs have comprised a larger share of DALYs (disability-adjusted life-years) than have YLLs. The leading risk factors related to DALYs were dietary risks, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use. Among 34 OECD countries between 1990 and 2010, the US rank for the age-standardized death rate changed from 18th to 27th, for the age-standardized YLL rate from 23rd to 28th, for the age-standardized YLD rate from 5th to 6th, for life expectancy at birth from 20th to 27th, and for HALE from 14th to 26th.

Conclusions and Relevance

From 1990 to 2010, the United States made substantial progress in improving health. Life expectancy at birth and HALE increased, all-cause death rates at all ages decreased, and age-specific rates of years lived with disability remained stable. However, morbidity and chronic disability now account for nearly half of the US health burden, and improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations.

http://jama.jamanetwork.com/article.aspx?articleid=1710486

Comment:

By Don McCanne, M.D.

According to The Washington Post (July 10), Thomas R. Frieden, director of the Centers for Disease Control and Prevention “noted that the United States is among the last of its economic peers in offering universal health care, and it is late in making societal changes to address the risks that needlessly shorten lives.” He said, “The good news is these are things we can do something about. If you look at the county-by-county charts, it shows in communities where they took improvements in health seriously, they were able to see dramatic improvements.”

With our great wealth, we can do both. We can offer universal health care, and we can expand public health programs, including fostering societal changes that address our health risks. But first we need to elect legislators and administrators who support these goals. It’s really up to us.

Public Citizen's 'Road Map to State Single Payer'

By Healthcare-NOW’s national staff
Healthcare-NOW, July 10, 2013

This year, some of our movement’s most inspirational organizing has focused on state-level single-payer healthcare legislation. Consequently, our ally Public Citizen released a report today titled “A Road Map to ‘Single Payer’: How States Can Escape the Clutches of the Private Health Insurance System.” The report aims to help state legislators and activists navigate the legal and legislative hurdles facing state-level single-payer efforts.

If you are active in a state single-payer campaign, we encourage you to download the report and share it with allies in your legislature.

Inspired by Vermont’s law designed to move the state through a series of phases culminating in a single-payer system, many other states have impressed us this year. Oregon activists organized a 1,000-person rally that resulted in passing a bill that compares the costs of single-payer with other healthcare financing systems. New York activists delivered over 10,000 signatures for single payer to legislators that resulted in securing a majority of the state Assembly supporting their state single-payer bill. Colorado activists launched a statewide ballot initiative to make access to healthcare a constitutional right, and is in the process of collecting 100,000 signatures.

Many states, however, do not enjoy the luxury of a state legislature that offers hope for single-payer legislation. We hope state-level victories will inspire national activism for achieving a right to healthcare for all, regardless of geography, income, or other social identities.

We hope that this Road Map will serve as a helpful tool in states’ organizing toolbox, and that you will share it with your network.

Sincerely,
Ben, Zoraida, and Jeff
Healthcare-NOW! National Staff

Healthcare-NOW! is a grassroots organization that addresses the health insurance crisis in the U.S. by educating and advocating for the passage of expanded and improved Medicare-for-all legislation, such as HR 676. Healthcare-NOW! – (800) 453-1305 – 1315 Spruce Street, Philadelphia, PA 19107.

PNHP note: For additional analysis of Public Citizen’s report, see “How states can get close to a single-payer system” by PNHP’s senior health policy fellow, Dr. Don McCanne.