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A message from Sen. Mark Leno on the California single payer bill

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A message from Sen. Mark Leno on the California single payer bill

A special message from Senator Mark Leno on SB 810, the California Universal Health Care Act:

September 3, 2010

Dear Friends,

By now most of you have heard the disappointing news that our bill, SB 810, the California Universal Health Care Act, was held on the Assembly Floor on the last night of session, effectively killing the measure until next year. Over my strong objections, Assembly leadership decided to hold the bill. Although we are greatly disappointed, we are determined to come back even stronger next year.

I want to thank and recognize the work of the California School Employees Association and California Nurses Association who worked hard to lobby members all year. I also want to recognize Health Care for All, California Physicians for a National Health Plan, Single Payer Now, California Alliance for Retired Americans, California Health Professional Student Alliance, League of Women Voters and the other dozen organizational members of our statewide alliance. Most importantly, I thank the thousands of advocates who made phone calls, requested meetings, attended rallies, and sent letters, faxes and emails, making it clear to legislators that the single payer health care movement is vibrant, strong and growing larger every day.

Our movement has always acknowledged that it is founded on a long-term vision and strategy. This setback does not change our work, it only emboldens it. For decades we have found the courage to speak out for single payer, even when others around us told us that now is not the right time. We have learned that fear and hesitation can only be overcome by courage and commitment – something with which our movement is rich. That is how we have come so far, and that is why we will win.

Without question, I commit to reintroducing this bill again next year, and to work ever harder with you to achieve the only real solution to our health care crisis – Medicare for All.

I encourage you to begin our work today to ensure the passage of this bill next session. Now is the time to educate your current representatives, and those who are seeking office, about the need for single payer universal health care and to ask for their support. More importantly, now is the time for you to educate your co-workers, neighbors, friends, and family members about why their elected officials should take a strong stance in support of Medicare for All.

We’ve always said that the closer we come, the harder our work will become. So often, it’s “two steps forward, one step back.” Let this temporary detour enliven us to work even harder to see single payer become a reality in California. With term limits, it is clear that each new class of representatives needs to be educated and reminded of how important this issue is to our state. Next year will bring a new governor and a new legislature – and consequently, new opportunities and challenges. To win, we must come closer together as allies, fight smarter, and work even harder.

As the author of SB 810, I believe deeply in you, this cause and this movement. Until every Californian has health care and no family faces medical bankruptcy, we will not be deterred. Until our state budget and entire economy are no longer being swallowed by health care costs, we will not cease. Until we have “Medicare for All,” we will not stop fighting. We’re the fastest growing grassroots movement in America, and we will win universal health care. Let’s dig deep, redouble our efforts and get back to work.

Sincerely,

Senator Mark Leno

http://senweb03.senate.ca.gov/focus/outreach/sd03/sd03-ealert-20100902.asp

Uwe Reinhardt on the details of the medical loss ratio

On Health Care, the Devil’s in the Details

By Uwe E. Reinhardt
The New York Times
September 3, 2010

The recently passed Affordable Care Act requires heath insurance issuers to use at least some minimum fraction of revenue from the premiums it receives on medical services. While the idea might sound straightforward, this fraction, known as the “medical-loss ratio,” is open to all sorts of creative arithmetic, and you can bet that interest groups from every corner are trying to get the math to add up in their favor.

Under the new law,  health insurers are supposed to spend at least 85 percent of premiums collected from large groups of insured on something defined as “medical benefits and activities that improve health care quality.” For small groups and individually sold policies, the standard is lower, at 80 percent.

Put yourself in the shoes of the health care providers.

They would like to put as many of an insurer’s outlays – other than provider payments – as can be justified into the denominators as “selling or administrative expense.” That would put pressure on insurers to increase payments to providers or to spend less on administration to meet the ratio requirement. Therefore, providers typically plead for a very narrow definition of an insurer’s outlays for “health care quality improvement” that, by statute, are to go into the numerator.

Health insurers, on the other hand, would like to pack as many of their outlays as possible into the numerator of the ratio.

In a letter to the commissioners, the president of America’s Health Insurance Plans, which represents about 1,300 member companies that provide insurance for more than 200 million Americans, pleads for inclusion in “activities to improve health care quality” such items as fraud prevention and detection, utilization review, costs associated with administrative simplification and health-information technology expenses, and the cost of implementing the new International Classification of Diseases, or ICD-10, codes.

Finally, there are the commissions that insurers pay to brokers, who currently play an important role in the small-group and individual market for health insurers.

The commissions usually range between 4 and 8 percent of the premium, depending on the state, but sometimes are 20 percent of the premium in the first year of a policy before dropping to the normal range.

How these commissions are incorporated into the ratio can have a significant impact on the economics of insurance brokers, whose future role in health care is of great concern to the commissioners.

http://economix.blogs.nytimes.com/2010/09/03/on-health-care-the-devils-in-the-details/

Comment: 

My response, also posted at the link here:

10.  Don McCanne, San Juan Capistrano, CA
September 3rd, 2010

Focusing on narrow issues such as whether the administrative cost of brokers’ fees somehow represents patient care or quality improvement as opposed to being an administrative expense distracts us from the much more important overriding issue of the profound administrative waste throughout our health care system that is related to the dysfunctional, fragmented manner in which we allocate health care spending.

The first consideration is the administrative cost of the private insurers. Should we really be allocating 15 to 20 percent of the insurance premiums to the private insurers for them to use for their own intrinsic purposes – funds that never make it to paying for health care? When you consider the very high health care expenditures in our nation, 15 to 20 percent is a huge allocation for non-medical purposes.

Another very important diversion of health care dollars is the cost of the administrative burden placed on hospitals and physicians merely to deal with our fragmented system of a multitude of public and private plans – especially in claims processing, including not only the protracted process of managing disputed claims, but also other administrative diversions such as negotiating and managing insurance company contracts.

This administrative burden on the providers has been estimated to consume about 12 percent of premium dollars. Thus the combined administrative costs merely for the insurance function will be about 27 to 32 percent of the insurance premium – a very high percentage of our very high priced system. That does not include all of the other essential administrative functions that hospitals and physicians face. What a waste!

It is unfortunate that consideration of a single publicly-financed and publicly-administered financing system was excluded before the reform negotiations began. Such a financing system – a single payer or an improved Medicare for all – would have dramatically reduced this profound administrative waste.

Even more important, a single financing system would have created our own public monopsony (single buyer of health care) in which we could ensure that we would be receiving maximum value in our health care purchasing – avoiding excessively high prices while ensuring that enough funds are available to maintain adequate capacity in the system. That is the cost control that we really need. And, oh yes… everyone is included!

Wasn’t that the goal of reform? Cover everyone and control costs?

Should we leave employers in charge of health benefits?

Employer Health Benefits

The Kaiser Family Foundation and Health Research and Educational Trust
September 2, 2010

The average annual premiums for employer-sponsored health insurance in 2010 are $5,049 for single coverage and $13,770 for family coverage.

Twenty percent of covered workers are in plans with an annual total premium for family coverage of at least $16,524 (120% of the average premium).

Covered workers on average contribute 19% of the total premium for single coverage (up from 17% in 2009) and 30% for family coverage (up from 27% in 2009).

Fifty-one percent of workers with family coverage pay more than 25% of the total premium.

Among workers with a deductible, the average general annual deductible for single coverage is $675 for workers in PPOs, $601 for workers in HMOs, $1,048 for workers in POS plans, and $1,903 for workers in HDHP/SOs.

For the last two years we have asked employers about changes that they made to their health benefits in response to the poor economy. Among large firms (200 or more workers), 38% reported reducing the scope of benefits or increasing cost sharing, up from 22% in 2009, while 36% reported increasing their workers’ premium share, up from 22% in 2009.

Tracking whether and how worker out-of-pocket costs continue to grow will be an important focus for the survey over the next few years. The slow economic recovery and continuing high unemployment suggests that this trend of increasing out-of-pocket costs will persist, as workers have little clout to demand better benefits or lower costs in the current labor environment.

http://ehbs.kff.org/pdf/2010/8086.pdf

Full report (226 pages):
http://ehbs.kff.org/pdf/2010/8085.pdf

Comment: 

By Don McCanne, MD

By design, the Patient Protection and Affordable Care Act (PPACA) will have the least impact on employer-sponsored health plans. Congress did not want to disturb these plans that seemed to be working reasonably well, in that they covered more of us than all other programs, and were already generously funded with employer contributions. This annual report on employer health benefits is even more relevant this year since Congress, through PPACA, has deemed that we will be living with these plans for decades to come.

The report brings us terrible news. Premiums continue to rise at intolerable rates, and more of the premium costs are being shifted to the employees. Employers also are requiring greater cost sharing on the part of their employees, especially in the form of higher deductibles. Employees are paying more for less protection.

With the poor economy employees need greater relief, yet employers are seeking relief for themselves by placing an even greater financial burden on their own employees.

This is a one-way trend. Employers will continue to seek ways to reduce the costs of their health benefit programs, and an ever increasing amount of the burden will be borne by the employees. Should we really be leaving these decisions in the hands of the employers?

Drew Altman, president and CEO of the Kaiser Family Foundation, said, “The new law helps a lot of people in a lot of ways… but in general it left employer-based coverage alone. That is what the politics of health care dictated and what the American people asked for.” (Kaiser Health News, Sep 2)

If Americans really prefer their employer-sponsored plans, then why are they so relieved when they get to go on Medicare? How much more burden will Americans have to bear before they change the politics and start demanding Medicare for all?

Democrats Block California Single Payer Bill

By Don McCanne
September 1, 2010

Speaker John Perez of the California State Assembly, on the very last day of the legislative session, pulled SB 810, the single payer bill, from the Assembly floor.

This highly unusual move of pulling a bill that had cleared all legislative hurdles except for the final Assembly floor vote was to protect Democrats from having to cast a health care reform vote in a difficult political environment three months before the next election.

Democrats feared a backlash from those who are opposed to the recently enacted federal health care legislation should they vote for the bill, and they feared offending their progressive base should they vote against the bill. Since a veto by Gov. Schwarzenegger was a given, it was decided that it would be safer to avoid the political risks by simply pulling the bill.

But did they really avoid that risk? Are the single payer advocates expendable? Don’t think so.

Fortunately, Senator Mark Leno is not to be deterred. He has vowed to reintroduce the bill in the next legislative session which begins in January.

The Democrats are worried about their political base, but maybe that’s not the framing we should be looking at. Perhaps the single payer advocates should be reassessing their own base instead.

Not all Democrats have been supportive of single payer, and several Republicans who are not part of the prevailing lock-step bloc do understand the benefits of the single payer model. The Patient Protection and Affordable Care Act is proof that we can’t rely on the Democrats to do the right thing. Most importantly, everyone understands the benefits of Medicare as a social insurance program (even if there is a fringe reactionary element that would emasculate it).

The Tea Party is proving that passionate voices can be heard. Maybe we can learn from them, though our message should contain more than simple platitudes. Our message needs to convey the principled substance of health care justice, and it needs to be loud, clear and highly infectious.

Baucus didn’t lead any health care debate

Letter to the Editor, Independent Record (Helena, Mont.)
Tuesday, August 31, 2010

Max Baucus really talked up his so-called health care “debate” for well over a year. The fact is there was no “debate.” Max’s health care bill was principally written by Liz Fowler, a Baucus staffer and former V.P. of WellPoint, one of the largest health insurance companies in America.

A major issue raised during Max’s Senate hearings on health care was the bogus claim that Medicare underpays physicians in comparison to private health insurers.  Here is a direct quote from a Chicago physician on that subject: “Private insurance companies may, on paper, pay physicians substantially more than Medicare, but this must be taken in the context that Medicare actually pays the rates it publishes and pays on time, (emphasis mine) while private insurance companies subject physicians to a maze of voluntary and involuntary discounts, denials, delays and underpayments that make calculations of what physicians actually get impossible.”

We were bilked by Baucus and his health insurance cronies. There was no health care debate. The cost of universal health care in other developed countries averages 10 percent of the GDP while we pay 17 percent and leave millions without coverage. Let Max try and explain that. Max acted as a shill for the health insurance industry. Do we really need his kind representing us in the Senate?

Bob Balhiser
Helena

Private insurers shifting support to Republicans

Health Insurer Cash Shifts to Favor Republicans Before Election

By Drew Armstrong
Bloomberg
August 26, 2010

Health insurers led by WellPoint Inc. are backing Republicans with campaign donations by an 8-to-1 margin, favoring the party that’s promised to repeal President Barack Obama’s health-care overhaul if it wins back Congress.

WellPoint, Humana, Aetna, Cigna and UnitedHealth Group Inc. have also been considering a $20 million-plus campaign fund to reward friends and punish enemies in Congress. That fund would target vulnerable Democrats who have spoken out against the industry, and would support candidates who are likely to argue for the industry’s positions during future debate on the health overhaul.

http://www.bloomberg.com/news/2010-08-26/health-insurer-cash-shifts-to-favor-republicans-before-november-elections.html

Comment:

By Don McCanne, MD

With private insurers supporting Republicans by an 8-to-1 margin, there is no question but that the insurers are supporting their own financial interests, regardless of the negative impact on people who need health care.

The Republicans remain opposed to all forms of social insurance that would make health care accessible and affordable for everyone (not that the Democrats did much better this time around). Instead Republicans support measures such as high-deductible health plans, health savings accounts, elimination of mandated benefits such as mental health and maternity care, and promoting interstate sale of less regulated, Spartan plans.

Insurers prefer these plans because they are the most profitable. Many individuals in the large healthy sector of our population tend to prefer these plans because the premiums are lower. Unfortunately for the sick, these plans shift a burdensome amount of the health care costs to the patients in need, not to mention the fact that the insurers have been relatively successful in avoiding these higher-cost individuals in the first place.

Republicans support these proposals because of their ideological stance, believing that each person should be responsible for their own welfare, making exceptions only for those who are the most destitute, not of their own making. They oppose the social solidarity of “collectivist” approaches such as universal insurance programs, whether public or private.

A distinction should be made between the current, lock-step, obstructionist, party-of-NO Republicans, and the nearly extinct species of progressive Republican – many of whom have become independent. It is this obstructionist Republican bloc that serves so well the interests of the private insurers.

It’s sad that the Democrats got into bed with these people. The Democrats ended up supporting the right-wing private insurance model of Mitt Romney and the Heritage Foundation to appease the Republicans and the private insurers. That resulted in the enactment of a terribly flawed program that will not adequately control costs, and will leave tens of millions uninsured and many more underinsured.

The insurers now want to send us more of these reactionary politicians. Aren’t there enough of us who care about the health of all of our people to step up and counter this? Or is it merely all words (for the pollsters), and no action (on behalf of those with health care needs)?

Where are our activists?

Honeywell Locks Out USW Local Over Health Care

Sister Local in Canada Wins Contract

By Kay Tillow
All Unions Committee For Single Payer Health Care–HR 676
Aug 29, 2010

On June 28, 2010, Honeywell locked out the 230 union workers at its uranium hexafluoride plant in Metropolis, an Ohio River town of 6,500 at the tip of southern Illinois 400 miles south of Chicago.  A working class town nestled amidst the corn, soybean and wheat fields, Metropolis is known for its Superman statue on the court house square where most Illinois candidates, including Barack Obama, have stopped by for a photo op.

Honeywell didn’t care if the workers liked their health care plan.  This corporation said it was not going to let them keep it.  The members of United Steelworkers (USW) Local 7-669 refused to accept the company proposal to increase workers’ out of pocket health care maximum to $8,500 a year and to end retiree health coverage.  The union proposed to continue working as they bargained.  Honeywell said no and locked the doors.

This is not a newly organized plant–the union has had contracts for 50 years.  The Oil Chemical and Atomic Workers issued the local its charter on May Day in 1959 and as a result of mergers the local became part of the USW in 2004.

USW 7-669’s sister local in Canada signed their current contract in July 2010, and health care coverage did not present a problem.  “Bargaining was not particularly difficult this time around,” said Chris Leavitt, President of USW Local 13173 in Port Hope, Ontario, Canada, home of the Cameco plant, the only other one in North America to make the uranium hexafluoride used to produce nuclear energy.  Canadian USW Local 13173 is about the same size as the Metropolis local and was a part of District 50 of the United Mine Workers which affiliated with the USW.

Everyone is covered under the Ontario Health Insurance Plan—automatically–as a part of Canada’s Medicare, a single payer plan, explains Leavitt.  Members of Local 13173 and their families pay nothing—no premium, no co-pay, no co-insurance, no deductible–for hospital care plus medication, out patient services, doctor’s visits, and other doctors’ services such as surgery.  Health care is publicly funded for everyone so unions can use their bargaining power to negotiate for wages and other benefits.

President Leavitt said this Canadian health plan makes it a lot better for unions.  With the basics covered, the unions negotiate only for the extras.  Leavitt said his local has bargained for the company to cover the total cost of premiums for the additions–the difference in cost for a private hospital room, private nurses, massage and speech therapy, prescription drugs, family dental including orthodontics, and vision care including glasses or contact lenses.  Members of the Canadian USW Local pay only $20 per year for family dental, $10 per year for an individual.

Leavitt has been president of his local for four years and a union member for 32 years.  He says union is a family tradition–his 23 year old son recently organized a union at his place of work.  Leavitt expresses pride in his nation’s health care achievements and in Tommy Douglas, the Father of Canada’s Medicare, but said Canadian unions face other problems similar to those of workers in the US.  He condemned the current Canadian “right wing government” for its job-destroying free trade pacts and its efforts to privatize.

Back in Metropolis workers have an even more sobering reason to fight for health care benefits for retirees.  It’s not kryptonite that threatens the workers and the community, but the chemicals they work with.  Local 7-669 President Darrell Lillie says, “What we do is a very, very dangerous job. We deal with the worse acids known to man.”

Directly in front of the Honeywell plant the local has erected a field of crosses, 42 in memory of their members who have died from cancer and 27 smaller crosses to represent workers who have cancer but are surviving. John Paul Smith, media spokesperson for the Metropolis local, said that the dangers that workers have been exposed to are acknowledged by the Energy Employees Occupational Illness Compensation Program that has designated the Metropolis plant as one where workers are eligible for special benefits if they contract certain types of cancer.  “We are working to expand the types of cancer that are covered by this program so that more of our members could get help,” said Smith.  In the meantime the workers walk the line to keep health coverage for retirees in the contract.

Smith says the local keeps track of their members and retirees and has counted the cancer victims from their personal knowledge of each other in this small community where everybody knows everybody.  The local has a list of about 250 retirees.

Honeywell denies that the cancer deaths are caused by exposures in the plant.  Honeywell said the same thing about its Bannister Federal Complex in south Kansas City where workers handled beryllium and other carcinogens with their bare hands uninformed of the consequences.  Many of those workers now suffer from cancer, leukemia and other aftereffects, and, so far, 643 Kansas City Honeywell workers have sought compensation under the Energy Employees Occupational Illness Program which has paid on 172 of their claims.

Smith reports that the Nuclear Regulatory Commission has not yet authorized the untrained replacement workers to make uranium hexafluoride.  Metropolis citizens are praying that Honeywell won’t try to make UF6 until the skilled workers are back on the job.  Jerry Baird who owns Diamond Lil’s Restaurant just up the road from Honeywell says that if the untrained recruits try to start it up and forget what to do, “They’ll probably kill us all.”  Baird expresses his solidarity with the union by generously supplying the pickets with barbeque and lemonade.

Despite the heat (over 90 degrees for a month and sometimes over 100 with the heat index rising as high as 115), the workers keep a constant vigil at the two gates on highway 45.  The Laborers’ Union has donated their giant inflated rat.  In a time of almost 10% unemployment and a sagging economy in which many unions have been forced into painful concessions, the members of USW Local 7-669 are in good spirits and standing strong. In addition to slashing health care, Honeywell also wants to do away with pensions for new hires, so the union fights in solidarity with the young and the senior, certain of the justice of their cause.

“Support USW 7-669” signs dot the yards and stores of Metropolis.  Over 3,000 marched in the streets then rallied with the local on August 7. Unions came from Gary, Granite City, all across western Kentucky and Tennessee and southern Illinois.  USW Local 15009 from Marion was out in force and expressed their support in song, “I’m union and I stand and no company’s demand will make me fall and I will not crawl.  The union is the key to make working people free and I won’t back down and lose my ground.”

“Wow,” said President Darrell Lillie, facing the August 7 crowd and obviously touched by the enormity of the support.  “This turnout is unbelievable.  It’s bigger than we ever dreamed of.”

The New York Times gave the lockout almost a full page including a picture of the crosses.  The St. Louis Post Dispatch has covered the story and so has the AFL-CIO website.  There is plenty of food and ice water on the picket line, and, because it is a lock out, workers were able to win unemployment compensation.

Cross border help is coming too.  Canadian USW President Chris Leavitt is bringing a group from Port Hope to Metropolis on September 12.  They’ll be there for four days and three nigh
ts to be on the picket line and express their solidarity.  There will be a lot to talk about.

Local 7-669 intends to win this battle.

Contributions are welcome.  Make checks payable to USW Local 7-669, PO Box 601, Metropolis, Illinois 62960.  Email:  admin@USW7-669.com

http://seminal.firedoglake.com/diary/68146

Distributed by:

All Unions Committee For Single Payer Health Care–HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217

Two year Medicare waiting period for those with disabilities

Groups Press Congress To End Patients' Wait For Medicare

By Jessica Marcy
Kaiser Health News
August 27, 2010

Under federal rules, most people with disabilities who are younger than 65 aren’t eligible for Medicare until more than two years after they qualify for Social Security disability income. A coalition of more than 65 organizations led by the Medicare Rights Center has been pushing Congress to do away with the waiting period. But the effort has stalled because of the high cost to the federal government – an estimated $113 billion over 10 years, according to the Congressional Budget Office. That takes into account a $32 billion reduction in federal spending on Medicaid, the state-federal program for the poor and the disabled. Many people with disabilities go on Medicaid while they wait to become eligible for Medicare.

When Medicare expanded in 1972 to cover the disabled, Congress created the waiting period to help control costs and ensure that only people with severe, ongoing disabilities received coverage. About 17 percent of Medicare’s total 47 million beneficiaries – just over 8 million people in 2010 – receive disability benefits, according to the Kaiser Family Foundation.

Still, the patient groups are pushing to end the Medicare waiting period because many people may still need government help. Currently, nearly 39 percent of patients are uninsured for at least some of the time during the Medicare two-year waiting period while 26 percent have no insurance for the entire time.

Discarding the Medicare waiting period “is always going to be an issue in Congress,” said Edmund Haislmaier, senior health policy research fellow at the Heritage Foundation. “Some of it is money, some of it is politics, too. For members of Congress, irrespective of party or where they stand on the issue, it’s kind of all-or-nothing because if they did it for some diseases, then they’re immediately going to be inundated with ‘Why didn’t you do it for us?'”

Joseph Antos, health care policy scholar at the American Enterprise Institute, said that a total elimination of the waiting period was not going to happen. “Across the board eliminating the two years just doesn’t seem practical,” he said. “This really is a money issue.”

http://www.kaiserhealthnews.org/Stories/2010/August/27/huntington-waiting-period.aspx

Comment: 

By Don McCanne, MD

When Congress expanded Medicare to cover individuals under 65 with long-term disabilities, they specified a two year waiting period to be certain that only those with truly permanent disabilities would be admitted to the program. Obviously this creates a hardship for precisely those for whom the eligibility was established. Will the Patient Protection and Affordable Care Act (PPACA) adequately address this injustice?

PPACA did not include any adjustments in the two year waiting period. Consequently different groups representing specific chronic disorders are lobbying for exceptions to the two year wait. Even if some of these groups achieve legislative success, it will not help the others who must wait the two years.

Since many lose their insurance and their income during that two year wait, some may become eligible for the expanded Medicaid program. Yesterday’s message explained how Medicaid may leave those with chronic disorders underinsured with impaired outcomes, so this is certainly not a satisfactory solution. Besides, many with inadequate incomes may still fall above the threshold for Medicaid eligibility.

For those who lose their insurance during the two year wait, the individual mandate would require that they purchase private plans. Even with premium subsidies, these plans may still not be affordable. Besides, their low actuarial values will not provide adequate protection for these individuals with high health care costs, even with out-of-pocket spending subsidies.

PPACA included the CLASS Act (Community Living Assistance Services and Supports Act) designed to provide long-term care insurance. Though you might think that this provides an out, there are significant problems with CLASS. The program is voluntary and the individual must pay premiums for five years before benefits are available. That alone will exclude those with modest incomes who might consider the premiums to be unaffordable, especially for a program they can’t use for five years and may never need. Furthermore, the benefits are anticipated to be quite meager and likely will provide only a modest daily cash benefit. The CLASS Act will not fulfill the insurance need for the two year gap.

The comments from the representatives of the Heritage Foundation and the American Enterprise Institute describe the real hurdles: politics and money. It’s not that we can’t find the money, but the anti-government politics of today is driven by the philosophy that the government has been drained dry so that no funds are available. That is ridiculous. Our national health expenditures are already adequate, but the funds are inequitably and inefficiently distributed. We need more government involvement, not less, in providing stewardship over our health care funds.

The two year waiting period is yet one more example of the profound injustices inherent in our fragmented, dysfunctional health care financing system – a unsound and iniquitous system perpetuated by Congress through the enactment of PPACA. All of this evil nonsense would go away if they instead would enact a single payer, improved Medicare for all.

Count yourselves blessed for the medicare you have

By Clark Newhall
The Charlottetown Guardian, Prince Edward Island, Canada
August 26th, 2010
 
I live in the U.S. 10 months of the year and in P.E.I. two months. From the election of Obama to the present, I have strongly advocated for medical care financed like Canada’s medicare. We have your system in the U.S. and we, too, call it Medicare — but we Americans only have the right to decent health care if we are over 65. Our last best chance to achieve what you have achieved — person-based health care instead of money-maker medicine — disappeared when Obama could not or would not stand up to bottom-feeders like Limbaugh, Beck and the Drudge Report.

Now the U.S. is on the way to a completely ‘market’ driven form of health care — if you are worth little in the ‘market’, then your health and your life is also worth little.

During our 10 years here, we have been in the Queen Elizabeth Hospital ER and in Souris hospital several times with our epileptic child. The experiences we have had are typical of ER’s everywhere — sometimes we wait, sometimes not — sometimes we get frustrated, sometimes not. Obviously, as non-citizens here in Canada, we don’t have the right to health care that you take for granted. But never in Canada — repeat, never — have we had the demeaning denigrating humiliating experience, so common in the U.S., of being treated as a second (or lower) class citizen because we don’t have health insurance.

I am a lawyer and an ER doctor. Nearly every person who comes to me with an injury caused by medical care is also a person who did not have insurance. In other words, your way of providing health care to everyone is also the reason that your health care is healthy and safe. When doctors know that everyone is equal, then everyone is treated with equal skill and attention. It works that way here, as it should. Despite what you may hear from wingnuts who read Drudge and other smudges, it does not work that way in the U.S., and it will never work that way as long as the ‘market’ rules medicine.

Count yourselves blessed for the medicare that you have. When we return to the U.S. in a few days, I will wish we had what you take for granted.

Clark Newhall MD JD is a physician and attorney in Salt Lake City, UT and a summer resident of Monticello, P.E.I. He founded HealthJustice.org which, along with Mike Farrell of TV’s M*A*S*H, produced a national TV campaign in 2009 explaining Medicare For All to Americans.

http://www.theguardian.pe.ca/Opinion/Letters-to-editor/2010-08-26/article-1699842/Count-yourselves-blessed-for-the-medicare-you-have/1

Rampant underinsurance in children

Underinsurance among Children in the United States

By Michael D. Kogan, Ph.D., Paul W. Newacheck, Dr.P.H., Stephen J. Blumberg, Ph.D., Reem M. Ghandour, Dr.P.H., Gopal K. Singh, Ph.D., Bonnie B. Strickland, Ph.D., and Peter C. van Dyck, M.D., M.P.H.
The New England Journal of Medicine
August 25, 2010

ABSTRACT

Background

Recent interest in policy regarding children’s health insurance has focused on expanding coverage. Less attention has been devoted to the question of whether insurance sufficiently meets children’s needs.

Methods

We estimated underinsurance among U.S. children on the basis of data from the 2007 National Survey of Children’s Health (sample size, 91,642 children) regarding parents’ or guardians’ judgments of whether their children’s insurance covered needed services and providers and reasonably covered costs. Data on adequacy were combined with data on continuity of insurance coverage to classify children as never insured during the past year, sometimes insured during the past year, continuously insured but inadequately covered (i.e., underinsured), and continuously insured and adequately covered. We examined the association between this classification and five overall indicators of health care access and quality: delayed or forgone care, difficulty obtaining needed care from a specialist, no preventive care, no developmental screening at a preventive visit, and care not meeting the criteria of a medical home.

Results

We estimated that in 2007, 11 million children were without health insurance for all or part of the year, and 22.7% of children with continuous insurance coverage — 14.1 million children — were underinsured. Older children, Hispanic children, children in fair or poor health, and children with special health care needs were more likely to be underinsured. As compared with children who were continuously and adequately insured, uninsured and underinsured children were more likely to have problems with health care access and quality.

Conclusions

The number of underinsured children exceeded the number of children without insurance for all or part of the year studied. Access to health care and the quality of health care are suboptimal for uninsured and underinsured children. (Funded by the Health Resources and Services Administration.)

From the Discussion

We found that inadequate coverage of charges was far and away the most common source of underinsurance. We also found that children enrolled in private plans were more than three times as likely as their counterparts in public plans to have inadequate coverage of charges. This dramatic difference is probably the result of federal rules that permit only very limited cost sharing under Medicaid and modest cost sharing under the Children’s Health Insurance Program.

http://healthpolicyandreform.nejm.org/?p=12176&query=TOC

And…

Treating Underinsurance

By James M. Perrin, M.D.
Editorial, The New England Journal of Medicine
August 25, 2010

Health care reform, through the Patient Protection and Affordable Care Act of 2010, may improve access to needed health care services for people with chronic health conditions, including children. Key private insurance reforms, including the removal of provisions imposing lifetime limits or unreasonable limits on annual benefit, the removal of discriminatory premium rates, guaranteed availability of coverage, and dependent coverage for young people up the age of 26 years, may go a long way toward improving coverage for Americans and lowering out-of-pocket costs.

However, the growth in child and adolescent disability, combined with the problem of underinsurance and its effects on the quality of care and access to care, also highlights gaps that will remain in public insurance coverage even after the institution of safeguards affecting private coverage. The basic Medicaid program, unlike Medicare, includes long-term care benefits, such as care at home or in nursing homes and specialized therapies, and it serves as a vital source of financing for nursing home care (about 41% of current total nursing home support). The assumption that most children are healthy, however, has led policymakers to limit long-term care and coverage of a number of other benefits for chronic conditions in other programs for children. SCHIP provided a less generous benefit package — and excluded coverage of services for many chronic conditions (e.g., respiratory therapy, speech and language services, and home-based services) on the basis of the belief that the SCHIP population would not need such benefits. Research conducted since the enactment of SCHIP has indicated that substantial numbers of enrolled children have chronic conditions and could benefit from these services.

The Affordable Care Act calls for a major expansion in Medicaid, especially to provide insurance for a large number of currently uninsured and ineligible adults — that is, those under 65 years of age who have incomes below 133% of the federal poverty line (an estimated 12 million to 17 million people). Here, too, the benefit package will resemble the SCHIP (now CHIP) benefit, with an emphasis on coverage of care for acute conditions and less generous coverage of long-term care. Yet the members of the low-income adult population who will become eligible under this Medicaid expansion include substantial numbers of people with chronic conditions, especially mental health conditions. Here, too, for cases in which long-term care is needed, the Medicaid expansion may leave many newly insured people underinsured. For those instances in which the major epidemics of chronic conditions among adolescents have already begun to affect the young adult population, it is unlikely that many of these young people, even with their new Medicaid coverage, will receive the coverage they need for long-term care.

http://healthpolicyandreform.nejm.org/?p=12178&query=TOC

Comment: 

By Don McCanne, MD

Being underinsured often results in the same or similar adverse outcomes as not being insured at all. This study demonstrates that the problem of underinsurance amongst children is even more widespread than being uninsured. Does the Patient Protection and Affordable Care Act (PPACA) adequately address this shameful injustice?

PPACA does expand coverage for children through the individual mandate to purchase private insurance, though this study demonstrates that private insurance plans were three times as likely as public insurance plans to have inadequate coverage of charges. Thus PPACA, while reducing the numbers who are uninsured, actually increases the incidence of underinsurance. Most will still be insured through private employer-sponsored plans. For those purchasing their plans through the exchanges, the subsidies will provide some relief but still will not be not adequate to eliminate underinsurance.

PPACA also expands Medicaid, though primarily for adults. Although Medicaid and CHIP cover out-of-pocket expenses better than do the private plans, the editorial by James Perrin explains how lower-income individuals in these programs may still be underinsured. This is particularly true of those with chronic conditions who may need long-term care.

An appropriately designed single payer system eliminates the problem of underinsurance by eliminating significant cost sharing for all appropriate health care services. The efficiencies and policies of the single payer model create enough savings to pay these costs equitably without increasing our national health expenditures.

As long as we remain content with merely tweaking PPACA, we will continue to live in a society that tolerates exposing individuals and families to the hardships created by underinsurance or by having no insurance at all. Certainly we must be a better nation than that.

Oregon to Look at Single-Payer Bill Next Session

Advocates for a dedicated tax to pay for basic health coverage want to introduce a single-payer bill next session

By David Rosenfeld
The Lund Report (Ore.), Aug. 25, 2010

A loose coalition of single-payer advocates in Oregon has taken the first steps toward developing legislation for the 2011 session

The bill would ultimately work in conjunction with the state’s ongoing efforts to form a health insurance exchange and possibly a public option, supporters say.

State Rep. Michael Dembrow, a first-term Democrat from northeast Portland, is interested in sponsoring a state-based single-payer bill, but first wants to give advocates a chance to reach consensus.

Groups involved in the effort include Portland Jobs with Justice, Physicians for a National Health Program with chapters in Corvallis and Portland, Health Care For All Oregon and the League of Women Voters.

“It’s all very preliminary,” Dembrow said. “There are many of us who feel that ultimately the best way to pay for healthcare is through a single-payer program – not deliver it, but pay for it. It’s something that needs to remain in the conversation.”

States including Vermont, Minnesota, Pennsylvania and California – where a Democratic-controlled legislature twice passed single-payer bills that were vetoed by Gov. Arnold Schwarzenegger – are also working on single-payer legislation this year.

A recent letter from U.S. Sen. Ron Wyden (D-Oregon) to Democratic and Republican leaders in the Oregon Legislature gave encouragement to the idea of seeking federal waivers so states can pursue innovative ideas that go further than the federal law. The letter did not, however, offer any specific concepts.

“I write to lend my support to your efforts to develop an Oregon-specific plan for our state to do health reform its own way,” the letter states. “I believe in the concept of ‘state choice,’ and that every state has the right to provide healthcare to its own residents in its own way, as long as the goal is to provide all citizens with quality, comprehensive coverage.”

Wyden said he authored section 1331 of the Patient Protection and Affordable Care Act to give states the ability to continue working toward cost-effective healthcare while retaining access to federal funding.

“We don’t see ourselves as acting in contradiction to anything people are doing in Salem,” said Peter Shapiro, an organizer with Portland Jobs with Justice. “We just see it as part of the mix.”

While the details of the proposed bill haven’t been ironed out, the tenets are strong. There would be a dedicated tax based on ability to pay, universal access, and a shared risk pool to increase purchasing power and reduce administrative costs.

“The basic principle is equity,” Shapiro said. “Everybody should have the same access to treatment regardless of how much risk they are or how much money they have in the bank.”

The group will soon begin working with a consultant on the costs of such a plan and the barriers, including ERISA that governs employee benefits, that could be overcome with federal waivers.

The Oregon State Public Interest Research Group is also pushing state healthcare leaders to do more with what’s already allowed in the federal law passed earlier this year. OSPIRG’s efforts, however, have focused on strengthening the health insurance exchange and creating a strong state-based public health insurance option, not a single-payer plan.

Laura Etherton, OSPIRG’s healthcare lobbyist, is pleased Oregon is among the first states to get out of the blocks to establish an exchange where individuals and small groups can purchase insurance that’s highly regulated and possibly subsidized. But, thus far, the draft plan which was released on Aug 14 falls short, Etherton said.

“Just an exchange by itself is not going to solve all the problems in healthcare,” she said. “But it’s a great tool to help us drive solutions.”

Etherton said the draft plan doesn’t allow the exchange to negotiate premiums on behalf of its members. It could include small businesses with more than 50 employees earlier. It needs stronger public accountability. And it lacks adequate protections to prevent the insurance industry from undermining the exchange’s stability, she said.

According to OSPIRG, the exchange as currently drafted would “let insurers cherry-pick only the healthiest people, and enroll them in plans only available outside the exchange. This would leave older, relatively less-healthy people inside the exchange.”

“The details matter,” Etherton wrote in comments to the draft plan on OSPIRG’s website. “Done right, the exchange will pool the buying power of hundreds of thousands of Oregonians, so all of us can get a better deal on healthcare. But done wrong, the exchange will just be a nifty website with the same expensive plans and spotty coverage.”

Single-payer advocates hope the state goes a whole lot further.

“There are a lot of people who want to see the conversation about single payer still happen,” Dembrow said. “I hope the federal plan will work. I’d like to see the state really seize the moment.”

http://www.thelundreport.org/resource/oregon_to_look_at_single_payer_bill_next_session