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Extending Medicare to everyone makes good economic sense

By James C. Mitchiner, M.D.
AnnArbor.com, July 31, 2011

In yet another attempt to bridge the debt ceiling impasse by reigning in entitlement spending, President Barack Obama recently proposed raising the eligibility age for Medicare from 65 to 67. As we pass Medicare’s 46th anniversary on July 30, I propose that rather than raising the age for Medicare, we consider lowering it instead. In fact, let’s lower it to zero.

This is not as offbeat as it sounds. Expanding and improving Medicare — essentially creating a Medicare-for-All national health insurance program — would eliminate the administrative duplication that pervades the private insurance industry, capture economies of scale, and use more of the health care dollar for actually improving health and preventing illness.

Medicare-for-All would create a system providing universal and portable health care so that all Americans could receive the same health benefit package regardless of where they lived, and one that would follow them if they relocated. An expanded Medicare system would embody a uniform set of rates and fees for hospitals and physicians, and medical records for patients, all supported by a universal health information technology platform.

Employers would have the health insurance monkey off their backs, allowing them to better compete in the global marketplace. And a national health program modeled on Medicare would allow the U.S. to join the ranks of other advanced democracies that provide health insurance to all their citizens.

Since its creation, Medicare has turned out to be an enormously successful program, as measured by universal access to benefits, portability, minimal administrative costs, and overall popularity among its 47 million current beneficiaries. And relative to private for-profit insurance, it has done a better job in pooling risk, bending the cost curve, and making timely payments to doctors and hospitals. Yet Medicare as it exists now is by no means perfect.

The average Medicare recipient is finding it increasingly harder to afford the growing out-of-pocket costs of health care. Many will skimp on necessary care, or just go without. And Medicare’s looming insolvency, currently projected to occur in 2024, is deeply concerning to beneficiaries, government actuaries, Congress and health policymakers alike.

Expanding Medicare to cover everyone would address these problems. Since young and middle-aged adults and their families are healthier than current Medicare beneficiaries, and therefore have lower health care expenses, an expanded risk pool under Medicare-for-All would have an average per-beneficiary cost that’s much less than the current cost for seniors (over $10,000 per current enrollee). And since expanded revenues would be greater than projected expenses, Medicare’s Trust Fund could be replenished, and personal out-of-pocket costs could be minimized. Of course, financing an expanded Medicare program would require the non-elderly to pay an increased tax on income, but this would be modest, progressive, and a fraction of the exorbitant private insurance premiums they’re paying now.

To my critics who would decry a universal Medicare program as “government-run health care” with its implied rationing and restrictions, think about how the for-profit insurance companies control your choices now. Then recall the image of the health care townhall protester in 2009 who shouted, “Keep your government hands off my Medicare.” Can you think of a better testimonial to the non-intrusiveness of the federal government in individual health care decisions? And as a physician, I find it much easier to deal with Medicare than with managed care plans.

It is clear that reducing government spending and thus forcing beneficiaries to pay more out-of-pocket will not by itself preserve Medicare and keep it sustainable for the baby boomers. Rather, what needs to be done is to find a better way of financing this important social insurance program so that it remains viable and available to future retirees. The solution is a single-payer national health insurance program modeled on the success of Medicare. That would be the icing on the Medicare birthday cake.

Dr. James Mitchiner, an emergency medicine physician, is the former president of the Washtenaw County Medical Society, and a member of Physicians for a National Health Program.

http://www.annarbor.com/news/opinion/extending-medicare-to-everyone-makes-economic-sense/

Medicare, an effective program, turns 46

By Ann Settgast, M.D.
Star Tribune (Minneapolis), July 30, 2011

Whether the debt ceiling is raised or not in the days ahead, Minnesotans and the nation have reason to celebrate this weekend. Saturday marked Medicare’s 46th birthday.

While we have a long way to go before our health care system works well for all patients, this anniversary gives us an opportunity to reflect on what we’ve done right.

Surprisingly, Medicare was born out of bitter controversy in 1965. It was condemned by some as “socialized medicine,” a threat to basic freedoms. As a physician, I’m embarrassed to say organized medicine was among its key opponents. It all seems silly today.

Since its inception, Medicare has afforded hundreds of millions of Americans access to high-quality health care. It has reduced poverty among seniors and improved the financial security of their families. It has become one of the most popular government programs in history.

Current political discourse is centered on spending cuts, including Medicare. But covering Americans via Medicare saves money. No, that is not a typo.

Medicare boasts far lower administrative costs than the leanest private insurance company. While it is true that Medicare spending has risen dramatically over time, its growth is far less than that of the private sector.

And remember that Medicare pays for the care of our sickest and oldest, while private insurers foot the bill for the young and healthier.

In fact, uninsured Americans in their late 50s and early 60s routinely delay needed care, only to become expensive Medicare recipients once they reach 65.

Medicare is not the cause of health care inflation; rather, it is a victim of our country’s sky-rocketing health care costs. Cuts to Medicare will not control these costs.

Rather, they will reduce access to care by the nation’s elderly, worsen their health status, and increase financial hardship among already-struggling Americans.

Not only is Medicare less expensive than private insurance, it provides superior service. An example is the free choice of doctor granted to patients under Medicare — a basic freedom many privately insured Americans are currently denied.

As a practicing internist, I can attest to the lower “hassle factor” doctors incur when dealing with Medicare rather than interacting with multiple private payers, each requiring different rules and regulations. Expecting us to treat patients differently because they have different or no insurance contradicts our professional responsibility.

Medicare is far from perfect, and it has some serious limitations. But for this weekend, let’s celebrate a government program that actually works incredibly well. Americans are proud of Medicare. It should be strengthened, expanded and improved to include all of us. A sustainable Medicare-for-all system is the reform our nation needs.

Ann Settgast, M.D., is a primary care doctor practicing in the Twin Cities. She co-chairs the Minnesota chapter of Physicians for a National Health Program.

http://www.startribune.com/opinion/otherviews/126430563.html

Save lives and money by expanding Medicare to all

By Dr. Quentin Young
FireDogLake, July 29, 2011

With media attention focused on the debt-ceiling drama in Washington, and with so many Americans rightly preoccupied with the frightening level of joblessness and bleak state of the economy, it might seem strange to urge a national celebration of Medicare’s 46th anniversary this Saturday, July 30.

After all, if we’re to believe top lawmakers, Medicare is part of the problem, right? Aren’t we supposed to be talking about raising the eligibility age from 65 to 67, reducing benefits, increasing seniors’ co-pays and deductibles or, even more dire, abolishing the program altogether and handing seniors vouchers to buy private insurance?

Wrong. Despite its market-obsessed detractors and those who would weaken the program in the name of deficit reduction, Medicare is the solution, not the problem. More precisely, an improved Medicare for all – a single-payer health system – is the right prescription for treating not only our health care woes, but our ailing economy as well.

How so?

The biggest albatross around the neck of our health care system is the private insurance industry, which remains firmly entrenched under the new federal health law.

Thanks to companies like UnitedHealthcare, WellPoint, Aetna, Humana and Cigna, our nation’s patients, businesses, and health providers are chronically tormented by skyrocketing premiums, denials of care, endless paperwork and bureaucracy, and the spectacle of obscene CEO salaries and insurance company profits.

And what does this so-called system get us? Fifty-one million people who have no coverage at all; 45,000 annual deaths linked to lack of coverage; a million personal bankruptcies annually (62 percent of the total) linked to illness or medical debt; and World Health Organization indicators that put us in 37th place globally, even though we spend twice as much per capita as any other nation.

Waste in our system is staggering. Research shows about 31 cents of each U.S. health care dollar is currently spent on administration, over half of which is unnecessary. That translates into $400 billion wasted annually. If we recaptured that money and applied it to clinical care – as we could under a single-payer system – we’d be able to assure everyone comprehensive, first-dollar, high-quality coverage.

So how does this relate to Medicare? As it happens, Medicare is an excellent model for a more rational, single-payer alternative to our present dysfunctional arrangements.

Medicare works. Patients go to the doctor or hospital of their choice. It’s efficient: its overhead is less than 3 percent, less than a quarter of private insurers’. Costs rise more slowly in Medicare than in the private insurance sector.

Medicare isn’t perfect, of course. The program can be empowered to negotiate with drug companies for lower prices. The deductibles and co-pays can be eliminated. Its funding can be augmented from general revenues or a miniscule tweaking of the general payroll tax rate.

But thanks to Medicare, the health and economic security of millions of seniors, the severely disabled, and our nation’s families have dramatically improved. It should not be weakened or destroyed. Those who advocate doing so will reap a whirlwind of popular rage, as GOP Rep. Paul Ryan, an exponent of ending Medicare, has found out.

In such an environment, the obvious approach of President Obama and Congress should be to join the American people in embracing Medicare, not to cut it. But right-wing ideologues, with personal assists from the president himself, have forced a debate on the wrong issue: the debt ceiling, as opposed to enhancing the health status of the American people.

The paradox in this flawed debate is that the solution to our nation’s fiscal problems would be greatly simplified by the creation of a streamlined, efficient and high-quality single-payer Medicare-for-all program. Data suggests that if we had a single-payer system like other industrialized nations, we’d currently have a federal budget surplus.

The 46th anniversary of Medicare should be a time to celebrate its achievements and to strengthen it by expanding it to all.

Quentin D. Young, M.D., is national coordinator of Physicians for a National Health Program (www.pnhp.org) and former chief of internal medicine at Cook County Hospital in Chicago.

http://my.firedoglake.com/quentonyoung/2011/07/29/save-lives-and-money-by-expanding-medicare-to-all/

The Commonwealth Fund compares twelve industrialized nations

The U.S. Health System in Perspective: A Comparison of Twelve Industrialized Nations

By David A. Squires
The Commonwealth Fund, July 2011

This analysis concentrated on 2010 OECD health data for Australia, Canada, Denmark, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

What is driving higher health care spending in the U.S.?

Spending on health care in the U.S. in 2008 far exceeded that seen in other countries. In both dollar figures and as a percentage of GDP, no country came within 70 percent of U.S. spending ($7,538 per capita, 16% GDP). This higher spending does not seem to simply reflect higher income.

There are many forces driving health care spending. An annual series of Commonwealth Fund-sponsored analyses of OECD health data dating back to 1999 has explored a number of potential factors, including: administrative complexity, the aging of the population, the practice of “defensive medicine” under threat of malpractice litigation, chronic disease burden, health care supply and utilization rates, access to care, resource allocation, and the use of technologically advanced equipment and procedures. These and other studies have found, contrary to often-cited explanations, the U.S. has a relatively young population, average or below-average rates of chronic conditions, and comparatively few doctor visits and hospitalizations compared with other industrialized countries. Instead, these studies suggest major reasons for higher spending include substantially higher prices and more fragmented care delivery that leads to duplication of resources and extensive use of poorly coordinated specialists.

A 2010 cross-national study conducted by The Commonwealth Fund ranked the U.S. sixth of seven countries in terms of quality, with average performance on effectiveness and patient-centeredness and low performance on safety and coordination.

These findings suggest that the U.S. health system is not delivering superior results despite being more expensive, indicating opportunities for cross-national learning to improve health system performance.

With chronic disease on the rise amidst an aging demographic and accounting for ever more health care spending, more effective treatment and management in primary care settings may have the potential to simultaneously improve patient care while preventing the unnecessary use of scarce and expensive resources.

http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2011/Jul/1532_Squires_US_hlt_sys_comparison_12_nations_intl_brief_v2.pdf

Comment:

By Don McCanne, MD

This Commonwealth Fund report confirms, once again, that we spend far more than other nations for health care while receiving only mediocrity from a fragmented system. There is much that we can do to improve quality and value, but it needs to begin with a rational system of financing health care.

We don’t have such a system now and will not have it under the provisions of the Patient Protection and Affordable Care Act – a model of reform that is the most expensive and falls far short on goals of reform. We already have learned much from the other eleven nations discussed in this report, but we have failed to act on what we know. Clearly, a single payer national health program with reinforcement of our primary care infrastructure is the redirection that we need.

Profits vs. health

By Kay Tillow
Letters, The Lexington (Ky.) Herald, July 27, 2011

The Commonwealth Fund has published a June 2011 study of Medicaid managed care plans. The news is not good, but it is not surprising.

This study found that “publicly traded plans that focused primarily on Medicaid enrollees paid out the lowest percentage of their Medicaid premium revenues in medical expenses and reported the highest percentage in administrative expenses.”

The study by M.J. McCue and M.H. Bailit also found that the for-profit plans scored lower on quality, preventive care, treatment of chronic conditions, members’ access to care and customer service.

Kentucky has just handed over the care of our most vulnerable citizens to such companies. What do we expect to happen when for-profit companies are paid a flat rate per person? There will be a built-in financial incentive to boost profits by denying care.

When will we learn what the rest of the industrialized world learned long ago — that health care is too precious to be entrusted to profit-making enterprises? Profit-seeking inevitably distorts care and diverts resources from patients to investors.

We could cover everyone while reining in the costs if we would move to a single-payer system as embodied in HR 676, the Expanded and Improved Medicare for All Act. We have to stiffen our spines, stand up to corporations and get it done.

Kay Tillow is coordinator of the All Unions Committee for Single Payer Health Care, which builds union support for H.R. 676. She lives in Louisville, Ky.

http://www.kentucky.com/2011/07/27/1825368/letters-to-editor-july-27.html#ixzz1TKMJRmcm

National Health Expenditures in 2011 and 2020

National Health Spending Projections Through 2020: Economic Recovery And Reform Drive Faster Spending Growth

From the Office of the Actuary, Centers for Medicare and Medicaid Services
Health Affairs, July 28, 2011

National Health Expenditures, billions:
2011 – $2,708.4
2020 – $4,638.4

National Health Expenditures, per capita:
2011 – $8,648.5
2020 – $13,708.8

National Health Expenditures, as percent of GDP:
2011 – 17.7%
2020 – 19.8%

http://content.healthaffairs.org/content/early/2011/07/27/hlthaff.2011.0662.full

Comment:

By Don McCanne, MD

This year we are spending $2.7 trillion on health care, or about $8,650 per person. What can we expect after the Patient Protection and Affordable Care Act is fully implemented? In 2020, we will be spending over $4.6 trillion, or about $13,700 per person. As a percent of GDP, our health care spending will increase from the current 17.7 percent to almost 20 percent.

Is the Affordable Care Act really affordable? A single payer national health program would be effective in controlling costs, but, much more importantly, it would ensure that all of us – no exceptions – would receive the health care that we need. The Affordable Care Act will cost us more while leaving far too many broke and without health care.

We can still have the health care system that we need, but we’ll have to replace our dysfunctional representatives in Congress. Can we do that?

Wisconsin doctors group: Preserve and expand Medicare!

Single-payer advocates call on the U.S. Congress to block measures which limit enrollment or privatize Medicare

FOR IMMEDIATE RELEASE
July 28, 2011

Media advisory

Contact:
Melissa Stiles, M.D.
Eugene Farley, M.D.

MADISON — The Wisconsin Chapter of Physicians for a National Health Care Program, the Linda & Gene Farley Chapter, will host a rally for Medicare on this Saturday, July 30, at 10 a.m. in downtown Madison to celebrate Medicare’s 46th birthday.

Medicare is the nation’s most popular social program. For 46 years it has provided those over 65 years old, those with disabilities and those with certain medical conditions access to comprehensive health care. Despite more than two generations of successful, cost-efficient health care delivery, Medicare opponents are seeking to privatize the program or cut its funding, along with cutting Medicaid and Social Security.

Wisconsin Congressman Paul Ryan’s “Path to Prosperity” proposes significant changes to Medicare. This plan would change the age of eligibility and shift Medicare from a public to a private voucher system. The end results would both increase the number of uninsured Americans and shift costs to Medicare recipients. The Congressional Budget Office estimates the plan would shift two-thirds of the cost of care to consumers by 2030, with out-of-pocket costs amounting to over $20,000 per year for each Medicare recipient.

“We need to continue to move forward on improving health care and the health of our citizens,” says Dr. Melissa Stiles of PNHP Wisconsin. “Until such time as our nation adopts a single-payer health plan that provides universal and comprehensive coverage to everyone, we will stand with our patients to support Medicare.” Medicare is the primary safety net for our seniors and those with disabilities and covers more than 880,000 people in Wisconsin (2009, Kaiser Family Foundation, State Health Facts).

PNHP Wisconsin is hosting “Happy 46th Birthday Medicare! A Rally for Medicare” on this Saturday, July 30, from 10-11 a.m. at the top of State Street (by the Wisconsin Veterans Museum), Madison. The event will feature the Raging Grannies singing protest songs, a giant birthday card and birthday cake. Dr. Chuck Benedict, former state assembly representative from Beloit, and Dr. Gene Farley, longtime single-payer advocate, will speak at the event.

*******
Physicians for a National Health Program (www.pnhp.org) is an organization of 18,000 doctors who advocate for single-payer national health insurance, an improved Medicare for all. To speak with a physician near you, visit www.pnhp.org/stateactions, or call (312) 782-6006.

Market forces destroy health care

By Milton Hirshberg, M.D.
Cape Cod Times, July 27, 2011

The executive director of a group called Health Care For All had a commentary in your July 8 edition bearing the headline “Creating patient-centered health care.” Long ago, in the town where I grew up, the people already had patient-centered health care. “Creating” is inappropriately used in this heading; “re-creating” would be more accurate.

In my town, my family doctor held office hours and made house calls. He seemed to be as happy working in this occupation as anyone could possibly be. The medical specialists in town were a surgeon and a radiologist. If certain other specialists were needed, they came from Boston to the community-owned hospital when called. The town doctor made rounds twice a day at the county home for the poor and was in his office the rest of the day. There were a school nurse and doctor. Everyone received necessary medical care.

Today we call this a system of Health Care for All, which other prosperous nations still have; but in the United States, it has been disposed of by market forces. Attempts to re-create it in America, through the mobilization of national or state resources under government sponsorship, have been condemned by critics as a socialistic affront to the “free” market — even though the market is the captive of financiers, is not free, has been tried in health care, and has failed us just as Alan Greenspan, the former Federal Reserve chairman, has acknowledged the market’s failure with regard to the financial crash of 2008.

Our current health system resembles Germany’s; both systems have combined public and private (wellness or insurance) plans with funding from public and private sources at 75 percent public and 25 percent private. But almost all of our private health plans are businesses with the primary purpose of making profits, and the plans in Germany are nonprofit. Germany supports health care at about 11 percent of its economy, while we take 17 percent of our gross domestic product for ours. And the German people spend about $3,700 each for their wellness system, and we spend $6,500 for roughly equivalent health quality.

Obviously we are cheating ourselves, as we pay $1.79 for the same health value that Germans obtain for $1. We know that Germany and the other nations with universal health programs do excel, in terms of program cost/effectiveness, by a great margin over ours.

Why do we persist in this colossal folly and obstinately reject systemic reform after such a comparison? We are the only nation in the world trying to operate a health program by defining health as a commodity, available if a person can pay the market price. And it hasn’t worked, and won’t.

Kenneth Arrow, 1972 recipient of the Nobel Memorial Prize in Economic Sciences, in a 1963 paper published in The American Economic Review, concludes that in the operation of the medical profession “the usual assumptions of the market are to some extent contradicted. The medical profession is only one example, though in many respects an extreme one.”

Health care is not for the market, Arrow concludes. So why are we still trying to invent a different reality that is illogical and doesn’t satisfy the needs of society, especially when there is an alternative available that has already been designed by others, tried by others, and works for others? We Americans already have Medicare, upon which a single-payer national health insurance model can easily be built as has been done in Thailand, South Korea, and Canada. “Know, my son,” said a dying Swedish statesman in the 17th century, “with how little wisdom the world is governed.”

Dr. Milton Hirshberg of South Harwich, Mass., is a retired psychiatrist.

http://www.capecodonline.com/apps/pbcs.dll/article?AID=/20110727/OPINION/107270343

National Day of Action for Medicare's 46th Anniversary: Medicare is the solution to the fiscal crisis, not its problem

Healthcare-NOW!

FOR IMMEDIATE RELEASE:
July 27, 2011

CONTACT:
Katie Robbins: National Organizer, Healthcare-NOW!. 330-618-6379, katie@healthcare-now.org.
Donna Smith: Community Organizer/Legislative Advocate, California Nurses Association/National Nurses United. 773-617-4493, donnas@calnurses.org.

Philadelphia, PA – As Washington stalls over reaching a deal on the debt ceiling, residents across the country point to a solution to our health and fiscal crisis: “Improved Medicare-for-all.” The Medicare program will celebrate its 46th anniversary this Saturday, July 30, and events are planned from coast-to-coast to honor the nation’s most popular social insurance program, as well as call for its preservation and expansion.

In deals being made over increasing the debt ceiling, cuts to Medicare, along with Medicaid and Social Security, have been discussed by both Republicans and Democrats. The false claims that Medicare costs are out of control leads Americans to believe that Medicare itself is an unsustainable program, when the truth is that Medicare costs themselves are not rising – it is healthcare costs as a whole that have become unsustainable.

“The real problem is the soaring costs of health care that lie beneath Medicare,” said Robert Reich, former Secretary of Labor under President Bill Clinton. “They’re costs all of us are bearing in the form of soaring premiums, co-payments, and deductibles. Medicare offers a means of reducing these costs – if Washington would let it.”i

An enormous amount of waste in our healthcare system comes from propping up the for-profit health insurance companies resulting in one out of every three healthcare dollars goes to administration, billing, advertising, CEO salaries and profits, while leaving most Americans uninsured or under-insured. Conversely, Medicare – acting as single payer by collecting all healthcare fees and paying out all healthcare costs for the elderly and the disabled – has a modest overhead of only 3 percent.ii

Healthcare-NOW!, a national advocacy organization for universal single-payer healthcare, knows that the solution to our nation’s deficit will not be found by cutting our vital social insurance programs. Rather, the solution lies in a national single-payer system or Medicare-for-all. This would greatly control sky-rocketing health costs, and reduce administrative waste, medical errors and unnecessary medical procedures and tests, as well as allow the government to use its enormous bargaining power to negotiate lower rates with hospitals and pharmaceutical companies. A national single-payer healthcare system would save $400 billion a year in overall health costs.iii

“We don’t have a fiscal problem in this country, we have a priority problem,” said Katie Robbins, Healthcare-NOW! National Organizer. “Healthcare-NOW! calls for responsible government that uses our healthcare dollar wisely and equitably, not a government that sacrifices human needs for political theater.”

As Congress and the White House hold working-class Americans’ needs hostage, thousands of Healthcare-NOW! members and supporters have organized more than 40 actions at Congressmembers’ offices and community centers in over 20 states to tell them Medicare is the solution – not the problem.

In honor of Medicare’s 46th, Healthcare NOW! members from across the country submitted videos detailing their personal experiences with the broken healthcare system. Phyllis Myers of Detroit stated, “When you have to spend $1000 for a supply of medication for one month…it is really harsh.”

“I have multiple sclerosis and need a medication in order to have a full and productive life,” said Roger Starcher of Charlotte, NC. “Aetna has consistently denied this medication and refuses to pay for it. That’s why I support Medicare-for-all in America.”

Healthcare-NOW is joined by many allied organizations including Physicians for a National Health Program, Progressive Democrats of America and National Nurses United in calling attention to Medicare’s anniversary and the Medicare-for-all solution.

###

*To see the video submissions by Phyllis Myers, Roger Starcher and dozens more, please visit our website at http://www.healthcare-now.org/campaigns/single-payer-rally/why-i-want-medicare-for-all/.

*For a complete listing of events nationwide, visit http://www.healthcare-now.org/takeaction/events-calendar/

i Reich, R. (2011, July 23). Medicare Is the Solution, Not the Problem. Reader Supported News. Retrieved from http://www.readersupportednews.org/opinion2/272-39/6724-medicare-is-the-solution-not-the-problem

ii Woolhandler, S., M.D., M. P. H., Campbell, T., M.H. A. & Himmelstein, D. U., M.D. (2003). Costs of Health Care Administration in the United States and Canada. The New England Journal of Medicine, 349. Retrieved from https://pnhp.org/publications/nejmadmin.pdf

iii See above (Costs of Health Care Administration in the United States and Canada).

Medigap Medical Loss Ratio Improvement Act

Rep. Stark, Sen. Kerry Introduce Bill to Provide Medicare Beneficiaries Better Value for Their Medigap Premium Dollars

Congressman Pete Stark
Press Release, July 26, 2011

Today, Rep. Pete Stark (D-CA) and Sen. John Kerry (D-MA) introduced the Medigap Medical Loss Ratio Improvement Act. The legislation improves consumer protections in the Medigap marketplace by raising the minimum percentage of premium dollars that must go toward medical care, not executive compensation or administrative costs. This percentage is called the medical loss ratio (MLR).

Under current law, Medigap insurers are required to meet an MLR of only 65 percent in the individual marketplace and 75 percent in the group market. The Medigap Medical Loss Ratio Improvement Act would require Medigap insurance plans to spend at least 85 percent of every premium dollar on medical care in the group market and 80 percent in the individual market.

http://www.stark.house.gov/index.php?option=com_content&view=article&id=2260:press-release-stark-kerry-introduce-bill-to-provide-medicare-beneficiaries-better-value-for-their-medigap-premium-dollars&catid=82:press-releases-2011&Itemid=62

And…

The Hill
July 26, 2011

The insurance industry opposes Kerry and Stark’s bill.

The healthcare law’s MLR requirements didn’t extend to Medigap because it’s a form of supplemental coverage, said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans.

As supplements, Medigap plans collect lower premiums than comprehensive policies, but the administrative costs aren’t necessarily lower. Extending the 80 to 85 percent MLR standards to Medigap would disrupt coverage with which seniors are satisfied, Zirkelbach said.

http://thehill.com/blogs/healthwatch/health-insurance/173623-aarp-backs-bill-to-extend-new-rules-on-insurers-spending

Comment:

By Don McCanne, MD

Medigap policies are private plans that supplement Medicare coverage. They are quite popular because of the exposure that Medicare beneficiaries have to relatively high out-of-pocket expenses. They also represent one of the worst values in private insurance because of their very low medical loss ratios (a low percentage of of the premiums collected is spent on actual health care).

Rep. Pete Stark and Sen. John Kerry have introduced the Medigap Medical Loss Ratio Improvement Act (HR 2645 and S 1416) to bring the Medigap medical loss ratios up to the same level as other private plans under the Patient Protection and Affordable Care Act. Individual Medigap plans will have to spend at least 80 percent of the premium on health care, and group Medigap plans at least 85 percent.

To no surprise, the insurance industry is opposed, and understandably so. In order to calculate the supplemental benefits to be paid under the Medigap plans, the insurers must still process all services, most of which are paid by Medicare, thereby involving the same administrative effort as comprehensive plans. Also, their marketing costs are similar to their comprehensive private plans. Thus their administrative costs and profits are proportionately much higher considering the small amount paid out in supplemental benefits.

The insurers are really in a bind. They can’t reduce their administrative services, yet, because the plans are only supplements, they can’t pay out much more in benefits. Requiring the same medical loss ratios as apply to comprehensive plans would likely destroy the Medigap model, and insurers would have to withdraw these plans.

That would be good since these plans are such a terrible value no matter how you cut it. But we have to keep in mind why these plans exist. Medicare benefits are inadequate, leaving beneficiaries exposed to excessive costs. To eliminate this wasteful private industry of Medigap plans, the appropriate solution would be to reduce or preferably eliminate the out-of-pocket cost sharing of Medicare.

Although that reintroduces the “moral hazard” issue of “free” health care, other nations have shown that comprehensive “free” health care can be provided at much lower costs than ours. If we’re going to talk about morality, then we should ask, what is moral about injecting an expensive, superfluous, worthless industry into our health care?

This legislation is important because it identifies the problem of excessive administrative waste, which adds even more to our very high health care costs. But rather than this bill, we really do need an improved Medicare for all.

Proponents pitch single-payer health care at Framingham State forum

By Scott O’Connell
The MetroWest Daily News (Framingham, Mass.), July 27, 2011

FRAMINGHAM, Mass. — Four members of a panel at Framingham State University last night gave their pitch for a single-payer health care system in the state, saying it would streamline administration, make care more widely available and potentially save billions of dollars.

But not everyone was swayed, including one audience member who said a switch to single payer would limit access to health care.

In a single-payer system, a version of which was recently passed in Vermont, health care would be paid for by one entity, most likely the government but also potentially a private company. That single payer would be responsible for collecting money for health coverage, like through a payroll tax, and then pay for all state residents’ health care bills.

Framing last night’s presentation is an ongoing effort on Beacon Hill to pass legislation enacting a single-payer system in the state. A chief sponsor of one of those bills, Sen. Jamie Eldridge, D-Acton, who was also one of the four panel speakers, said about one-fourth of legislators support it.

Eldridge and the other panel members – UMass Amherst economics professor Gerald Friedman, business owner Alex Robbins, and Ben Day, executive director of single-payer advocacy group Mass-Care – said it will take a coordinated grassroots effort to build enough support for a single-payer system even in Massachusetts, which broke new ground for states by making health insurance mandatory for residents in 2006.

The panel said that while the state’s reform and the subsequent passage of federal health care reform a year ago expanded access to health care, it hasn’t made it more affordable.

“Now we’re looking at phase two,” said Rep. Tom Sannicandro, D-Ashland, the moderator of last night’s forum, which he said was intended to “get the discussion out there” on single-payer health care.

Panel members said the single-payer system, already adopted by many developed nations around the world, makes health care more affordable by reducing the amount of administrative work that bogs down America’s existing hybrid public, private system. By having a single payer like the government responsible for all health coverage costs, physicians will be able to focus more on care, and patients won’t have to be stressed by the process of dealing with an insurance company, they said.

Friedman said he believes a switch to single payer could save as much as $8 billion in health care costs in the state, and lower the average per person cost from $7,000 to $6,000.

“The money’s there on the street, waiting for us to pick it up,” he said.

Robbins, who owns William Henry Furniture in Cambridge with his wife, said a single-payer system could spare small companies like his from the annual squeeze of rapidly rising employee health care costs.

“We’re paying twice as much for health care than 10 years ago, but the coverage is half of what it used to be,” he said.

One audience member, Paul Pietro of Southborough, who said he works at Mid-State Insurance, said the single-payer system ultimately won’t do anything to control costs, though, as long as health care providers and doctors continue to drive the current system of delivery of care. Mid-State is an insurance broker from Worcester.

“I don’t see that happening at all,” Pietro said. “If you had single payer, you’d be rationing, and the quality of care is going to come down significantly.”

Some other questions posed to the panel by audience members also insinuated that a move to single care ultimately would only replace premiums with a tax bill from the government.

After the presentation, though, some audience members said they’re ready for a change. Mel Warshaw of Framingham said last night’s show of support for the measure could be a step in that direction.

“It tells me that there’s a movement in Massachusetts to do this,” he said. “I’m very much in support of it.”

Medicare for All: Fair, Frugal, and Inclusive

By Johnathon Ross, M.D.
CommonDreams, July 26, 2011

For 30 years I’ve been teaching young doctors how to practice primary care medicine at a center-city clinic in Toledo. Every day we witness heart-wrenching scenes right out of a Charles Dickens novel — scenes that illustrate the cruelty, arbitrariness and absurdity of our health care “system.”

Imagine for a moment a 64-year-old, low-income and uninsured man whose condition requires hospitalization and specialty care. Due to the likely cost of his treatment, he and his family could soon be facing bankruptcy. As if the physical suffering were not enough, he’s now grappling with a terrible financial crisis.

Right next to him is another patient with the same condition and of similarly modest means. However, because he’s 65 and enrolled in Medicare, he’s able to get dignified and relatively hassle-free care, without the worry of a financial shipwreck. He can go to the doctor and hospital of his choice, get treated and not face overwhelming medical bills.

Two patients, two very different stories — all because one person just happened to have been born a year earlier than the other.

Medicare, whose 46th anniversary will be observed July 30, has been a lifesaver for millions of elderly and severely disabled Americans. It’s been a major pillar of financial security for our nation’s families. And yet there are those in Congress today who would weaken or even dismantle it in the name of “fiscal responsibility.”

The Medicare program has many virtues. It has created incentives for hospitals and doctors to improve the quality of care. It has produced better cost control than the private sector, despite giving patients freedom to see any doctor and go to any hospital.

The cost of administering the program is in the 1.3 percent to 3 percent range, much less than the 12-14 percent range typical of big employer-based private plans, and the 25-30 percent overhead associated with individual plans.

Given these strengths, Medicare should have been the model for health reform. Instead, in passing the Affordable Care Act, Congress added a third floor to house with a crumbling foundation. That crumbling foundation is our inefficient, wasteful private-insurance-based system of financing health care.

Private insurers make money by screening out the sick, denying claims and raising premiums. They cause us to waste enormous amounts of money on excess paperwork and bureaucracy — their own paperwork and the paperwork they inflict on hospitals, patients and doctors like me. An estimated 31 cents of every health care dollar goes toward administration in U.S. health care, at least half of it unnecessary.

It doesn’t have to be this way. Our nation needs to enact a single-payer national health insurance program, an improved Medicare for all.

Instead of the being saddled with the mean-spirited, wasteful and exclusionary insurance arrangements we have now, an improved Medicare for all program would be fair, frugal and inclusive.

By replacing the private insurers with a single, streamlined, publicly financed system that handled all bills, we’d recapture about $400 billion annually that’s currently spent on unnecessary paperwork — enough to provide comprehensive coverage to all the uninsured and to improve coverage for the rest of us.

Such a system could negotiate pharmaceutical prices like the Veterans Administration does, lowering drug costs by about 40 percent. The same principle would apply to other supplies and services, helping us rein in costs.

The burden of rising health care costs on businesses would be sharply reduced, thereby enhancing the competitiveness of U.S. products overseas. Lowering out-of-pocket health costs would leave more money for discretionary spending that stimulates the economy.

Alarmingly, the budget deficit is prompting some in Washington to talk about cutting Medicare or delaying eligibility to age 67. That would be exactly the wrong direction in which to go. Medicare is the victim of rising health costs, not its cause.

It’s not too late to do the right thing. We should celebrate Medicare’s birthday by improving it and expanding it to all. The new system will save lives, save money and will place our nation on a path to become one of the best health systems in the world — something of which we can all be proud.

Johnathon Ross, M.D., M.P.H., is past president of Physicians for a National Health Program (www.pnhp.org) and an executive committee member of the Single Payer Action Network in Ohio (www.spanohio.org).

http://www.commondreams.org/view/2011/07/26-8

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