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Hospital Association and others support raising Medicare age to 67

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Hospital Association and others support raising Medicare age to 67

Medicare eligibility age should go up, hospitals say

By Susan Jaffe
Politico, September 8, 2011

The American Hospital Association has a strategy for heading off any more Medicare payment cuts: Tell Congress to get the money from Medicare beneficiaries instead.

The association is urging its nearly 5,000 members to lobby Congress to raise the Medicare eligibility age from 65 to 67, in addition to other money-saving alternatives.

http://www.politico.com/news/stories/0911/63020.html

And…

The health industry case for raising Medicare’s eligibility age

By Sarah Kliff
The Washington Post, September 14, 2011

The Health Leadership Council, a consortium of 47 health industry leaders including Aetna, Pfizer and the Cleveland Clinic, will vote Wednesday on whether to endorse raising Medicare’s eligibility age. It’s “very likely” that the group will throw its weight behind the proposal, says HLC vice president Michael Freeman.

States, employers and seniors would all suffer if the Medicare eligibility rules were changed. It would shift about $11.4 billion in new costs to those parties while saving the federal government only $5.7 billion, according to the Center on Budget Priorities and Policy.

“This policy does nothing to control costs,” Sen. Bernie Sanders, an independent from Vermont, wrote in a memo obtained by the New York Times. “It simply shifts substantial costs from Medicare to other parts of government and to private and public employers.”

The Budget and Policy center estimates that if the Medicare eligibility age were raised, seniors under age 67 would have to spend $3.7 billion more in out-of-pocket cost. For many in the political system, that’s enough to reject the idea out of hand. But for some in the health-care system, that’s a profit waiting to be made.

http://www.washingtonpost.com/blogs/ezra-klein/post/the-health-industry-case-for-raising-medicares-eligibility-age/2011/09/14/gIQAJJ8sRK_blog.html

Comment: 

By Don McCanne, MD

Most of us who believe that the health care system should be designed to serve patients are enraged by America’s health industry leaders who believe that the system should be designed to serve the industry. Yet who has red carpet access to Congress and President Obama? Aren’t we going to do anything about that?

Gov. Shumlin announces appointments to Green Mountain Care Board

SEPTEMBER 13- MONTPELIER – Gov. Peter Shumlin today announced his appointments to the Green Mountain Care Board, a body that is central to the implementation of health reform in Vermont.  The Board is responsible for creating the first single payer health care system in the country, which will control costs and guarantee coverage regardless of employment status.

“In putting together this team, I looked for five really smart people who are fully committed to the goal of controlling health care costs, achieving universal coverage, and who can work as a team,” Gov. Shumlin said. “I also looked for people who could think creatively about how to encourage and reward Vermonters and Vermont health care practitioners for improving health and getting the most value out of our health care dollars.”

The Governor’s appointees include a business person, a practicing Vermont physician, an internationally-known health policy leader, an experienced state leader with extensive health care experience, and an expert in state-based health care reform.  They are:

Chairwoman Anya Rader Wallack, Ph.D. of Calais.  Wallack will chair the Green Mountain Care Board.  Wallack has served as Gov. Shumlin’s Special Assistant for Health Reform since January and spearheaded his legislative effort on health reform during the 2011 session.  Wallack is a native Vermonter who has lived for the past 13 years in Rhode Island.  She staffed then-Gov. Howard Dean on health care in the 1990s and ran the Vermont Program for Quality in Health Care.  More recently she ran the Massachusetts Medicaid Policy Institute and served as interim President of the Blue Cross Blue Shield of Massachusetts Foundation before launching a consulting business in state health policy.

 Al Gobeille of Shelburne.  Gobeille owns a restaurant business in Chittenden County.  He is active in the Lake Champlain Chamber of Commerce and serves on the Shelburne select board.  He also is a board member of the Visiting Nurse Association and a member of the state of Vermont’s payment reform advisory committee.

Karen Hein, M.D. of Jacksonville.  Hein is immediate past President of the William T. Grant Foundation, which funds research to improve the lives of adolescents throughout the U.S.  Previously she served as Executive Officer of the Institute of Medicine, overseeing the IOM Quality Initiative and numerous projects and publications aimed at informing efforts to improve health care delivery.  Hein was a Robert Wood Johnson Health Policy Fellow with the U.S. Senate Finance Committee in 1993-94.  She also is a longstanding faculty member at Columbia University and the Albert Einstein College of Medicine, where she has conducted extensive research on adolescent HIV/AIDS.  Hein has served on a number of non-profit boards, including the Dartmouth Medical School Board of Overseers and the board of RAND Health.

Con Hogan of Plainfield.  Hogan has worked for the past 10 years as an international consultant and co-authored two books about Vermont health reform with Dr. Deb Richter.  Previously he served as Secretary of Human Services under Governors Dean and Richard Snelling.  Hogan was President of the Montpelier firm International Coins and Currency from 1980-1991.  Before that he served in numerous positions in the State’s Department of Corrections.  Hogan is a well-known single payer advocate who has authored several books on Vermont health reform.

Allan Ramsay, M.D. of Essex Junction.  Ramsay is a family physician in Colchester.  Ramsay has been a professor in UVM’s Department of Family Medicine since 1980.  He has been a national leader in developing unique models for making sure that patients’ wishes are followed at the end of their lives.  Before coming to Vermont, Ramsay served as Medical Director for an HMO in rural Colorado and served in the National Health Service Corps.

Gov. Shumlin said he was pleasantly surprised at the level and volume of talent exhibited by applicants to the Green Mountain Care Board.  More than 100 people applied for the five jobs.  A nine-member nominating committee reviewed their applications and forwarded to the Governor 22 candidates who they deemed “qualified” to meet the requirements set forth in Act 48, the state’s health reform law.  Gov. Shumlin thanked the nominating committee for their work and also thanked those who applied for the board and were not chosen as appointees. 

“All of the candidates showed a strong commitment to meaningful health system reform and had impressive skills and experience,” the Governor said. He said that in making his choices, he focused on competence, experience, and a proven ability to affect real change in the health care system. 

“These five people have their job cut for them,” Gov. Shumlin said. “But I have no doubt that they will rise to the challenge and lead Vermont toward a bright future in which all of our citizens can afford access to quality care and our health care system is an asset unmatched by that of any other state.”

The Green Mountain Care Board will begin work on October 1.

Number of uninsured climbs to highest figure since passage of Medicare, Medicaid

50 million uninsured shows urgency of enacting single-payer Medicare for all: national doctors group

FOR IMMEDIATE RELEASE
Sept. 13, 2011

Contact:
Garrett Adams, M.D., M.P.H.
Steffie Woolhandler, M.D., M.P.H.
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org
Local physicians in 43 states available for comment (See historical table of uninsured by state below).

Official estimates by the Census Bureau showing an increase of about 1 million in the number of Americans without health insurance in 2010 – to a 45-year high of 49.9 million persons, or 16.3 percent of the population, under the bureau’s revised calculation method – underscore the urgency of going beyond the Obama administration’s federal health law and swiftly implementing a single-payer, improved Medicare-for-all program, spokespersons for Physicians for a National Health Program said today.

Employment-based coverage continued to decline. The bureau said 55.3 percent of Americans were covered by employment-based plans in 2010, down from 56.1 percent in 2009. It was the eleventh consecutive year of decline, from 64.2 percent in 2000.

In Massachusetts, whose 2006 health reform is widely viewed as the model for the federal health law, 370,000 people remained uninsured in 2010, representing 5.6 percent of the population, a jump from 4.3 percent who were uninsured in 2009.

Some states posted greater than a 3-percentage-point to 5-percentage-point increase in their uninsured rate, namely Idaho, Louisiana, Mississippi, Montana and South Carolina. In terms of absolute numbers, Louisiana had the largest increase in the number of uninsured, 240,700, followed by New York (177,700) and South Carolina (173,300). (See link to table of historical state-based data below.)

Among various population groups, the greatest loss of coverage was among working-age adults between the ages of 35 and 64, people with incomes below $49,999, and people with disabilities. Hispanics continue to disproportionately face uninsurance (30.7 percent), compared with blacks (20.8 percent), Asians (18.1 percent) and non-Hispanic whites (11.7 percent).

About 7.3 million children remain uninsured, the bureau said. Young people between the ages of 19 to 25 had a drop of 1.6 percentage points in their uninsurance rate, a figure the Census Bureau suggests is linked to the federal health law’s provision that allows dependent children to be covered under a parent’s health plan.

Lack of health insurance is known to have deadly consequences. A 2009 study in the American Journal of Public Health showed that 45,000 deaths annually can be linked to lack of coverage. Along the same lines, studies have shown that uninsured people with chronic illnesses like heart disease often delay or forgo care, often leading to serious complications of their medical condition and, in some cases, premature death.

“Tragically, we know that the new figures of uninsured mean a preventable annual death toll of about 50,000 people — that’s about one death every 10 minutes,” said Dr. Garrett Adams, president of PNHP, a nationwide organization of 18,000 physicians.

The Louisville, Ky.-based physician said that even if the administration’s new health law works as planned, the Congressional Budget Office estimates 23 million people will remain uninsured in 2019.

Adams was in Washington today, testifying before a subcommittee of the Senate Health, Education, Labor and Pensions Committee on the topic, “Is poverty a death sentence?”

Significantly, the Census Bureau said the number of people living in poverty, 46.2 million, is the largest number recorded in the 52 years such estimates have been published.

The increase in the uninsured would have been significantly higher had it not been for an increase in the number of people covered by government health programs such as Medicare, Medicaid, and military health care. Some in Congress have urged substantial cuts to such programs, particularly Medicare and Medicaid. If implemented, such cuts would almost certainly increase the uninsured rate in years ahead.

“The only remedy for this persistent problem is to insure everyone,” Dr. Adams said. “And the only way to insure everyone at a reasonable cost is to enact single-payer national health insurance, an improved Medicare for all. Single payer would streamline bureaucracy, saving $400 billion a year on administrative overhead, enough to pay for all the uninsured and to upgrade everyone else’s coverage. The new system’s bargaining clout would also help rein in rising costs.”

Dr. Steffie Woolhandler, professor at the City University of New York School of Public Health and visiting professor of medicine at Harvard Medical School, noted that the Census Bureau was once again silent on the pervasive problem of “underinsurance.”

“Not having health insurance, or having poor quality insurance that doesn’t protect you from financial hardship in the face of medical need, is a source of mounting stress, personal bankruptcy and poor medical outcomes,” Woolhandler said.

Referring to the Affordable Care Act, she said, “The new law’s subsidies for health insurance will not be sufficient to provide quality and affordable coverage to the vast majority of Americans. Tens of millions will remain uninsured, underinsured and without access to care. We need more fundamental reform. We need a single-payer national health insurance program.”

*****

Historical state-by-state data on the uninsured from 2007-2010, compiled by PNHP staff from the Census Bureau’s newly adjusted data, can be found here: https://pnhp.org/docs/2011/Uninsured-by-state-2007-2010.pdf

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.

Census numbers on the uninsured

Income, Poverty, and Health Insurance Coverage in the United States: 2010

U.S. Census Bureau
September 2011

Income

Real median household income was $49,445 in 2010, a 2.3 percent decline from 2009.

Comparing changes in household income at selected percentiles shows that income inequality is increasing.

Poverty

The official poverty rate in 2010 was 15.1 percent — up from 14.3 percent in 2009.

In 2010, 46.2 million people were in poverty, up from 43.6 million in 2009.

The number of people in poverty in 2010 is the largest number in the 52 years for which poverty estimates have been published.

Health Insurance Coverage

The number of uninsured people increased to 49.9 million in 2010 from 49.0 million in 2009. In 2010, the percentage of people without health insurance, 16.3 percent, was not statistically different from the rate in 2009 (16.1 percent).

The percentage of people covered by private health insurance decreased in 2010 to 64.0 percent (195.9 million). The percentage and number of people covered by government health insurance increased to 31.0 percent and 95.0 million in 2010.

The percentage of people covered by employment-based health insurance decreased to 55.3 percent in 2010 from 56.1 percent in 2009 (decreased to 169.3 million from 170.8 million).

The percentage and number of people covered by Medicaid in 2010, 15.9 percent and 48.6 million, were not statistically different from 2009 estimates.

The percentage and number of people with Medicare coverage in 2010 increased to 14.5 percent and 44.3 million.

In 2010, the uninsured rates decreased as household income increased — 21.8 percent of people in households with incomes ranging from $25,000 to $49,999 were uninsured; 15.4 percent of people in households with incomes ranging from $50,000 to $74,999 were uninsured; and 8.0 percent of people in households with incomes of $75,000 or more were uninsured.

U.S. Census release:
http://www.census.gov/newsroom/releases/archives/income_wealth/cb11-157.html

Full report (95 pages):
http://www.census.gov/prod/2011pubs/p60-239.pdf

Comment: 

By Don McCanne, MD

This Census report for 2010 shows that 919,000 more people were uninsured this past year than in 2009. This may be considered a ho-hum statistic by those who seem to be reassured by the provisions of the Affordable Care Act since the Act would expand coverage. However, there are other reasons to be very concerned, not the least of which are the statistics on income and poverty from this same report.

Of significance is the fact that this report counts anyone who was insured for any part of the year as being insured. It leaves out from the count of the uninsured those who have gaps in their coverage even if they were uninsured for most of the year. This results in a serious undercount of of those impacted by not being insured.

Another important deficiency is that this study makes no effort to quantify the rates of under-insurance. Employers and insurers have been redesigning their insurance products to shift more health care costs to the patient. Many studies have shown that this has impaired access to care and has caused significant financial hardship. The Census report is silent on this problem.

What is the shocker in this report is that these unfavorable insurance statistics are imposed on a background of declining income and expanding poverty. Median household income has dropped to $49,445 while income inequality is increasing. Further, the number of people in poverty (46.2 million) is the largest number in the 52 years for which poverty estimates have been published!

Anyone who has studied the Affordable Care Act realizes that health insurance policies will be very expensive even though they have relatively low actuarial values (leaving the patient responsible for 30 to 40 percent of health care costs). The new national standard in health insurance is “unaffordable under-insurance.” The subsidies for the premiums and for out-of-pocket spending have been shown to be inadequate for far too many people, again impairing access, creating financial hardship, and even leaving tens of millions with no insurance at all.

Had we enacted a single payer national health program, we could have included everyone, while eliminating under-insurance by providing first dollar coverage. We could have paid for it by eliminating the profound administrative waste that uniquely characterizes our system, and by introducing the other efficiencies of a single payer system. Wouldn’t it have been nice to be rid of the problem of the uninsured and under-insured so that we could intensify our efforts to improve income and reduce poverty? Or are those just not our national priorities?

VA experience suggests that most readmissions may not be preventable

VA Experience Shows Patient 'Rebound' Hard To Counter

By Jordan Rau
Kaiser Health News, September 12, 2011

The Veterans Health Administration, the largest integrated health care system in the country, has long employed many of the approaches Medicare is pushing on all hospitals to cut unnecessary readmissions. But new data show VA hospital patients are just as likely to end up back in a hospital bed as are patients at private hospitals.

Studies have found the VA does better than most hospitals in following appropriate guidelines for the best care to give patients.

The new statistics underscore how hard it may be for hospitals to stop patients from rebounding back through their doors, a major goal of Medicare as it seeks to curtail the nation’s ballooning health costs.

http://www.kaiserhealthnews.org/Stories/2011/September/12/VA-readmissions.aspx

Comment: 

By Don McCanne, MD

Obviously, when a patient is discharged from a hospital, every effort should be made to avoid slip-ups that might result in an unnecessary readmission soon after discharge. Yet many patients have serious, unstable conditions that can require readmissions that are unavoidable.

Differentiating avoidable from unavoidable readmissions can be very difficult. This report on VA hospital readmissions reveals that it may be nearly impossible, or that the numbers may be negligible. The VA already has in place guidelines and systems that should prevent unnecessary readmissions, yet their readmission rates are the same as private hospitals.

This brings into question the current efforts by Medicare to save costs by penalizing hospitals for readmitting patients. This policy could be particularly harmful if it resulted in the refusal to readmit patients who really needed to be back in (e.g., manage them in the emergency room and then send them back home).

Although quality improvement should be a continuing effort, this is simply another example of the totally inadequate cost containment measures of the Affordable Care Act – measures that only pretend that we are going to control costs. We need a massive overhaul of the financing system if we ever expect to bring costs under control – yes, a single payer national health program.

A decade later

Following is the Quote of the Day from September 12, 2001.

Editorial
The New York Times, September 12, 2001

“But this is an age when even revenge is complicated, when it is hard to match the desire for retribution with the need for certainty. We suffer from an act of war without any enemy nation with which to do battle. The same media that brought us the pictures of a collapsing World Trade Center shows us the civilians who live in the same places that terrorists may dwell, whose lives are just as ordinary and just as precious as the ones that we have lost.”

https://pnhp.org/news/2001/september/nyt-editorial

And now…

Editorial
The New York Times, September 10, 2011

“A decade later, we’re still trying to understand, looking back and looking ahead. It is not enough simply to remember and grieve.”

http://www.nytimes.com/2011/09/11/opinion/sunday/loss-and-hope.html

Study: Costs Keep Med Students From Much-Needed Mental Health Care

By Fran Cronin
WBUR CommonHealth blog, Sept. 7, 2011

Medical students are a challenged lot — sleep-deprived, stressed and driven. With the constant cramming of facts into their overloaded heads, and the constant need to steel themselves against the daily rounds of disease and injury, many medical students are left mentally and emotionally drained. Like their patients, they need a doctor. But many don’t reach out for help.

In a research letter just published in the Journal of the American Medical Association, Drs. Rachel Nardin and J. Wesley Boyd — both from the Harvard-affiliated Cambridge Health Alliance (CHA) — help illuminate the vulnerability of U.S. medical students to untreated and debilitating depression and substance abuse. These at-risk students tend not to seek the mental health services they need, the researchers found, due to the overwhelming cost of appropriate mental health services.

Schools and parents may be mandated to provide health insurance, but the study found that many of the plans offered did not provide affordable or adequate coverage for mental health and substance abuse treatment.

Data culled for this first-time survey of health insurance offered to U.S. medical students was collected from June through December 2010. The findings from 115 of the total 129 public and private medical schools in the U.S. revealed wide variability in annual dollar and visit limitations across the non-uniform plans.

For example, mental health dollar limits ran from $1000 – $200,000 for outpatient services; $800 – $200,000 for outpatient substance abuse treatment; and $1000 – $200,000 for inpatient mental health and substance abuse treatment.

Nardin said the survey also revealed that “Private medical schools are more likely than public schools to offer worse-than-average cost-sharing for outpatient substance abuse treatment. The worst region in the country, she said, was the Northeast.

Boyd, a faculty psychiatrist and an outspoken advocate for physician health, served for six years as associate director of the Physician Health Services, Inc., a nonprofit subsidiary of the Massachusetts Medical Society that provides confidential consultation and support to at-risk medical students and doctors across the state.

“Over the past two decades,” he said, “I have seen medical schools try to humanize the student’s experience and observed hospitals ratcheting up easier practices along with their awareness of physician health.” But the reality remains that medicine is very intense and stressful for those who are vulnerable to depression, anxiety, and substance abuse.

Troubled students often resist seeking treatment at the onset of their symptoms, fearing high out-of-pocket costs and an accumulation of more school debt. “But with any psychiatric disorder or substance abuse,” said Boyd, “early intervention definitely correlates to better outcomes.”

“There is a lack of sympathy for this fear of debt,” he said. “Most people just assume doctors will make a lot of money. But mounting debt from long stints at expensive schools weighs very heavily upon the students and most will do anything they can to avoid increasing it.”

According to statistics from the graduating medical school class of 2008, Nardin said, the median debt for public school students was $145,00 and for private school students it was $180,000.

To provide context for the cost of outpatient substance abuse treatment, I spoke with Talbott Recovery Campus, in Atlanta, Georgia, well known by Boyd and others for its Impaired Professionals Program. Debbie Kingston of the intake department told me: “The 90-day residential treatment program costs $39,000 for out-of network plans. If in-network, most insurance plans only cover $2000-$8000 of the total cost.”

Kingston added that detox, even though required, was not included in this tab. Depending on the addiction, detox can take from two to ten days. These costs also do not include the need for on-going monitoring and mental health support once a patient completes their residential stay.

In an article posted recently on Commonhealth, Rachel Zimmerman reported on a study, also authored by Boyd, that points to a more general obstacle to mental health care. The study’s hypothesis, which was borne out, posited that availability of psychiatric services has greatly diminished “due to a combination of paltry reimbursement rates and budget cutbacks.” The study’s authors wrote: “Reimbursements for psychiatric services are far lower than for other types of care, so institutions frequently restrict access as stringently as possible.”

Of the 64 medical facilities listed by Blue Cross and Blue Shield in the greater Boston area and contacted for the study, only four could offer an appointment within two weeks. Others refused to offer an appointment due to requirements that all patients be enrolled with a primary care doctor affiliated with that particular psychiatric facility. Study researcher Andy Lindenmeyer, a fourth- year resident in the Harvard Longwood psychiatric program, said, “I think the point here is that having health insurance does not equal access to care.”

Stephanie Woolhandler, a professor of public health at City University of New York and a visiting professor of medicine at CHA, summed up  the state of mental health care in a recent email: “The reality is that access to mental health care is very poor in this country, even for people with private insurance. Because mental illness is stigmatized, the mentally ill are often unable or unwilling to fight their insurance company to get their care reimbursed. The result is a very uneven distribution of care, with abundant mental health resources available to those who can pay out of pocket, while those that must rely on their insurance find that mental health care is restricted or even unavailable.”

“We need our medical schools to push themselves to provide students with more affordable care,” said Boyd. “What’s best for the health of our students will result in better physicians and the future well-being of their patients.”

A note of disclosure: Both Drs. Boyd and Nardin, authors of the survey letter published in JAMA, are active members of the group Physicians for a National Health Program, an organization of physicians who advocate for single-payer national health insurance.

http://commonhealth.wbur.org/2011/09/med-students-psych-care/

New health care jobs we don't need

Health Care Reform and the Health Care Workforce — The Massachusetts Experience

By Douglas O. Staiger, Ph.D., David I. Auerbach, Ph.D., and Peter I. Buerhaus, Ph.D., R.N.
The New England Journal of Medicine, September 7, 2011

In 2006, Massachusetts enacted legislation to provide universal health insurance coverage that later served as a model for the national health care reform legislation passed in 2010.

Since implementing these provisions, Massachusetts has achieved near-universal insurance coverage but has also seen continuing growth in health insurance premiums, a net increase in state spending on health care, and growing political pressures to control cost growth. Polls of the public and of physicians indicate that the state’s health care reforms are generally viewed favorably, though physicians are concerned about access to primary care and administrative burdens.

The Massachusetts reform experience has been watched closely for indications of what might occur throughout the country as national health care reform is implemented under the Accountable Care Act (ACA). One aspect of the Massachusetts experience that has remained unexplored is the impact on the health care workforce, particularly the question of whether greater numbers of health care professionals or support personnel were needed to ensure the success of the reform in increasing access to care.

Since Massachusetts enacted the Health Care Reform Plan in early 2006, total health care employment per capita in the state has grown more rapidly than that in the rest of the country.

Most of the divergence in employment growth between Massachusetts and the rest of the country occurred in 2006 and 2007, when the Massachusetts reforms were being phased in. Had health care employment in Massachusetts grown at the same rate as in the rest of the country, approximately 18,000 fewer people would have been employed in health care by 2010.

Most of the difference in health care employment growth occurred in administrative occupations. From 2005–2006 to 2008–2009, employment per capita in administrative occupations grew by 18.4% in Massachusetts, as compared with 8.0% in the rest of the country. These administrative occupations include management, business and financial operations, and office and administrative support (including medical records and health information technicians). In contrast, employment levels in nonadministrative positions in Massachusetts increased by 9.3% after health care reform, an increase similar to that of 8.6% in the rest of the United States.

The Massachusetts experience provides lessons for national health care reform. First, reform may accelerate the trend toward health care’s being the dominant employment sector in the economy. More important, our analysis supports physicians’ concerns about the administrative burden of health care reforms, an issue that will have to be addressed as the ACA is implemented. Finally, rather than requiring greater numbers of physicians and nurses, reform may require larger numbers of people supporting the work of such health care professionals.

http://healthpolicyandreform.nejm.org/?p=15255

Comment: 

By Don McCanne, MD

With today’s high unemployment rates, some have celebrated the fact that employment in the health care sector has continued to grow. This study confirms that health care employment in fact has grown within the state of Massachusetts, which has served as a model for our national reform through the Affordable Care Act. Should we be celebrating these newly generated jobs?

When the Massachusetts plan was proposed the policy experts at Physicians for a National Program warned that the additional administrative excesses would add to the already very heavy administrative burden that uniquely characterizes the U.S. health care system. PNHP issued the same warning when the Affordable Care Act was under development.

And what are these new jobs in Massachusetts? According to this report, “Most of the difference in health care employment growth occurred in administrative occupations.” More administration!

Although there is much interest in finding new employment opportunities for residents of the United States, there is also a compelling interest in controlling runaway health care costs. With a single payer system, one of the most important efficiency targets is to reduce this profound administrative waste. Instead, our legislators brought us changes that dramatically increase this waste!

We do need more jobs, but not more administrative jobs in a profoundly expensive health care system that is now almost sinking under the costly added burden of administrative excesses. There are far more important potential employment opportunities throughout society that would benefit all of us if Congress were to enact the type of jobs program that we need.

Instead of adding to our profound administrative waste, let’s use our health care dollars for, of all things, health care!

Blue Cross outsourcing shows need for single payer

By Rick Ford
Letters, The Palm Beach Post, Sept. 7, 2011

The excellent reporting by The Post’s Stacey Singer (“Blue Cross shifts business/cuts rates”) revealed that Blue Cross/Blue Shield of Florida has outsourced the management of its mental health network to an out-of-state company, which will ration the delivery of mental health care by hiring fewer doctors and therapists and paying these providers less.

This is probably only the first of many sub-specialties of medicine such as dermatology, ophthalmology, general surgery and podiatry in which health care and doctors will be rationed by Blue Cross via middleman corporations in order to assure profitability. There is no evidence that decreasing the number of doctors and therapists available or paying the remainder of Blue Cross health care doctors less will improve the quality of care. Despite this, Florida patients and businesses can be assured that their insurance premiums and out- of-pocket expenses to Blue Cross will not be reduced.

The future of health care does not involve hiring more for-profit middle-men corporations to ration quality health care at the expense of patients and small businesses.

Single-payer national health insurance based on Medicare would prevent this abuse of Florida’s patients and small businesses by multi-level for-profit health insurance companies by providing publicly financed, privately delivered health care for all Floridians at lower cost.

Editor’s note: Rick Ford is the president of Floridians for Health Care, which favors a single-payer system of health care insurance. He resides in Palm Beach Gardens, Fla.

http://www.palmbeachpost.com/opinion/letters/letters-paul-right-about-putting-an-end-to-1823863.html?printArticle=y

Uninsured figures due Tuesday; Single payer gets new wind

Sept. 8, 2011

Dear PNHP colleagues,

While the state of the U.S. economy understandably continues to dominate the news, the festering health care crisis is not far below the surface. And the compelling merits of single-payer health reform are bubbling up again in public discourse – including in newspaper editorials and in Congress.

What follows is a heads-up on an opportunity for adding your voice to this national discussion, a few highlights of recent media coverage of single payer, and news of two PNHP leaders’ upcoming appearances on Capitol Hill.

Register now for PNHP’s Annual Meeting in D.C.

We cordially invite you to attend PNHP’s Annual Meeting on Oct. 29 in Washington, D.C., to help us strategize about the next steps forward for the single-payer movement. Register today! You’re also invited to attend our popular Leadership Training Institute the day before. If you’d like to help sponsor a health-professional student’s attendance at the meeting, please donate to the Nicholas Skala Health Activist Scholarship Fund. If you’re a student, you can apply for a scholarship by filling out this form.

1. Next Tuesday, the U.S. Census Bureau will announce its findings on the number of uninsured persons in the United States in 2010. That figure – which is part of the bureau’s annual report on income, poverty and health insurance coverage – was 50.7 million in 2009, reflecting a record one-year increase of 4.3 million people.

Because of continuing job losses, companies dropping employee health insurance benefits, families going without coverage due to high costs, and the paring back of state Medicaid rolls, it’s likely the 2010 figure will be even higher.

Such predictions are always risky, of course. But one thing is certain: the problem of tens of millions of people who lack coverage will not go away anytime soon, even with the full implementation of the Affordable Care Act (assuming it survives legal challenge).

Nor will the pervasive problem of inadequate or shoddy coverage, what Dr. Don McCanne, senior health policy fellow at PNHP, calls the “new norm” of “unaffordable underinsurance,” go away until our nation adopts a single-payer system.

We urge you to be alert for the Census Bureau announcement and, when the new numbers are released, to write an opinion piece or a letter to the editor citing the those figures and making the case for single-payer national health insurance, an improved Medicare for all.

In addition, on Tuesday or Wednesday we’ll be releasing a PNHP statement on the Census Bureau report and providing a state-by-state breakout of the uninsured numbers – a state-specific figure that can serve as a news peg for your local media.

To help you in your efforts, we can offer a new, up-to-date PNHP fact sheet on the health care crisis and the case for an improved Medicare for all, along with some tips on how to write an op-ed or letter.

Please also consider calling your representative or senators in support of single-payer legislation like Rep. John Conyers’ H.R. 676 or Sen. Bernie Sanders’ S. 915, citing the latest figures.

2. A recent letter to The New York Times on single payer from Dr. Samuel Metz of Portland, Ore., provoked an extraordinary response.

Dr. Metz wrote in part: “Health care reform could provide better care at less cost by replacing individual mandates with a single-payer national health care plan financed by taxes. Congress’s power to mandate purchase of private products sold at a profit is disputable, but Congress’s power to tax is not.”

The Times decided to showcase the letter and made a special appeal for reader responses. The result, according to a reliable source, was about 500 letters in support of Dr. Metz’s letter, and only 2 that were opposed – one of which was anonymous! The Times ended up printing 8 “for,” 1 “against.”

3. In recent weeks, at least five newspapers – the St. Louis Post-Dispatch, the Cleveland Plain Dealer, the Kansas City Star, the Charleston (W.Va.) Gazette and the Cape Cod Times – have published editorials describing the merits (and undisputed constitutionality) of a single-payer plan, with several citing PNHP’s research. Columnists like John Nichols of The Nation and economist Robert Reich have also upped their writing about an-improved-Medicare-for-all approach.

4. As yet another sign of the growing interest in single payer, two PNHP leaders have been invited to speak on Capitol Hill next week. On Tuesday, I am scheduled to testify before a subcommittee of the Senate Health, Education, Labor and Pensions Committee on “poverty and health care access,” and on Wednesday, PNHP co-founder Dr. Steffie Woolhandler has been invited to meet with several members of Congress and to deliver a congressional staff briefing on “Single Payer 101 and Cost Control.”

5. Finally, we’d like to draw your attention to a new study in the Journal of the American Medical Association, JAMA, showing that medical schools offer subpar private health insurance coverage to their students for mental health and substance abuse treatment, thereby imperiling doctors-in-training and their future patients.

The authors, including PNHP board member Dr. Rachel Nardin and PNHP member Dr. J. Wesley Boyd, told reporters that their findings are yet another reason for adopting a single-payer system. The study was covered by Medscape, WBUR’s CommonHealth blog, The Chronicle of Higher Education and Inside Higher Ed.

Cordially,

Garrett Adams, M.D., M.P.H.
President

Downward mobility for the middle class

Downward Mobility from the Middle Class: Waking up from the American Dream

By Gregory Acs
The Pew Charitable Trusts, Economic Mobility Project, September 2011

The idea that children will grow up to be better off than their parents is a central component of the American Dream, and sustains American optimism. However, “Downward Mobility from the Middle Class: Waking up from the American Dream” finds that a middle-class upbringing does not guarantee the same status over the course of a lifetime. A third of Americans raised in the middle class — defined here as those between the 30th and 70th percentiles of the income distribution — fall out of the middle as adults.

http://www.pewtrusts.org/uploadedFiles/wwwpewtrustsorg/Reports/Economic_Mobility/Pew_PollProject_Final_SP.pdf

Comment: 

By Don McCanne, MD

Extensive studies have shown that over the past few decades income has dramatically shifted upwards to the wealthiest individuals. This study adds to that data base by showing the impact on the middle class. A third of Americans raised in the middle class have fallen out of the middle (and this was before the economic downturn).

Because health care costs are now so high the middle class can no longer afford to fund an insurance pool that would be adequate to cover their collective health care needs. If the middle class is to receive adequate health care then it is imperative for the wealthy to contribute a greater amount through a progressive financing system (i.e., taxes).

What won’t work is an underfunded welfare program for the poor (Medicaid) and exchanges of low actuarial value under-insurance plans for the middle class, yet this is what the Affordable Care Act is bringing us.

What will work is a single comprehensive risk pool that is equitably funded and includes everyone. If the wealthy were allowed to have a higher standard for themselves with a lower, mediocre standard for everyone else then their support for the health plans serving the “commoners” would diminish. By having a single high standard for everyone, the wealthy would use their influence to see that the health care system met their standards, thereby pulling up the standards for everyone else.

Of course, that is precisely the goal of an improved Medicare for all.

Med Students' Own Mental Health Care

By Elizabeth Murphy
Inside Higher Ed, Sept. 7, 2011

A study published Tuesday paints a grim picture of America’s increasingly stressed medical students, in what researchers say they hope will be a “wake-up call” to the nation’s medical schools and health care policy makers.

The study, led by researchers at the Cambridge Health Alliance, a hospital system near Boston, includes data from 115 of the nation’s medical schools, looking specifically at what type of health insurance they offer to students with mental health and substance abuse problems.

“This is one small example of how the system is failing at-risk people,” said Rachel Nardin, chief of the neurology division at Cambridge Health Alliance and a co-author of the study, which was part of a special issue of the Journal of the American Medical Association on medical education. “The study is partly a wake-up call to look at the health insurance [the schools] offer. They are struggling in the face of a health care system that has unsustainable costs.”

Studies have shown medical students have higher rates of depression than their peers and are equally at risk for substance abuse issues, said Nardin, also an associate professor of neurology at Harvard.

The researchers looked at medical students’ annual maximum visit limits, co-pay amounts, dollar limits and co-insurance, which is the percentage of total costs paid by the patient. The study found that fewer than 22 percent of the medical schools provided mental health and substance abuse coverage without a cost-sharing requirement. What’s more, six of the 115 offered no coverage for in-patient mental health visits, substance abuse treatment or either.

“This is worrisome because of evidence that cost-sharing discourages students from seeking both [mental health treatment and substance abuse treatment],” the study says.

Researchers culled student insurance data from college websites and surveys. The study did not look at how many students use outside insurance or university-wide counseling services separate from the specific colleges. Those limitations were among several problems cited by medical school officials about the JAMA study.

The majority of medical schools are making a “valiant effort” to provide mental health coverage for their students that is affordable and cognizant of the societal stigma attached to such disorders, said Sam Parrish, associate dean of student affairs at Drexel University’s College of Medicine.

Parrish pointed to a 2009 survey conducted by the Association of American Medical Colleges, which indicated that 59 percent of schools reported that mental health services for students were available with no out-of-pocket costs associated. The survey did not separate out substance abuse care. Parrish, a member of the AAMC survey’s committee, said his college provides a psychologist and psychiatrist for its medical students at no cost. Communication between those professionals and their patients are kept confidential by several “firewalls” put in place by the college, he said.

This, however, does not fully address the issue of confidentiality, Nardin said. Some medical students fear that by seeking help for mental health or substance abuse issues, they will jeopardize future opportunities as doctors, especially if that help is from someone right in the college, she said.

Elizabeth Wiley, a fourth-year medical student at George Washington University, said access to services that entail seeing faculty members can be difficult for some medical students. At George Washington, the psychiatry faculty who oversee students in class are also oftentimes the doctors that treat students.

“The only option is to be seen by someone that will likely play a role in evaluating you,” Wiley, also a student member of the American Medical Student Association, said. “It creates a deterrent in seeking care.”

“My goal is not to demonize these schools that are struggling,” Nardin said. “Health care costs are just staggering for all types of institutions these days. Although it was bad, it’s not necessarily worse than private coverage in general. This is a particularly poignant example of this because we can see the consequence of this for these patients.”

At-risk medical students are an example of a larger systemic problem with a health care system that relies on a patchwork of private plans, Nardin said.

The real solution, Nardin believes, will not come from the schools themselves. It’s lawmakers on the national level who have to put in place more regulation to protect students, medical or otherwise.

Aaron Smith, co-founder and executive director of the health care advocacy group Young Invincibles, said the reality is that college health care plans vary widely.

Smith said it is a “weird contrast to have these medical students who are so passionate about helping others” be left in the lurch when it comes to mental health and substance abuse care from their schools.

“I think all schools, not just medical schools, should see this as an opportunity to provide decent health care for their students and improve it when it is not up to par,” he said.

But students can hopefully look forward to new proposed regulations for student health care, Smith said. Proposed federal regulations through the Department of Health and Human Services call for less cost-sharing, restrictions on benefits caps and free preventive care, among other policies. If approved, these regulations would tentatively take effect next academic year, Smith said.

Even so, Parrish said the mental health professionals at his school have been consistently busy for the 11 years he has held his position. If time is any marker, this is a problem that is unlikely to go away.

http://www.insidehighered.com/news/2011/09/07/study_finds_mental_health_care_coverage_for_medical_students_lacking