PNHP

Expansion of the Mexico City Policy

pnhpf3a

Expansion of the Mexico City Policy

Trump to Expand Funding Ban Tied to Abortion Overseas

By Gardiner Harris and Somini Sengupta
The New York Times, May 15, 2017

The Trump administration said on Monday it would vastly expand the so-called global gag rule that withholds American aid from health organizations worldwide that provide or even discuss abortion in family planning. The new policy could disrupt hundreds of clinics in Africa and around the world that fight AIDS and malaria.

It affects about $8.8 billion in global health funding, up from about $600 million during the administration of President George W. Bush.

The rules, issued by the State Department, mean that any foreign nongovernmental group that wants American money for any of its health activities — from AIDS treatment to malaria prevention to safe childbirth practices — must promise not to “promote abortion as a method of family planning.” Already, American taxpayer dollars cannot be used for abortion services abroad.

The global gag rule was introduced by President Ronald Reagan in 1984 at the International Conference on Population in Mexico City, and is also known as the Mexico City Policy. Since then, Republican administrations have kept or reimposed it, while Democratic ones have rescinded it.

Mr. Bush visited Botswana and Namibia only last month to highlight the need for aid under the President’s Emergency Plan for AIDS Relief, or Pepfar, to treat cervical cancer. He also argued that care for cervical cancer should be provided right along with care for H.I.V.

But under the policy announced Monday, that could be impossible.

The policy “risks undoing years of progress on women’s health in Pepfar countries,” said Asia Russell, executive director of the Health Global Access Project, a public health group.

https://www.nytimes.com…

***

Background Briefing: Senior Administration Officials on Protecting Life in Global Health Assistance

U.S. Department of State, May 15, 2017

MODERATOR: Thank you very much, and thanks to all those who have joined us for this afternoon’s call. This will be an on-background conference call on Protecting Life in Global Health Assistance. I’ll introduce our participants this afternoon, but as a reminder, for attribution they will be senior administration officials, and the rules for this call will be on background.

Today we are joined by [Senior Administration Official One]. We are also joined by [Senior Administration Official Two], and finally, by [Senior Administration Official Three].

SENIOR ADMINISTRATION OFFICIAL ONE: Thank you, [Moderator], and good afternoon.

On January 23rd, 2017, President Trump issued a presidential memorandum reinstating the 2001 presidential memorandum on the Mexico City policy, and directed the Secretary of State to implement a plan to extend to the extent allowable by law the Mexico City policy to global health assistance furnished by all departments or agencies.

Secretary Tillerson has approved a plan to implement the manner in which U.S. Government departments and agencies will apply the provisions of the Mexico City policy to foreign nongovernmental organizations that receive U.S. funding for global health assistance. The policy, now known as Protecting Life in Global Health Assistance, implements what the President has made very clear: U.S. taxpayer money should not be used to support foreign organizations that perform or actively promote abortion as a method of family planning in other nations.

Under this policy, global health assistance includes funding for international health programs, such as those for HIV/AIDS, maternal and child health, malaria, global health security, family planning, and reproductive health. Protecting Life in Global Health Assistance applies to global health assistance to or implemented by foreign NGOs, including those to which a U.S. NGO makes a sub-award with such assistance funds.

Once all appropriate steps have been taken, the policy will apply to all new funding agreements, grants, cooperative agreements, and contracts, and gradually to existing agreements when they are amended to add funding.

Protecting Life in Global Health Assistance applies to approximately $8.8 billion in funds appropriated to the Department of State, the U.S. Agency for International Development, and the Department of Defense. Previously, the policy applied only to family planning assistance provided by USAID and the Department of State.

Given the expansive nature of the new policy, the department will undertake a thorough and comprehensive review of the effectiveness and impact of the policy’s application over the next six months, which could include identifying implementation issues and any other new information affecting implementation going forward. Newly covered programs, including PEPFAR, the President’s Malaria Initiative, and other global health programs, will be given special attention under this review.

MODERATOR: And with that, we’ll open this up for questions. Thank you.

OPERATOR: Ladies and gentlemen, once again, it’s *1 for questions. And our first question will come from the line of Yeganeh Torbati of Reuters. Please, go ahead.

QUESTION: Thanks so much. A couple quick questions: Can you – you said that now it applies to $8.8 billion in funding. Other – some critics have said and I’ve seen the wording that previously it applied to $600 million in funding. Can you confirm that? And also, you mentioned that PEPFAR and the malaria – the President’s Malaria Initiative are new programs that will be added to this or newly covered under this. Can you name a few other specific programs that weren’t covered before and now will be? Thank you.

SENIOR ADMINISTRATION OFFICIAL ONE: Okay, thank you very much. Yes, the $8.8 billion includes primarily the PEPFAR program, which is approximately $6 billion. Additional funding included in this $8.8 billion is USAID family planning, reproductive health, maternal health, and other types of programs.

The $600 million figure that you mentioned was approximately the amount of money that was covered under the previous Mexico City policy that only affected USAID’s and State Department’s family planning program.

SENIOR ADMINISTRATION OFFICIAL THREE: Just to add on, the other programs affected also would include exactly as [Senior Administration Official One] said – the maternal child health programs, malaria, PEPFAR, as well as other infectious disease programs and the full array of global health assistance provided through USAID.

OPERATOR: Okay. Next, we’ll go to the line of Jina Moore of BuzzFeed.

QUESTION: And just a quick follow-up. I know this came up a little earlier, but can you talk a little bit more specifically about how you will measure compliance?

SENIOR ADMINISTRATION OFFICIAL THREE: So compliance is measured by the ongoing monitoring of programs, right. We do – typically we do visits to our partners on a regular basis, and [Senior Administration Official Two] can talk about this more specifically with regard to PEPFAR. But it is certainly routine visits, if you will, routine monitoring of what the programs are doing, paying attention to what kinds of information they – the partners put out in the general press and those kinds of things. So it really is part of the routine monitoring.

SENIOR ADMINISTRATION OFFICIAL TWO: Just to pick up on that, and this is talking from the PEPFAR standpoint, we’ve extended our monitoring very much down to the site of where we deliver services. We think that’s absolutely critical. So our – both our U.S. Government personnel who are in country as well as our large implementing partners and host governments actually go to the sites. And we require quarterly reporting from the sites so we know exactly what’s being provided at the site, the gender of the person receiving those services, and the age band that they’re in so that we can monitor the quality of our services. So this would be one more element of monitoring. So I just want to really make it clear that this is not new to us about ensuring quality global health assistance services provisions, whether it’s for TB, HIV, malaria, or immunizations. So that’s a standard component of our program, to ensure high quality of services that the U.S. Government funds.

OPERATOR: Thank you. And now we have Rachel Oswald of the Congressional Quarter.

QUESTION: Okay, great. What, if any, outreach was had with PEPFAR receiver countries, the governments there, like Uganda, about the expansion of the Mexico City policy? And what feedback did those foreign governments give to you about any concerns they may have about the new policy?

SENIOR ADMINISTRATION OFFICIAL TWO: Yeah, thank you. So we’re in dialogue with our countries all along about implementation of PEPFAR, because obviously this is done in cooperation with host governments but also civil society. So I think we were waiting for the guidance from the Secretary; so now that we have guidance on the implementation, we will circle back to all of our countries.

And we have, of course, people in all of our countries well-represented by the ambassadors that are in that country from the U.S. State Department, who are poised to talk immediately to our host countries but also to our communities and civil society, because we implement all of our programs in conjunction both with the host government but also the communities that we’re serving.

MODERATOR: All right. If there are no further questions, as one final reminder, attribution for today’s call is on background to senior administration officials. And now that this call has concluded, the embargo is lifted. Thanks very much, everyone. Have a nice day.

U.S. Department of State Background Briefing:
https://www.state.gov…

U.S. Department of State Fact Sheet:
https://www.state.gov…

PEPFAR – The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is the U.S. Government initiative to help save the lives of those suffering from HIV/AIDS around the world:
https://www.pepfar.gov…

***

Comment:

By Don McCanne, M.D.

Today’s topic is not on abortion per se, but rather it is on Donald Trump’s expansion of Ronald Reagan’s Mexico City Policy, which pertains to abortion, and the impact this will have on George W. Bush’s Emergency Plan for AIDS Relief (PEPFAR). So what are these programs?

The global gag rule introduced by President Reagan in 1984 at the International Conference on Population in Mexico City prohibited foreign nongovernmental organizations that receive U.S. aid funds from promoting abortion as a method of family planning.

PEPFAR is an important public health program initiated by President Bush which has helped to stem the world-wide epidemic of HIV/AIDS.

President Trump has expanded the Mexico City Policy to apply to PEPFAR. Since it is virtually impossible to eliminate all references to termination of pregnancy from the PEPFAR program, this means that about $6 billion of U.S. aid will be denied to this program. That can have only tragic results in turning back some of the progress we have made in countering the scourge of HIV/AIDS.

This is highly nefarious, and the Trump administration seems to understand that. Look at the excerpts from the State Department teleconference announcing the expansion of the Mexico City Policy. Although they introduced three senior officials to explain the expansion, they established rules for attribution in which these administrators would be referred to only as SENIOR ADMINISTRATION OFFICIAL ONE, SENIOR ADMINISTRATION OFFICIAL TWO, and SENIOR ADMINISTRATION OFFICIAL THREE. That’s bizarre. Is this to protect these administrators from potential personal attacks? If so, they seem to understand that there must be considerable passionate opposition to this policy change. Or is this simply more evidence of this dysfunctional administration simply moving forward with the implementation of obviously detrimental policies while  trying to hide in order to avoid blame? Clearly they are not attempting to invite accolades.

This is really sad. As we try to advocate for health care for all in America, how can we expect to make any progress when we have a Congress and an Administration that are tearing down our fortresses of health care justice – here, and throughout the world.

Embrace Medicare for all: There’s no time like the present

By Marcosa J. Santiago, M.D.
Laconia Daily Sun, May 16, 2017

We all wish better health care costing less.

The ACA (ObamaCare) patch, written by private health insurance and pharmaceutical industries but excluding consumer advocates, gave some benefits, but introduced more complexity to paying for health care. It protected and bolstered private insurance profits, through sale of mandated coverage and penalties for failure to buy. Federal taxpayer subsidies increased the number of the insured, but did not eliminate multi-tiered benefits based on ability to pay, or prevent policies with inadequate coverage.

Without cost-containment provisions, consumers are paying more, directly and through taxes, hindering access and needed medical services. Less expenditure of health care dollars means more profits for insurance and pharmaceutical industry CEOs and stockholders. Regardless, some insurers are leaving insurance exchanges due to insufficient profits.

To repeal and replace ACA, American Health Care Act (AHCA/TrumpCare) assures that some positive components of ACA will remain. But the devil’s in the details of AHCA are even worse than ACA. A few disturbing features are Medicaid reductions, higher premiums for millions of older people not yet Medicare eligible, and those with pre-existing health conditions might be charged higher premiums or denied coverage. More tax benefits for the rich and more expenditure for vulnerable and most needy populations.

Discontinue ineffective life supports like ACA and AHCA to the terminal fragmented healthcare. Abandon politics, embrace the non-political, bipartisan solution – improved Medicare For All. No time like the present!

http://www.laconiadailysun.com…

CMS pushing Sec 1332 waivers for high risk pools/reinsurance

CMS Checklist For State 1332 Waivers Focuses On High-Risk Pools, Reinsurance

By Timothy Jost
Health Affairs Blog, May 12, 2017

On May 11, 2017, the Centers for Medicare and Medicaid Services and the Department of the Treasury released a checklist for state 1332 innovation waiver applications. Following up on Health and Human Services Secretary Price’s letter to state governors of March 13, 2017, the checklist specifically focuses on state 1332 proposals to support high-risk pools or reinsurance programs.

The checklist restates the procedural requirements that states must meet under the current 1332 rules, such as posting a notice of the waiver proposal and accepting comments for at least 30 days, holding two public hearings, and consulting with Indian tribes where relevant.

Most elements in the checklist, however, describe specifically what information states must submit with applications for a 1332 waiver involving a reinsurance or high-risk pool program. While states must generally document state legislative authority to operate a 1332 waiver program, a state seeking a waiver to operate a high-risk pool or reinsurance program must establish that the legislation makes the program contingent on 1332 waiver approval or that the program will only become operational if the waiver is approved.

In sum, the checklist provides a roadmap for states that want to pursue high-risk pool or reinsurance 1332 waiver proposals, indicating again the priority that the Trump administration places on this approach for increasing the affordability of health insurance coverage.

http://healthaffairs.org…

CMS Checklist for Section 1332 State Innovation Waiver Applications, including specific items applicable to High-Risk Pool/State-Operated Reinsurance Program Applications:
https://www.cms.gov…

***

Comment:

By Don McCanne, M.D.

One of the prime drivers of the Affordable Care Act was the inherent flaws in the individual insurance market. As more people with expensive health care problems enrolled in the individual plans, premiums went up and the healthy dropped out, resulting in the “death spiral” of skyrocketing premiums. Insurers countered by limiting benefits, by excluding individuals with preexisting disorders, or by pulling out of markets with higher-cost beneficiaries.

To cover those who had a greater need for care, many states established high-risk insurance pools, but these pools were very expensive. The benefits were quite limited, and the premiums were very high, but they also required large contributions from the states. Think about the fact that the 20 percent of people who had major health problems consumed 80 percent of the health care (the 80/20 rule). Moving 80 percent of the costs for these patient populations into separate pools proved to be far too much for the states, so the pools were severely underfunded. Benefits were spartan, many could not afford the premiums, and intolerable waiting lists were established due to enrollment caps. They were a policy failure.

Yet what does the current Congress and administration want to do about this problem? They have emphasized repeatedly that the leading priority is to make premiums affordable. To do this they would go back to the dysfunctional individual market in which only the healthy were insured, with one technical modification. They would reestablish separate high-risk pools to insure the costly patients, or they would leave everyone in the same risk pool but provide reinsurance to cover the excessive losses resulting from caring for the more expensive patients. In either case, the costs of the pools and/or reinsurance would be very high. Since they want to keep the premiums low these extra costs would have to be paid by the state or by “federal pass-through payments.”

The CMS checklist states, “State-operated reinsurance programs have a demonstrated ability to help lower premiums, and if the state shows a reduction in federal spending on premium tax credits a state could receive Federal pass-through funding to help fund the state’s reinsurance program.” In other words, the federal contribution would be only the amount that they would otherwise be contributing in the form of premium tax credits – a budget neutral solution. This could not possibly fund either a high-risk pool or a reinsurance program for the the most expensive patients. The prior experience with the state high-risk pools has already confirmed that the states, for both political and fiscal reasons, are not capable of funding these pools either.

So all of this talk about federal authorization of high-risk pools and reinsurance programs through Section 1332 waivers is garbage. The current federal government has no intention of funding these programs, but they will authorize them and then sit back and blame the states for failing to implement them properly. Who is harmed by all of this? The patients, of course.

We would not have to worry about the 80/20 rule if everyone were in the same universal risk pool as they would be in a single payer, improved Medicare for all program. Unless our current political leaders suddenly have a miraculous communal epiphany, we need to replace them.

Market forces are no salve for the high cost of prescription drugs

By Jan Swaney, M.D. and Ed Weisbart, M.D.
Columbia (Mo.) Daily Tribune, May 14, 2017

Leave it to an independent businessman to get so fed-up with the rising costs of his employee health plan that he hired a documentary film crew to get to the bottom of things. The result is “Big Pharma: Market Failure,” a new documentary that takes a deep dive into profiteering by the pharmaceutical industry and concludes this sector of our economy is a real and imminent threat to American business.

The first free local public screening will be at the Columbia Public Library on May 18 at 3 and 6 p.m. with a panel of experts. We invite you to attend and tell your story.

Riding a forklift along the warehouse floor with CEO and producer Richard Master, you learn that the company’s rise in cost of health care coverage from one year to the next amounts to $4 per employee per hour. The film also tells us that a third of Master’s health care costs are for prescription drugs, and it’s no longer unheard of for an employee with a chronic condition to be placed on medications that cost twice the employee’s annual salary.

The predicament faced by Master’s company is playing out all over the United States, in businesses small and large.

Things haven’t always been this way. Passage of Medicare Part D was a windfall for PhARMA, the organization that represents pharmaceutical manufacturers. While seniors gained some prescription drug coverage, the industry got a big infusion of elderly consumers. And if that weren’t enough, drug companies also got a nifty gift in the legislation called the “noninterference clause” that says the government can have no role in negotiating or setting drug prices in Medicare Part D. Medicare pays whatever the manufacturers charge.

Both major party candidates for president in 2016 called for legislation to enable the federal government to negotiate drug prices on behalf of Medicare recipients, as it does for Medicaid and the Veterans Administration.

Though candidate Trump promised to use his negotiating prowess to take on the pharmaceutical manufacturers, he has been remarkably silent on this pledge since meeting with representatives of PhARMA at the White House on Jan. 31. Instead, talk seems to have turned to providing regulatory relief for the manufacturers by speeding-up the drug approval process within the FDA.

Although we need to bring down drug prices, we can’t afford to stifle innovation in the pharmaceutical industry. Yet, having the financial resources to develop new drugs and making a killing in drugs are two entirely different things. The manufacturers say it takes $2 billion to bring a new drug to market. But according to Elizabeth Rosenthal, a Harvard medical school graduate and former emergency room doctor turned New York Times journalist and author of “An American Sickness: How Healthcare Became Big Business and How You Can Take it Back,” the actual price for research and development is a small fraction of this larger figure. That’s because the research development claim includes all of the glitzy television ads and related marketing strategies.

Now that healthcare costs us $3.2 trillion a year and represents 17.8 percent of GDP, you might well feel sucked dry from the bloodletting as you cobble together enough to purchase your medications. If so, you might think these numbers represent a mandate for change. But these figures also tell a second story — that very powerful special interests thrive in healthcare just as it is, benefitting from the status quo — and these people will try to persuade you and your elected representatives to opt for a salve or placebo.

Reining in the profiteering in healthcare will require citizens to come together for the common good and recognize what health economists have long observed: Unfettered markets do not work in healthcare and there are times when government must act boldly on its citizens’ behalf. We are financing a bonanza for pharmaceutical manufacturers and invite you to learn more about what can be done.

Join us on May 18 at the library.

Jan Swaney of Columbia and Ed Weisbart of St. Louis are members of Missouri chapter of Physicians for a National Health Program (www.pnhpmo.org).

http://www.columbiatribune.com…

This health care circus of delusions must face facts

By Robert S. Kiefer, M.D.
Concord (N.H.) Monitor, May 14, 2017

I have been to a fair number of rallies lately in support of sane health care policy. A lot of slogans are bandied about, but I have not heard the following chant go like this.

People: “We don’t want health care!”

Leader: “When don’t we want it?”

People: “We don’t want health care NOW!”

Evidently, however, House Republicans have heard this message from their constituents loud and clear, or so they say. By repealing most of the positive aspects of Obamacare and proposing their own patchwork of fixes, they are acceding to special interests while putting millions at risk.

Few of the House reps have actually read or understand the ramifications of the bill, and certainly the president seemed to conceal from the public any faint semblance of comprehension. Mr. Trump has a merry-go-round of delusions circling in his head, which occasionally stops to pick up an extra delusion or two.

House Republicans, eager to jump on his carousel of crazy, have proposed the end of Medicaid expansion, an end to defined benefits and broad definition of pre-existing conditions, with the end result of pricing many people out of the insurance market. Further, they would toss chronically ill patients into underfunded high risk pools without lifeguards on duty.

The most wealthy among us can treat themselves to Dom Perignon by the case, courtesy of the $700 to $800 billion in tax cuts which they will accrue while the less fortunate struggle for survival in the deep end of the risk pools. Not that he pays taxes anyhow, but Trump gets a Mar-a-Lago-sized break, even as he expends half of his vocabulary on shallow, callous expressions of praise for the bill.

Rep. Raul Labrador of Idaho summed up the Republican position at a Town Meeting when he blurted that “nobody dies because they don’t have access to health care.” Nice one.

And so it falls upon the Senate to add this bill to the compost pile, and to work on comprehensive, affordable health care for all. Sen. Bernie Sanders will shortly save them a lot of trouble by introducing a Senate bill promoting Expanded Medicare for All. The House version, HR 676, now has 108 co-sponsors, though Reps. Kuster and Shea-Porter have yet to sign on.

We must encourage our full congressional delegation to come off the sidelines to speak for us, to be part of a thoughtful solution to the health care crisis, and not part of the circus in Washington.

Dr. Robert S. Kiefner is a retired family physician in Concord and a member of Granite State Physicians for a National Health Program.

http://www.concordmonitor.com…

Re: What the Republican Health Plan Gets Right

By Jay V. Solnick, M.D.
The New York Times, Letters, May 13, 2017

Marc K. Siegel argues that since 5 percent of Americans generate more than 50 percent of health care expenses, they should also pay more. He gives us the gratuitous example of his patient with seasonal allergies who comes to see him unnecessarily every few weeks.

This is absurd. Most of us understand that the reason so few account for so much of our health care costs is not because they enjoy visits to their doctor; it is because they are sick. They are mostly elderly. They have cancer, heart disease or any number of other afflictions that visit us as we age.

It’s really pretty simple: We must each pay into a pool so that if and when our number is called, health care is available. This could come in the form of a plan like the besieged Affordable Care Act, or, better yet, national health insurance like that found in virtually every other developed country, where health care is usually better and always much cheaper.

The writer is an infectious diseases doctor and a professor at the Center for Comparative Medicine, University of California, Davis.

https://www.nytimes.com…

Medicare’s high out-of-pocket costs

Cost Burdens by Income and Health Status

By Cathy Schoen, Karen Davis, Amber Willink
The Commonwealth Fund, May 12, 2017

Abstract

Issue: Fifty-six million people — 17 percent of the U.S. population — rely on Medicare. Yet, its benefits exclude dental, vision, hearing, and long-term services, and it contains no ceiling on out-of-pocket costs for covered services, exposing beneficiaries to high costs.

Goal: To inform discussion of possible changes to Medicare, this issue brief looks at beneficiaries’ out-of-pocket costs by income and health status.

Methods: Spending estimates based on the Medicare Current Beneficiary Survey.

Findings and Conclusion: More than one-fourth of all Medicare beneficiaries — 15 million people — spend 20 percent or more of their incomes on premiums plus medical care, including cost-sharing and uncovered services. Beneficiaries with incomes below 200 percent of the poverty level (just under $24,000 for a single person) and those with multiple chronic conditions or functional limitations are at significant financial risk. Overall, beneficiaries spent an average of $3,024 per year on out-of-pocket costs. Financial burdens and access gaps highlight the need to approach reform with caution. Already-high burdens suggest restructuring cost-sharing to ensure affordability and to provide relief for low-income beneficiaries.

From the Summary and Implications

The high financial burdens documented in this brief illustrate the need for caution. Half of Medicare beneficiaries have low incomes; one-third have modest incomes (200% to 399% of poverty). Any potential policy should first consider the impact on beneficiaries.

Access and affordability remain key concerns. In any discussions of potential Medicare reform, it will be important to pay particular attention to consequences for those vulnerable because of poor health or low income. Indeed, the findings point to the need to limit out-of-pocket costs and enhance protection for low-income or sicker beneficiaries.

http://www.commonwealthfund.org…

***

Comment:

By Don McCanne, M.D.

Although President Trump has said that he is going to leave Medicare alone, we have learned that he is not a reliable source for information about pending policy changes. The Republicans controlling Congress have indicated that they want to reduce projected spending on Medicare by privatizing it and switching to vouchers (premium support) in order to ratchet down the government’s contribution to the program. So what does this report tell us about the wisdom of their intentions?

Medicare is already an inadequate program. Instead of cutting the Medicare budget further we should be expanding it to fill in the deficiencies that are leaving Medicare beneficiaries exposed to excessive debt.

The full article available at the link above discusses programs that are used to patch some of the holes, but just as patches are inadequate for the Affordable Care Act, patches have also been inadequate for Medicare, just as this report demonstrates.

We need a Medicare that meets the much higher standards of the “Physicians’ Proposal for Single-Payer Health Care Reform,” and then we need to enroll everyone in it automatically. That’s why we talk about an Improved Medicare for All.

Physicians’ Proposal for Single-Payer Health Care Reform:
https://www.pnhp.org/nhi

Alaska needs a single-payer health care system

By Alan Gross, M.D.
Anchorage Daily News, May 12, 2017

Alaska is in recession and is unable to reconcile its huge deficits, despite a 40 percent cut in government services. Thirty-five percent of the total state budget is now devoted to health care. Alaska employers struggle to keep pace with wages while the cost of providing employee health care benefits skyrockets and are the highest in the world. Many Alaskans remain uninsured or pay small fortunes for private insurance with prohibitively high copays and deductibles. The only reasonable solution to this crippling problem is to adopt a state or national single-payer government health care program.

Alaska health care prices do not simply reflect increased labor, shipping and travel costs — at most only 30 percent more than the same services in other states. Alaska doctors often charge and collect 500 percent or more, than the costs for obtaining the same service outside the state. Alaska utilizes the “80th percentile rule,” which mandates insurance companies pay at least 80 percent of what its providers bill, thereby encouraging medical fee increases with virtually no restraint. Every six months, insurance companies must reevaluate average regional fees to keep pace with this rule.

Cutting the 80th percentile rule to a lower percentage is not the answer. This would only motivate providers to raise their respective rates faster. Also, most specialty medical groups in Alaska lack real competition and have joined to form regional monopolies and set prices at will, leading to upwardly spiraling prices across virtually every aspect of health care delivery.

Doctors, pharmaceutical companies, medical suppliers and ancillary service owners (e.g., labs, imaging, physical and massage therapy) are usually well-meaning, great people trying to do good work. They are not crooks. But, money is very much on the table thanks to our broken system, and health care providers have taken full advantage of this amazing flow of Alaska dollars from the state of Alaska and from the individuals and employers who are paying for incredibly high insurance premiums, into the hands of the health care industry and its providers.

No realistic solution is currently being considered, on either a state or federal level, to adequately control health care costs. Both political parties kick this expensive and politically explosive can down the road, offering us Obamacare, health savings accounts, tax breaks, government subsidies, state reinsurance and other incentives, but these are insufficient and minor adjustments to a terminally broken system. Milton Friedman, a renowned conservative economist, admitted he had “no idea” how to control costs with our current health care system. Don’t blame health care providers, insurance companies, or the health care attorneys.  The problem is the design of our system and it needs to change.

The only solution to Alaska’s health care fiscal crisis is to create a single-payer health care system. A single-payer system will successfully cover every Alaskan, without compromising provider choice or quality of care. This has been successfully implemented in most other first world nations with high satisfaction rates. Moreover, our federal government already offers Medicare to all citizens over the age of 65. It has proven itself successful and efficient in controlling health care costs and pricing with overall high satisfaction. Our current administration in Washington is leaning toward giving individual states more autonomy related to federal Medicaid dollars. This presents a tremendous opportunity for the state of Alaska to work with our federal government to pioneer our own state-run universal health care system.

There is no free market in Alaska health care. There never will be with our current third-party payer system. It does not make us all socialists for our government to fix a broken system. Health care prices are devastating the state’s economy and the state could save hundreds of millions of dollars a year if it self-insures its citizens.

Furthermore, workers will see marked increases in wages once benefit packages become less expensive for employers to provide. No other mechanism can control the prices for health care in Alaska or for the rest of the United States.

Winston Churchill once said, “Americans always get it right in the end, after they’ve exhausted all other options.” It is time for Alaska to get it right.

Dr. Alan Gross is a lifelong Alaskan and an orthopedic surgeon who has practiced since 1994. He also holds a masters degree in public health and is a commercial fisherman. He lives in Petersburg.

https://www.adn.com…

Political divide on AHCA

YouGov, May 6, 2017

As you may know, Republican leaders in the House of Representatives recently passed a new health bill (AHCA). Do you generally favor or oppose this bill?

Favor strongly or somewhat:
Total – 31%
Democrats – 13%
Independents – 24%
Republicans – 69%

Oppose strongly or somewhat:
Total – 44%
Democrats – 70%
Independents – 40%
Republicans – 11%

Not sure:
Total – 25%
Democrats – 17%
Independents – 36%
Republicans – 20%

http://big.assets.huffingtonpost.com…

***

Comment:

By Don McCanne, M.D.

This poll is being reported as showing that Americans oppose the Republican repeal and replace health care legislation (American Health Care Act) passed by the House of Representatives. It would be more accurate to state that Republicans and Democrats are divided in their support, but many remain undecided, especially amongst Independents. Neither support nor opposition reached a majority, except within the two major parties.

Unfortunately, the results indicate that political polarization remains strong between the two parties, but that a careful consideration of the implications and consequences of the policy features of the legislation seems to be lacking. That makes the assumption that we should be able to agree on what is better for America – affordable and accessible health care for all, or that individuals need to be empowered to take ownership of their health care or do without.

It is tragic that we reduce public health policies to a battle of political slogans. The health of the nation depends on getting the policies right. Too many of us seem to tune in to what our political leaders have to say, and then parrot their words. What a terrible way to try to craft rational, humane policy.

Many contend that moving forward from a political divide requires bipartisanship – compromise. No, not when both sides are wrong. Merging ACA and AHCA would only perpetuate our high costs, inequities, and wasteful administrative inefficiencies. We need to eject the politicians and move on with crafting reform based on sound policies. Perhaps it’s time to bring the sociologists into the arena.

Now is the time for Medicare for all

Single-payer program saves money

By Jessica Schorr Saxe, M.D.
Charlotte Post, May 11, 2017

Have you—or anyone you know—skipped needed health care because of cost? Since this is true of one in three Americans, you probably answered yes. Do you think this is unfair?

When I worked as a family doctor at Carolinas Medical Center-Biddle Point, I saw people every day who didn’t get needed health care because they couldn’t pay. I don’t think it’s fair. There is another kind of health care system which would eliminate this unfairness.

Amid the talk of health care change—repeal the Affordable Care Act, AKA Obamacare or replace it or improve it—more and more voices are speaking out for improving and expanding Medicare for all. This is also known as a single-payer system.

Why? Health in this country is poor, with lower life expectancies, worse infant mortality (deaths of babies before the age of one), and poorer health than other developed countries. These statistics are much worse for African-Americans than for the general population. And we spend more money than other countries—about twice as much per person as the average developed country. All of those countries provide health care for all, while we do not.

They do it by providing universal access to health care, through some form of a single-payer system. Single-payer health care refers to a financing mechanism by which one payer (either the government or an agency established by the government) pays the bills. Our current complicated system includes payments by Medicare, Medicaid, numerous insurance companies (with thousands of different plans), all of which have different rules. This unwieldy bureaucracy creates headaches—and expense—for patients, hospitals, and doctors’ offices.

We, too, could have a single-payer system if Congress passed HR 676, the Expanded and Improved Medicare for All Act, It currently has 108 co-sponsors, more than ever since it was first introduced in 2003. More than half of the Democrats in Congress, including all three from North Carolina, are co-sponsors. Rep. Alma Adams of the 12th District was the first representative from N.C. to sign on.

HR 676 would eliminate all co-pays and deductibles—so we would no longer have one-third of our country who could not afford needed care.

How would we afford to cover everyone? An article in the Annals of Internal Medicine in February noted that we would save over $600 billion. This would come from decreasing costs of administration as well as lower prescription drug costs. We would fund this program through small progressive increases in taxes.

Don’t like taxes? You are likely to find that you pay much less in taxes than you’re currently paying for health care. And the billions of dollars in savings would allow us to cover everyone.

Think of what health care coverage for all would mean. Everyone would be able to get the care they need and no longer have to make choices between seeing a doctor and paying their other bills. This would allow us to improve the health of our country. Further, we could reduce racial disparities.

Do you know anyone who suffers from lack of needed health care, anxiety over their medical bills, or getting inequitable care because of their financial limitations? Then you, too, should support improving Medicare and expanding it to all.

Dr. Jessica Schorr Saxe is chair of Health Care Justice – NC.

http://www.thecharlottepost.com…

Faso urged to change his vote

By Steffie Woolhandler, M.D., M.P.H., and David Himmelstein, M.D.
The (Hudson, N.Y.) Register-Star, May 11, 2017

Congressman Faso’s vote for the GOP’s American Healthcare Act (AHCA) that repeals much of the Affordable Care Act (the ACA or Obamacare) gravely threatens the health of thousands of his constituents.

The GOP bill would take $880 billion out of Medicaid, and another $312 billion out of subsidies that help working families buy private coverage through the ACA exchanges. Instead of helping people get care, this money would be diverted to give an $800 billion tax-break windfall to people with incomes over $200,000, as well as big insurance and drug companies. The rest of us would get virtually no tax relief.

In Rep. Faso’s district, the ACA has expanded Medicaid by 68,600 and helped another 16,500 afford new coverage through the exchange. All told, his vote threatens to strip coverage from 85,100 people in our district, would weaken protections for people with pre-existing conditions, boost premiums for people over 40, and take tens of millions of dollars from our hospitals and clinics.

The ACA is deeply flawed. It left 28 million Americans uninsured and millions more with unaffordable premiums, deductibles and copayments. But the GOP plan would make things worse. Instead of moving backward, we should move forward from the ACA to a Medicare for All plan like the one proposed by Bernie Sanders and Rep. John Conyers (HR 676).

Rep. Faso can change his vote if the AHCA comes back to the House of Representatives for a final vote after the Senate acts on it. Please urge him to vote “no” next time, and to endorse HR 676. The health of our neighbors hangs in the balance.

http://www.registerstar.com…

Medical debt and personal bankruptcy

How the Affordable Care Act Drove Down Personal Bankruptcy

By Allen St. John
Consumer Reports, May 2, 2017

http://www.consumerreports.org…

***

Comment:

By Don McCanne, M.D.

It is reassuring to learn that personal bankruptcies are declining, but we should not extrapolate the conclusion that the Affordable Care Act is responsible for largely eliminating the problem of medical debt. It is still very much with us.

In 2016, about 43.8 million Americans had problems paying medical bills in the past 12 months. A Consumer Reports survey in January of this year revealed that “55 percent of consumers said they lacked confidence that they or their loved ones would be able to afford insurance to secure that care.” Affordability of health insurance and health care remains a major problem in the United States.

It is likely that the expansion of Medicaid and the introduction of generous subsidies for low-income individuals reduced the rate of medical debt amongst the 20 million people who gained coverage under ACA, but the reduction in the rate of personal bankruptcy for the other 300 million Americans was more likely due to a combination of an improved economy and the Bankruptcy Abuse Prevention and Consumer Protection Act of 2005 which made it much more difficult to file for personal bankruptcy. (The albatross of life-long debt is another story.)

When over half of Americans lack confidence that they can afford health insurance and almost 44 million are already having difficulties paying their medical bills, we have a problem. It could be virtually eliminated by enacting a well designed single payer national health program – an improved Medicare for all – that automatically includes everyone while removing financial barriers to care. Celebrating ACA is not enough.