PNHP

Important RAND study of single payer and other options for Oregon

pnhpf3a

Important RAND study of single payer and other options for Oregon

Oregon faces obstacles expanding health insurance to all residents, study finds

By RAND Corporation
Medical Xpress, January 19, 2017

Researchers from the RAND Corporation and Health Management Associates were asked by the Oregon Health Authority to analyze three proposals put forward by policymakers as potential ways to expand health coverage among the uninsured and compared the likely outcomes to the existing health care system.

Researchers used several modeling techniques to analyze how each of the options would affect outcomes on insurance enrollment, payments from households to support health care, total health spending in the state and other impacts. They also assessed the regulatory aspects of each of the proposals.

The single-payer option, introduced as a bill in the Oregon House, would use public financing to provide privately delivered health care to all Oregon residents, including those currently enrolled in Medicare and Medicaid. The proposal would pool state and federal outlays for current public programs, and add additional revenue from new state income and payroll taxes. The plan would cover 100 percent of health care costs for residents with incomes under 250 percent of the federal poverty line and 96 percent of health costs for other residents.

The Health Care Ingenuity Plan would pool revenue from state and federal outlays for Medicaid and ACA marketplaces with addition revenue generated from a new state sales tax. The plan would create a public financing pool to provide basic health insurance for most nonelderly Oregon residents. Medicare would continue to cover seniors and the disabled.

Cost sharing of the private health plans would vary depending on enrollees’ incomes, with the average share of costs covered by the plan ranging from nearly 100 percent for those with incomes below 138 percent of the federal poverty level to 70 percent for those with incomes above 250 percent of poverty. Enrollees could purchase private supplemental insurance to cover cost sharing and additional benefits.

The third proposal, a so-called public option, would create a state-run health plan to cover essential health benefits outlined by the Affordable Care Act and would compete with private plans in the ACA marketplaces. Enrollees in the public option would be eligible for federal advance-premium tax credits and cost-sharing reductions. The public option would set provider reimbursements levels equal to Medicare fee-for-service rates and would require providers who participate in other state health programs to participate in the plan.

Researchers found that both the single-payer option and the Health Care Ingenuity Plan increase coverage relative to the status quo and reduce financial barriers to care.

Under the single-payer plan, researchers assumed the state would have power as the sole purchaser of health care to set payment rates for most providers at 10 percent below the status quo. Overall, there would be little change in health system costs because the increase in patient demand would be offset by lower payments rates and administrative savings.

Under the Health Care Ingenuity Plan, researchers expect there would be higher system costs because Medicaid enrollees and the uninsured would be shifted into private insurance plans, which typically reimburse providers at significantly higher rates than the Medicaid program. These higher payment rates would increase system costs, expand the supply of providers and ease congestion. Researchers also estimate that under the plan, three-fifth of state residents would purchase supplementary insurance to reduce their individual cost sharing.

Researchers estimate that the public option would cover about 9,000 additional Oregon residents, leaving the share of the population who are uninsured at 5 percent. But many people already buying coverage through the ACA marketplaces would likely shift to the public option, saving the average enrollee about $850 per year.

https://medicalxpress.com…

A Comprehensive Assessment of Four Options for Financing Health Care Delivery in Oregon:
http://www.rand.org…

Download full report (147 pages total; Summary is 12 pages):
http://www.rand.org…

***

Comment:

By Don McCanne, M.D.

This study can be very helpful to those who are considering comprehensive health care reform on a state level. RAND has shown that a single payer system would cover everyone without increasing total health care spending; private health insurance for the nonelderly plus Medicare for seniors and the disabled would cover everyone but would increase total spending; and providing a state-run health plan (public option) would have only a negligible impact on coverage and spending.

Health policy wonks should read the full study, and reform activists should read at least the 12 page summary. As with any study of this type, certain assumptions are made and differing emphases can be placed on various features of the reform models. For these reasons this study warrants at least the following comments.

For the single payer model, the authors assumed that payment rates for health care providers would be reduced ten percent below the current average Oregon rates. That supposedly would keep total spending at the same level by offsetting the increased volume of care for those who are newly insured and for those who have a significant decrease in their cost sharing.

The authors assume that services would be less available because of the payment reductions, contending that some providers would reduce their supply of care or perhaps even leave the state. They state that this would lead to “congestion” – greater consumer demand with diminished provider availability. This could result in excessive queues or in the need to travel greater distances for care.

This conclusion derives partly from the fact that they assumed that the administrative savings would be much smaller than several other studies have shown. Although a study demonstrating the tremendous administrative burden placed on the providers was included in the appendix, the authors did not factor in the savings that would accrue for the providers by eliminating the private insurers and simplifying the public payment procedures through a single payer. In fact, one of the reasons for reducing payments is that the amount recovered by eliminating the administrative waste is quite significant.

Another factor is that when the volume increases more room is made for the more pressing problems which partially displaces care that is of little or no value. Thus health care value actually increases when there is some pressure on the schedule. Also the use of other health care professionals such as nurse practitioners and physician assistants can help meet the increased demand at a lower marginal cost.

Also their modeling at a ten percent reduction in average payments is still quite a bit above the Medicare rates that are paid in Oregon. Most providers would not find that having absolutely everyone covered with higher than Medicare rates to be particularly onerous. Besides, most dedicated professionals would be satisfied with reasonable payments for their services. Those who are not perhaps should look for income opportunities that would shift them into the one-percenters – a breed not really welcome in health care.

Another point that should be made is that the two comprehensive models are characterized as a public model that would cause “congestion” (queues for non-urgent services) versus a private model that would increase spending. But the two most objectionable features of the private insurance model are given only fleeting acknowledgment in this study. Those are the very high deductibles and other cost sharing and the limited choice in care because of narrow provider networks. In the single payer model, cost sharing is dramatically reduced or eliminated, and there is only one provider network that includes the entire legitimate health care delivery system. Although high cost sharing and narrow networks may reduce spending in the private insurance model, they are not needed in a publicly administered single payer model.

This study also has important lessons for those who insist that we must enact single payer on the state level before we attempt to enact a national program. For those who believe that enacting a state-level public option will eventually lead to single payer, this study shows that it would have only a negligible impact in reducing the uninsured and in controlling costs. Pass it and then nothing else will happen for years to follow.

The other lesson for state reform activists is that there are major barriers to enacting a bona fide single payer system at the state level – barriers that will most likely require federal legislation. As long as we need to carry the battle to the national level, we might as well go for a national single payer program – an improved Medicare for all. Please do continue to work for beneficial changes at the state level, but please do not let it diminish your advocacy for health care justice for the entire nation.

Replace Obamacare with single-payer national health insurance

By Claudia Fegan, M.D.
STAT, January 20, 2017

During the bruising 2016 presidential campaign, Donald Trump vowed to repeal Obamacare “on day one of the Trump administration.” Today is that day. If soon-to-be President Trump makes good on that promise, I urge him to replace it with single-payer national health insurance.

If it, or some other equitable form of insurance, isn’t quickly put in place, I worry about the patients who will die when they lose access to timely health care.

The Affordable Care Act expanded coverage to 20 million people and improved their access to care. Every day I see its beneficial impact on the patients I serve as the chief medical officer at Chicago’s largest public hospital. Tens of thousands of our patients were covered for the first time, many under the law’s Medicaid expansion, and we were able to provide them care that was previously out of their reach.

While the ACA represents an important step forward in other respects, such as eliminating penalties for preexisting conditions and covering children until age 26 on their parents’ plan, our health care system is still the worst of any wealthy nation.

Millions remain uninsured, and most Americans’ coverage comes with gaping holes, like a hospital gown that looks pretty good in front but leaves a lot hanging out in back. Patients often find they can’t afford care, given the high deductibles and copays, and their choice of doctors and hospitals is often restricted. Costs continue to soar, and greedy corporations have gained an even tighter stranglehold on health care.

Defending that status quo, as many Democratic politicians have been trying to do, is a losing battle. The ACA continues to allow insurance companies to limit access to health care, and the pharmaceutical industry to limit access to lifesaving treatment with predatory pricing.

Soon-to-be President Trump and the Republicans want the law repealed. Most people in favor of that happening want something better, not a return to the past. Replacement has to move forward to universal and upgraded coverage and move away from shifting costs to the patients least able to bear the financial burden of illness rather than going backward to the bad old pre-ACA days.

Here’s one inspiring vision of health care reform that would lift the vast majority of Americans: single-payer national health insurance. Enactment of a single-payer plan would demonstrate that we are a caring nation. People shouldn’t die in the richest country in the world due to lack of access to care.

According to a Gallup poll last year (and a similar Kaiser survey), more than half of Americans wanted to repeal the ACA, and most Americans still have a dim view of the law. They know it is not working. They know the deductibles are too high and they can’t afford the copayments. (Curiously, on the eve of its repeal, a growing number of Americans say they support the law.)

But the Gallup poll also showed that 58 percent of Americans — including 41 percent of Republicans and 53 percent of those who favored repeal — wanted the ACA replaced with “a federally funded health care program providing insurance for all Americans,” in other words, single-payer reform. They want a plan that covers the care they need and lets them see the providers they choose with no out-of-pocket costs.

Now is the time for a single-payer health system — improved Medicare for all. It would take the hundreds of billions now wasted on insurance bureaucracy and billing paperwork and use that money to expand and upgrade coverage. It would cover all of the uninsured. And it would abolish copayments and deductibles for the 91 percent of Americans who are currently covered by health insurance.

After Trump’s election, my newly insured patients began to ask if they were going to lose their health insurance. Trump has said he has a plan to cover everyone, cut costs, and cut painful deductibles and copayments that limit access to care. But so far there is no firm plan, he is notoriously unpredictable, and his cabinet nominees indicate that his administration will take a different course.

Single-payer health systems have a proven track record on cost control. When Canada passed its single-payer medical insurance plan in the 1960s, its health spending was commensurate with ours and growing at the same rate. Today, Canada spends about half of what the US does. Much of the savings have come from slashing insurance overhead and paperwork. Where insurance giant Aetna keeps about 20 cents of every premium dollar for itself, the comparable figure for overhead in Canada’s system is 2 cents, and for Medicare it’s 3 cents. And Canada has saved vast amounts by simplifying hospitals’ and doctors’ billing paperwork.

Republican plans for the ACA threaten the health of my patients and millions of other Americans, and the status quo is unacceptable. That’s why I, and the 20,000 colleagues who have joined me in Physicians for a National Health Program, are fighting for single payer — a health reform that would cure America’s health care ills, not just provide some pain relief.

Now is the time to take that step.

Claudia Fegan, MD, is an internist who serves as the national coordinator of Physicians for a National Health Program. She is a coauthor of “Universal Health Care: What the United States Can Learn from Canada” and is a contributor to “10 Excellent Reasons for National Health Care.”

https://www.statnews.com/2017/01/20/obamacare-single-payer-national-health-insurance/

“Medicare for All”: A Uniting Call to Action in the Age of Trump

By Michael Corcoran
Truthout, Jan. 19, 2017

The world will change tomorrow when Donald Trump becomes president — and so, too, must the movement for social justice. It is this reality that prompted Mariame Kaba, who for years has been organizing on issues such as the criminal punishment system and domestic violence, to shift gears in the lead-up to the inauguration.

“I have been thinking about how to organize in this current moment, and figure out ways to build the power to resist on various fronts,” she said in a Truthout interview. “I was thinking of an issue that can reach a broad range of people, regardless of where they stand ideologically, racially [or] economically.”

This search led her to the issue of health reform and the need for a public system that guarantees care to everyone. The result will be tomorrow’s Medicare for All National Day of Action, a nationwide online event to be held on Inauguration Day. While Trump is giving his oath of office, thousands of activists across the country will be working online (using the hashtag #medicare4all) to push for the reform: contacting Congress, making memes and forming relationships with other like-minded people.

Participants are encouraged to make use of the official website, Facebook page, Twitter feed and pre-made graphics that can be shared on social media — all devoted to what Kaba calls a “virtual” day of action. “I wanted those who are unable to go down to Washington, DC, where there will be lots of resistance activities, to have a chance to participate,” she said.

The long-term goal, Kaba elaborates, is bigger than just health care reform. She sees the fight for Medicare for All as having the potential to play a central role in building a mass movement against the inequities of capitalism more broadly. “This is ultimately what the struggle is against, and we need to start talking in those terms,” she said, adding that those in power “want to take away your health care and give a tax break to people who are already rich. People can understand redistribution upward.”

We Are All Patients: the Broad Appeal of Medicare for All

There is no shortage of issues that activists can organize around. Trump’s victory has further exposed the world to environmental, media and immigration crises, to name just a few. But the fight for a real health care system, organizers believe, has unique potential to be the hub of a wider movement.

“We have all been patients at one point or another,” said Dr. Carol Paris, the current president of Physicians for a National Health Program (PNHP) in an interview with Truthout. “So, yes, reforming the delivery of health care is something we all need … what many people have now is just an insurance card and the illusion of care.”

Indeed, health care policy is a major concern for workers seeing their paychecks shrink due to the rising cost of health care, as well as the 30 million Americans who remain uninsured despite progress on access from the Affordable Care Act (ACA). It is also a problem for those who have health insurance but are still exposed to massive debt and potential bankruptcy. This exposure causes millions of insured Americans to forego care they need.

The lack of a universal health system has also led to serious racial disparities, the Harvard Business Review observed in 2015, with Black Americans having a shorter life span and worse outcomes than whites on a number of ailments, including “heart disease, diabetes, and cancer, as well as higher risks for HIV infection, homicide, and infant mortality.” The seriousness of the crisis cannot be understated. A 2012 study by consumer advocacy group Families USA concluded that 26,000 people die each year due to a lack of insurance.

Paris has a long history as a health care activist, extending long past her current role as a physician who is president of an organization that provides much of the seminal research on the subject. In May 2009, she was one of the “Baucus 8,” who stepped up at the US Senate Finance Committee hearing on health care reform chaired by Sen. Max Baucus to ask why there wasn’t a single advocate for single-payer health care on a 41-person panel. Baucus had all eight peaceful protesters, including Dr. Paris, arrested.

The Nashville-based doctor was arrested again — which can be seen on video at PNHP.org — two days after President Obama said in his 2010 State of the Union that he would listen to anyone with a “better approach” to reform. “Well, we had a serious set of proposals and tried to let him know,” she said of her arrest, which occurred in Baltimore outside a conference featuring the president. They attempted to give him a letter that urged him to consider Medicare for All to save thousands “of American lives each year, not to mention the prevention of unnecessary suffering.”

“It is important not just to rely on research and data but to organize, to protest and to fight for single-payer,” Paris said to Truthout on the role of activism and organizing. “We have worked with many organizations [that] aren’t solely focused on health care, such as labor groups, who know to get economic justice, creating a Medicare for All system would be an important step.”

The Coming National Debate on Health Reform

While health care is always an important issue, it is going to be front and center in the national debate as Trump and the new GOP Congress seek to rapidly repeal (and supposedly replace) the ACA. This will be a messy, complex process and could cost more than 20 million people their health insurance, according to the Congressional Budget Office. But it will provide a chance for advocates to spread their message.

“In a back-handed way, [the GOP efforts to repeal the ACA] will provide advocates a chance to get our message across,” Paris told Truthout on the phone while watching Bernie Sanders speak at the confirmation hearing for Tom Price, Trump’s appointment for head of Health and Human Services.

“It is going to be up to activists and independent media [outlets] to give legitimacy to Medicare for All as a reasonable, cost-effective alternative to the status quo,” Paris added.

Democrats are promising to fight the repeal and possibly minimize some of the consequences of the GOP’s approach. Even if the repeal could somehow be stopped, however, the fight for Medicare for All remains the ultimate goal for many progressive activists. “Our job today is defend the Affordable Care Act. Our job tomorrow is to create a single-payer system Our job today is defend the Affordable Care Act. Our job tomorrow is to create a single-payer systemOur job today is to defend the Affordable Care Act,” Bernie Sanders recently said on Twitter. “Our job tomorrow is to create a single-payer system.”

Certainly, Sanders has his detractors, including many in the Democratic Party, some of them beneficiaries of large donations from Pharma and the private insurance industry. This bipartisan opposition to Medicare for All is a reality that organizers say the movement must tackle head on.

“Politicians from both parties say it is politically impossible,” Paris said. “But what does that mean? It means that our representatives won’t vote for it. It means many won’t risk alienating their donors at the pharmaceutical and health industries, who fund their campaigns.”

Education and Class Consciousness

Certainly, education must be central to building a movement, which is why organizers’ use of the term “Medicare for All,” over “single-payer” is deliberate. While policy wonks are familiar with the term single-payer, it is still a phrase that confuses many people. “Most people know what Medicare is,” Kaba said.

Amazingly, despite a narrow debate in the media and in Washington that villainizes or ignores the policy, the public is still broadly supportive of Medicare for All (when the question is asked in those terms), and has been for years. In December of 2015, a Kaiser poll showed 58 percent of the public supported the policy, including 81 percent of Democrats. But polls using the term “single-payer” do not fare as well as ones using the term “Medicare for All.”

“Medicare for All has the potential for extremely broad appeal because it would help the vast majority of Americans, including many with quite conservative views,” said PNHP founders David Himmelstein and Steffie Woolhander, in an email to Truthout.

A lack of understanding single-payer and how it is financed has been an obstacle for the movement in the recent past. “If you find that you have to keep explaining what your proposal is, you haven’t done enough, and your opponents can and will destroy your efforts with a few soundbites,” explained Dr. Don McCanne, of PNHP, in response to a failed health reform effort in Colorado that was supported by single-payer activists.

And with a rigid ideological adherence to market-based solutions in the media and in Washington, many Americans are not aware that the United States is an outlier in its lack of a public health care system: The only member of the Organization of Economic Cooperation and Development (a coalition of wealthy nations) without universal care.

An explanation of how outside the norm the US is in terms of providing a safety net — the US ranks 25 out of 34 OECD nations on social spending — can provide a stunning contrast to those who are trying to understand how American capitalism functions, raising class consciousness.

The Sanders presidential campaign, as Truthout observed in August, did help to educate the public about these differences. At times, Sander’s message broke into the dominant media narrative, which typically ignores or wrongly dismisses Medicare for All as impossible, radical or unaffordable. Some recent coverage is laughably bad. Last Friday’s David Brooks column in The New York Times made the ridiculous claim that the Republican Party has granted “the Democratic point that health care is a right.”

But despite these falsehoods being so pervasive in the media, the fruits of a growing class awareness are evident in the rising number of people challenging Democrats’ reluctance to make real changes on the health care front. Last week, a public outcry erupted when 13 Senate Democrats voted against an amendment by Sanders to allow drugs to be imported from Canada, lowering prices for Americans. Sen. Cory Booker, a high-profile Senator who is rumored to have presidential ambitions, was among the group that sided with Republicans to kill the amendment.  In the aftermath of Sanders’ presidential campaign, a vocal and aggressive group of progressives were paying attention to the amendment, and when they saw that Booker received big money from Big Pharma, they connected the dots between campaign finance, Congress and health policy. The result was a flood of indignation toward Booker on social media.

There has been pushback from the establishment, mocking the critiques leveled by the “Sanders Wing” toward the Democratic Party. The surge of opposition to Booker’s vote, however, is promising. It demonstrates not only how many Americans are aware of how private capital can influence health policy, but also how the internet can serve as an effective tool for vocal protest of the congressional machinations that too often happen behind closed doors. The fallout from Booker’s vote is something that Democrats will remember, especially as they plan for the need to connect with progressives in future elections.

What Lies Ahead

After the Medicare for All National Day of Action is over, the work of organizing, educating and agitating will continue. Kaba has plans to create curriculum — a sort of Medicare for All 101 — on the website in the weeks following the inauguration.

Organizers are also encouraging activists to get involved at the local level. There are organizations advocating for Medicare for All across the country. Physicians for a National Health Program, for instance, has chapters in 43 states. Healthcare-Now has chapters in 38 states and is seeking to start chapters where none exist. Single-payer actions are also being organized by a variety of other organizations across the country.

We are in the process of entering a scary new world. But if activists and organizers can keep one another engaged and active, there is a chance that this moment will also be an important occasion for social justice — and the fight for a humane health care system could have impacts for generations to come.

Copyright, Truthout.org. Reprinted with permission.

http://www.truth-out.org…

Harris Poll on profits and ethics in health care

Only Nine Percent of U.S. Consumers Believe Pharma and Biotechnology Put Patients over Profits; Only 16 Percent Believe Health Insurers Do

The Harris Poll, January 17, 2017

Only nine percent of U.S. consumers believe pharmaceutical and biotechnology companies put patients over profits, while only 16 percent believe health insurance companies do, according to a Harris Poll study released today. Meanwhile, 36 percent of U.S. adults believe health care providers (such as doctors and nurses) put patients over profits, compared to hospitals (23%).

More consumers rate health insurance (24%) and pharmaceutical and biotechnology companies (20%) with low reputations, compared to hospitals (6%), health care providers (doctors and nurses) (5%) and technology (2%). Fifty-eight percent rate the reputation of the technology industry as high, compared to health care providers (43%), hospitals (37%), pharmaceutical and biotechnology companies (20%), and health insurance companies (15%).

Consumer Skepticism High Across Health Care – But to Varying Degrees

Nearly half of consumers say they think store pharmacists (49%) and health care providers (48%) offer high quality products and services, compared to hospitals (44%), pharmaceutical companies (31%), and health insurance companies (26%). Roughly half of consumers believe providers (51%) and hospitals (49%) make a positive difference in the country, compared to store pharmacists (39%), health insurance companies (26%) and pharmaceuticals (26%).

Consumers See Providers, Patients Solving Health Care Challenges

When asked where solutions to the health care industry’s challenges will come from, more than half of U.S consumers (55%) say health care providers, such as doctors or nurses. Nearly half (47%) see patients and consumers solving health care challenges, while 38 percent cite the government. Other responses include health insurance companies (34%), pharmaceutical and biotechnology companies (32%), hospitals (31%), academics, non-profits or think tanks (29%), technology companies (25%), and retail pharmacies (7%).

Ethics Deemed Important Trait to Solve Health Care Challenges

The Harris Poll study finds that in order to be a part of the solution in addressing U.S. health care needs, consumers believe it is most important for organizations to demonstrate ethics (62% say very important) and quality (57%). Other critical factors include efficiency (51%), a long-term view versus a short-term gain (49%), collaboration (47%), flexibility (47%), and transparency (47%).

http://www.theharrispoll.com…

***

Comment:

By Don McCanne, M.D.

While pharmaceutical firms and insurers stand out for having reputations of placing profits over patients, the rest of the health care industry has not totally escaped the perception of this blemish in its ethics.

It is reassuring that health care professionals – physicians and nurses – still have enough respect that the poll respondents believe that these professionals working with patients are best suited to provide solutions to our health care industry challenges. They believe that it is important to demonstrate ethics above all in addressing these problems.

Since ethics is integral to organizations such as Physicians for a National Health Program and National Nurses United/California Nurses Association, they and other sectors that operate on the same ethical plane are well positioned to work with the people of the nation to bring health care justice to all. We, along with the people, need to lead.

Tom Price Is a Horrible Choice for Health Secretary

The Georgia representative redefines what it means to have conflicts of interest

By Adam Gaffney, M.D.
In These Times, January 19, 2017

Donald Trump’s nominee for Secretary of Health and Human Services (HHS) faced sharp questioning on the ethics of his stock deals—among other issues—at a hearing Wednesday before the Senate Health, Education, Labor and Pensions Committee. Perhaps the most damaging inquiries revolved around a “sweetheart deal” that allowed Rep. Tom Price to buy stock of Australian biotech company Innate Immunotherapeutics as one of a select group of “sophisticated U.S. investors,” as Kaiser Health News reported. After he took advantage of this investment opportunity, the company’s stock price soared.

Things got tense at the hearing when Price acknowledged, in response to questions from Sen. Patty Murray (D-Wash.), that he bought stock after learning about the company from Republican Rep. Chris Collins (R-N.Y.), another investor, who is also on the company’s board. As the Huffington Post’s Paul Blumenthal notes, this raises the specter of insider trading—so long as Price acted on information that was not public. Moreover, as Murray noted, Congress was then debating the 21st Century Cures Act, legislation that had “several provisions that could impact drug developers like Innate Immunotherapeutics.” The bill passed last month.

Shocking? Yes. But the sleazy stock buy is actually just a single episode in a long political career riddled with eyebrow-raising moves—all of which make Price utterly unacceptable as health secretary.

“Medical-industrial complex”     

Price’s medical specialty is orthopedic surgery, but he is perhaps better known as a savvy operator both serving and profiting from the “medical-industrial complex.”

In the last four years, the Georgia representative has traded in excess of $300,000 in health-related stocks, while simultaneously advancing bills with relevance for those companies and also receiving campaign contributions from the very same enterprises, Wall Street Journal reported in December.

Another issue raised at the hearings, including by Sens. Elizabeth Warren (D-Mass.) and Al Franken (D-Minn.), was his purchase last year of stock in a medical device company, Zimmer Biomet. Within a week of that purchase, Price introduced a bill that would have directly benefited the company by protecting it from regulation, as originally reported by CNN.  Subsequently, the company donated to Price’s campaign. (Price contends that his stock account is managed by a stock broker, and that he didn’t know about the purchase until later.)

Be that as it may, Price has shown himself to be a consistent advocate for various corporate health interests over the years, frequently going “to bat for companies whose executives and employees have generously contributed to his campaigns and political action committees,” Kaiser Health News reported.

When powerful national healthcare policymakers have financial interests in healthcare companies, a form of insider trading is all but inevitable. Such individuals always have access to at least one rather valuable nonpublic stock tip: their own future policy plans. Legal or not, these ties are rotten.

“Do no harm”?

And yet, none of this is the real reason why Price would make for a terrible health secretary. For that, look to Price’s evident intent to eviscerate the healthcare safety net, his disdain for LGBT rights, his regressive vision on reproductive healthcare and his climate change denialism.  

Indeed, it would be unfair to cast Price as little more than a tool of the medical-industrial complex. He is a true believer in a coherent right-wing healthcare ideology. He is also, it turns out, a member of a fringe-conservative medical group, the Association of American Physicians and Surgeons, which—according to a 2009 Mother Jones profile—sees no real role for government in healthcare, has shilled for the tobacco industry and publishes a journal that periodically espouses fake science, including articles calling into question vaccine safety.

In spite of his record, at least two mainstream medical groups disgracefully dashed to endorse Price in the wake of his nomination. The American Medical Association (AMA) praised Trump’s pick and urged his prompt confirmation, harkening back to the group’s reactionary past. Even more inexplicable was the endorsement of the Association of American Medical Colleges (AAMC), which represents U.S. medical schools. (Other medical groups, including Physicians for a National Health Program—in which I am active—as well as the National Physicians Alliance, have condemned the choice). But perhaps the AMA and the AAMC were simply happy to have one of their own in a position of power. After all, could Price violate the Hippocratic promise to “do no harm”?

Of course he could. Indeed, he seems intent on it.

“Universal access”

Price seeks to gut the existing healthcare safety net, as a number of senators asserted at Wednesday’s hearing. A bill he introduced in 2015, for instance, would strip insurance from millions. As a recent article in the New England Journal of Medicine reported, “Price’s replacement proposal would make it much more difficult for low-income Americans to afford health insurance. It would divert federal tax dollars to people who can already buy individual coverage without subsidies and substantially reduce protections for those with preexisting conditions.”

Then again, it’s not fair to pick only on Price; his approach is fully consistent with a larger conservative healthcare reform vision. Oddly, that vision is now being branded by Republicans as a plan for “universal access,” as the New York Times reported. Trump likewise claimed in an interview with the Washington Post that he wanted “insurance for everybody.” Price’s answers at the hearing seem consistent with this pseudo-universalist reorientation. He suggested that the Republican plan would not cut coverage and that “nobody is interested in pulling the rug out from under anybody.”

Indeed, Price was able to score some points as a result of our current lack of a universal system, noting that 20 million Americans remain uninsured and that high deductibles prevent people from receiving care. This is true—and it’s a strong argument for single-payer reform—but it’s also true that GOP designs would only exacerbate these injustices.

Unworthy candidate

Liberals who assert that conservatives lack a coherent healthcare vision of their own are wrong. They have a free market vision of healthcare that, in truth, requires significant public subsidization. For instance, at the hearing, Sen. Todd Young (R-Ind.) praised Mike Pence’s privatized Medicaid expansion in Indiana, a program that was engineered by Trump’s Centers for Medicare and Medicaid Services (CMS) nominee Seema Verma. Price agreed that Pence’s program was “really a best practice I think for many other states to follow.”

The Pence-Verma program created “POWER” (Personal Wellness and Responsibility) accounts for Medicaid participants that are theoretically modeled on health savings accounts (HSAs). HSAs, which are invariably tied to high-deductible insurance plans, have been trumpeted by Trump, by Price and by Paul Ryan’s “Better Way” healthcare plan. In Indiana, the Pence-Verma approach has meant that very low-income individuals are expected to deposit funds on a monthly basis into their POWER accounts. As summarized by the Kaiser Family Foundation: Participants slightly above the poverty line who fail to make payments are kicked out of the program for six months, while those below the poverty line who similarly fail to make such payments are downgraded into a worse version of Medicaid that does not cover vision or dental benefits and imposes copayments on these very poor individuals. 

Such spiteful modifications to Medicaid—ostensibly directed to “provide them [participants] with ‘skin in the game,’” as the program’s waiver put it—do not require an act of Congress. They only need the approval of waivers by CMS, which will no doubt be forthcoming with Verma at its head (and with Price above her).

Price, it should be clear, is part and parcel of this larger corporate healthcare advocacy front. He has thrived at the nexus of government and corporate healthcare interests and, at the same time, appears to truly believe in a free market healthcare vision—albeit one that funnels dollars from the government to insurers and pharmaceutical companies, and then back to their investors, like him.

Though the doctor is no doubt an unworthy candidate for health secretary, he is an entirely consistent choice for the incoming Trump administration, and—if not derailed by his stock buys—will be very much at home in the hornet’s nest of free market privatizers, deregulators, ideologues, billionaires, and crony capitalists who will shortly be at the helm of the U.S. government.

Adam Gaffney is a physician and writer with a focus on healthcare politics, policy and history. He is an instructor in medicine at Harvard Medical School and a pulmonary and critical care physician at the Cambridge Health Alliance. His writing has appeared in the New Republic, Los Angeles Review of Books, Salon, CNN.com, USA Today, Jacobin and elsewhere. He’s a board member of Physicians for a National Health Program, a single-payer advocacy organization. The views expressed are his own.

http://inthesetimes.com…

Dr. Adam Gaffney on ‘The Real News’

PNHP national board member Dr. Adam Gaffney appeared on “The Real News” on Jan. 18, 2017, to discuss the nomination of Tom Price to head the Dept. of Health and Human Services. He advocated for a single-payer national health program to alleviate the persistent problems of lack of coverage, high out-of-pocket costs, and pharmaceutical price gouging.

Pew poll confirms support of government responsibility in health care

More Americans say government should ensure health care coverage

By Kristen Bialik
Pew Research Center, January 13, 2017

As the debate continues over repeal of the Affordable Care Act and what might replace it, a growing share of Americans believe that the federal government has a responsibility to make sure all Americans have health care coverage, according to a new Pew Research Center survey.

Currently, 60% of Americans say the government should be responsible for ensuring health care coverage for all Americans, compared with 38% who say this should not be the government’s responsibility. The share saying it is the government’s responsibility has increased from 51% last year and now stands at its highest point in nearly a decade.

More than eight-in-ten Democrats and Democratic-leaning independents (85%) say the federal government should be responsible for health care coverage, compared with just 32% of Republicans and Republican leaners.

While about three-quarters of those with family incomes of less than $30,000 per year (74%) say the government should ensure coverage, only about half (53%) of those with incomes of $75,000 or higher say the same.

The belief that the government has a responsibility to ensure health coverage has increased across many groups over the past year, but the rise has been particularly striking among lower- and middle-income Republicans.

Currently, 52% of Republicans with family incomes below $30,000 say the federal government has a responsibility to ensure health coverage for all, up from just 31% last year. There also has been a 20-percentage-point increase among Republicans with incomes of $30,000-$74,999 (34% now, 14% last year). But there has been no significant change among those with incomes of $75,000 or more (18% now, 16% then).

Overall, 43% of Democrats and Democratic leaners support a so-called single payer approach, but this approach is more popular among liberal Democrats (51%) than among conservative and moderate Democrats (38%).

Most of those on the other side of the issue – people who say the government does not have a responsibility to ensure health coverage – say on a subsequent question that the government should continue Medicare and Medicaid (32% of the overall public), while just 5% of the public says the government should have no role in health care.

Pew Research Poll

http://www.pewresearch.org…

***

Comment:

By Don McCanne, M.D.

Once again about 60 percent of Americans say that the government should be responsible for ensuring health care coverage for everyone. There are a couple of observations in this particular poll worth considering.

As the health care reform process began, there was a decline in support of a government responsibility in health care coverage. That decline has reversed and is now back to 60 percent (see graph).

Last year, 31 percent of Republicans with family incomes below $30,000 supported a government responsibility for coverage and now that has increased to 52 percent. This suggests that the prospects for bipartisan support are greater, including Trump voters.

The poll also suggests that the term “single payer” has not gained as much traction, though a previous Kaiser Health Tracking Poll has demonstrated much stronger support for the “Medicare for all” framing.

Regardless, the ground is fertile to advance the cause of health care justice for all. Let’s do it.

Doctors who support ‘Medicare for All’ among those opposing Price as HHS secretary

FOR IMMEDIATE RELEASE, January 18, 2017

Contact: Mark Almberg, communications director, Physicians for a National Health Program, (312) 782-6006, mark@pnhp.org

More than 2,000 physicians and medical students who oppose the nomination of Rep. Tom Price to head the Department of Health and Human Services — and who support the creation of a single-payer national health program to cover all Americans — are among the signers of petitions being presented this morning to the Senate Health, Education, Labor and Pensions Committee calling upon the committee to reject President-elect Donald Trump’s nominee.

Their statement, which appears below,  concludes as follows: “Price’s health policy prescriptions would move our nation’s health care system in the wrong direction, endangering the health of tens of millions. These policies would further obstruct access to care and concentrate even more power in the hands of corporate interests. What America needs, now more than ever, is a single-payer national health program — an improved Medicare for all.”

In a related statement, Dr. Carol Paris, president of Physicians for a National Health Program, said the following today: “Physicians for a National Health Program urges the members of the Senate HELP committee to reject the nomination of Rep. Tom Price for secretary of health and human services. A vote for Tom Price is a vote against 30 million Americans who will lose their health insurance. It is a vote against Medicare. It is a vote against Medicaid. It is a vote to sharply reduce Americans’ access to health care, when in fact we urgently need to expand it to all.”

The text of the petition — signed by 2,010 medical professionals in 48 states and the District of Columbia — turned in to the Senate HELP committee this morning reads as follows:

An Open Letter from Physicians Regarding the Nomination of Tom Price

We urge the Senate to reject the nomination of Rep. Tom Price (R-GA) as head of the Department of Health and Human Services. Dr. Price’s record indicates that his confirmation as Secretary would be disastrous for patients, doctors, and all who care about the health of the American people.

• As a member of Congress, Price introduced the Empowering Patients First Act as a replacement for the Affordable Care Act. That bill relies on discredited policies such as high-risk pools, individual tax credits, and allowing insurers to sell bare-bones policies. If signed into law, it would eliminate coverage for millions of Americans; benefit young healthy males at the expense of women, and the old, sick and poor; and offer the wealthy substantial new tax breaks.

• Together with House Speaker Paul Ryan, Price has pushed to replace Medicare with a “premium support” (i.e. voucher) program that would threaten traditional Medicare, increase out-of-pocket costs for seniors, and bolster the profits of the private insurance and financial services industries.

• Price, along with Centers for Medicare and Medicaid Services nominee Seema Verma, has supported converting Medicaid into a block grant program. This would allow states free reign to implement cruel Medicaid cutbacks and policies that compromise the health of their poorest residents. (Verma’s health savings accounts in Indiana are a prime example.)

• Price has been hostile to family planning, and has endorsed policies that would place millions of women at risk. His extreme views include opposition to abortion under almost all circumstances, a preference for “religious freedom” over access to contraception, and an obsession with eliminating federal funding for Planned Parenthood.

• Price has a long history of opposition to LGBT rights. As HHS secretary, he may decline to enforce nondiscrimination provisions of existing laws. Furthermore, his preferred Medicaid policies would restrict access to HIV/AIDS treatment for the most vulnerable patients.

Price’s health policy prescriptions would move our nation’s health care system in the wrong direction, endangering the health of tens of millions. These policies would further obstruct access to care and concentrate even more power in the hands of corporate interests. What America needs, now more than ever, is a single-payer national health program — an improved Medicare for all.

Physicians for a National Health Program (www.pnhp.org) is a nonprofit research and educational organization of 20,000 physicians who advocate for single-payer national health insurance. It was founded in 1986.

CBO update of estimates of premiums and coverage under repeal of ACA

How Repealing Portions of the Affordable Care Act Would Affect Health Insurance Coverage and Premiums

Congressional Budget Office, January 2017

A little more than a year ago, the Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) estimated the budgetary effects of H.R. 3762, the Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015, which would repeal portions of the Affordable Care Act (ACA) — eliminating, in two steps, the law’s mandate penalties and subsidies but leaving the ACA’s insurance market reforms in place. At that time, CBO and JCT offered a partial assessment of how H.R. 3762 would affect health insurance coverage, but they had not estimated the changes in coverage or premiums that would result from leaving the market reforms in place while repealing the mandate penalties and subsidies. This document—prepared at the request of the Senate Minority Leader, the Ranking Member of the Senate Committee on Finance, and the Ranking Member of the Senate Committee on Health, Education, Labor, and Pensions—provides such an estimate.

In brief, CBO and JCT estimate that enacting that legislation would affect insurance coverage and premiums primarily in these ways:

* The number of people who are uninsured would increase by 18 million in the first new plan year following enactment of the bill. Later, after the elimination of the ACA’s expansion of Medicaid eligibility and of subsidies for insurance purchased through the ACA marketplaces, that number would increase to 27 million, and then to 32 million in 2026.

* Premiums in the nongroup market (for individual policies purchased through the marketplaces or directly from insurers) would increase by 20 percent to 25 percent—relative to projections under current law — in the first new plan year following enactment. The increase would reach about 50 percent in the year following the elimination of the Medicaid expansion and the marketplace subsidies, and premiums would about double by 2026.

If the Congress considers legislation similar to H.R. 3762 in the coming weeks, the estimated effects could differ from those described here. In particular, the response of individuals, insurers, and states would depend critically on the particular specifications contained in such legislation.

https://www.cbo.gov…

***

Trump vows ‘insurance for everybody’ in Obamacare replacement plan

By Robert Costa and Amy Goldstein
The Washington Post, January 15, 2017

“It’s not going to be their plan,” he said of people covered under the current law. “It’ll be another plan. But they’ll be beautifully covered. I don’t want single-payer. What I do want is to be able to take care of people,” he said Saturday.

Trump did not say how his program overlaps with the comprehensive plan authored by House Republicans. Earlier this year, (Tom) Price suggested that a Trump presidency would advance the House GOP’s health-care agenda.

https://www.washingtonpost.com…

***

Comment:

By Don McCanne, M.D.

So far Congress has initiated a process to eliminate health plan subsidies and eliminate individual and employer mandates authorized by the Affordable Care Act. This update estimates the numbers who would be uninsured and estimates the increase in non-group insurance premiums that would occur if insurance reforms such as guaranteed issue remained in place. In the next decade another 32 million people would be without insurance and premiums for exchange plans would double.

It is highly unlikely that Congress would stop here since they have promised a replacement plan. We do not know what that is but President-elect Trump now says that he does not want single payer, and the Republicans in Congress do not either. Trump does say that he has a plan and that people will be “beautifully covered.”

Beautiful coverage is not a standard health policy term, but if it means that everyone will be covered with plans that are affordable and provide access, we can see problems ahead. Expanding coverage to everyone, reducing financial barriers such as high deductibles, and ensuring access while rejecting the efficiencies of a single payer system will be very expensive. Most Americans will not be able to afford the cost of such coverage which means that Congress must authorize massive subsidies to help pay for the very high costs. This Congress?

You can see that this tale is not finished. The people are going to have to watch closely as it unfolds and then be prepared to thrust our wrath onto our elected representatives as they begin to move down the wrong path on reform. Although our signs will say SINGLE PAYER, our pitchforks should have more than the traditional two or three tines since forks with four or five tines are crafted to pitch manure.

Support expanded Medicare for all

By Richard A. Damon, M.D.
The Missoulian (Missoula, Mont.), Letters, Jan. 17, 2017

United States health care is currently at a tipping point. If Obamacare is to be repealed, it should be replaced by Improved and Expanded Medicare for All.

Health care should not be dependent on the free market, income, race, gender, political party or any other status of the human condition. Health care costs should not force anyone into bankruptcy because of serious illness. The quality of health insurance should not determine whether people live or die. Health care should not be designed to make huge profits for multi-billion-dollar insurance companies, drug companies, hospitals and medical equipment suppliers.

Health care is not a commodity to be bought and sold. The purpose of any sane health care system is to keep people well, not to make stockholders wealthier.

Our current system is costly, bureaucratic, wasteful and inefficient, ranking 37th in the world. Economist Gerald Friedman, University of Massachusetts at Amherst, has done mountains of research on Medicare for All and concludes that Expanded and Improved Medicare for All would save $592 billion annually in health care costs, reduce drug costs by $116 billion, and create savings enough to cover all 44 million uninsured and underinsured citizens.

H.R. 676 even provides $51 billion for transition costs of displaced insurance and health care workers. H.R. 676 already exists as Rep. John Conyers’ legislative bill, designated “Expanded and Improved Medicare for All,” in the House of Representatives.

It is time for Congress to act on H.R. 676. We must join together. The enactment of H.R. 676 is straightforward. We must get to work, get involved, speak out, take action and make it happen. Join the national movement called “Our Revolution” to get it done. Remember, if you do not speak out against injustice, you are on the side of the opposition.

Dr. Richard A. Damon resides in Bozeman.

http://missoulian.com…

Single payer is best option

By Michael C. Huntington, M.D.
Albany (Ore.) Democrat-Herald, Letters, Jan. 16, 2017

Thomas Kraemer (Jan. 10) implied that Medicare costs are unacceptable. He should quickly add, however, that Medicare has controlled costs and allowed better access to care for people of retirement age than private insurance has for everyone else. The average annual growth rate in Medicare per capita spending from 2000 to 2015 was 2 percent. The average inflation rate during that time was 2.1 percent.

Mr. Kraemer equated Medicare to a single-payer system, but Medicare is prohibited by law from being a single-payer system like those that are so successful in other countries.

For both Medicare and the general population, a medical procedure in the United States is priced not on the value to the individual or the population but on the value bestowed on it by an obscure committee (RUC) of the American Medical Association. The committee creates financial incentives favoring high-cost procedures over primary care, just the opposite of what is needed to control costs and improve health for any population.

Medicare is not allowed to negotiate prices with the pharmaceutical industry or use scientific method to determine what pharmaceuticals Medicare should pay for. To get a drug approved by the Food and Drug Administration, a company needs only to prove that the drug is more effective than a placebo, not better or less costly than an existing equivalent drug. The company then markets the drug at the highest price the market will bear.

Help create a Medicare for All, free from crippling restrictions. Visit Mid-Valley Health Care Advocates (www.mvhca.org).

Dr. Michael C. Huntington resides in Corvallis.

http://democratherald.com…

Madison Doctor: Don’t Repeal ACA Without Same Protections, Benefits

Health Providers Want Health Care Changes To Be Affordable, Maintain Coverage

By Shamane Mills
Wisconsin Public Radio, Jan. 16, 2017

In a 1966 speech, Dr. Martin Luther King Jr. said, “of all the forms of inequality, injustice in health care is the most shocking and inhuman.”

Now, Dr. Jeff Huebner, a family physician in Madison and chair of the National Physicians Alliance, is calling on lawmakers to not repeal the Affordable Care Act without a replacement offering the same protections, including affordability and adequate medical benefits.

“We (NPA) were a proud leader in voicing support for (the) Affordable Care Act, and we will continue to raise our voices in support of improving the ACA and not going back to the days of inhumane health care,” Huebner said at a press conference Monday following the Martin Luther King Jr. holiday celebration at the state Capitol.

Huebner and other doctors also expressed concern Monday about Republican plans to offer premium support, or vouchers, for Medicare and cap Medicaid spending through block grants.

The press conference was sponsored by Physicians for a National Health Program and Physicians for Social Responsibility, both support a national health care system.

But the nation’s largest doctor’s group, the American Medical Association, has long opposed the idea of a single-payer model. In June, however, the AMA did adopt a resolution to study single-payer, along with other payment models.

http://www.wpr.org…