pnhpf3a

Santorum right about 'Better Health, More Freedom'

By Daniel D. Bennett, M.D.
The Capital Times (Madison, Wis.), March 30, 2012

As a freedom-loving American, I am pleasantly surprised to find that presidential candidate Rick Santorum and I agree on an issue. While the Supreme Court considers the merits of the Affordable Care Act (aka “Obamacare”), Santorum is campaigning in front of a banner proclaiming “Better Health, More Freedom.” So far, so good. We agree.

On better health, I assume that Santorum desires better health for ALL Americans. One critical element in achieving “better health” is universal access to necessary health services. Emergency rooms cannot and do not provide adequate health care for the vast majority of illnesses but, for many Americans, emergency rooms are their only venue for obtaining medical care. Our medical “safety net” is weak and porous. Millions of Americans have no access to health care, and millions more are limited by their inability to pay high deductibles and co-pays. Unaffordable medical care is no longer just a problem for the poor and uninsured. Fortunately, it appears that Santorum and I agree on our dire need to improve access to care.

On more freedom, absolutely. I want the freedom to see the physician of my choosing rather than the physician on contract with my insurance company. A parent with a chronically ill child deserves the freedom to know that her child will have health care without regard to “lifetime limits” and “pre-existing conditions.” Imagine the freedom to start a small business or create a new product without worrying that you and your family are left at risk of bankruptcy (or worse) due to a serious illness or injury. How many budding entrepreneurs are trapped in large companies because they need health insurance? Patients would find it freeing to make medical decisions based on outcomes data rather than out-of-pocket cost. As a physician, I want freedom from the expanding administrative complexity of our profit-driven health insurance industry. Fundamentally, we cannot be truly free while shareholder interests take priority over the needs of the sick.

There is only one rational solution and this, I suspect, is where Rick Santorum and I disagree. A national tax-supported single-payer health insurance system will provide better health care AND more freedom. The Affordable Care Act makes the critical mistake of perpetuating and expanding the for-profit health care model. I bristle at the idea of using taxes to subsidize and force citizens to purchase a terrible product. As things stand, health insurance coverage does not guarantee health care access. This is the time for real health care reform. This is our moon landing, our interstate highway system and, considering the casualties, our civil war. With the money we are already spending, we can design and implement a universal health care system that will be the envy of the world. If Rick Santorum will agree to that, even I might vote for him.

Dr. Daniel D. Bennett is a member of the steering committee of Wisconsin Physicians for a National Health Program.

http://host.madison.com/ct/news/opinion/column/dr-daniel-d-bennett-santorum-right-about-better-health-more/article_d3876198-79e4-11e1-9e73-0019bb2963f4.html?sourcetrack=moreArticle

Santorum right about ‘Better Health, More Freedom’

By Daniel D. Bennett, M.D.
The Capital Times (Madison, Wis.), March 30, 2012

Dr. Daniel D. Bennett is a member of the steering committee of Wisconsin Physicians for a National Health Program.

http://host.madison.com/ct/news/opinion/column/dr-daniel-d-bennett-santorum-right-about-better-health-more/article_d3876198-79e4-11e1-9e73-0019bb2963f4.html?sourcetrack=moreArticle

Health information technology is a tower of Babel, by intent

By Marvin Malek, M.D.
Vtdigger.org, March 29, 2012

On Feb. 12, 2002, Fred Hernden, a retired Vietnam veteran, developed weakness and abdominal pain. He had recently moved to New Mexico from Woodstock, Vt. It was not by accident that the small home he bought was located near the Albuquerque Veterans Affairs Hospital. Within seconds of sitting down with Fred in the examining room at the VA, Dr. Steve Searles, Fred’s new doctor, pulled up Fred’s entire record from the White River VA on his computer, including detailed information about the treatment Fred had received for colon cancer, and the exact dimension of the aortic aneurysm that had been identified six months earlier at the White River VA. Based on his exam that day and review of these previous records, Dr. Searles could develop a diagnostic plan on the day of that first visit.

Even a full decade later, Fred’s experience can only happen at a Veterans Affairs hospital. If Fred were being treated in any private sector hospital, receipt of medical information from other practitioners will require days, sometimes weeks, nearly always be incomplete, tests will be needlessly repeated, treatment may be delayed.

During the 1990s, the VA system was converted from a medical backwater to the forefront of high quality medical care. Ten years earlier, doctors and programmers within the VA system began the pioneering work of developing a software program to be used as a medical record. Ultimately named “Vista,” this well-liked software is now used by every clinical worker in the VA system. This linkage of every VA facility in the country with the same, user-friendly software program was the centerpiece of the effort to improve quality of care throughout the VA system.

This effort paid off. In the largest such study yet performed, VA hospitals outranked a large group of private sector hospitals in every area measured, including preventive care, chronic care, patient satisfaction, and treatment of heart disease, while spending 35 percent less than the private sector hospitals.

In 2001, the Institute of Medicine released an influential series of reports documenting the large number of serious medical errors occurring on a daily basis in hospitals and medical practices across the U.S., and they recommended adoption of electronic health records as a key solution. In early 2004, President George Bush set out a landmark federal policy whose goal was to have every Americans’ health record be in electronic form by 2014.

Bush era policy — and the consequences

But the Institute of Medicine — as well as subsequent federal policy — did not specifically recommend the VA system’s route toward computerization: To use a single, popular software language to connect every hospital and doctor’s office. Instead, under Bush era policy — which has been continued through the Obama years, new agencies and programs were created to promote wider electronic health records adoption. Also, through the federal Medicare program, the federal government adopted strong financial incentives to providers to use any “certified” software program — initially bonus payments, then later financial penalties for failing to do so. The government also provided funding across the country for state-based organizations to encourage hospitals and medical practices in each state to make use of electronic health records, and to provide technical assistance. In Vermont, that organization is called Vermont Information Technology Leaders (VITL).

In response to this policy, over 100 private sector software companies rushed to take advantage of this huge market niche. The rush occurred because it would be key to these companies’ financial success to quickly get an attractive product on the market so that hospitals would opt for their product first. This was important both because hospitals’ decisions would likely influence the decisions of doctors in the hospitals’ service areas, but especially because the costs of transitioning from one software system to another would likely be as great or greater than the cost of initially adopting an electronic health record.

Unsurprisingly, given the rush to quickly gain market share, these software products have been a huge disappointment to providers: They are falling far short of their potential to improve quality of care, and it will require years of use — and substantial upgrades of the software — to even think about the possibility that electronic health records adoption will ever actually reduce health care costs.

If the late Steve Jobs were forced to use any of these products, he would be appalled at the primitive functionality doctors and nurses are contending with.

Babel, by intent

And in addition to being “user-unfriendly,” another disadvantage of the government’s strategy of leaving medical software to the private sector was that none of these programs “speak” with any of the other competing software products.

The 11th chapter of Genesis tells the story of humanity disobeying a commandment of God by building a very tall tower as a symbol of their earthly power. To punish mankind for this disobedience, God “confused the languages of humanity so that they could no longer communicate with each other.” As a consequence, the tower at Babel could not be completed.

In health care, we have created our own “Babel” of incompatible medical software products. And this time, we can’t blame God.

Federal policy not only failed to encourage all providers to adopt a single software system, but the Office of the National Coordinator of Health IT actually requires VITL and all the state-based agencies to highlight a minimum of two software programs as a condition of receiving federal grant funding.

But it’s not exclusively the government’s fault: There is plenty of blame to go around: None of the major hospital or professional organizations pushed for having all hospitals use the same software — in spite of the enormous success the VA and other countries have achieved doing just that.

Recognizing that this laissez-faire approach has primarily benefited the software developers rather than patients, the government has been funding VITL and the other relevant state grantees to work on “inter-operability” — meaning taking all these incompatible languages, and trying to extract key data elements and making them available to those using other programs. Needless to say, even after years of this effort, this interoperability retrofit remains a distant second place to the seamless communication VA providers have with each other through the VISTA system.

So we remain in the non-communicative chaos of Babel. And it is safe to say that our goal — the “towering” need for improved quality and lower cost — will not be achieved until we create a unified information system.

What should be done now: federal policy

How could we have done better? By the year 2000 or so, when the VA’s accomplishment was already crystal clear, the federal Department of Health and Human Services should have acted promptly to have the VISTA system adopted at hospitals throughout the country. To their credit, they did open up VISTA as public access, downloadable software available for free to all potential users. But this was not enough: For adoption outside the VA system, VISTA would have required technical support staff widely available to train new users, to troubleshoot problems and glitches that crop up, especially for hospitals that are just starting to adopt the system.

The VA is in the midst of a major upgrade of their electronic health records. A new Web-based software system (currently referred to as “Aviva”) is being designed with superior data-sharing capacity with the major private sector commercial electronic health records s
ystems.

But a single upgrade is not enough. With all the computer-related talent in the U.S., it’s not hard to imagine teams of programmers working with physicians in all specialties and other health workers as well to continually upgrade and improve the software.

Federal policy should also begin to incorporate a comprehensive cost control strategy into their HIT policy. Neglecting the cost issue has led electronic health records adoption in the U.S. to have taken the most expensive possible route. So long as the electronic health records policy remains balkanized in the private sector, electronic health records costs will remain extremely high.

What should Vermont do?

The state of Vermont has thus far conformed to the U.S. model of HIT policy, promoting the least effective and most costly avenue toward the adoption of electronic health records. Even within our small state, dozens of incompatible software systems are being used by providers of care, and are generally disgruntled with the quality of the software they are using.

Policy recommendation #1: Conduct a survey of all institutions and a random sampling of Vermont health-care workers to determine the number of electronic health records software programs currently in use in Vermont, and also user satisfaction with these software applications (comparing user friendliness to software used for other functions, such as spreadsheet, word processing, etc).

The intent of the recently enacted Act 48 health reform legislation is to create a “universal, unified” health care system that provides affordable care to all residents of our state. Those who crafted the legislation envisioned a single reimbursement system, and this is clearly an integral element of reform. But failing to unify the medical information systems providers are using is ludicrous. If the various providers who are involved in the care of a patient are all using incompatible software languages, the essential goal of providing seamless, coordinated care will not be realized.

Policy recommendation #2: Vermont’s health policy leaders — both in government (e.g. Green Mountain Care Board) and in the private sector — should promote the adoption of a single, user-friendly software system. Appropriate incentives should be put in place for its adoption. A task force should be convened which would include all major providers in the state — including representatives from the Veterans Administration and both university centers — whose goal would be to realize this vision. If appropriate technical support can be obtained to support the transition, having every provider in the state of Vermont adopt the VA’s software system would be preferable, since it is well-liked by users and available free of charge in the public domain. Since this effort will likely take at least two to three years, it seems reasonable to try to transition to the VA’s upgraded “Aviva” system. The state-of-the-art data sharing capacity being built into the new system will facilitate this transition.

Vermonters seeking care in other states in the U.S. will not benefit from this proposal. Regrettably, it is not realistic to expect that the rest of the U.S. will attempt to create this obvious underpinning for the transformation to an efficient, unified system of care. Fortunately, even if this transition is limited to Vermont providers, a big step forward will still be accomplished for Vermont.

Until now, policy makers in Vermont have not regarded the cost of electronic health records adoption as one of the areas we could look to in the effort to achieve control over our health care costs. Remarkably, when the state of Vermont released an annual report on health cost inflation last year, they even went so far as to completely exclude HIT costs from their analysis of hospital cost inflation. There is no justification for walling off HIT costs into an untouchable, sacrosanct category.

Policy recommendation #3: HIT costs should be on the table. The huge expenditures made to private sector software companies each year, the needlessly high training costs and lost productivity associated with the use of user-unfriendly software, and the cost of scrambling to receive linguistically incompatible records from other providers are all highly relevant to Vermont’s health cost control effort.

The task force I am proposing should take into consideration both short- and long-term HIT costs. The hospitals in Vermont are paying extremely high charges to software vendors annually, and will be doing so for years to come. While transitioning to a different software system will be costly for these hospitals, this initial cost would be paid off over time if the cost to hospitals of the new system were significantly lower.

Numerous national foundations are interested in improving the poor performance of the U.S. health care system both in the domains of cost and quality. The health information system is the linchpin of the effort to improve quality and control cost. It therefore seems likely that Vermont could receive grant support from one or more national foundations for this effort.

As is the case with most of the other key aspects of Vermont’s reform process, resistance to change and to subsuming parochial interests to the greater interest of the state as a whole will form a major obstacle to its implementation. But if policymakers and leaders in Vermont’s health care community set out the goal of creating a unified, cost-effective HIT system for the state of Vermont, this goal can be achieved.

Marvin Malek, M.D., is a physician who practices internal medicine at Central Vermont Hospital.

http://vtdigger.org/2012/03/29/malek-health-information-technology-is-a-tower-of-babel-by-intent/

Don’t lose any sleep over supply of doctors

By Jason Kelley, M.D.
The Stowe Reporter, March 22, 2012

I have to take issue with the assertions in Mr. Steve Chambers’ letter (Stowe Reporter, March 15) regarding the health-care legislation passed last year by the Vermont Legislature.

He makes it clear that he doesn’t like the legislation, describing it as “reckless,” a “train wreck” and even “Marxist.”

His comments were based on a recent symposium at the public safety building which brought to Stowe three staunch opponents of the legislation.

There’s not room enough to rebut all the assertions made by Mr. Chambers, but as a physician I have to take issue with one point. Among the scare tactics he musters about Vermont’s novel legislation is the claim that untold numbers of doctors will “flee” Vermont when it is implemented.

There are simply no data to support this assertion.

To the contrary, plenty of physicians are attracted to the quality of life that Vermont is so proud of. Indeed, the record shows that the pool of licensed physicians in Vermont has more than kept pace with the growth of the population. As a result, Vermont now boasts the sixth-highest proportion of physicians per capita of any state. That translates into nearly 600 more doctors per capita than the national average.

And if any ideologue physicians left the state, they would quickly be replaced by newly recruited physicians. At a rally at Montpelier last year, 250 medical students and doctors in training from as far afield as Oregon and California made it clear they would be particularly attracted to practicing in our state when universal health care coverage is implemented.

Vermont’s supply of doctors is not something we have to lose any sleep over.

Dr. Jason Kelley lives in Hartford, Vt.

http://www.stowetoday.com/stowe_reporter/opinion/letters_to_the_editor/article_76c24cda-7443-11e1-98f3-0019bb2963f4.html

Healthcare Debate: As Supreme Court Hears Landmark Case, Does Law Do Enough to Fix Health Crisis?

Democracy Now!
March 27, 2012

As the Supreme Court weighs whether the Affordable Care Act goes too far, we host a debate on whether the law goes far enough. The case is reviving the heated tensions that surrounded the healthcare reform law in the debate leading up to its passage two years ago. Although support for the measure is often equated with backing the expansion of health coverage for all Americans, there are some who maintain it didn’t go far enough in helping the uninsured. We speak to Dr. Stephanie Woolhandler, co-founder of Physicians for a National Health Program, and Dr. John McDonough, who played a key role in shaping Mitt Romney’s healthcare reform law in Massachusetts as well as the Affordable Care Act. The new healthcare law is “going to leave tens of millions of Americans woefully underinsured, with gaps in their coverage like copayments and deductibles, so they’ll still be bankrupted by illness. And it’s not going to control cost,” Woolhandler argues. “So we still need single-payer national health insurance regardless of what happens at the Supreme Court.” But McDonough notes that “the moment when there would be sufficient political will for the Congress and the president to come together and pass meaningful, near-comprehensive reform, that might take another 20 years.”

Health Care Jujitsu

By Robert Reich
The Huffington Post, March 26, 2012

Not surprisingly, today’s debut Supreme Court argument over the so-called “individual mandate” requiring everyone to buy health insurance revolved around epistemological niceties such as the meaning of a “tax,” and the question of whether the issue is ripe for review.

Behind this judicial foreplay is the brute political fact that if the Court decides the individual mandate is an unconstitutional extension of federal authority, the entire law starts unraveling.

But with a bit of political jujitsu, the President could turn any such defeat into a victory for a single-payer health care system – Medicare for all.

Here’s how.

The dilemma at the heart of the new law is that it continues to depend on private health insurers, who have to make a profit or at least pay all their costs including marketing and advertising. Yet the only way private insurers can afford to cover everyone with pre-existing health problems, as the new law requires, is to have every American buy health insurance – including young and healthier people who are unlikely to rack up large health care costs.

This dilemma is the product of political compromise. You’ll remember the Administration couldn’t get the votes for a single-payer system such as Medicare for all. It hardly tried. Not a single Republican would even agree to a bill giving Americans the option of buying into it. But don’t expect the Supreme Court to address this dilemma. It lies buried under an avalanche of constitutional argument.

Those who are defending the law in Court say the federal government has authority to compel Americans to buy health insurance under the Commerce Clause of the Constitution, which gives Washington the power to regulate interstate commerce. They argue our sprawling health insurance system surely extends beyond an individual state.

Those who are opposing the law say a requirement that individuals contract with private insurance companies isn’t regulation of interstate commerce. It’s coercion of individuals.

Unhappily for Obama and the Democrats, most Americans don’t seem to like the individual mandate very much anyway. Many on the political right believe it a threat to individual liberty. Many on the left object to being required to buy something from a private company.

The President and the Democrats could have avoided this dilemma in the first place if they’d insisted on Medicare for all, or at least a public option.

After all, Social Security and Medicare require every working American to “buy” them. The purchase happens automatically in the form of a deduction from everyone’s paychecks. But because Social Security and Medicare are government programs financed by payroll taxes they don’t feel like mandatory purchases.

Americans don’t mind mandates in the form of payroll taxes for Social Security or Medicare. In fact, both programs are so popular even conservative Republicans were heard to shout “don’t take away my Medicare!” at rallies opposed to the new health care law.

There’s no question payroll taxes are constitutional, because there’s no doubt that the federal government can tax people in order to finance particular public benefits. But requiring citizens to buy something from a private company is different because private companies aren’t directly accountable to the public. They’re accountable to their owners and their purpose is to maximize profits. What if they monopolize the market and charge humongous premiums? (Some already seem to be doing this.)

Even if private health insurers are organized as not-for-profits, there’s still a problem of public accountability. What’s to prevent top executives from being paid small fortunes? (In more than a few cases this is already happening.)

Moreover, compared to private insurance, Medicare is a great deal. Its administrative costs are only around 3 percent, while the administrative costs of private insurers eat up 30 to 40 percent of premiums. Medicare’s costs are even below the 5 percent to 10 percent administrative costs borne by large companies that self-insure, and under the 11 percent costs of private plans under Medicare Advantage, the current private-insurance option under Medicare.

So why not Medicare for all?

Because Republicans have mastered the art of political jujitsu. Their strategy has been to demonize government and seek to privatize everything that might otherwise be a public program financed by tax dollars (see Paul Ryan’s plan for turning Medicare into vouchers). Then they go to court and argue that any mandatory purchase is unconstitutional because it exceeds the government’s authority.

Obama and the Democrats should do the reverse. If the Supreme Court strikes down the individual mandate in the new health law, private insurers will swarm Capitol Hill demanding that the law be amended to remove the requirement that they cover people with pre-existing conditions.

When this happens, Obama and the Democrats should say they’re willing to remove that requirement – but only if Medicare is available to all, financed by payroll taxes. If they did this the public will be behind them — as will the Supreme Court.

Robert Reich, Ph.D., is professor of public policy at the University of California, Berkeley. This post originally appeared at RobertReich.org.

http://www.huffingtonpost.com/robert-reich/single-payer-health-care_b_1381382.html

NHS dismantling law passes, while risks kept secret

NHS reforms finally become law

By Andrew Woodcock, Tim Schulthorpe
The Independent, March 27, 2012

The Government’s controversial reforms to the NHS became law today after a tortuous 14-month passage through Parliament, when the Queen granted Royal Assent to the Health and Social Care Bill.

The new rules mean the Government can create GP commissioning groups to buy health care for patients and scrap Primary Care Trusts (PCTs).

Labour has bitterly opposed the passage of the new law, insisting it threatens the foundation of the NHS and paves the way for private services to get too involved.

A draft risk register leaked today showed that ministers were warned 18 months ago of the risk that the reforms could lead to a loss of financial control, reduced productivity and emergencies being less well managed.

The Department of Health, which refused to comment on today’s leak, has resisted a ruling from the Information Commissioner that it should release the final version of the risk register in response to a freedom of information request from Labour.

Shadow health secretary Andy Burnham said today’s document showed that ministers were warned before they launched the Bill that it was “likely to cause major damage to the NHS”.

Identifying 43 separate areas of potential risk, the draft register rates each on a scale of one to five, where a rating of one means little likelihood and very low impact and five means almost certain to occur and very high impact.

The likelihood and impact figures are multiplied together to give an overall risk rating, with a maximum score of 25.

Among 13 areas given a risk rating of 16 – with likelihood and impact each assessed at four out of five – were:

* Parliamentary amendments creating “unforeseen consequences for the system”;

* Costs being driven up by GP consortia using private sector organisations and staff;

* Implementation beginning before adequate planning has been done;

* Loss of financial control;

* “Unhelpful conflict” between the NHS commissioning board and regulator Monitor;

* GP consortia going bust or having to cut services for financial reasons;

* GP leaders being drawn into managerial processes which end up driving clinical behaviour.

Other dangers, considered to have a lower rating of 12, included the risk that “NHS role in emergency preparedness/responsiveness is more difficult to manage through a more devolved organisation, and so emergencies are less well managed/mitigated”.

Staff concerns and union action over the reforms could lead to “deterioration in relations, lower productivity in the Department of Health/NHS and delays in programme”, the document said.

And there was a warning that strategic health authorities and primary care trusts might lose “good people” who then have to be re-employed to run the new system.

Mr Burnham told the Guardian: “Now we know why David Cameron refused to publish the risk register before the Bill was through Parliament – it’s because civil servants were telling him his reorganisation was likely to cause major damage to the NHS.

“David Cameron will never be forgiven for knowingly taking these risks with the country’s best-loved institution.”

http://www.independent.co.uk/news/uk/politics/nhs-reforms-finally-become-law-7592991.html

Comment:

By Don McCanne, MD

David Cameron’s conservative government has succeeded in dismantling the National Health Service, turning it over to “GP consortia using private sector organisations and staff,” with “GP leaders being drawn into managerial processes which end up driving clinical behaviour.” The process became final today when the Queen granted Royal Assent.

As a sign of the nefarious process involved, the Cameron government refused an order to release the “risk register” that described the dangers inherent in this legislation that were “likely to cause major damage to the NHS.” Only on the day that the Queen granted her Royal Assent was a draft of the risk register leaked.

The lesson for the United States? Without greater citizen involvement, nominal democracies are, in fact, plutocracies. We bear the consequences of our inaction.

What greater example could there be than the fact that the most watched Supreme Court decision in decades evolves around a consideration as to how large the private insurance industry’s market will be, rather than the consideration that should be under review: whether the people have the right to join together as a nation to ensure health care justice for all.

Comparing the presidential candidates’ views on health reform

By Reid Fletcher
March 27, 2012

PNHP note: The following synopsis of the health care planks of some of the prominent contenders for the U.S. presidency was prepared and offered to us by Reid Fletcher, a second-year student at Northwestern University’s Feinberg School of Medicine. Note that Mr. Fletcher also sketches a picture of the Massachusetts reform of 2006 as part of his analysis. For a more extensive assessment of the latter, see the Mass-Care and PNHP report of last October.

Mitt Romney, Republican Party

Mitt Romney wants to repeal the Patient Protection and Affordable Care Act (ACA) and replace it with a market-based reform. His primary objective is to increase the number of people insured by the wasteful private insurance companies. Despite abundant evidence to the contrary, Romney claims that increasing reliance on the free market will produce more competition and lower costs. His plan would force more seniors into Medicare Advantage (MA) plans which do not provide any added benefit to seniors, are more expensive, and limit the free choice of seniors due to restrictive private insurance care networks. In fact, MA plans are paid, on average, 14 percent more than traditional Medicare per beneficiary. In addition, MA plans are able to game the risk-adjustment system and thereby overcharge Medicare an additional $30 billion annually, or 8 percent of total Medicare spending.

Romney would also block grant the Medicaid system, which would shift costs to the states and ultimately result in fewer benefits being available to lower income individuals. This is essentially a first step toward unraveling the safety net for the very poor, whom Romney admittedly is “not very concerned about.”

His plan also involves a massive expansion of the availability of health savings accounts (HSAs) combined with high deductible plans (HDPs). Individuals and employers can deposit tax-free dollars into HSAs which can be used to pay for medical expenses. The theory behind these plans is that they will make consumers more “cost-sensitive” to the medical services they acquire. In reality, these plans encourage rationing and discourage preventive care. Furthermore, these plans expose patient to greatly increased risk if the HSA runs out due to unexpected illness and the plans have not been demonstrated to lower overall health care costs.

Romney, of course, is also closely associated with the 2006 Massachusetts reform, a description of which is appended.

Newt Gingrich and Rick Santorum, Republican Party

Both Gingrich and Santorum have expressed health reform plans that are essentially identical to Mitt Romney’s plan. The commonalities include the repeal of the ACA, block granting Medicaid, privatizing Medicare, and expanding the use of HSAs.

Barack Obama, Democratic Party

The Obama administration has touted the ACA as the first step toward universal coverage. Unfortunately this is not true. The ACA will leave at least 25 million people uninsured and tens of millions more underinsured. Low income individual will be forced into an expanded, but still poorly funded, Medicaid system. With increasingly fewer providers excepting Medicaid patients, this will prove to be an inadequate solution. Everyone else will be given subsidies to purchase coverage in the broken private insurance market. Studies have shown that the fragmented private insurance system has contributed to the fact that 31 percent of all health care dollars are spent on administration, nearly twice the amount paid in the single-payer Canadian system.

Jill Stein (Green Party) and Rocky Anderson (Justice Party)

Stein and Anderson are both proponents of a single-payer plan, which would essentially be an improved-Medicare-for-all system. Stein is more consistent on this point than Anderson. Anderson, while he supports a single-payer system, has also said he’s leaving the door open for a market-based reform.

In a single-payer plan, everyone would be automatically covered by a single public insurer. Everyone would be given the same level of coverage and everyone would have the same freedom to see any provider they choose. This system would reduce administrative waste to the acceptable Canadian levels, which would save nearly $400 billion each year, which is more than enough to cover all of those who are currently uninsured or underinsured.

Furthermore, mechanisms like capital planning, global budgeting, and bulk purchasing would help to control ever-increasing health care costs and improve efficiency within the system.

*****

The Massachusetts reform: an analysis

In 2006 the Massachusetts Legislature, under direction from then-Gov. Mitt Romney, passed a major health reform bill which four years later became the model for the ACA supported by the Obama administration. Given the seeming inevitability of Romney winning the GOP nomination and the highly controversial nature of health care reform, it is highly likely the reform in Massachusetts will come to the forefront of the nation’s attention at some point during the fall elections. The Obama campaign will try to weaken Romney by claiming that the Massachusetts plan is successful and a means to increase insurance coverage; meanwhile the Romney campaign will suggest that the Massachusetts reform was successful, but was not the model for the ACA. In truth, both campaigns will be wrong. The Massachusetts was the model for the ACA and it has been unsuccessful.

What was done in Massachusetts?

Like the ACA, the Massachusetts reform increased coverage by expanding public programs for residents up a certain level of the poverty line while forcing everyone else to buy public insurance or face penalties. The net effect has been to push more people into the private insurance market, so as to lower the total number of uninsured, without modifying the existing private insurance system.

An evaluation

While proponents of the Massachusetts reform will point to the fact that the state now has one of the high rates of health insurance coverage in the country (97.3 percent) as evidence of the success of the legislation, a closer look at the situation quickly shows that the reform effort has not been successful.

We will analyze three areas to demonstrate the failure of the Massachusetts reform: insurance for the poor, cost controls, and rate of underinsurance.

Insurance for the poor

One of the biggest changes that came with the Romney reform was to the safety net program that provided coverage to low-income residents. Prior to the reform, the “Free Care Pool” completely subsidized medical services for the uninsured and underinsured up to 200 percent of the poverty line, in addition to partially subsidizing care for residents between 200 percent and 400 percent of the poverty line. Health care reform replaced the Free Care Pool with the “Health Safety Net”, which was covers medical services for those unable to purchase insurance on their own. However, major differences exist between these two programs which have serious implications for the level of coverage for the poor. For example, The Health Safety Net only fully subsidizes care for those up to 150 percent of the poverty line and increases cost sharing for residents up to 400 percent of the poverty line. Thus there is a larger burden placed on the poor, which will ultimately result in avoidance of necessary care and poor outcomes

Cost controls

While Massachusetts now boasts one of the highest level of health insurance coverage in the nation, the state also has one of the highest health care costs per capita. Health care reform has done nothing to
slow the quickly rising costs of health care in Massachusetts, and in fact, by some measures the reform legislation has actually exacerbated the problem. This is largely because the reform failed to address the fundamental defects in the system. Instead of directly addressing the dysfunctional and wasteful private insurance market, the reform pumped more people into the system. Overhead and administrative costs related to private insurance are one of the main drivers of increased health care costs, and the Massachusetts reform, like the PPACA, did nothing to address these deficiencies.

Rates of underinsurance

Rates of underinsurance have skyrocketed in Massachusetts since the implementation of reform. The rising costs of private insurance, combined with the individual mandate to purchase that insurance has forced consumers to opt for low cost options like high deductible health plans. In fact from 2010 to 2011, the number of people in high deductible health plans doubled. These plans shift costs to consumers and have been shown to decrease utilization of necessary medical services. These plans de-incentivize cost-saving preventive care and put consumers at high financial risk if they get sick.

Conclusion

The Massachusetts health reform has not been successful. While the state can boast one of the highest rates of insurance coverage in the country, it also has an excessive amount of underinsurance and skyrocketing health care costs. Given that President Obama’s PPACA was largely based on the Massachusetts reform, the prospects for success of the PPACA are minimal. Simply put, forcing a large percentage of the population into the wasteful and inefficient private health insurance system cannot achieve cost savings or quality coverage for all. The only way to achieve this is to reform the health insurance system, and the most effective way to do this is to implement single payer reform.

Single-payer system would control health care costs

By Cory D. Carroll, M.D.
The Coloradoan, Letters, March 25, 2012

In medicine, physicians use their training and experience to diagnose and treat patient ills. Over the years, I have witnessed a new condition, not covered in any of my medical school lectures or textbooks, that is at epidemic proportions and worsening. The condition is caused by an out-of-control parasite — the for-profit medical insurance industry.

Decreasing pharmacy benefits, increasing co-pays and out-of-sight deductibles coupled with diminished coverage for care are the symptoms — and there is no foreseeable cure. The for-profit insurance system covers the healthiest Americans and has perfected the art of sucking more and more money from business/patients (higher premiums) and providers (diminished payments) while increasing profits for their executives and shareholders. The governmental programs (Medicare, Veterans Affairs and Medicaid) that are responsible for our elderly, veterans and poor are also cutting back, but these patients are not experiencing the incredibly large increase in out-of-pocket expenses and rarely see a loss of expected services.

The Patent Protection and Affordable Care Act, known by some as “Obamacare,” is a Republican-leaning bill (suggested by Nixon in 1974 and implemented by Romney in 2006) that was an attempt to control costs and protect patients. The two main problems with President Barack Obama’s bill is the legislation is phased in during a four-year period (i.e. it will not be until 2014 until all aspects of the bill will be in place) and it keeps the for-profit insurance industry as a central player (our elderly, veterans and poor still will be covered by the government). The delay in implementing the bill has given the insurance industry ample time to outmaneuver the aspects of the bill that will actually control costs and protect patients. Already, several provisions that should be in effect now have been modified to accommodate the for-profit insurance industry’s whining.

If you support American jobs and desire a stable economy, you need to understand how the lack of medical coverage destabilizes our country. If we had an accessible health care system, for all citizens regardless of employment, businesses would no longer be burdened with escalating health care costs and would be able to generate more jobs — for Americans. Additionally, having affordable access to health care for all citizens would allow entrepreneurs to flourish and allow others to break the corporate chains that keep them from starting private businesses.

If all Americans had guaranteed coverage for necessary medical care, then the medical delivery systems in our communities would be more financially stable and the cost shifting between the “haves” and the “have nots” would cease. Everyone would pay (through a progressive tax system) their fair share. It is insane that the wealthiest nation on the globe allows its citizens to incur personal bankruptcy when they suffer a significant accident or serious illness. Fun fact: The majority of medical bankruptcies occur to individuals/families with insurance.

A single-payer system is not a “government takeover of medicine.” Rather, it is a shift in the financing of health care and would end the inefficiencies and greed of the for-profit insurance industry. It would be the best option to control medical costs and improve health outcomes. A single-payer health care system (not for-profit) is essential if America wants to have a sustainable future.

Dr. Cory D. Carroll lives in Fort Collins.

http://www.coloradoan.com/article/20120326/OPINION04/203260307/Single-payer-system-would-control-health-care-costs

The Medical Golden Rule: Physicians Advocate for Patients

An Expert Interview With David Ansell, MD

By Nancy A. Melville
Medscape Medical News, March 22, 2012

HOUSTON — David Ansell, MD, chief medical officer at Rush University Medical Center in Chicago, Illinois, is the author of “COUNTY: Life, Death and Politics at Chicago’s Public Hospital.” The book details Dr. Ansell’s 17 years of experience working in deplorable conditions at Chicago’s Cook County Hospital, where he and his colleagues would “care for patients in the morning and picket in front of the county building in the afternoon,” as they became activists for health reform.

Dr. Ansell and his colleagues published a study on conditions at the hospital that ultimately led to the passage of the Emergency Medical Treatment and Labor Act, which made it illegal in the United States to dump patients in need of emergency care, regardless of their insurance status.

In his keynote address here at the American Medical Student Association (AMSA) 62nd Annual Convention, Dr. Ansell declared that “healthcare as a human right is the moral issue of our time,” and urged the audience of future physicians to commit themselves to patient advocacy during their careers.

“We are the natural advocates for the poor,” he said. “Because we see the human condition first hand, it is our obligation to speak up on their behalf. You can’t be a doctor and not be touched by the patients and their struggles.”

Dr. Ansell noted that the fact that his mother’s family perished in the Holocaust instilled in him the strong belief in speaking up in the name of human rights.

“The problem I saw wasn’t that governments could do bad things to people, but that neighbors didn’t speak up on behalf of their neighbors.”

A key focus of Dr. Ansell’s ongoing activism is closing inequalities in healthcare, or what he calls the “death gap,” in the United States, which result in Americans dying younger than residents of most other developed countries. “The idea that one should die because they’re poor is obscene,” he said.

Medscape: You noted that the death gap between the richest and poorest communities in the United States is 24 years, whereas in England it is just 7 years. What key elements could realistically be implemented in the United States to reduce this disparity?

Dr. Ansell: Actually, the gap in the United States is 30 years and the gap in Great Britain is now 13 years. Some of the death gap is the result of the design of our healthcare system; much of the death gap is the result of broader social inequalities; some of it has environmental causes. Regardless, the death gap in the United States is unacceptable. We have a healthcare system that is separate and unequal. Where you go, what services are available, are determined by the insurance card you have.

Those with gold-plated insurance policies get access to the best institutions and the best care. Those with lesser insurance, Medicaid, or no insurance have much more difficulty accessing care. Health reform will give more people a card, but will it get them the care they need when they need it?

We know that 45,000 individuals in the United States die each year because of lack of insurance, and 80,000 die because of racial inequalities. It is one thing to have the income and wealth inequalities we have…, but the notion that we allow people in this, the wealthiest nation in the world, to die because they cannot access care is just not right.

Single-payer healthcare for all is the best solution for the United States. It is fair, allows people choice, and it would treat people equally. This would not address all the reasons for the death gap, but it would go a long way to making our health system more equal.

Medscape: The study that you and your colleagues published was pivotal in bringing about the change needed to address the problem of patient “dumping.” What kinds of studies are necessary to address the inequalities in life expectancy between the “haves” and the “have-nots”?

Dr. Ansell: I don’t think we need more studies. We need solutions. Let’s start by agreeing that healthcare is a human right. I believe our failure as a nation to agree that healthcare is a human right, and not a commodity to be bought and sold, is at the root of the problem and is the moral issue of our time.

If we accept that healthcare is a human right, then we would design and operate our health system around the principles of equal access for all and a series of essential healthcare benefits that people would have as a condition of their “citizenship,” not as a condition of their ability to pay. Again, a single-payer system — Medicare for all — is an important first step.

Medscape: The AMSA and other medical groups are working to make the single-payer option a reality in the United States. What changes need to be made in the current healthcare environment for such a system to succeed?

Dr. Ansell: The collective voices of medical students, doctors, and the public will be necessary. The real opposition to a single payer is the health insurance companies, who are profiting mightily from the current set-up. They will not go down without a big fight.

Medical students, doctors, and other healthcare professionals will need to speak up and educate the public about this. The United States has the most expensive healthcare system in the world by 2-fold. We have more than enough money in the system to serve everyone well and turn the focus from sick care to prevention.

A single-payer system will not solve all our ills, but it will provide fair coverage to many more people at a much lower cost. Doctors are the natural advocates for those with less. It is important that those of us who can speak up for fairness and equality — solid American and democratic values — do so. And we will have to elect folks to office who share these beliefs.

Medscape: You mentioned that you were inspired by the commitment of the Suffragettes to change. What person or movement in the present inspires you?

Dr. Ansell: I am inspired by people like Nelson Mandela, who was imprisoned for 26 years because of his opposition to apartheid and then became the president of South Africa. It reminds me that one has to have the long view of these fights for social justice and equality. If we believe that healthcare is a human right and that a single payer is the solution, then we have to look back on previous struggles for inspiration and lessons.

http://www.medscape.com/viewarticle/760728

PNHP statement on the Supreme Court deliberation of the Affordable Care Act

Health law, constitutional or no, fails to remedy ailment: doctors group

Press Release, March 26, 2012

Leaders of Physicians for a National Health Program, an organization of 18,000 doctors who advocate for single-payer national health insurance, released the following statement today:

Regardless of whether the Supreme Court upholds or overturns the Affordable Care Act in whole or in part, the unfortunate reality is that federal health law of 2010 will not work: (1) it will not achieve universal coverage, as it leaves at least 26 million uninsured, (2) it will not make health care affordable to Americans with insurance, because gaps in their policies will leave them vulnerable to bankruptcy in the event of major illness, and (3) it will not control costs.

Why? Because the ACA perpetuates a dominant role for the private insurance industry. That industry siphons off hundreds of billions of health care dollars annually for overhead, profit and the paperwork it demands from doctors and hospitals; it denies care in order to increase insurers’ bottom line; and it obstructs any serious effort to control costs.

In contrast, a single-payer, improved-Medicare-for-all system would achieve all three goals – truly universal, comprehensive coverage; health security for our patients and their families; and cost control. It would do so by replacing private insurers with a single, nonprofit agency like Medicare that pays all medical bills, streamlines administration, and reins in costs for medications and other supplies through its bargaining clout.

The major provisions of the ACA do not go into effect until 2014. Although we will be counseled to “wait and see” how this reform plays out, we’ve seen how comparable reforms in Massachusetts and other states have worked over the past few decades. They have invariably failed our patients, foundering on the shoals of skyrocketing costs – even as they have profited the big private insurers and Big Pharma.

The Supreme Court’s ruling is not expected until June. Regardless of how it rules, we cannot wait for an effective remedy to our health care woes any longer, nor can our patients. The stakes are too high.

We pledge to continue our work for the only equitable, financially responsible and humane cure for our health care mess: single-payer national health insurance, an expanded and improved Medicare for all.

https://pnhp.org/news/2012/march/health-law-constitutional-or-no-fails-to-remedy-ailment-doctors-group

Comment:

By Don McCanne, MD

The attention to the Supreme Court deliberations on the Affordable Care Act is an unfortunate distraction since, regardless of the outcome, intolerable levels of uninsurance, undersinsurance, and unaffordability will still be with us. We need to replace the Affordable Care Act with single-payer national health insurance, an expanded and improved Medicare for all.

Please share this pivotal message with others, and feel free to use it as a basis for other communications such as letters to the editor, op-eds, reports to community organizations, and any other modality that can educate others on this crucial issue.

Other resources:

PNHP statement on the passage of the Affordable Care Act (March 2010):
https://pnhp.org/news/2010/march/pro-single-payer-doctors-health-bill-leaves-23-million-uninsured

Fact sheet on single payer, improved Medicare for all:
https://pnhp.org/docs/2011/Improved-Medicare-for-All-Fact-Sheet.pdf

Many other resources are available at www.pnhp.org

Health law, constitutional or no, fails to remedy ailment: doctors group

FOR IMMEDIATE RELEASE
March 26, 2012

Contact:
Garrett Adams, M.D., president PNHP
Andrew Coates, M.D., president-elect PNHP
Oliver Fein, M.D.
David Himmelstein, M.D.
Steffie Woolhandler, M.D.
Mark Almberg, PNHP communications director, (312) 782-6006, mark@pnhp.org

Leaders of Physicians for a National Health Program, an organization of 18,000 doctors who advocate for single-payer national health insurance, released the following statement today:

Regardless of whether the Supreme Court upholds or overturns the Affordable Care Act in whole or in part, the unfortunate reality is that federal health law of 2010 will not work: (1) it will not achieve universal coverage, as it leaves at least 26 million uninsured, (2) it will not make health care affordable to Americans with insurance, because gaps in their policies will leave them vulnerable to bankruptcy in the event of major illness, and (3) it will not control costs.

******

Background

Statement of Physicians for a National Health Program upon the passage of the health law in March 2010. Fact sheet on the crisis in U.S. health care and the case for single-payer health reform. A recent analysis of the Massachusetts health reform.

*******
Physicians for a National Health Program (www.pnhp.org) is an organization of more than 18,000 doctors who support single-payer national health insurance. To speak with a physician/spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.

pnhpf3a

Comment:

The Massachusetts reform: an analysis

Comment:

Footer