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ACOs are another distraction from universal single-payer health care

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ACOs are another distraction from universal single-payer health care

By Peggy Anna Carey, M.D.
Vtdigger.org, Sept. 26, 2012

Fletcher Allen Health Care and Dartmouth-Hitchcock Medical Center have formed their new accountable care organization (ACO) called OneCare Vermont. The stated vision is “a statewide network with a coordinated clinical model and toolset … to enhance the quality of the care provided to Vermont’s Medicare beneficiaries while remaining good stewards of health care expenditures …”

The first question should be what exactly does this statement mean? Am I mistaken, or hasn’t the Vermont Legislature created the Green Mountain Care Board to establish the statewide infrastructure to create our universal single-payer health care system called Green Mountain Care? Does not Green Mountain Care model both high quality and cost-effectiveness by eliminating the morass of administrative waste created by the present health care situation that is virtually run by for-profit corporations?

ACOs such as “OneCare” are a ruse for hospitals, insurers and providers to consolidate more of their clout to control their turf of profits. The Medicare Shared Saving Program that is encouraging the formation of these ACOs is based upon pilot studies that showed little savings and little improvement in care. Amy Goldstein, medical reporter for The Washington Post, wrote over a year ago:

“The five-year test enlisted 10 leading health systems around the country and offered financial bonuses if they could save enough by treating older patients more efficiently while providing high-quality care. In 2010, the final year, just four of the 10 sites, all long-established groups run by doctors, slowed their Medicare spending enough to qualify for a bonus, according to an official evaluation not yet made public. Two sites saved enough to get bonuses in all five years, the evaluation shows, but three did not succeed even once. The uneven progress is significant because the experiment involves ‘accountable care organizations,’ one of the hottest trends in health policy and an idea included in the year-old federal law intended to overhaul the nation’s health-care system.”

In reality, OneCare Vermont ACO is a device for large medical organization like Fletcher Allen and Dartmouth in cahoots with for-profit insurance companies to maintain control of their vested interests. With greater efficiency, i.e., limited care as practiced by the HMO disaster of the 1990s, the “consolidators,” not the patients will get federal monetary kickbacks. If FAHC were truly committed to Act 48 and Vermont’s legislated path to create our universal single-payer health care system, why did FAHC’s CEO John Brumsted rally FAHC specialists, in spring 2011, to testify against the passage of Act 48 that sets Vermont on the path to true health care reform.

And why would Vermont want to CONSOLIDATE health care that is caring and efficient occurring independently in primary care practices across the state? Hospitals are the most costly care organizations not because of the acuity and severity of care they offer, but because of their modus operandi to push for expansion of bricks and mortar as well as expensive technology only to have to pay for these cost overruns by the overuse of costly procedures.

And where do FAHC and Dartmouth medical centers exemplify superior practices of communication between health professionals? As a family physician in Cambridge, Vt., I need to work with three hospitals that my patients use: Copley in Morrisville, Northwest Medical Center in St. Albans and FAHC in Burlington. I receive timely reports from Copley be it specialists’ or Emergency Department records. Repeatedly my staff and I are calling for records of our patients who seem to fall into a black hole of the FAHC behemoth.

Finally, where is the focus on the patient in this duplicitous scheme that rewards financial kickbacks to ACOs for doctors doing their jobs providing good care? Let’s remember that the most important “special interests” are our patients. I have complete faith in Vermonters to see ACOs for what they are, nothing more than the emperor’s new clothes.

Dr. Peggy Anna Carey is a family physician. She lives in Burlington.

http://vtdigger.org/2012/09/26/carey-acos-are-another-distraction-from-universal-single-payer-health-care/

Important! Over 90 percent fail choose the right Part D plan

Plan Selection in Medicare Part D: Evidence from Administrative Data

By Florian Heiss, Adam Leive, Daniel McFadden, Joachim Winter
The National Bureau of Economic Researchm June 2012

From the NBER Digest:

Fewer than 10 percent of individuals enroll in what for them would be the most cost-effective plans.

In Plan Selection in Medicare Part D: Evidence from Administrative Data (NBER Working Paper No. 18166), co-authors Florian Heiss, Adam Leive, Daniel McFadden, and Joachim Winter analyze data on medical claims in Medicare Part D drug insurance programs. They find that fewer than 10 percent of individuals enroll in what for them would be the most cost-effective plans. This is apparently because seniors pay more attention to their out-of-pocket premiums than to the overall benefits of the dozens of drug plans available to them. Equally significant, the researchers believe that how seniors decide whether to enroll in Medicare Part D, and what plans they select, is important not only for management of the Part D program, but also is indicative of how consumers behave in real-world decision situations with a complex, ambiguous structure and high stakes. The researchers add that their findings may yield predictions for how seniors will handle plan choices in the new general health insurance exchanges that will implement the Patient Protection and Affordable Care Act of 2010.

http://www.nber.org/digest/oct12/w18166.html

NBER Working Paper No. 18166 (47 pages):
http://www.nber.org/papers/w18166.pdf

Comment:

By Don McCanne, MD

If over 90 percent of purchasers of the Medicare Part D drug plans fail to choose the plans that are best for themselves, then how could we ever expect them to make wise decisions in selecting the best plans from the much more complex plans of the state health insurance exchanges, or, for that matter, from the choice of Medicare Advantage plans or the plan choices to be offered in the proposed premium support (voucher) markets?

The last sentence from “Conclusions” in their paper: “Our results then do not support the proposition that consumers can make and benefit from good choices in private health insurance markets, and direct health care resources to their best use.”

This is really important. Inserting very expensive, profoundly wasteful insurer administrative intermediaries into the system under the guise of choice – choices that cannot be made on a rational basis, choices that are all worse than a single, comprehensive publicly-administered plan would be – is the ultimate of reckless decisions made by the policy community and the politicians that they work for.

Let’s improve Medicare by eliminating the Part D and Medicare Advantage intermediaries and folding an improved version of those benefits into the traditional Medicare program, and then provide it to everyone. It would be cheaper overall and would open up our choices to the choices we really want – that of our health care professionals and institutions. That would be far better than this nonsense of choosing from all the wrong choices.

Single-payer system would save American lives, money

By Richard A. Damon, M.D.
Bozeman Chronicle, Letters, Sept. 25, 2012

The nation should be ashamed that we allowed 48,000 people to die of preventable deaths in 2011. The persistence of 48.6 million uninsured people (2011 Census Bureau) and their related deaths reveals the urgency of enacting an improved Medicare-for-All type system. An untreated preventable death occurred every 11 minutes in 2011. Tens of thousands of people die every year because they lack health insurance. Does the nation really care that people are dying of preventable diseases by the thousands? The Congressional Budget Office estimates the unsustainable costs of our money-driven health care system, embraced by insurance and drug corporations, will continue, and 30 million people will still be uninsured in 2022, even under the provisions of the Accountable Care Act (aka Obamacare).

The situation can be expected to grow worse as employers continue to shift health care costs to their workers because of escalating premiums.

The insurance and drug company profits will grow, while benefits diminish and premiums rise, increasing under-insured enrollees.

Uninsured individuals and families are now realizing more each day they cannot afford the increasing insurance costs and consequently are losing accessibility to care. The crisis is made worse for those who have unexpected illness. More treatable diseases and chronic conditions will go untreated, and the general health of the nation will continue to decline.

There is an answer to this situation. It requires the public to demand that Congress move quickly to a National Single Payer Health Care program that provides more efficient, effective, affordable, universal, equitable, available, accountable, high quality, and comprehensive health care. At the same time we can rid ourselves of the scourge of insurance and drug company related waste, bureaucracy and profiteering.

The opportunity to pursue good health is a human right. A single-payer system would save both American lives and money.

Dr. Richard A. Damon resides in Bozeman.

http://www.bozemandailychronicle.com/opinions/letters_to_editor/article_2f9b075c-0723-11e2-ad51-001a4bcf887a.html

The Democrats' market-friendly health care alternative

The Democrats' Market-Friendly Health-Care Alternative

By Ezekiel J. Emanuel, Neera Tanden and Donald Berwick
The Wall Street Journal, September 24, 2012

Conservative and liberal health-policy experts agree that the key to sustainable cost control lies in encouraging physicians and hospitals to focus on quality rather than quantity, and value rather than volume.

According to a study published in August in the New England Journal of Medicine, over the past decade per-person costs in Medicare have increased less than those of private insurance, and are projected to be 1.2 percentage points lower than those of private insurance per year over the next decade.

Why should anyone believe that the Affordable Care Act and our new proposals will actually control costs? After all, skeptics argue, Medicare costs have increased inexorably despite myriad policies designed to control them. But we propose a break from the past, which has largely relied on the government’s setting of payments. Our alternative is to allow the market to set many prices for medical goods and then to change payment and reimbursement methods so that physicians and hospitals have the incentive to keep patients healthy. This is neither government nor insurer rationing. It is a market-friendly approach that empowers health providers to re-engineer how they care for patients.

http://online.wsj.com/article/SB10000872396390444017504577645193107383610.html?mod=googlenews_wsj

And…

Health Care Cost and Utilization Report:  2011

Health Care Cost Institute (HCCI)
September 2012

For 2011, HCCI found increases in prices were the primary cause of increased health care spending for the privately insured younger than 65 and covered by ESI (employer-sponsored insurance).

The rate of price growth for all major services outpaced changes in utilization. The primary cause of increased prices was growth in unit prices.

http://www.healthcostinstitute.org/files/HCCI_HCCUR2011.pdf

Comment: 

By Don McCanne, MD

The authors of this Wall Street Journal opinion article have participated in the development and implementation of the Democrats’ Affordable Care Act. Increases in prices continue to be a primary cause of increases in health care spending, so what do these authors recommend? “Our alternative is to allow the market to set many prices for medical goods and then to change payment and reimbursement methods so that physicians and hospitals have the incentive to keep patients healthy.”

Health care prices remain a problem. The health care market, such as it is, always has set prices high and will continue to do so. Utilization is not excessive. It is comparable to other nations with far lower total spending. Incentives designed to reduce utilization risk impairing access to appropriate care, thereby impairing quality.

It is futile to continue to pretend that market approaches within our highly dysfunctional financing system – that perpetuated by the Affordable Care Act – will ever bring us quality health care at a reasonable cost. Allowing the market to set prices is utter nonsense. Our own public stewards, working with the health care delivery system, can price our health care services and products properly, providing that they are allowed to function as a single payer monopsony (not to mention all of the other benefits of single payer financing).

We don’t need more market-friendly Democrats. We need patient-friendly politicians, though they are a rare sighting these days.

The Democrats’ market-friendly health care alternative

The Democrats’ Market-Friendly Health-Care Alternative

By Ezekiel J. Emanuel, Neera Tanden and Donald Berwick
The Wall Street Journal, September 24, 2012

Conservative and liberal health-policy experts agree that the key to sustainable cost control lies in encouraging physicians and hospitals to focus on quality rather than quantity, and value rather than volume.

According to a study published in August in the New England Journal of Medicine, over the past decade per-person costs in Medicare have increased less than those of private insurance, and are projected to be 1.2 percentage points lower than those of private insurance per year over the next decade.

Why should anyone believe that the Affordable Care Act and our new proposals will actually control costs? After all, skeptics argue, Medicare costs have increased inexorably despite myriad policies designed to control them. But we propose a break from the past, which has largely relied on the government’s setting of payments. Our alternative is to allow the market to set many prices for medical goods and then to change payment and reimbursement methods so that physicians and hospitals have the incentive to keep patients healthy. This is neither government nor insurer rationing. It is a market-friendly approach that empowers health providers to re-engineer how they care for patients.

http://online.wsj.com/article/SB10000872396390444017504577645193107383610.html?mod=googlenews_wsj

And…

Health Care Cost and Utilization Report:  2011

Health Care Cost Institute (HCCI)
September 2012

For 2011, HCCI found increases in prices were the primary cause of increased health care spending for the privately insured younger than 65 and covered by ESI (employer-sponsored insurance).

The rate of price growth for all major services outpaced changes in utilization. The primary cause of increased prices was growth in unit prices.

http://www.healthcostinstitute.org/files/HCCI_HCCUR2011.pdf

Comment: 

By Don McCanne, MD

The authors of this Wall Street Journal opinion article have participated in the development and implementation of the Democrats’ Affordable Care Act. Increases in prices continue to be a primary cause of increases in health care spending, so what do these authors recommend? “Our alternative is to allow the market to set many prices for medical goods and then to change payment and reimbursement methods so that physicians and hospitals have the incentive to keep patients healthy.”

Health care prices remain a problem. The health care market, such as it is, always has set prices high and will continue to do so. Utilization is not excessive. It is comparable to other nations with far lower total spending. Incentives designed to reduce utilization risk impairing access to appropriate care, thereby impairing quality.

It is futile to continue to pretend that market approaches within our highly dysfunctional financing system – that perpetuated by the Affordable Care Act – will ever bring us quality health care at a reasonable cost. Allowing the market to set prices is utter nonsense. Our own public stewards, working with the health care delivery system, can price our health care services and products properly, providing that they are allowed to function as a single payer monopsony (not to mention all of the other benefits of single payer financing).

We don’t need more market-friendly Democrats. We need patient-friendly politicians, though they are a rare sighting these days.

True democracy demands a healthy electorate

By Dr. Sara Stalman
Kennebec Journal, Sept. 25, 2012

To write about health care and politics is to write about the sacred and the profane.

Our word “health” has the same etymological root as our words “whole” and “holy.”

It reflects ancient awareness that we are designed and guided by sacred forces that, although beyond human comprehension, we know to be greater than ourselves and to be good. “Health” has “the sacred” at its very root.

“Politics,” on the other hand, refers to activities related to governance. Our political realities foster the greatest disparity of wealth between rich and poor that our country has ever known.

One in five Mainers do not seek medical care because they cannot afford it. Many have health insurance but, with high monthly payments and high deductibles, they see doctors only in emergencies.

At the same time, Maine is hemorrhaging health care dollars to out-of-state insurance profiteers. In 2002, 38 to 50 cents of every dollar spent on health insurance left Maine never to return. It’s only gotten worse.

Working people pay for everybody’s health care. That’s the reality.

In a single-payer health insurance system, that money would go into a single pot that would pay all health care costs directly. There would be minimal overhead, no insurance company profiteers and direct purchase of medications for the cheapest negotiated price.

Our veterans receive health care through a single-payer system. Minus the prescription-drug nonsense, Medicare, too, is a single-payer system.

In 2001, Maine was the first state to be standing within a hair’s breadth of legislatively passing a single-payer health insurance system.

By a vote of 76-54, “single-payer” passed with strong bipartisan support in the House. With the Senate set to vote in favor along party lines (18-16), then-Gov. Angus King vowed to veto the bill.

The final Senate vote of 15-17 precluded the governor’s veto, but in no way changed his position.

The tremendous economic impact a single-payer health insurance system would have for Maine can be seen in the results of a feasibility study funded in 2002. Maine is a small state with an aging population and high incidence of chronic disease.

Even so, a single-payer health care pot composed of just 4 percent of Maine working people’s income and 7 percent of business payroll could pay for everyone’s health care (individual choice of doctor, preventive care, medical and surgical care, eye and dental care, prescription drugs and home care) — and save $350 million in the first year alone.

Minimal co-pays assessed on a sliding scale were required, but the maximum individual expense would be $1,000 per year, with no family paying more than $2,000. (With single-payer health insurance, businesses, of course, would no longer have to pay the health care costs of workers compensation insurance.)

With Maine’s population of 1.35 million, $350 million would mean that, for each of us, $260 unavailable now would be in the local economy — buying food, clothing, text books, whatever. Money would be changing hands, improving our quality of life and increasing our local tax base.

Moreover, local school budgets would no longer be burdened with the costs of employee health benefits.

Demonstrating we could afford a single-payer health insurance system (and could pass legislation to create that system) put Maine in the sights of those interests still working to undermine health care reform.

In 2002, the National Heritage Foundation arrived in the guise of the Maine Heritage Policy Center. Pouring money from around the country into our state, those interests continue to dominate Maine electoral politics — underwriting, for example, the candidacy of now-Gov. Paul LePage.

In writing the Declaration of Independence, our Founding Fathers asserted that government should recognize “Life, Liberty and the Pursuit of Happiness” as inalienable (sacred) rights of humankind.

Our democracy was the first modern government based on that principle.

Because powers of wealth and economic violence have threatened its founding principle since our country began, our American democracy (honored worldwide by men and women trusting that principle) remains a work in progress. Today, that threat can be seen at its most dangerous in the political battle over health care reform.

True democracy demands a healthy electorate. It demands an electorate able to experience the sacred, trust the sacred, and act on that trust.

Those opposing quality health care and a single-payer insurance system typically are accused of acting from profit motive alone. More profoundly, opposition to health care reform is opposition to true democracy: Democracy of the people, by the people, and for the people. All the people.

Dr. Sara Stalman of Brooklin has practiced neuropsychiatry for 18 years. Her clinical research investigating the relationship between early childhood experience and adult chronic depressive disorders is available from her website: bornforjoy.com.

http://www.kjonline.com/opinion/columnists/true-democracy-demands-a-healthy-electorate_2012-09-24.html

Music and health care

By Anne Scheetz, M.D.
Chicago Tribune, Letters, Sept. 24, 2012

Chicago Symphony Orchestra musicians are on strike because the CSO Association and the Orchestra Members Committee cannot agree on how to share the cost of health insurance premiums — only the latest of many labor disputes around escalating health care costs. Meanwhile, in 2009, the top executives of the nation’s five largest health insurance companies received $200 million in total compensation; Edward Hanway, CEO of Cigna, retired with a $73 million bonus; UnitedHealth Group earned $3.82 billion in net income, and its CEO reportedly earned more than $8 million. 

The CSO brings pleasure to millions, insurance companies deny claims and we see who is rewarded.

It doesn’t have to be this way.

If we get rid of health insurance companies with their bloated bureaucracies for marketing, underwriting and claims denial, as well as their profits and outrageous executive compensation, and instead enroll every person in the country in expanded and improved Medicare for all (also called single payer), we can cut our health care administrative costs in half. The $400 billion in savings generated is enough to pay for all necessary health care for everyone. We can have music and health care.

Anne Scheetz, M.D., resides in Chicago.

http://www.chicagotribune.com/news/opinion/letters/chi-music-and-healthcare-20120924,0,6378965.story

So you want coverage as good as that of members of Congress?

Rep. Jesse Jackson, Jr. Forced To Sell Luxury Townhouse To Pay Medical Bills

Your Black World
September 20, 2012

In a statement released by Rep. Jesse Jackson, Jr.’s chief of staff, Rick Bryant, Rep. Jackson and his wife have made the decision to sell their townhouse in Washington D.C. to defray medical expenses Jackson has acquired for his depression and bipolar disorders. “Like millions of Americans, Congressman Jackson and Mrs. Jackson are grappling with soaring health care costs and are selling their residence to help defray costs of their obligations,” the statement read. “The congressman would like to personally thank everyone who has offered prayers on behalf of his family.” Jackson aides could not say how much, if any, of the expenses are covered under his health insurance plan.

http://www.yourblackworld.net/2012/09/black-news/rep-jesse-jackson-jr-forced-to-sell-luxury-townhouse-to-pay-medical-bills/

Comment:  

By Don McCanne, MD

Those who say repeatedly that everyone should have the same health care coverage as members of Congress should check with Rep. Jesse Jackson, Jr. He is losing his Washington, D.C. townhouse because of medical bills.

Other than the statement released by his chief of staff, we don’t know any of the details, and we shouldn’t since common decency dictates that we respect his privacy.

We could speculate on the great many potential factors that might be involved as to why a member of Congress faces a financial hardship due to medical bills, but we won’t, even though many come to mind. We’ll merely state that we need a health care financing system that removes financial barriers to care – for everyone. A properly designed single payer national health program would do that.

Medical group administrator urges Medicare for all, supports H.R. 676

Administrator of Clark & Daughtrey interprets health care reform issues

By Robin Williams Adams
The Ledger (Lakeland, Fla.), Sept. 22, 2012

LAKELAND, Fla. — Sticking with the status quo won’t solve the woes of the United States health care system, Adil Khan said Friday, but he’s not convinced the changes now being implemented will either.

Khan, chief administrative officer of Clark & Daughtrey Medical Group in Lakeland, sees more promise in proposed legislation — languishing in Congress for years — that would expand Medicare to cover all ages. It’s H.R. 676, the National Health Insurance Act.

“This is not socialized medicine,” he told members of the Lakeland South Rotary Club at their noon meeting.

“We’re not talking about changing Medicare. It’s already there. We’re talking about expanding it.”

Socialized medicine, he said, would be if the government owned all or most hospitals and medical practices, a change neither the current legislation approved by Congress nor the Medicare expansion would make.

Medicare already is in place, serving almost 10 percent of the population, Khan pointed out, and its 3 percent overhead costs are much lower than those of commercial health insurance plans.

Hospitals and most doctors accept Medicare.

In contrast, Medicaid, which the current health care reform effort would expand, isn’t popular among doctors.

Most don’t accept it, Khan said, explaining that Medicaid “does not cover the cost of providing care.”

A shortage of doctors, particularly acute in Polk County, already makes it difficult for people on Medicaid to have much choice when getting medical care.

Khan spent a few minutes showcasing the expanding capacity of Clark & Daughtrey before getting straight to the heart of his message:

What’s wrong with the current system?

Will the Patient Protection and Affordable Care Act solve the current health care crisis?

If not, what could?

“Our system is on the verge of collapse,” said Khan, 44.

Eighteen percent of the gross national product went to health care last year, a percentage that’s expected to increase, he said. The cost in dollars was $2.6 trillion, almost half of it government funded.

“We are seeing a lot of hospitals changing their practices,” he said. “Some are having to close.”

And 33 percent of people in the U.S. say they’ve avoided getting needed health care because of the cost, he said, compared with 5 percent in the United Kingdom, 15 percent in Canada and 25 percent in Germany.

Many people who lack health insurance seek care at hospital emergency departments, which Khan said is less efficient and more costly than seeing a doctor.

The Patient Protection and Affordable Care Act, which several in the audience referred to as Obamacare, would close some gaps in getting care to the currently uninsured, Khan said.

Aspects he said he favors include letting children stay on their parents’ insurance plans until age 26 and not allowing pre-existing medical conditions to keep people from getting insurance coverage.

He considers the Medicaid-expansion it would use “very inefficient,” however, and said implementing all the changes would add additional bureaucracy.

If the alternative he prefers were adopted, Khan said, Medicare could cover the entire U.S. population for $2.2 trillion dollars, which is less than the $2.6 trillion spent on health care overall in 2011.

“It’s far from perfect,” he said of H.R. 676, “but it’s better than the health-care reform plan we have now.”

http://www.theledger.com/article/20120922/NEWS/120929771/1134?Title=Administrator-of-Clark-Daughtrey-Interprets-Health-Care-Reform-Issues-

Webster Physician Joins Health Care Debate

Dr. William Fogarty Jr. to present his views Sept. 20 at Ethical Society

By Don Corrigan
Webster-Kirkwood Times, September 14, 2012

Speeches on health care, its costs and its delivery found a place at both party conventions this 2012 election season. Dr. William Fogarty Jr. fears the fiery political oratory may be generating more heat than light.

Fogarty, who serves on the local leadership committee of Physicians for a National Health Program, finds all the political rhetoric exasperating. He will explain his organization’s take on the health care debate at the Ethical Society, 9001 Clayton Road, at 6:30 p.m., Thursday, Sept. 20.

“If logic dictated what we do in America – which it doesn’t – we would have Medicare for all,” said Fogarty, a resident of Webster Groves. “Medicare works well at a far lower cost than private insurance. It has high levels of patient satisfaction. 

“Talk to most doctors and you will find far more unhappiness with the insurance companies, than with the government’s Medicare,” Fogarty added. “Some $400 billion is now lost to administrative costs of health insurance companies annually. This could be saved to cover the 25 million who remain uncovered under the Affordable Care Act (ACA).”

The ACA, tagged by its critics as “Obamacare,” has inspired negative reactions and harsh political rhetoric. Fogarty said the reaction underscores his premise that America and its citizenry are illogical when it comes to a good health care system.

“All the polls show that Americans like a system where you cannot be cut off care for pre-existing conditions; where prescription costs are held down; where the young can stay on their parents’ policies until 26,” said Fogarty. “Then you ask them if they like the Affordable Care Act and they scream, ‘no.'”

Fogarty said it makes no sense, because all of the positive attributes for care are under ACA. Fogarty said he has no desire to be embroiled in politics and his wife tells him that after a solid practice in St. Louis medicine for more than three decades, he should keep a low profile.

“It’s hard not to get political with this,” said Fogarty. “The Democrats have done a poor job promoting ACA and health care for all. Republicans have just been disingenuous. There is no doubt they are in the back pocket of the health insurance industry.

“I see ACA as a step on the way to Medicare for all,” said Fogarty. “ACA is not my first choice, but progress is slow and it’s a first step. The irony (of GOP opposition) is that ACA has two key Republican ideas: an insurance mandate that everyone must pay; and, a health insurance company policy exchange for many participants to choose from.”

Against “Obamacare” 

Once the ACA was passed in March 2010, the outcry against it was swift. That summer, citizens voiced their objections, often noisily, at candidate forums in the lead up to the midterm elections.

“I went to one of the forums at a school in South County and was shocked to see all these seniors yelling about keeping government hands off their Medicare,” Fogarty recalled. “I wanted to tell them that Medicare is by the government, but I was afraid I would get hurt.”

Republicans in the 2010 state legislature put “Obamacare” on the state ballot for August. Missourians then rejected it resoundingly in the non-binding referendum on Aug. 3. State Rep. Mike Leara, R-Sunset Hills, voted to put the ACA on the ballot and campaigned against it. 

“I am against the government having anything to do with our health care,” Leara told the Times. “People who pay for their health care should not be forced into a system resulting in rationing 10 years from now. The majority of people are covered now, and they like what they have.”

Sen. Jane Cunningham, R-Chesterfield, a primary sponsor of the referendum bill, said state voters wanted to nullify the ACA as unconstitutional, because it would fine them for not purchasing medical insurance coverage or for not participating in the federal plan.

In contrast, state Rep. Jeanne Kirkton, D-Webster Groves, said the referendum was a “symbolic political ploy.” She said the ACA, with its mandate to buy health insurance, was constitutional. On June 28 of this year, Kirkton was vindicated when the U.S. Supreme Court ruled ACA as constitutional.

Nevertheless, Missouri legislators continue to try to block ACA’s implementation in Missouri. They support another ballot measure to affirm “freedom and Missouri’s sovereignty” and to try to stop Gov. Jay Nixon from cooperating with setting up ACA in the state.

Battling Continues 

Cunningham and many outstate Republicans continue to battle for “nullification of Obamacare.” Some Democrats argue that failure to implement an approved federal program, which has been declared as constitutional, amounts to secession.

“I am a reluctant advocate for affordable care and for Medicare for all,” said Fogarty. “I’m reluctant because I dislike politics. I dislike all the political money being poured into this. I dislike all the legislative and industry obstacles being thrown up against health care for people.

“Missouri has already lost millions of ACA money meant to update and streamline our computerized medical records system,” said the Webster Groves physician, who was educated at St. Louis University School of Medicine. “Missouri is losing out and it’s all because politicians want something to beat up Obama with.”

Fogarty, who has been serving as a volunteer physician at two indigent clinics since retiring, said he can point to numerous studies that point to the benefits of health care reform for America.

“There’s a very good study of the U.S. health care system as compared to a dozen other developed countries,” said Fogarty. “Whether it’s the Danes or the French, they all have better patient satisfaction, better outcomes, better economics.

“But you try to point this out and you are accused of foisting European socialism on America,” said Fogarty. “All this hysteria over our American exceptionalism – we always do it better, except we don’t. And Medicare for all would not be socialism. Doctors would still have private practices.”

Several other study guides that Fogarty cites to support his views on health care are from the American College of Physicians, American Association of Retired Persons and Consumer Reports. For information on his Sept. 20 presentation go to: www.mosp.us/events.htm.

Read more: http://new.websterkirkwoodtimes.com/Articles-Features-i-2012-09-14-182677.114137-Webster-Physician-Joins-Health-Care-Debate.html#ixzz27P15fwWx

Anthem Blue Cross learns how to control costs

Cedars-Sinai and UCLA cut from Los Angeles health plan

By Chad Terhune
Los Angeles Times, September 21, 2012

Two of the most prestigious names in Southern California healthcare — Cedars-Sinai and UCLA — are getting shut out of a major insurance plan for being too expensive.

In a bold cost-cutting move, Anthem Blue Cross has eliminated doctors affiliated with the hospitals from a health plan offered to about 60,000 employees and dependents at the cash-strapped city of Los Angeles.

The city opted for Anthem’s plan because it will save $7.6 million in annual premiums next year by excluding physicians from the two institutions known for tending to the Southland’s rich and famous.

“Purchasers are sending a signal that certain prices are just unaffordable,” said David Lansky, chief executive of the Pacific Business Group on Health, which represents large companies such as Walt Disney Co. “We want great teaching and medical research institutions to survive. Whether that should happen by charging everyone in society a higher rate for routine services is more debatable.”

“Implementation of the narrow network was a difficult choice, but one made necessary by the city’s fiscal constraints,” a city spokesman said. Los Angeles is expected to be the biggest employer to offer Anthem’s Select plan.

Officials at Cedars-Sinai and UCLA criticized the rationale for the move, saying the increased costs are tied to their world-class medical research and cutting-edge treatments in areas such as cancer or organ transplants that benefit the entire community.

Thomas Priselac, chief executive of Cedars-Sinai Medical Center, said these exclusions offer a “false economy” because they don’t reduce costs in the healthcare system overall.

“It just pushes the cost onto those who continue getting care at those facilities,” Priselac said. “Secondly, it doesn’t recognize the reason why places like Cedars and UCLA are more expensive than the typical community hospital.”

For its part, UCLA said its hospitals treat a large number of patients in Medi-Cal, the government program for the poor and disabled.

“Other providers don’t have to deal with the expenses UCLA has to deal with,” said Santiago Muñoz, chief strategy officer for the UCLA Health System.

Anthem isn’t alone in pursuing this strategy. Many insurers are aggressively pitching these sharply limited networks, which offer fewer choices and lower-priced doctors and hospitals, as a cost-cutting tool at a time when U.S. health insurance premiums have climbed three times as fast as inflation and wages over the last decade.

Industry giant WellPoint Inc., which owns Anthem Blue Cross in California, offers plans that include as few as 30% of the company’s full list of providers.

http://www.latimes.com/business/la-fi-hospital-costs-20120921,0,4069159,full.story

Comment:  

By Don McCanne, MD

The explosion in limited-network private insurance plans is taking choice away from more and more patients. The business tools that  private insurers use to control costs are very different from the patient-service tools of a single payer national health program. Not only do the private insurers’ tools restrict patients’ care, but they are also quite ineffective in controlling overall spending, as is demonstrated by the fact that our health care costs are about twice the average of other nations.

Under a single payer system, all legitimate costs are paid by the government and are not linked to specific health plans assigned to different individuals – a very inefficient and fragmented method of financing health care. Using the example of UCLA, there would be no tiers of private coverage and no problem with an underfunded Medicaid program. The hospital costs would be globally budgeted, just as are police and fire departments. Separate, extraordinary costs of research functions would be funded through our National Institutes of Health. Education grants can be provided through the global budgeting process since house staff members are, from a financing perspective, really just low-paid hospital employees.

We need to get WellPoint/Anthem Blue Cross and their ilk out of our health care and out of our lives. Let’s improve our own Medicare program and then provide it for everyone.