PNHP

Fixing Medicare’s Physician Payment System

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Fixing Medicare’s Physician Payment System

Bruce C. Vladeck, Ph.D.
New England Journal of Medicine
May 5th, 2010

Now that Congress has completed the epochal, exhausting, and contentious task of enacting comprehensive health care reform, it must confront another health care issue that is perhaps even more politically difficult: reform of Medicare’s physician payment system. On April 15, Congress voted to postpone a 21% reduction in Medicare fees that was to have gone into effect April 1, but a longer-term solution is not yet in sight.

The problems with the Medicare physician payment system are twofold, and each dimension poses complex political difficulties. First, Medicare is captive to an arbitrary, if elegantly conceived, formula for total payments to physicians — the sustainable growth rate (SGR). In the alternate reality of the Congressional budget process, the SGR will reduce Medicare’s physician payments, which already trail those from private insurers, as far into the future as the eye can see. Second, there is widespread consensus that the relative fees in the current system are a significant cause of the growing imbalance in supply and utilization between primary care and specialty services in the U.S. health care system. That imbalance, in turn, is widely perceived as a major cause of both excessive costs and inadequate quality of care. This is not just a Medicare problem: the Medicare Resource-Based Relative Value Scale is used by most private insurers to set relative prices for physicians.

In 1997, when Congress refined the formula by which the annual change in Medicare physician fees was determined, it decided that total physician payments per beneficiary should grow no faster than the economy as a whole, as measured by the gross domestic product (GDP). Policymakers were concerned about increases in the volume of services that beneficiaries received; since total spending equals price times volume, under an aggregate cap, if volume grew more quickly, fees would grow more slowly or be reduced.1 The expectation that total physician spending could be kept to such a level was probably unrealistic, since few countries have ever attained that target, and an increasing proportion of health care services were migrating from inpatient hospitals to the lower-cost settings of outpatient facilities and physicians’ offices, which many thought would improve outcomes and save money. But the economy was growing robustly, and the SGR’s framers were pursuing a broader agenda of trying to drive the entire Medicare system away from fee for service toward private, capitated plans.

Moreover, the excessively ambitious growth target is only the beginning of the problem. The SGR is a cumulative, prospective formula; if actual spending in a given year exceeds that year’s target, the following year’s spending is supposed to be reduced proportionately, but if that reduction is insufficient, then additional reductions must come in the future. Every time Congress postpones a formula-determined fee reduction, it compounds the difference between actual and expected fees, making the (theoretical) eventual adjustment that much more severe. Thus, since the SGR was implemented in 1998, total Medicare physician expenditures have exceeded the allowed amounts by only $20 billion (on a total of almost $1 trillion), but to recoup that all in 1 year would require a 21% reduction in 1 year’s fees. And those reduced fees would then become the base for payment levels in all subsequent years.2

In a rational world, Congress would write off the $20 billion as a relatively small policy error and establish a more realistic prospective formula. But under Congressional budget rules, the cost of doing so is not $20 billion, but $20 billion per year, compounded by inflation, times 10 years. The Congressional Budget Office and the Office of Management and Budget are required to assume that someday Medicare’s physician fees will be permanently lowered to SGR levels and that anything above that amount is “extra spending.”

Of course, even $250 billion over 10 years is a rounding error relative to an annual deficit of $7 trillion, but elected officials, while steering every nickel they can to their constituents or contributors, like to pose as sworn opponents of deficit spending. Out of context, $250 billion certainly seems like a lot of money, and in today’s U.S. Senate, it takes only a handful of politicians to bring the legislative gears to a halt. In fact, early last year, the House of Representatives passed legislation that would have changed the budget rules to permit a more sensible fix for the SGR, but the proposal died in committee in the Senate.

The country’s long-term budgetary status is a serious problem, and budget discipline has to begin somewhere. But everyone seems to agree that reducing Medicare’s physician fees by 21%, in perpetuity, while private fees continue to increase might create access problems for at least some beneficiaries and might harm providers whose high volume of service to Medicare beneficiaries leaves them especially dependent on Medicare revenues.

As if that weren’t problematic enough, the basic mechanics of the Medicare Physician Fee Schedule, which was supposed to change physician payment to increase rewards for primary care services at the expense of procedural and interventional services, appears to have gone totally off track. For various reasons, the fee schedule, which originally did increase the prices of evaluation and management services relative to those of surgery or invasive procedures, turned in the other direction through the process of annual updating of relative value units.3 Surgeons, radiologists, and some medical specialists are now paid two to three times as much per hour as providers of cognitive services, which is about where we began 20 years ago; this was the situation that the fee schedule was supposed to fix.

The question of the relative virtues of primary versus specialty care can be debated ad nauseam, but in other wealthy countries that serve their populations at least as well as we do, the ratio of primary care physicians to specialists is much higher than in the United States, and the gap in compensation is much smaller or the poles even reversed.4 Young physicians, burdened by increasing educational debts, may well choose a career path on the basis of a major difference in compensation, especially when the better-compensated positions require less ongoing responsibility for patients and offer better working hours.

Under a budget constraint, however, changes to the relative fees paid to various categories of physicians give rise to zero-sum “distributional politics”; there may be a theoretically correct way to determine relative fees, but that is larg
ely irrelevant to a legislative process in which various groups are free to pursue their self-interests. The only general solution to such a political free-for-all is to increase the total pot available for distribution — as is customarily done, for instance, in the realm of agricultural policy. Last year’s House-passed health care reform bill took this approach, and the final reform law does add a modest amount of money to primary care fees.

But here the two dimensions of the problem intersect. The way to redress the imbalance between primary care and specialty compensation while shrinking the disparity between Medicare and private insurance is to add more money to primary care while leaving specialists’ fees unchanged, on average. But doing so worsens the federal deficit, providing fodder for those who pose, at least, as opponents of deficit spending. And then the pundits argue that fixing the current system isn’t really worth the bother — that fee-for-service payments are so intrinsically counterproductive that we should just scrap them in favor of something better.5 Except that no one knows what that something is.

The enactment of health care reform after many considered it irreversibly derailed by the Senate election in Massachusetts has suggested to some that perhaps the U.S. political system is not so hopelessly gridlocked after all. Health care reform, some believe, might be a harbinger of a more sensible and productive approach to solving serious policy problems. Untying the political knots enmeshing Medicare physician payment will test that optimism.

Disclosure forms provided by the author are available with the full text of this article at NEJM.org.


Source Information

From Nexera (a health care consulting business), New York.

This article (10.1056/NEJMp1004709) was published on May 5, 2010, at NEJM.org.

References

  1. The sustainable growth rate system. In: Report to the Congress: assessing alternatives to the sustainable growth rate system. Washington, DC: Medicare Payment Advisory Commission, March 2007:11-27.
  2. Centers for Medicare & Medicaid Services. Estimated sustainable growth rate and conversion factor for Medicare payments to physicians in 2010. November 2009. (Accessed April 26, 2010, at http://www.cms.gov/SustainableGRatesConFact/Downloads/sgr2010f.pdf.)
  3. Ginsburg PB, Berenson RA. Revising Medicare’s physician fee schedule — much activity, little change. N Engl J Med 2007;356:1201-1203. [Free Full Text]
  4. Lee TH. The need for reinvention. N Engl J Med 2008;359:2085-2086. [Free Full Text]
  5. Wilensky GR. Reforming Medicare’s physician payment sys

NHIS uninsured report portends underinsurance for most

Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2009

By Robin A. Cohen, Ph.D., Michael E. Martinez, M.P.H., M.H.S.A., and Brian W. Ward, Ph.D.
Centers for Disease Control and Prevention (CDC)
National Center for Health Statistics
June 16, 2010

In 2009:

46.3 million (15.4%) were uninsured at the time of the interview

58.5 million (19.4%) had been uninsured for at least part of the year

32.8 million (10.9%) had been uninsured for more than a year

Estimates of enrollment in HDHPs, CDHPs, and FSAs:

Based on data from the 2009 NHIS, 22.4% of persons under age 65 years with private health insurance were enrolled in a HDHP (high deductible health plan), including 6.3% who were enrolled in a CDHP (consumer-directed health plan) and 16.1% who were enrolled in a HDHP without a health savings account (HSA). Enrollment in HDHPs increased from 17.5% in 2007 to 22.4% in 2009. There was a significant increase in enrollment in HDHPs without HSAs and in CDHPs.

Based on data for 2009, among persons under age 65 with private health insurance, 20.2% with employment-based coverage were enrolled in a HDHP, compared with 46.9% of those with a private plan that was directly purchased or obtained through means other than employment. The percentage of persons covered by employment-based private plans that are HDHPs increased from 15.6% in 2007 to 20.2% in 2009. The percentage of persons covered by directly purchased private health plans that are HDHPs increased from 39.2% in 2007 to 46.9% in 2009. For persons under age 65, approximately 8% of private health plans are directly purchased. HDHPs constitute a growing share of both employment-based and directly purchased health plans.

In 2009, among persons under age 65 with private health insurance, 20.4% were in a family that had a FSA for medical expenses. This is an increase from 2007, when 16.7% of persons under age 65 with private insurance were in a family with a FSA.

http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201006.htm

Comment: 

By Don McCane, MD

Although the net loss in insurance coverage for 2009 left another 3 million individuals without coverage, the media response is tempered by the anticipated expansions in health care coverage under the Patient Protection and Affordable Care Act (PPACA). What is being missed in the media reports is a new trend revealed in this survey that will result in an exponential increase in the rates of underinsurance.

A few facts:

* 20.2% of individuals with employer-sponsored plans have high deductible health plans (HDHP)

* 46.9% of individuals with private plans purchased outside of employment have HDHPs

* 72% of those with HDHPs do not have health savings accounts

* PPACA will require plans to have an actuarial value of only 60 percent

Much has been written about how high deductible health plans (HDHPs) result in underinsurance for the majority of Americans, so little will be said here other than to point out that those with medical needs do not receive all of the care that they should have when faced with the financial barrier of a high deductible before they can access the benefits of their health plan. Insurance should improve access to necessary care rather than impair it.

Although the right-wingers in the policy community tout health savings accounts (HSAs) as the solution for making deductibles affordable, there are several flaws. First, close to three-fourths of HDHPs don’t even have an HSA component. For those that do, excess expensive and burdensome administration is being wasted on managing the HSAs which are really no different from the patient paying the expenses out of personal savings, except for the very modest tax advantage of the HSA. Whether in an HSA or in a personal savings account, it is still the patient’s own money that is being spent. If the HSA or the personal savings account were empty, as might be expected for individuals with medical problems, then the high deductible remains as a barrier to care.

Another approach is to set up a flexible spending account (FSA) instead of an HSA. One-fifth of individuals are in families that already have FSAs through their employment. These are even less rational than HSAs since it is the employee’s own pre-tax money that is deposited into the FSA, yet any funds remaining at the end of the year are forfeited. How smart is that?

There is a coalescence of trends that makes it likely that HDHPs will become the standard for most of us with private coverage. To slow the increase in insurance premiums, employers are starting to convert to HDHPs, and one-fifth of them have already done so. Plans in the individual market are much less affordable except for HDHPs. Almost half of those purchasing plans in the individual market have now switched to HDHPs. Because of concerns about high insurance premiums, the drafters of PPACA decided on an actuarial value of only 60 percent for private insurance plans (the patient pays 40 percent of the costs of care). Large deductibles and high coinsurance are used to keep the actuarial value down. Adverse selection of plans will low deductibles will cause a premium spiral that will make those plans unaffordable, forcing even more individuals to choose HDHPs. With these trends it seems that the future will hold little option for most of us not eligible for government programs, other than to enroll in HDHPs.

Since PPACA provides subsidies for both the premiums and out-of-pocket spending, does it even matter if the plans have high deductibles? Since the alleged purpose of high deductibles is to decrease the use of health care by making patients sensitive to health care prices, then it makes no sense to add the administrative excesses and expenses of removing a benefit in the form of the deductible and adding it back in in the form of administered subsidies if the patient ends up bearing only a negligible portion of the costs, thereby jettisoning price sensitivity. As the means- tested subsidies diminish, the deductibles may have more significance, but not for those who are responsible for most of our health care costs – the 20 percent who use 80 percent of our health care.

Will the insurance exchanges obviate the need for HDHPs? When they crafted the PPACA model, it was clear that premiums for comprehensive plans were already too high. That is why they decided on reducing the actuarial values of the plans – 60 percent for the least coverage, though premium subsidies will apply to silver plans with a 70 percent actuarial value. Silver plans will still require high deductibles since they fall short of the typical employer-sponsored plan with an actuarial value of 80 percent or more.

Since the cost sharing would still be excessive for most individuals and families, PPACA provides for cost sharing credits that would have the effect of increasing the actuarial value on a sliding scale based on income – 70 percent for those at 250-400% of the federal poverty level (FPL) and up to 94 percent for those with incomes at 100-150% FPL.

There is concern that the combined premium plus the cost sharing for the exchange plans is still too high for most families, but these are the levels that Congress decided would be necessary because of their arbitrary decision to limit how much of the costs would pass through the federal budget.

But what is really ridiculous is that merely to avoid an efficient system with a single, publicly financed universal risk pool, they designed an administratively complex system of variable actuarial values, with variable premium subsidies, with variable cost sharing credits, which will drive the plans to introduce high deductibles as the national standard, when high deductibles have already
been demonstrated to be a perverse policy for controlling costs.

Remember, by continuing on our current PPACA course, we are going to see an explosion in high deductible health plans, to the detriment of people who need health care. Of course, we could change course and enact an improved Medicare for all without any deductibles. We wouldn’t need price sensitivity if we had our own public health care monopsony.

Groups protest health care cuts outside Pawlenty's office

By Elizabeth Dunbar
Minnesota Public Radio, June 15, 2010

ST. PAUL, Minn. — A coalition of groups offered blood pressure, cholesterol and blood sugar screenings outside Gov. Tim Pawlenty’s office on Tuesday as part of a protest against cuts to a state health care program for the poor.

The Universal Health Care Action Network of Minnesota and other groups have set up free or low-cost clinics elsewhere before, but organizers said they came to the State Capitol to urge Pawlenty and others to see health care as a human right.

“Health care is a human right based on need. If you need care, you get care. It’s an entitlement and it’s a public good,” said Joel Albers, a pharmacist who is part of the Universal Health Care Action Network.

Four hospitals have agreed to participate in a scaled-back version of General Assistance Medical Care, but all of them are in the Twin Cities. The program uses a coordinated care delivery system, meaning hospitals would get a lump sum of money to care for a certain number of patients.

The new GAMC program was the result of negotiations between Pawlenty and the DFL-controlled Legislature to solve the state’s budget deficit. The changes took effect June 1.

Albers said the cuts will mean the program won’t meet the needs of the 30,000 or so low-income adults without children who are in the program.

“We do know that over time, when you make drastic cuts like this and people don’t have access,” he said, “Eventually that will lead to greater hospitalizations, greater emergency room visits and, frankly, increase morbidity and mortality.”

Dr. Elizabeth Frost, a family practice physician and a member of Physicians for a National Health Program, said the groups would like to see all Minnesotans covered by a plan paid for by state government.

That way, the state could eliminate many of the administrative costs for programs like GAMC and MinnesotaCare and focus on caring for everyone, she said.

“All this stress about signing people up, finding out who gets covered, who isn’t covered … all that waste would be eliminated,” Frost said. “We want to lead the nation and show that you can do government-funded health insurance and it can work and it can be very successful.”

http://minnesota.publicradio.org/display/web/2010/06/15/groups-protest-healthcare-cuts/

Groups protest health care cuts outside Pawlenty’s office

By Elizabeth Dunbar
Minnesota Public Radio, June 15, 2010

ST. PAUL, Minn. — A coalition of groups offered blood pressure, cholesterol and blood sugar screenings outside Gov. Tim Pawlenty’s office on Tuesday as part of a protest against cuts to a state health care program for the poor.

The Universal Health Care Action Network of Minnesota and other groups have set up free or low-cost clinics elsewhere before, but organizers said they came to the State Capitol to urge Pawlenty and others to see health care as a human right.

“Health care is a human right based on need. If you need care, you get care. It’s an entitlement and it’s a public good,” said Joel Albers, a pharmacist who is part of the Universal Health Care Action Network.

Four hospitals have agreed to participate in a scaled-back version of General Assistance Medical Care, but all of them are in the Twin Cities. The program uses a coordinated care delivery system, meaning hospitals would get a lump sum of money to care for a certain number of patients.

The new GAMC program was the result of negotiations between Pawlenty and the DFL-controlled Legislature to solve the state’s budget deficit. The changes took effect June 1.

Albers said the cuts will mean the program won’t meet the needs of the 30,000 or so low-income adults without children who are in the program.

“We do know that over time, when you make drastic cuts like this and people don’t have access,” he said, “Eventually that will lead to greater hospitalizations, greater emergency room visits and, frankly, increase morbidity and mortality.”

Dr. Elizabeth Frost, a family practice physician and a member of Physicians for a National Health Program, said the groups would like to see all Minnesotans covered by a plan paid for by state government.

That way, the state could eliminate many of the administrative costs for programs like GAMC and MinnesotaCare and focus on caring for everyone, she said.

“All this stress about signing people up, finding out who gets covered, who isn’t covered … all that waste would be eliminated,” Frost said. “We want to lead the nation and show that you can do government-funded health insurance and it can work and it can be very successful.”

http://minnesota.publicradio.org/display/web/2010/06/15/groups-protest-healthcare-cuts/

Arizona’s immigration law and health care

By Paul T. Cheung
Denver Post, 06/16/2010

Even though the impact of Governor Brewer of Arizona signing S.B. 1070 into law may appear distant, the law has far reaching implications for the general public including here in Colorado.

Amid all the discussions of the legislation – including the marginalization of the Latino culture and society – few have noted its impact on health. Arizona S.B. 1070 will decrease health care usage, leading to increase public medical care spending, worse health outcomes, and lower immunization rates.

Take for example Juan, the owner of a local taqueria restaurant in Aurora, whom I met last month. He is a legal citizen facing a number of challenges in obtaining health care. For many years, he did not have regular access to a primary care physician and has relied on cultural remedies as his main source of care. Juan told me a common story. Care is difficult to come by for a multitude of reasons: time, money, lack of transportation, language barriers, and the complexity of navigating the maze that is the U.S. health system.

When Juan learned I was a medical student, he told me about his health. Several weeks ago, he was stricken with severe heart palpitations, night sweats, and chest pain. He waited three weeks before he decided to go see a doctor. Ultimately, the doctor that saw Juan diagnosed his high blood pressure and gave him a prescription to control it. Untreated, he was at significant risk for strokes and heart attacks. Juan waited to seek help because he does not have insurance and had no idea how to get an appointment with a Spanish-speaking physician.

To the long list of barriers Latinos face in getting care in this country, the Arizona immigration law adds another. Our health care system works best when chronic conditions such as high blood pressure, diabetes, and asthma are controlled. Had Juan suffered a stroke or heart attack from uncontrolled blood pressure, his medical costs would rise dramatically and ultimately be passed on to the community through taxes and higher insurance premiums. More importantly, Juan likely would have suffered long term health effects impacting the quality of his daily life.

On a broader level, the law will strain the relationship between the Latino community and health care providers. Important public health goals such as immunizations will be compromised. High immunization rates are important for children who are in close contact in school to prevent spread of disease. This law will prevent Latino families from bringing their children in to see the doctor and these unimmunized children will increase the presence of diseases like flu, measles, and mumps in the community. Fear and uncertainty about the health care providers’ role in enforcing the documentation requirement will foster distrust of physicians by Latino patients.

The Latino community already is facing numerous challenges in obtaining optimal care. Routine medical attention consistently leads to better control and treatment of chronic conditions like high blood pressure. Barriers to health care need to be removed.

As a medical student, I am concerned about how this new law will affect health in the community. As I progress into my clinical training, I am worried about meeting more patients like Juan – who nearly missed more serious health consequences from his untreated high blood pressure – because of barriers to care. Ultimately, such delays will lead to even more expensive health care for all.

Paul Cheung is a first year medical student at the University of Colorado School of Medicine and a resident of Aurora. EDITOR’S NOTE: This is an online-only column and has not been edited.

http://www.denverpost.com/commented/ci_15302543

Arizona's immigration law and health care

By Paul T. Cheung
Denver Post, 06/16/2010

Even though the impact of Governor Brewer of Arizona signing S.B. 1070 into law may appear distant, the law has far reaching implications for the general public including here in Colorado.

Amid all the discussions of the legislation – including the marginalization of the Latino culture and society – few have noted its impact on health. Arizona S.B. 1070 will decrease health care usage, leading to increase public medical care spending, worse health outcomes, and lower immunization rates.

Take for example Juan, the owner of a local taqueria restaurant in Aurora, whom I met last month. He is a legal citizen facing a number of challenges in obtaining health care. For many years, he did not have regular access to a primary care physician and has relied on cultural remedies as his main source of care. Juan told me a common story. Care is difficult to come by for a multitude of reasons: time, money, lack of transportation, language barriers, and the complexity of navigating the maze that is the U.S. health system.

When Juan learned I was a medical student, he told me about his health. Several weeks ago, he was stricken with severe heart palpitations, night sweats, and chest pain. He waited three weeks before he decided to go see a doctor. Ultimately, the doctor that saw Juan diagnosed his high blood pressure and gave him a prescription to control it. Untreated, he was at significant risk for strokes and heart attacks. Juan waited to seek help because he does not have insurance and had no idea how to get an appointment with a Spanish-speaking physician.

To the long list of barriers Latinos face in getting care in this country, the Arizona immigration law adds another. Our health care system works best when chronic conditions such as high blood pressure, diabetes, and asthma are controlled. Had Juan suffered a stroke or heart attack from uncontrolled blood pressure, his medical costs would rise dramatically and ultimately be passed on to the community through taxes and higher insurance premiums. More importantly, Juan likely would have suffered long term health effects impacting the quality of his daily life.

On a broader level, the law will strain the relationship between the Latino community and health care providers. Important public health goals such as immunizations will be compromised. High immunization rates are important for children who are in close contact in school to prevent spread of disease. This law will prevent Latino families from bringing their children in to see the doctor and these unimmunized children will increase the presence of diseases like flu, measles, and mumps in the community. Fear and uncertainty about the health care providers’ role in enforcing the documentation requirement will foster distrust of physicians by Latino patients.

The Latino community already is facing numerous challenges in obtaining optimal care. Routine medical attention consistently leads to better control and treatment of chronic conditions like high blood pressure. Barriers to health care need to be removed.

As a medical student, I am concerned about how this new law will affect health in the community. As I progress into my clinical training, I am worried about meeting more patients like Juan – who nearly missed more serious health consequences from his untreated high blood pressure – because of barriers to care. Ultimately, such delays will lead to even more expensive health care for all.

Paul Cheung is a first year medical student at the University of Colorado School of Medicine and a resident of Aurora. EDITOR’S NOTE: This is an online-only column and has not been edited.

http://www.denverpost.com/commented/ci_15302543

League of Women Voters calls for 'Medicare for all'

League of Women Voters calls for 'Medicare for all'

Physicians for a National Health Program
June 16, 2010

Noting the Obama administration’s new health law falls short of providing affordable care to all U.S. residents, the national convention of the League of Women Voters passed a resolution Monday calling on the group’s board to “advocate strongly” for “an improved Medicare for all.”

Although many other groups, including labor unions, religious denominations and medical associations, have gone on record in recent years in support of a single-payer health program, or an improved Medicare for all, the League’s action is believed to be the first national endorsement of its type since Congress passed the Patient Protection and Affordable Care Act in March.

The resolution was introduced at the Atlanta meeting by Karen Green Stone of Bloomington, Ind., who argued that the new law lacks effective cost controls and does nothing to eliminate wasteful paperwork and bureaucracy in the U.S. health system.

Green Stone commented after the vote, “The delegates at the meeting understood that it has never been more important to push for a single-payer plan, an improved Medicare for all. They loved our new slogan in Indiana: ‘Health care reform: We’re still for it … and we’re not done yet!'”

https://pnhp.org/news/2010/june/league-of-women-voters-calls-for-medicare-for-all

And…

2010 Convention

League of Women Voters
Atlanta, Georgia
June 11-15, 2010

Motion #549-473, submitted by LWV of Bloomington-Monroe, IN.

Whereas the League of Women Voters of the United States believes quality health care at an affordable cost should be available to all U.S. residents; and

Whereas the current and proposed systems do not achieve the League goals of affordability and access to everyone; and

Whereas an improved Medicare for all, a publicly funded and privately delivered national health care plan, is consistent with this goal;

Therefore, be it resolved that we, the representatives of local and state Leagues assembled at the 2010 LWLVUS Convention, call upon the LWVUS Board to advocate strongly for bills that legislate for improved Medicare for all.

Motion APPROVED.

http://www.lwv.org/AM/Template.cfm?Section=Council_and_Convention&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=15476

And…

LWV Address by Health and Human Services Secretary Kathleen Sebelius

Closing remarks:

So I want to thank you for all your hard work on behalf of the Affordable Care Act.  It’s a tremendous accomplishment.

But I’m also here to tell you that our work isn’t over.  You understand this.  The League of Women Voters was created right before the passage of the 19th amendment.  Some people might have said it was a strange time to start a group focusing on women and democracy.  After all, women were already poised to get the right to vote.

But you knew that passing the amendment was just the first step.  There was still hard work to be done to fulfill its promise.  That’s also true for the Affordable Act.

We’re on the right track.  But we’ve still got a long way to go.  And we’ll need your help to get there.

http://www.lwv.org/AM/Template.cfm?Template=/CM/ContentDisplay.cfm&ContentID=15477

Comment: 

By Don McCanne, MD

Once again, the League of Women Voters leads the way. Although they supported the Patient Protection and Affordable Care Act (PPACA), they realize that it falls far short of the League goals of affordability and access for everyone. Even HHS Secretary Kathleen Sebelius concedes that we still have a long way to go.

There are several beneficial measures in PPACA that we should continue to support. But the greatest deficiency in the act is that the PPACA financing model can never get us to an affordable system that includes everyone. The delegates at the LWV convention recognized this when they passed the resolution calling for the national LWV Board (LWVUS) to “advocate strongly for bills that legislate for improved Medicare for all,” since it would provide the financing infrastructure that we desperately need.

The individuals and organizations, who in the name of compromise abandoned support for a national health program, have achieved their lesser goal of passing something – anything – as long as the act provided some benefit. Now that it is clear that tweaks to PPACA will still leave us with only compromised “something – anything” policies, it’s time to remount the unified effort to enact an improved Medicare program that includes everyone. We need to give Kathleen Sebelius the tools that she needs to get us there, and that didn’t happen with PPACA.

The League of Women Voters has picked up the torch. Let’s join them. After all, as they say in Indiana, “Health care reform: We’re still for it … and we’re not done yet!”

League of Women Voters calls for ‘Medicare for all’

League of Women Voters calls for ‘Medicare for all’

Physicians for a National Health Program
June 16, 2010

Noting the Obama administration’s new health law falls short of providing affordable care to all U.S. residents, the national convention of the League of Women Voters passed a resolution Monday calling on the group’s board to “advocate strongly” for “an improved Medicare for all.”

Although many other groups, including labor unions, religious denominations and medical associations, have gone on record in recent years in support of a single-payer health program, or an improved Medicare for all, the League’s action is believed to be the first national endorsement of its type since Congress passed the Patient Protection and Affordable Care Act in March.

The resolution was introduced at the Atlanta meeting by Karen Green Stone of Bloomington, Ind., who argued that the new law lacks effective cost controls and does nothing to eliminate wasteful paperwork and bureaucracy in the U.S. health system.

Green Stone commented after the vote, “The delegates at the meeting understood that it has never been more important to push for a single-payer plan, an improved Medicare for all. They loved our new slogan in Indiana: ‘Health care reform: We’re still for it … and we’re not done yet!'”

https://www.pnhp.org/news/2010/june/league-of-women-voters-calls-for-medicare-for-all

And…

2010 Convention

League of Women Voters
Atlanta, Georgia
June 11-15, 2010

Motion #549-473, submitted by LWV of Bloomington-Monroe, IN.

Whereas the League of Women Voters of the United States believes quality health care at an affordable cost should be available to all U.S. residents; and

Whereas the current and proposed systems do not achieve the League goals of affordability and access to everyone; and

Whereas an improved Medicare for all, a publicly funded and privately delivered national health care plan, is consistent with this goal;

Therefore, be it resolved that we, the representatives of local and state Leagues assembled at the 2010 LWLVUS Convention, call upon the LWVUS Board to advocate strongly for bills that legislate for improved Medicare for all.

Motion APPROVED.

http://www.lwv.org/AM/Template.cfm?Section=Council_and_Convention&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=15476

And…

LWV Address by Health and Human Services Secretary Kathleen Sebelius

Closing remarks:

So I want to thank you for all your hard work on behalf of the Affordable Care Act.  It’s a tremendous accomplishment.

But I’m also here to tell you that our work isn’t over.  You understand this.  The League of Women Voters was created right before the passage of the 19th amendment.  Some people might have said it was a strange time to start a group focusing on women and democracy.  After all, women were already poised to get the right to vote.

But you knew that passing the amendment was just the first step.  There was still hard work to be done to fulfill its promise.  That’s also true for the Affordable Act.

We’re on the right track.  But we’ve still got a long way to go.  And we’ll need your help to get there.

http://www.lwv.org/AM/Template.cfm?Template=/CM/ContentDisplay.cfm&ContentID=15477

Comment: 

By Don McCanne, MD

Once again, the League of Women Voters leads the way. Although they supported the Patient Protection and Affordable Care Act (PPACA), they realize that it falls far short of the League goals of affordability and access for everyone. Even HHS Secretary Kathleen Sebelius concedes that we still have a long way to go.

There are several beneficial measures in PPACA that we should continue to support. But the greatest deficiency in the act is that the PPACA financing model can never get us to an affordable system that includes everyone. The delegates at the LWV convention recognized this when they passed the resolution calling for the national LWV Board (LWVUS) to “advocate strongly for bills that legislate for improved Medicare for all,” since it would provide the financing infrastructure that we desperately need.

The individuals and organizations, who in the name of compromise abandoned support for a national health program, have achieved their lesser goal of passing something – anything – as long as the act provided some benefit. Now that it is clear that tweaks to PPACA will still leave us with only compromised “something – anything” policies, it’s time to remount the unified effort to enact an improved Medicare program that includes everyone. We need to give Kathleen Sebelius the tools that she needs to get us there, and that didn’t happen with PPACA.

The League of Women Voters has picked up the torch. Let’s join them. After all, as they say in Indiana, “Health care reform: We’re still for it … and we’re not done yet!”

League of Women Voters calls for 'Medicare for all'

FOR IMMEDIATE RELEASE
June 16, 2010    

Contact:
Karen Green Stone and Rob Stone, M.D., grostone@gmail.com
Quentin Young, M.D., (312) 782-6006, info@pnhp.org
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org

Noting the Obama administration’s new health law falls short of providing affordable care to all U.S. residents, the national convention of the League of Women Voters passed a resolution Monday calling on the group’s board to “advocate strongly” for “an improved Medicare for all.”

The convention’s 600 delegates, meeting in Atlanta on the group’s 90th anniversary, voted more than 2 to 1 in support of the measure. In the run-up to the national meeting, nearly identical resolutions were adopted by more than 50 local chapters and 11 state organizations of the League, which claims more than 150,000 members nationwide.

Although many other groups, including labor unions, religious denominations and medical associations, have gone on record in recent years in support of a single-payer health program, or an improved Medicare for all, the League’s action is believed to be the first national endorsement of its type since Congress passed the Patient Protection and Affordable Care Act in March.

“The League’s action is highly welcome and highly significant,” said Dr. Quentin Young, national coordinator of Physicians for a National Health Program, an organization of 17,000 doctors who support a single-payer system. “Among other things, it shows that its members are in tune with numerous polls indicating strong majority support for a government-sponsored, improved Medicare-for-all program.

“Such a program is urgently needed to bring to a close the economic and medical fiasco that is the tragic reality of our present health system – a condition which, sadly, the newly passed health law will not cure,” he said.

The convention vote took place shortly before the arrival of Kathleen Sebelius, President Obama’s secretary of health and human services, who was scheduled to address the gathering and to plug the administration’s new health law. When Sebelius arrived, she was greeted by delegates holding a banner that read, “LWV Supports Improved Medicare for All.”

While Sebelius was warmly received by the delegates, the Medicare-for-all message undoubtedly got through, Young said.

The health care resolution (see below) was promoted across the country by League members who built upon the group’s previous declaration that a viable health care plan should be universal, affordable, accessible and funded by taxation rather than by insurance premiums.

The resolution was introduced at the Atlanta meeting by Karen Green Stone of Bloomington, Ind., who argued that the new law lacks effective cost controls and does nothing to eliminate wasteful paperwork and bureaucracy in the U.S. health system.

Green Stone commented after the vote, “The delegates at the meeting understood that it has never been more important to push for a single-payer plan, an improved Medicare for all. They loved our new slogan in Indiana: ‘Health care reform: We’re still for it … and we’re not done yet!'”

Single-payer advocates say replacing the nation’s multiple private health insurers with a single streamlined, nonprofit, public insurance program would save about $400 billion annually in administrative costs, enough to provide all U.S. residents with comprehensive, quality care.

Health Care Resolution passed by LWVUS – June 14, 2010

Whereas the League of Women Voters of the United States believes quality health care at an affordable cost should be available to all U.S. residents; and

Whereas the current and proposed systems do not achieve the League goals of affordability and access to everyone; and

Whereas an improved Medicare for all, a publicly funded and privately delivered national health care plan, is consistent with this goal;

Therefore, be it resolved, we, the representatives of local and state Leagues assembled at the 2010 LWVUS Convention, call upon the LWVUS Board to advocate strongly for bills that legislate for improved Medicare for all.

Physicians for a National Health Program (www.pnhp.org) is an organization of more than 17,000 physicians who support a single-payer national health insurance program. To contact a physician-spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.

Humiliation and Shame: Part of Being Insured in America

By Donna Smith
CommonDreams.org, June 16, 2010

Oh, the things we did not fix in the healthcare bill are shocking. Just as seniors falling into the Medicare drug benefit donut hole begin to get the $250 checks meant to calm their fears about our new healthcare legislation, the rest of us would do well to remember the abuses of the for-profit healthcare system that will continue and even accelerate in the coming years.

Health insurance is not health care. Health insurance is a financial product marketed and sold to protect health and wealth which may do neither thing very well. I view it as a defective product. Yet, very soon we will be buying more of it and helping more of our fellow Americans buy more of it with the subsidies that support the great health insurance bailout that is being called “patient protection.”

Yesterday, I went to the doctor for an appointment I waited weeks to secure. I am insured. I have what some would say is fairly good insurance from one of the for-profit insurance giants. I waited patiently in the waiting room, and then was escorted to the exam room. There was a flurry of activity around me. A thorough history was taken. X-rays were taken. The nurse said, “Oh, honey, are you in pain? Those X-rays show some pretty awful deformity.” I said I have been hurting for years but that I have waited until I could stand no more to seek treatment. Most of the time I take large amounts of OTC anti-inflammatory medication and muddle through. It’s the American way. It’s the insured American’s way. It’s the working, insured American’s way.

The doctor buzzed in rather quickly and began discussing a treatment plan with me. Some immediate care to relieve some of the pain, and some longer term non-invasive care to see if we could avoid surgery. I was hopeful and thrilled though a bit worried about how it would feel to get shots in the joints of my feet to help the heel spurs and the bone pain. I’ve had shots in my knees, and it isn’t fun.

Suddenly, as quickly as I had felt the anticipation of some relief, the flurry of activity ground to a halt. The doctor left the room. Another office person came in. She said, “I’m sorry Ms. Smith. Your insurance will not cover what the doctor wants to try.” Matter of fact. She’s said these words before – many times. I ask how much it would cost to pay for it myself. She answers. I cannot pay that much. The visit is ending. The hope is shriveling. I could feel the muscles in my face tense as the humiliation spread through my body. This body, just moments ago worthy of plans to relieve pain and head for some better health, now was deemed unworthy of care. Shame. All that old shame I used to feel before our medical bankruptcy was rising in my gut. It hurt so badly. But I was determined not to show my anger or my sadness.

The doctor wandered by the room and saw me. He stepped in and gave me some soft inserts for my shoes. He said they won’t help much or for long, but that maybe it would be a little relief. He must have seen the look on my face and felt at least a little compassion. A little. I thanked him. But I could say little else, and I could not look him in the eye. I felt so ashamed, and I don’t even really understand why I’ve been so conditioned as a patient to feel it is my failure when these things happen.

On the way home, I alternated between sadness and anger. Clearly someone wasn’t being honest with me. Either the treatments this doctor was suggesting really aren’t a good idea (as the insurance company’s denial to pay would lead one to believe) and therefore are not approved for coverage or the insurance company just wants to push those costs onto patients who cannot usually afford them. Either way, I didn’t get the care I needed. Either way, I left hurting. Either way, I lose. The doctor made some money on the office visit and my co-pay at least. The insurance company avoided paying for anything beyond that.

My husband sat beside me in the car, sad and angry for me. As a person covered under one of our nation’s single-payer programs and a supplemental private policy, he has never heard the words I heard — he has never been denied care. He felt helpless for me. As I cried tears of rage, he sat silently.

And, so, how will any of this change under the new healthcare bill? It won’t. In fact, the pressure for insurance companies to deny more care will grow as they are compelled by law to take more people who have pre-existing conditions like having feet. Cherry picking the healthiest folks will require a bit more skillful contortions for the for-profit insurance companies, and doctors will leave more patients sitting on the edge of exam tables like naughty little children who do not deserve to be treated.

Healthcare is a basic human right in most of the rest of the modern world. Only in this nation do we believe that only the richest people deserve the best of care. It’s a wild twist on the old Bible lesson about it being tougher for a rich man to get to heaven than for a camel to get through the eye of a needle. We’ve made it harder for a working person or a poor person to get healthcare in America than for a rich man to get to heaven. We are a sick society indeed. No Golden Rule values herein.

Only when we finally decide that we believe in a compassionate and just healthcare system for all will we ever have the courage to change it. Right now we just don’t believe in that sort of system at all. As a patient, I am fodder. At least this morning I was able to turn my outrage back on the system that left me in that exam room alone and sucking back tears of anger. No one should go to a doctor to seek care and leave less well. That’s cruel and unusual.

I was raised to have more compassion than this for my fellow human beings, and I think most Americans were raised with similar values. How in the world did we get to a place where we participate in doing this to one another? Is this the system we want to leave to our children? Do you want to leave your child lacking care when he or she needs it? Your grandchild? Then, for heaven’s sake — for heaven’s sake — stand up and let’s get back to work to fix this mess. There is much to be done.

Donna Smith is a community organizer for National Nurses United (the new national arm of the California Nurses Association) and National Co-Chair for the Progressive Democrats of America Healthcare Not Warfare campaign.

League of Women Voters endorses single payer, Medicare for All

June 16, 2010

Dear PNHP colleagues,

Good news!

The 150,000-member League of Women Voters called for “an improved Medicare for all,” i.e. for single-payer health reform, at its national convention on Monday.

The League’s action – the first major organizational endorsement of single payer since the passage of the Obama administration’s health bill in March – was facilitated by the work of PNHP members and other single-payer advocates across the country who have educated their colleagues in the League about the merits of single-payer national health insurance over a period of several years. Congratulations to all!

PNHP news release on the endorsement appears below; please feel free to bring it to the attention of your local media contacts.

Local chapters of the League, of which there are 900 nationwide, are presently holding public meetings and other forums about health care reform, including what the administration’s new health law contains and how it will likely play out.

We encourage PNHP members to participate in such League-sponsored meetings and to provide expert information about the single-payer alternative, possibly by serving as a panelist. You can locate a League chapter near you by going here.

PNHP slideshows and other resources are available for your use in this regard and in other contexts.

We also encourage you to explore all other opportunities of working in coalition with the League to further our common goal, single-payer Medicare for all.

Cordially,


Ida Hellander, M.D.
Executive Director


Quentin Young, M.D.
National Coordinator

League of Women Voters calls for ‘Medicare for all’

FOR IMMEDIATE RELEASE
June 16, 2010

Contact:
Karen Green Stone and Rob Stone, M.D.
Quentin Young, M.D., (312) 782-6006, info@pnhp.org
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org

Noting the Obama administration’s new health law falls short of providing affordable care to all U.S. residents, the national convention of the League of Women Voters passed a resolution Monday calling on the group’s board to “advocate strongly” for “an improved Medicare for all.”

The convention’s 600 delegates, meeting in Atlanta on the group’s 90th anniversary, voted more than 2 to 1 in support of the measure. In the run-up to the national meeting, nearly identical resolutions were adopted by more than 50 local chapters and 11 state organizations of the League, which claims more than 150,000 members nationwide.

Although many other groups, including labor unions, religious denominations and medical associations, have gone on record in recent years in support of a single-payer health program, or an improved Medicare for all, the League’s action is believed to be the first national endorsement of its type since Congress passed the Patient Protection and Affordable Care Act in March.

“The League’s action is highly welcome and highly significant,” said Dr. Quentin Young, national coordinator of Physicians for a National Health Program, an organization of 17,000 doctors who support a single-payer system. “Among other things, it shows that its members are in tune with numerous polls indicating strong majority support for a government-sponsored, improved Medicare-for-all program.

“Such a program is urgently needed to bring to a close the economic and medical fiasco that is the tragic reality of our present health system – a condition which, sadly, the newly passed health law will not cure,” he said.

The convention vote took place shortly before the arrival of Kathleen Sebelius, President Obama’s secretary of health and human services, who was scheduled to address the gathering and to plug the administration’s new health law. When Sebelius arrived, she was greeted by delegates holding a banner that read, “LWV Supports Improved Medicare for All.”

While Sebelius was warmly received by the delegates, the Medicare-for-all message undoubtedly got through, Young said.

The health care resolution (see below) was promoted across the country by League members who built upon the group’s previous declaration that a viable health care plan should be universal, affordable, accessible and funded by taxation rather than by insurance premiums.

The resolution was introduced at the Atlanta meeting by Karen Green Stone of Bloomington, Ind., who argued that the new law lacks effective cost controls and does nothing to eliminate wasteful paperwork and bureaucracy in the U.S. health system.

Green Stone commented after the vote, “The delegates at the meeting understood that it has never been more important to push for a single-payer plan, an improved Medicare for all. They loved our new slogan in Indiana: ‘Health care reform: We’re still for it … and we’re not done yet!'”

Single-payer advocates say replacing the nation’s multiple private health insurers with a single streamlined, nonprofit, public insurance program would save about $400 billion annually in administrative costs, enough to provide all U.S. residents with comprehensive, quality care.

Health Care Resolution passed by LWVUS – June 14, 2010

Whereas the League of Women Voters of the United States believes quality health care at an affordable cost should be available to all U.S. residents; and

Whereas the current and proposed systems do not achieve the League goals of affordability and access to everyone; and

Whereas an improved Medicare for all, a publicly funded and privately delivered national health care plan, is consistent with this goal;

Therefore, be it resolved, we, the representatives of local and state Leagues assembled at the 2010 LWVUS Convention, call upon the LWVUS Board to advocate strongly for bills that legislate for improved Medicare for all.

Physicians for a National Health Program (www.pnhp.org) is an organization of more than 17,000 physicians who support a single-payer national health insurance program. To contact a physician-spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.

AMA health insurer report card

New AMA Health Insurer Report Card Finds Need For More Accuracy

AMA
June 14, 2010

The American Medical Association (AMA) today announced that one in five medical claims are processed inaccurately by health insurers, according to the AMA’s third annual check-up of the nation’s commercial health insurers and the systems they use to manage and pay claims. This was the key finding of the AMA’s 2010 National Health Insurer Report Card.

The AMA estimates that $777.6 million in unnecessary administrative cost could be saved if the health insurance industry improves claims processing accuracy by one percent. Increasing the health insurance industry’s accuracy rating to 100 percent would save up to $15.5 billion annually that could be better used to enhance patient care and help reduce overall health care costs.

http://www.ama-assn.org/ama/pub/news/news/2010-report-card.shtml

National Health Insurer Report Card
http://www.ama-assn.org/ama1/pub/upload/mm/368/2010-nhirc-results.pdf

Comment: 

By Don McCanne, MD

The private insurance industry is selling us administrative services at an outrageously high price. This report card confirms that we certainly are not receiving value. Not only are we paying them too much, but they also continue to do a lousy job at their most important function – claims processing. Their error rate results in an additional $15 billion annually in administrative waste that could be used for patient care, according to this AMA report.

This year the AMA did not report Medicare’s error rate, but, in the 2008 report card, Medicare’s compliance rate was vastly superior to all of the private insurers – over 98 Percent.

But the greatest argument for changing to an improved Medicare program that covers everyone is not the reduction in waste caused by private insurer claims processing errors which would save about $15 billion, rather it is the replacement of our dysfunctional, fragmented, private/public financing system with a single payer system which would save us about $400 billion annually.

Even if the private insurers could match the claims performance of Medicare, that wouldn’t fix our problems. It’s the financing model that needs to be changed. The $4 trillion that we could recover over the next decade would pay for the needed care for the uninsured and the growing numbers of underinsured. We would have solved our health care financing problems, and that would allow us to direct more of our attention and effort to much needed health system reform.