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Importance of Boston City Council supporting single-payer health care reform

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Importance of Boston City Council supporting single-payer health care reform

By Ture Richard Turnbull
Jamaica Plain (Mass.) News, Aug. 22, 2016

The Boston City Council will take a bold step on Wednesday, August 24, by passing a resolution reaffirming its support for a single-payer health care system.  The resolution calls upon the state legislature in the upcoming 2017-2018 legislative session to propose and pass a measure to achieve a single-payer system in the Commonwealth.

This resolution is an extremely important endorsement for true health care reform that would make health care a right for all Massachusetts citizens and “provide availability and affordability of healthcare for all Massachusetts citizens.”

In 2001 the Boston City Council passed a similar resolution supporting single payer (also known as Improved Medicare for All). In 2008 the Commonwealth adopted Chapter 58 in an attempt to cover more people by mandating that everyone must buy health insurance or pay a stiff fine; but it lacked the ability to control health care costs. We now have the Affordable Care Act (ACA) that is largely based on Chapter 58. It does cover more people, but it is still unable to control costs. In Massachusetts there are about 300,000 people who are uninsured and many more who have insurance, but the co-pays, deductibles, co-insurance and high cost of medications make it impossible to access the medical care they need.

We need to ask ourselves why our present health care system fails to provide everyone with affordable, high quality coverage. If we look at the money trail it is clear that the private health insurance companies, the pharmaceutical corporations, and the big hospital groups are stashing away billions of dollars while patients are struggling to pay for needed and routine medical care.

We have a profit-based or market-based system that basically allows the health insurance companies to make huge profits by skimping on medical care creating a large profit margin that satisfies their shareholders. The pharmaceutical companies are on a rampage to raise prices on their prescription drugs to the point that in some cases life-saving medications for HIV, hepatitis C, and cystic fibrosis will cost as much as $300,000 per year. These corporations say they need the money for research and development, but most of the money goes to the CEOs with obscene salaries and to payouts to satisfy their shareholders. We need a health care system that is patient-centered not market-based.

Why should Massachusetts move to a single-payer system?

• It guarantees access to medical care for everyone, up front, with no co-pays, deductibles, or high out-of-pocket costs.

• It is continuous from birth to death, no eligibility requirements if you reside in Massachusetts, with no loss of coverage if you change or lose a job, and no need to stay in a bad job just because of the health insurance it provides.

• Businesses and municipalities would benefit because they would no longer be responsible for providing health insurance for their employees. Instead they would pay a payroll tax that would be predictable for long-term planning and in most cases would cost less than what they pay now, allowing for growth in businesses and more funding for vital municipal programs such as schools and fire and police for towns and cities.

• A single-payer system would be funded by income taxes made as progressive as possible under Massachusetts law, a business contribution through a payroll tax, and possibly taxes on unearned income. State income taxes might rise for some people, but the rise in taxes would be in most cases much less than what we pay now for health insurance premiums (around $22,000?!?! for a family of four), co-pays, deductibles, co-insurance, all of which would be eliminated.

• Private health insurance companies would be streamlined to cover only things not covered by the single-payer system. This would eliminate the wasted money spent on unnecessary administrative functions and the profits that are siphoned off the system estimated to be around 30% of total health care expenses for the state. Pharmaceutical companies would be forced to negotiate their prices with the single payer administration. This would keep the cost of medications affordable and set better guidelines for development of new drugs.

• Hospitals and large medical groups would be funded by a negotiated budget for all hospital expenses. Capital improvements would have to be approved by the single payer administration to avoid duplicated services that aren’t necessary for the system.

• A single-payer system is a patient-oriented system that would reduce health disparities since everyone is covered, and improve the quality of care. It would also strengthen the healing power of the doctor-patient relationship by giving doctors the right to make decisions about medical care instead of insurance bureaucrats allowed full choice of doctors. A single-payer system is based on the premise that a healthy society promotes opportunities for the young, comfort and dignity for the elderly, and good health care for families that make up the workforce of the country.

The timing of the resolution by the Boston City Council is tremendously important. A single-payer system is being championed by candidates across the country and it is now a mainstay of the large and growing progressive movement. In Massachusetts there are many new candidates who will be added to the strong group of legislators who already support a single-payer system. The primaries will be held September 8th and it is extremely important for everyone to vote and to support the candidates who will vote for a single-payer system. Cities and towns across the Commonwealth have the incentive now to follow the Boston City Council and make resolutions of their own to support a single-payer system. The 2017-2018 legislative session will show whether we have the political will to achieve what almost all the other countries in the world already provide, a single-payer (Improved Medicare for All) system that covers everyone with high quality care, is affordable, sustainable, and equitable.

Thank you Boston City Council!

For more info visit www.MassCare.org.

Ture Richard Turnbull is the executive director for Mass-Care. Mass-Care’s mission is to establish a single-payer health care system in Massachusetts.

http://www.jamaicaplainnews.com/2016/08/22/op-ed-importance-of-boston-city-council-supporting-single-payer-health-care-reform/20657

Des Moines Register says government should not rely on private insurers

Government should not rely on private insurers

By The Editorial Board
The Des Moines Register, August 22, 2016

Aetna announced last week that it was reducing participation in health insurance exchanges created by the Affordable Care Act. It will sell plans in only four states next year, including Iowa, down from 15 this year. This follows similar market exits from UnitedHealth Group and Humana.

This is yet another reminder of why government should not rely on private companies to deliver health insurance to Americans. History has repeatedly shown this is a costly, dangerous and unsustainable idea. Yet politicians refuse to listen to history.

When Medicare was created in 1965, the goal was to insure seniors through a program administered by the government. In traditional Medicare, Uncle Sam directly pays providers for health services. The program is reliable, predictable and has low administrative costs. But politicians saw an opportunity to funnel public money to for-profit insurers to take over the job of administering benefits.

In the 1990s, private “Medicare+Choice” plans saved taxpayers no money while insurers demanded more and more money from the government. The companies failed to turn a healthy profit and disappeared. Fortunately, seniors could return to traditional, government-run Medicare.

Instead of learning from that experience, Congress embraced private insurers again in 2003. Medicare Advantage plans resulted in taxpayers paying 14 percent more per senior than the cost of care in traditional Medicare. Yet these plans are popular with seniors, who pay lower monthly premiums — and vote. Earlier this year, the GAO reported the feds improperly paid Medicare Advantage companies $14.1 billion in 2013. That’s billion with a “b.”

Lucky private insurers. Unlucky taxpayers. Reckless politicians.

Then there are governors, including Terry Branstad, who insist on handing over Medicaid administration to for-profit companies. Let’s take a look at how this has worked in Florida, where former Gov. Jeb Bush pushed the idea, arguing the cost of Medicaid operated by the state was “unsustainable.”

Privatization was rolled out statewide in 2014. Almost immediately, insurers complained they were losing money. They asked the state for a $400 million raise and a 12 percent increase in rates. This, of course, jeopardized any savings taxpayers may have realized. Two months ago Florida received a surprise Medicaid bill: It owed $433 million in unpaid reimbursements to insurers.

Then there is the Affordable Care Act.

One of the law’s fundamental flaws is its reliance on private insurers to provide coverage to millions of Americans through exchanges. With no “public option” safety net to offer government coverage if companies jump ship, the insurers have incredible political and financial power. They can, in fact, try to hold the government hostage. Pay higher reimbursements, don’t dispute our business decisions, do what we say or we are dropping out of exchanges.

Enter Aetna.

In a July 5 letter, Chief Executive Mark Bertolini informed the Justice Department that if it sued to block Aetna’s dealt to acquire Humana Inc., the insurer would reduce its presence in exchanges. The Obama administration says such a merger would increase consumer costs.

“If the deal were challenged and/or blocked we would need to take immediate actions to mitigate public exchange and ACA small group losses,” he wrote.

Is that a warning? A threat? And how is the Obama administration supposed to respond?

The Justice Department sued to block the merger. Then Aetna announced it was scaling back its offerings in exchanges.

Americans’ access to health insurance should not depend on the profit margins, business dealings, or mergers of for-profit companies. Not in Medicare. Not in Medicaid. And not in exchanges created by health reform law. Instead of funneling tax dollars to private companies, government is better equipped to administer insurance. It is not beholden to stockholders. It does not seek to turn a profit. And it will not abandon the responsibility of providing health coverage to Americans.

http://www.desmoinesregister.com/story/opinion/editorials/2016/08/22/editorial-government-should-not-rely-private-insurers/89107404/

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Comment:

By Don McCanne, M.D.

There is much discussion today about moving forward with reform by introducing a public option – a competing government insurance plan – into the ACA insurance exchanges. Yet that would leave in place the current health care financing system, including the multitude of private insurers. As this editorial explains, the government “should not rely on private companies to deliver health insurance to Americans” as “this is a costly, dangerous and unsustainable idea.”

Under our current system, the design of a public option would be very similar to existing private plans. That would perpetuate the flaws of the individual insurance model when what we need is a universal, prepaid health care system. Also, a public option designed as an individual plan to compete with private plans would fail to capture almost all of the efficiencies of a single payer national health program, leaving in place our dysfunctional, fragmented system of a multitude of public and private plans.

The editorial provides a very powerful message on why private insurers should be excluded from our health care financing. Once the public clearly understands that then we can explain to them why we should not accept even a fragmented system of public programs, even if dominated by a “public option” individual insurance plan. We need one single, efficient government financing program like Medicare, except even better.

Aetna CEO doesn’t get sympathy

By Kay Tillow
The Courier-Journal (Louisville, Ky.), letters, Aug. 23, 2016

No one should cry for Aetna CEO Mark Bertolini over his claim of losses in the Obamacare exchange plans. Bertolini raked in $27.9 million in total compensation in 2015.

Just last May, he was positive about the Affordable Care Act, stating that Aetna’s losses were nothing in comparison to the $2 billion Aetna would have had to spend to acquire those customers without the health care law.

Since Obamacare passed in March 2010, Aetna’s stock has soared 270 percent. Cigna and Humana have risen about the same. UnitedHealth Group, which is also pulling out of the exchanges, is up 371 percent. During that time the S&P 500 Index has increased only 99 percent.

Under the ACA, the insurers are getting billions each year to subsidize their insurance plans. No matter how much money we throw at these companies, the market will never work to fix our health care system.

No other industrialized country in the world allows private insurers to control their health care. Those countries have better health outcomes than the U.S. while spending, on average, about half as much per capita as the U.S.

Fixing health care means we must move to a single payer system as proposed by Congressman John Conyers in HR 676. We will save both lives and money.

Kay Tillow resides in Louisville.

http://www.courier-journal.com/story/opinion/readers/2016/08/22/letter-aetna-raking-soaring-profits/89097118/

When income is too high for a subsidy for ACA plans

Without a subsidy, couple faces higher insurance premiums

By Carla K. Johnson
Associated Press, August 20, 2016

With a household income too high for a federal subsidy, Bruce Mainzer and Beth Shadur are bracing for higher health insurance premiums in 2017.

As in other states, many insurers in Illinois have requested double-digit rate increases. Americans ineligible for the government subsidies that help cover their premiums will be hit hardest.

Health insurance already takes a hefty bite out of the couple’s budget. They pay $1,200 a month for a bronze plan with high deductibles, which means they pay $13,000 annually out of pocket before their coverage even kicks in.

“It has been a challenge, and it causes us to dip into our retirement savings and increase our debts,” Mainzer said.

On top of the cost, they’ve experienced the hassles of major disruptions in the Illinois insurance market. For one, their insurance company recently folded. It was one of the struggling co-ops set up under the federal health care law.

They are switching to Aetna in October but will start shopping again for another insurer a month later because Aetna recently said it is bailing out of the Illinois exchange-based marketplace.

They are in good health, but Mainzer has a blood disorder, a pre-existing condition that led insurers to reject him before the Affordable Care Act took effect. He was able to get coverage only through Illinois’ high-risk pool, at about the same price he pays today.

Mainzer rejects the “repeal and replace” Republican solution, in part because getting rid of the law would mean that insurance companies could go back to denying coverage for people with pre-existing conditions.

“Ultimately, it’s clear that health care is not something that can be efficiently provided by the private sector,” he said. “The rest of the Western world has figured out that health care is a right and is intrinsically a government, public-sector activity.”

http://bigstory.ap.org/article/900bafbce1e44be2a0f2f9c30a76f634/without-subsidy-couple-faces-higher-insurance-premiums

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Experts Predict Sharp Decline in Competition across the ACA Exchanges

By Dan Mendelson
Avalere, August 19, 2016

A new analysis from Avalere finds that nearly 36 percent of exchange market rating regions may have only one participating insurance carrier offering plans for the 2017 plan year and there may be some sub-region counties where no plans are available. Nearly 55 percent of exchange market rating regions may have two or fewer carriers.

“Lower-than-expected enrollment, a high cost population, and troubled risk mitigation programs have led to decreased plan participation for 2017,” said Dan Mendelson, president of Avalere.

http://avalere.com/expertise/life-sciences/insights/experts-predict-sharp-decline-in-competition-across-the-aca-exchanges

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Comment:

By Don McCanne, M.D.

An important measure of the success of the Affordable Care Act is how well it is working for middle and upper middle income working families who are not eligible for employer-sponsored health plans. The experience of the two-income couple described in this AP article demonstrates that it is not working so well for some.

Bruce Mainzer and Beth Shadur received their coverage through the ACA exchange in Illinois, but it was with one of the co-ops that failed (giving us a hint of what might happen to a “public option” once the private insurers provide their input into the design of such an option).

They had then applied for coverage with Aetna, but now it is pulling out of the Illinois exchange. Fewer plans will be available. In fact, according to the Avalere report, over one-third of exchange market rating regions throughout the United States will have only one plan available, eliminating competition as a means of holding down premiums (not that it was particularly effective anyway).

Because insurers in the exchanges have been experiencing losses, typical premium increases are expected to be in the double digits for 2017. For their bottom-tier bronze plan which has high deductibles, this couple has been paying $1,200 per month for coverage. Next year it will certainly be higher. Also the instability of plan coverage destabilizes access to health care because of the incongruity of the narrow provider networks.

In rejecting single payer, progressive politicians say that we should build on the success of ACA. What changes would you make in the system so that it would work well for Bruce and Beth? When you think about it, it is obvious that mere tweaks will not work. The changes that they need would require comprehensive reconstruction of the health care financing infrastructure.

Well, Bruce Mainzer has figured it out. As he says, “Ultimately, it’s clear that health care is not something that can be efficiently provided by the private sector. The rest of the Western world has figured out that health care is a right and is intrinsically a government, public-sector activity.”

Departure of health insurers from exchanges demonstrates need for single payer

Physicians for a National Health Program founder Dr. Steffie Woolhandler: the fundamental problem is our reliance on market-based solutions to healthcare

The Real News Network, Aug. 19, 2016

The following transcript has been provided by The Real News Network. You can watch the video of the interview here.

JAISAL NOOR, TRNN: Welcome to the Real News Network. I’m Jaisal Noor in Baltimore.

AETNA, the nation’s third-largest insurance provider, announced this week it was pulling out of a majority of the Affordable Care Act’s health exchanges next year, citing hundreds of millions of dollars in losses. But then the Huffington Post obtained a letter Aetna had sent to the Department of Justice in July in which the insurance giant had threatened this exact move if its merger with rival Humana was blocked. And this is exactly what anti-trust regulators with the DOJ did in late July.

Now joining us to discuss all of this is Steffie Woolhandler. She’s a physician and public health professor at the City University of New York. She co-founded Physicians for a National Health Program, whose 20,000 member advocates demand single-payer health insurance. Thanks so much for joining us.

STEFFIE WOOLHANDLER: My pleasure.

NOOR: So it’s not just Aetna that has pulled out. United Health Group has pulled out. Humana has also pulled out of some of the exchanges. Let’s start off by talking about the impact on people that have many–you know, for the first time have been able to get insurance, or more affordable insurance, through these health exchanges, also known as Obamacare.

WOOLHANDLER: Right. Well, hundreds of thousands of people are going to lose their current insurance. Many of them are going to be left in counties with only one or even zero options. There’s a county in Arizona that has no plans participating as of today. So the people are going to be left with one option, meaning there’s no competition and they have no choice whatsoever. It’s kind of take it or leave it on the insurance. And of course if they decided to leave it they have to pay a fine under the Obamacare legislation.

I think the thing that’s really stunning is how arrogant these insurance giants have become, that they have been invited into the Obamacare system, and then they feel that they can actually threaten the federal government that if you want to take an antitrust action against us, on the behalf of consumers, we’re going to threaten you, we’re going to pull out of Obamacare altogether.

So I think this really shows that it’s a very bad idea to try to get to universal coverage through private insurance companies. Private insurance companies are there to make a profit, and the minute they stop making profit, they want to pull out. And of course, they have a lot of trouble making a profit if the enrolees get sick. So instead of having a system that provides care to sick people, we have a system where insurance companies want to run away from providing care for people who need it.

NOOR: And so this, you know, the Obamacare Affordable Care Act, has been defended by Hillary Clinton during the Democratic primary. Bernie Sanders said we need universal healthcare and the only way we can do that is single-payer. Clinton said, you know, it’s not possible to achieve it. We can use Obamacare as a start to help expand coverage. Respond to that argument, because that–you know, Hillary Clinton is now the Democratic nominee, and she’s going to be putting forward those policies if she wins the White House. And it goes without saying, the Republicans have vowed to repeal Obamacare.

WOOLHANDLER: Look, Hillary Clinton has been pushed to the left during this election campaign, and she can be pushed more to the left. Polls are showing that 58 percent of the American people now endorse the idea of Medicare for all. So as soon as Senator Sanders started talking about Medicare for all, the majority of Americans said, gee, that sounds pretty good. In fact, about 40 percent of the people who hate Obamacare, who feel Obamacare should be repealed, and most of those people are Republicans, 40 percent of them support a Medicare for all system.

So the American people want this. The thing that’s blocking it are the insurance companies and the drug companies. The insurance companies blocked Medicare for all. They blocked the public option. And now Aetna is pulling out of Obamacare basically in retaliation for the Justice Department trying to stop them from forming a monopoly.

So what I would say to that is what’s possible is what people believe is possible. If the president, if the Demomcrats go back there and say, we’re going to work for single-payer, we’re going to challenge the insurance industry and drug company, then it’s really possible. As long as politicians are shrugging their shoulders and saying there’s nothing I can do, that’s a problem.

NOOR: And another issue that many have come across is that even through the exchanges, the price of getting insurance can be very, very high and unaffordable for many even working people.

WOOLHANDLER: Well, absolutely. For someone my age, if I went on the New York State exchange to buy insurance my premium for a bronze plan, the cheapest plan, my premium would be $5,000. And then if I got sick I would have another $5,000 deductible. So I’d be $10,000 out of pocket before my insurance paid one penny.

So you know, that’s not affordable care for people, and it’s not fair to ask people to pay that kind of money if they’re a low-income person. That’s why we really need a Medicare for all system, that would be based on a fair tax funding, and be available to everyone on an equal basis.

And of course, the beauty of Medicare for all, the beauty of single-payer, is that you save so much on administrative overhead that you can improve coverage for people, get rid of those copayments, deductibles, get 100 percent universal care without increasing total spending. Aetna last year had overhead of 19.9 percent. Nearly 20 percent overhead. Which mean for every dollar in premiums you handed them they held on to 20 cents. They never gave it to a doctor or a hospital or a drug company. They hold on to 20 cents right there for their overhead and profit. And we simply can’t afford to cover everyone if we’re going to waste all this money on that overhead and profits of these insurance giants.

NOOR: And so, you know, supporters of the current system would say this is better than what existed before. Millions of people now have insurance that didn’t have it before. And that weekend, you know, we can work to reform it. But it’s just not possible in the current climate, with Republicans controlling Congress, to get the proposal you have put forward.

WOOLHANDLER: Well, remember, there is an election coming up. So if the politicians say let’s go for Medicare for all, maybe we can get it. Certainly Bernie Sanders surprised all of us with the resonance that his message had with the American people. Really very–before he was a little-known senator from a tiny state, and next thing you know he’s really a contender in the presidential race because of the force of his ideas, including his idea for Medicare for all.

So by putting those ideas out to the American people, that would help us build the movement that would get us to a single-payer. There’s not another way to get there. A movement is really the only thing that’s going to defeat these insurance giants and these pharmaceutical giants.

NOOR: All right. Well, Steffie Woolhandler, thanks so much for joining us.

WOOLHANDLER: My pleasure.

NOOR: And thank you for joining us at the Real News Network.

http://therealnews.com/t2/index.php?option=com_content&task=view&id=31&Itemid=74&jumival=17051

Still hope for health care?

By Steve Sebelius
Las Vegas Review-Journal, Aug. 20, 2016

During the Democratic primary, as Bernie Sanders battled Hillary Clinton for the nomination, a strong disagreement emerged over health care.

Sanders — who has supported a single-payer health care system similar to those in Canada and Great Britain — asked voters why America can’t do the same thing.

Clinton replied that she supported the progress made in extending access to health insurance under the Affordable Care Act, and wanted to expand that legislation to cover more people.

Clinton’s approach is consistent with history. In the 1990s, she was working on a “managed competition” plan that some of the larger insurance companies found quite favorable, although their smaller competitors objected. That plan was never consummated.

By the way, Donald Trump pledges to repeal the entire Affordable Care Act. Although Trump once had kind words for single-payer health care in foreign lands, he’s come out against it for Americans.

So, now the election is a choice between Clinton’s extend-the-ACA and Trump’s kill-the-ACA.

But what if it didn’t have to be?

There is a plan that would take the existing Medicare system and gradually extend it to all Americans. (In fact, that was the original idea when President Lyndon Johnson signed the law in 1965.)

The fact that most Americans are already familiar with Medicare is one of its chief selling points as an alternative to insurance-based coverage, says Dr. Ed Weisbart, chairman of the Missouri chapter of the Physicians for a National Health Program.

A single-payer system is vulnerable to being attacked as “socialized medicine.” But under Medicare-for-all, doctors and hospitals would still compete with each other in the open market to offer care, Weisbart said.

But the Medicare program could use its purchasing power to lower costs, say, by negotiating with drug companies to lower prices on mass purchases of prescriptions. In fact, that’s where Weisbart says the expansion ought to begin.

This is not just a theoretical idea, either: It exists in legislative form in HR 676, the Expanded and Improved Medicare for All Act, a bill from Rep. John Conyers, D-Mich. There are 62 co-sponsors, although none from Nevada.

Rep. Dina Titus, the lone Democrat in Nevada’s House delegation, said she hasn’t signed on to Conyers’ bill because she agrees with Clinton — build on the success of the ACA. Implementing a Medicare-for-all system, she said, would require rolling back some of the hard-fought gains of the ACA.
 
But the real issue here is pragmatism, Titus said. In a Republican-controlled Congress, the only ACA-related bills that get votes are those seeking to repeal it, in whole or in part. Medicare for all has virtually no chance of passing with the GOP in charge, Titus said.

But can’t the same thing be said for the Democrats? When the ACA was introduced, the idea of a single-payer approach was rejected almost out of hand. A public option within the law was similarly tossed (couldn’t get the votes, majority Democrats said).

It’s not likely a President Hillary Clinton is going to invest much time and energy in a Medicare-for-all approach, especially when she’s never shown much interest in such a plan during her long career in politics. And it’s even less likely that Trump would move on the idea.

But approaching health care in the same way we’ve always done it — by finding new and exciting ways to funnel money to insurance companies — will produce only more political fights, more campaign contributions to fuel anti-reform efforts and less real change for Americans who pay too much and get far too little when it comes to their health care.

Steve Sebelius is a Review-Journal political columnist. Follow him on Twitter (@SteveSebelius) or reach him at SSebelius@reviewjournal.com.
 
http://www.reviewjournal.com/opinion/columns-blogs/steve-sebelius/still-hope-health-care

America cannot be a superpower with a substandard health care system

By Ahmed Kutty, M.D.
Monadnock Ledger-Transcript (Peterborough, N.H.), Aug. 16, 2016

In July 1965, President Lyndon Johnson had to settle for half a loaf, in lieu of the full loaf that three predecessors in The White House (Teddy Roosevelt in 1912, FDR in 1935 and Harry Truman in 1948) had proposed or attempted to legislate: a national health plan. The compromise reached, accommodating powerful opposing interest groups, gave us the Social Security Title XVIII Act, better known as Medicare, which went into effect 50 years ago this July.

Now in its “middle age,” the program has a proven track record of success in its mission of providing publicly financed health care for America’s seniors. Given its enduring popularity, it is time to review the stance of our two major political parties on health care security in general and Medicare in particular.

The Republicans in their long-awaited plan, recently authored by House Speaker Paul Ryan and offered after acrimonious and divisive attempts at a “repeal and replace” campaign launched in response to the Affordable Care Act (Obamacare) of 2010, seek to gut most of the significant gains achieved by the ACA. Their plan calls for slow, steady and subtle attempts to privatize and eventually kill the Medicare program as we know it today.

Starving by funding cuts to traditional Medicare, generous funding of the part-privatized Medicare Advantage plans and granting rule-making discretion to compliant federal agencies are some of their tools to bring about the demise of the social insurance program for the health care of seniors, who would then be on the hook for huge medical bills when a major or catastrophic illness strikes.

Then “you are on your own,” which is consistent with the zeitgeist as perceived by the Republican Party.

No surprise there!

The Democrats are saying that we have delivered the best reform in 2010 and are now on to other priorities. The fact that about 27 million Americans will remain uninsured and about 30 million underinsured after full implementation of the ACA in 2018, remain just numbers in the political calculus of the party elite. Martin Luther King’s words, “Of all forms of inequality, injustice in health care is the most shocking and inhuman,” fall on deaf ears within today’s Democratic Party. Any party in America that will heed King’s call appeared destined for political extinction until recently.

Among the major party presidential candidates, Sen. Bernie Sanders provided the most powerful, galvanizing and unwavering support for “Medicare for All”: a bold move to establish a national health care plan. Negotiations in July between the campaigns of Clinton and Sanders led to compromise, and the Democratic Party platform now promises (1) to lower the eligibility age for Medicare to 55, (2) to offer a public option in the ACA exchanges, (3) to lift the ban on Medicare from negotiating drug pricing and (4) to increase funding for qualified Community Health Centers. Alas, platform promises are non-binding.

While welcome, the incremental approach of the Democratic establishment, including Obama and Clinton, is a far cry from the much-needed basic structural reform of financing our health care system, as advocated by Sanders and others, and embedded in the bills before Congress: S. 1782 in the Senate by Sanders (and Rep. Jim McDermott’s companion bill on the House side) and H.R. 676, sponsored by Rep. John Conyers of Michigan.

The details in these bills show the plans’ financial viability and fiscal soundness, to cover all 320 million Americans under a universal, comprehensive, publicly funded program for financing health care at a cost to the nation that would be less, by a half a billion dollars, than we spend currently.

A majority of health care economists agree that that our health care costs of $3 trillion a year, amounting to 18 percent of our GDP, are unsustainable. All other major advanced economies spend an average of 9 to 10 percent of their GDP and secure coverage for all their residents. Per capita we expend $18,000 per year while Canada, the EU countries, Japan, Taiwan and Australia, among others, get all necessary health care for their citizens at approximately $9,000 per capita annually.

An average family with an annual household income of $55,000, currently paying about $11,000, including premiums and out-of-pocket deductibles, would pay $4,000 a year as taxes under the national plan and get far better, comprehensive coverage with no premiums, deductibles or copays. For about $5,000 to $6,000 – and by some estimates no more than $9,000 a year per household – we could have a publicly funded, privately delivered (as we do now) program in which everybody is in and nobody out. We must agree with President Truman, who said in 1948, that “We as a nation can afford this.”

A century ago, Lloyd George, the British prime minister during World War I, said: “You cannot run an A1 empire with a C3 population.”

We, the people, must send a message, loud and clear, to our elected leaders and candidates for offices from president on down, that America cannot build an A1 21st-century economy, and remain a superpower, with a C3 health care system. For the law stating that the arc of the moral universe bends toward justice to be operational, people must do the bending.

Dr. Ahmed Kutty is a retired physician who lives in Peterborough.

http://www.ledgertranscript.com/

PNHP note: Physicians for a National Health Program is a nonpartisan educational organization. It neither supports nor opposes any candidate for public office.

Dr. Steffie Woolhandler on ‘The Real News Network’

PNHP co-founder Dr. Steffie Woolhandler appeared on “The Real News Network” on Aug. 19, 2016, to discuss Aetna’s decision to withdraw from the Affordable Care Act marketplace in most of the states where it currently operates. A transcript of her interview with host Jaisal Noor is available on The Real News Network website, here.

CMS response to steering dialysis patients to private plans

CMS examines inappropriate steering of people eligible for Medicare or Medicaid into Marketplace plans

Centers for Medicare and Medicaid Services, August 18, 2016

The Centers for Medicare & Medicaid Services (CMS) today issued a request for information seeking public comment on concerns that some health care providers and provider-affiliated organizations may be steering people eligible for, or receiving, Medicare and/or Medicaid benefits into Affordable Care Act-compliant individual market plans, including Health Insurance Marketplace plans, for the purpose of obtaining higher reimbursement rates. CMS also sent letters to all Medicare-enrolled dialysis facilities and centers informing them of this announcement.

The request for information and letters to providers focus on situations where patients may be steered away from Medicare or Medicaid benefits, which can among other concerns, result in beneficiaries experiencing a disruption in the continuity and coordination of their care as a result of changes to their network of providers.

In addition to asking for more information on instances of problematic steering of consumers to individual market plans, CMS is also considering potential regulatory and operational options to prohibit or limit premium payments and routine waiver of cost-sharing for qualified health plans by health care providers, revisions to Medicare and Medicaid provider enrollment rules, the imposition of civil monetary penalties for individuals that fail to provide correct information about consumers enrolling in a plan, and potential changes that would allow issuers to limit their payment to health care providers to Medicare-based amounts for particular services and items of care.

https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-08-18-2.html

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Comment:

By Don McCanne, M.D.

In a previous message we described how some dialysis centers were steering patients away from Medicare and Medicaid and into private plans which have much higher payment rates. CMS is now assessing this problem and considering various measures to address it.

CMS’s primary concern seems to be that they want to protect the private insurers from high cost patients, especially in light of the fact that the nation’s largest private insurers are withdrawing from the ACA exchanges because of their exposure to high needs patients. The punitive interventions they suggest are aimed at the providers rather than the insurers. Particularly noteworthy is the recommendation to allow private insurers to reduce their provider payments down to Medicare rates.

If CMS established the principle that they can have recourse to price controls for privately insured patients, then why should we have to continue to pay the private plans extra for their superfluous administrative excesses and investor returns?  For that matter, why should we continue with an inefficient, fragmented health care financing system wherein our public administrators are bending over backwards to cater to the private insurers at an extra cost to those of us paying the bills?

In these thousands of daily messages on the heaps of rotten policies in health care financing it seems like there must be a pony in here somewhere. Single payer, perhaps?

Dr. Andy Coates: Single payer will enhance our lives across the board

The following is a lightly edited, unofficial transcript of the second half of an interview that Dr. Andrew D. Coates gave to Ed “Flash” Ferenc, host of the labor-oriented, Cleveland-based America’s Work Force Radio, WERE AM 1490, on March 30, 2016. Dr. Coates is immediate past president of Physicians for a National Health Program.

In this segment of the interview, Dr. Coates talks about how a single-payer, improved-Medicare-for-All system would benefit everyone who lives in the United States. In the first half of the interview (not transcribed here), Dr. Coates describes how he came to support single payer, how a majority of physicians now support it, and how the Affordable Care Act, despite the gains it has achieved, has failed to resolve the health care crisis in the U.S. and has actually strengthened the hand of the for-profit sectors of health care, whose interests run counter to the nation’s health.

The audio of the entire program is available at http://awfradio.com/todays-show-3-30-16/. The first segment of the interview with Dr. Coates runs from the 17:20-minute mark to 27:30; the second segment, transcribed below, runs from the 30-minute mark to 54:38.

HOST ED ‘FLASH’ FERENC: [We’re speaking with] Dr. Andy Coates, Physicians for a National Health Program. He’s a professor of medicine at Albany Medical College. We’re here to talk about taking Medicare as you know it and expanding it to everybody in America. Now this is not a new system. Other countries have used this system that you’re talking about, that you’re supporting, and it’s working, right?

Dr. Andy CoatesANDREW COATES, M.D.: Indeed. Every other industrialized nation has some version of this system. We could talk about a program where the government owns all of the health care infrastructure and pays the caregivers – nurses, doctors, pharmacists, and so on – directly; that would be like the National Health Service in Scotland now or as it used to be in England. There are some other examples.

And there are systems like the Canadian, Taiwanese, New Zealand systems, where the government pays the bills but where the health care infrastructure remains privately owned and operated, but operated on a not-for-profit basis.

Then there are some hybrid models that came from the 19th century, where there is some version of “private insurance,” but the private insurance is usually – as in Germany or other European nations – where the private insurance doesn’t correspond to UnitedHealthcare, Aetna or the kind of insurers in the United States. It’s an insurance fund that came through religious health organizations or through the labor movement, unions, or from communities. These are heavily regulated and controlled by the government to make sure that everybody’s in, and nobody’s out. So to call those systems private insurance systems is really a misnomer.

So the way of organizing the payment of care is, in my view, the beginning of the way to organize the delivery of care. If you don’t have control over the elements that go into the system, then how can you make the system serve the people in the right way? It seems to me that in a modern democracy, health care being so essential to our lives, that we absolutely would have to have control over how everyone in the country has access to the best possible care. That would be a key responsibility of a truly democratic government.

HOST: So the plan that’s on the table right now, this is a piece of legislation that has been introduced, it’s House Resolution 676, it’s called the Expanded and Improved Medicare for All Act: I know it’s been introduced and reintroduced a number of times. John Conyers of Michigan is supporting it. It’s my understanding that there are about 60, maybe 70 members of the Congress that are behind it. It’s just a fraction – you’d need a whole lot more support. But you’re in favor of that bill, which would take essentially Medicare, the way we have it right now, and expand it to everybody – every man, woman and child in the United States – is that right?

COATES: Yes. The Medicare for All Act, or H.R. 676, is a very, very useful document. Listeners should look it up. It’s short; if you print it out, it’s about 30 pages – easy to read. It’s a blueprint of a system that we know, — from the great deal of health policy evidence, — would absolutely work. It would cover all necessary care, there would be no copays or deductibles.

By all necessary care, I’m taking about all prescription drugs – here, I’ll just read it to you: primary care and prevention, dietary and nutritional therapies, inpatient care, outpatient care, emergency care, prescription drugs, durable medical equipment, long-term care, palliative care, mental health services, the whole scope of dental services, including periodontics, oral surgery, and endodontics, but excluding cosmetic dentistry, substance abuse treatments, chiropractic services, not including electrical stimulation, basic vision care and vision correction (other than laser vision correction), hearing services, including coverage of hearing aids, and podiatric care.

So all necessary care. Many of these things are not presently covered by Medicare, so it would expand and improve Medicare.

And this idea would exclude charges due at the point of service by patients. And that’s very important. It’s been very popular for the last decade or so to talk about “skin in the game” – you know, making patients go shopping for care when they’re sick, as the way to drive down prices. This has become a talking point, and this is very much the kind of neoliberal nuttiness that led to the Affordable Care Act, which has the taxpayers subsidizing the private insurance companies. You know, the idea is that if people don’t pay for their care when they’re sick, then they won’t understand how things work. But it turns out that if people are asked to pay charges for necessary care, they will avoid necessary care. There’s a wealth of evidence that will show that, in all kinds of different ways.

So this bill, H.R. 676, will actually work for the patients, and it will take us in the direction that we need to go. On the one hand there’s a big question about how it would be paid for and I’d be glad to talk with you about that. But the other thing that I’d really like to talk to your listeners about is to think about what it would mean for our daily lives if we had a system like this.

HOST: Let’s start with No. 1, how we’re going to pay for it. Because you know the conservatives are going to say, “Oh, we can’t afford it.”

COATES: Well, it’s not just the conservatives. That’s what Hillary Clinton’s advisers have been yelling to the public too. I think that Hillary Clinton’s campaign has come out attacking this idea that we should have a national health program. Look – all of the existing – if you look at the taxpayer money in the United States that is funding health care right now – all of this calculated on a per-person cost basis, a majority of the care is already funded by taxpayers in the U.S. And if you compare the U.S. level of spending with all the other nations on the planet, the United States spends more taxpayer money on health care per person than any other nation spends in total. It’s an astonishing thing. On a per-person basis, we have more taxpayer money spent on health care than any other nation spends in total on health care.

So there’s plenty of money in the U.S. system already, plenty of taxpayer money. If the existing sources in our employer-based system – you know, the employers pay huge amounts into the insurance companies to cover their employees – I’m taking about the big employers that have the big plans, if that money were put into the system, there would be plenty of resources to cover everyone.

But more, there would be enormous savings of hundreds of billions of dollars because there’s an enormous amount of waste in having a myriad, a great big pile of insurance companies fighting over every penny – with the hospitals and doctors’ offices having many people, whole departments to fight for the money. Hospitals might have hundreds of coders and billers trying to fight for the money. There’s this incredible administrative waste, waste that comes down to chasing money in the system.  That would be eliminated, and so there would be hundreds of billions of dollars in savings there.

In addition, in the Conyers bill, H.R. 676, would convert the system to a not-for-profit basis. There’s a spectacular amount of waste in profits and profit-seeking. It might be difficult to make a hefty profit off the care of a sick person, but the effort to do so brings with it a great deal of administration. So when it comes to pharmaceutical prices and medical equipment, all kinds of efficiencies could be found in the system if there were only one payer – in other words, the pharma companies would have to bargain with the people over prices. So the savings in the single-payer system would be spectacular from that point of view, and could liberate all of those resources so we could cover everyone.

There’s also a myth that some of the uninsured and sick patients would come flocking into the system and that would burden the system unduly. It turns out that, for example, when Medicare was built, and that was when the elderly in the United States had no one to pay for their care, it wasn’t the case that patients overwhelmed the system.

Furthermore, the single payer, because now we’d have a way for every patient’s care to be compensated, we could plan to expand our health system – I think of some of the rural counties here in upstate New York that don’t really have hospitals or adequate clinics. Those places could now afford to have them. And so the expansion of care could take place could take place in a planned way.

HOST: If you think back to when Medicare was debated back in the ’60s – Medicare was instituted in 1965 under Lyndon Baines Johnson – the same arguments that you’re hearing today, “Oh, you can’t do that!” In fact, Ronald Reagan, as I recall, was one of the big opponents of Medicare. “It’s socialistic, they do that in communist countries, we can’t do that!” Now, if you ask a senior today what they thought of Medicare, they’d say it’s the best thing since sliced bread. So this would basically take Medicare and expand it to everybody. I tell you, we have a long way to go. We need to educate people on this. Let me ask you one more question before you go. Do you feel, as a doctor, as a medical professional, that eventually this is going to happen – because of the high cost of health care under the Affordable Care Act, that this is the only way to solve the situation of getting access to health care in America? What are your thoughts on that?

COATES: If the goal is to cover absolutely everybody, to make sure that all necessary care is attainable, so we don’t have the undesirable situation where many people are completely left out, lost to medical follow-up, not able to access the clinic … if the goal is to do that, and also to keep the costs from spiraling completely out of control, and to help control costs overall, then, this is the only system that’s going to work.

The other thing I’ve learned though, in my travels around over the last 10 years or so, talking to many different audiences – way beyond some kind of FOX News feature where there’s a phony debate about whether some people “deserve to die” of illnesses that they never asked for – I think virtually everyone believes that if you’re sick, you should be able to get the best possible care. It doesn’t matter if you live in the city or the countryside, if you’re wealthy or poor, in an African American community, Latino – it doesn’t matter.

HOST: Right.

COATES: Because that’s the way it should be. That’s what everyone understands, in some way. I hope what will happen, and I think what will happen, is what we’ll start to understand is how liberating it would be if we didn’t have to get health care through our employer, or through our spouse, or through our parents.

What it would mean to us if we didn’t have to worry about our children being unsafe, meaning without health care – getting out of high school and looking for work – at time of stress and insecurity for them, as they find their way? Imagine how liberating it would be for them not to have to worry about health care.

Imagine what it would mean for the union movement. It’s very hard to organize unions when the thought of a strike means they’ll discontinue your health insurance, and that means that your wife won’t have access, or for a working woman to keep her job because her husband ended up getting multiple sclerosis and she is afraid to leave, the “job lock” phenomenon.

Really, when it comes to health care, there are so many insecurities in our personal lives – for instance with a parent has to transition to nursing home because of a devastating stroke. This should not be a time when the whole family, I mean the expanded family, should have its finances decimated, with brothers and sisters, cousins all drawn into it because of one person’s health care crisis. This is really a terrible situation and undignified and all too common in the United States. 

But if you look at it the other way, how liberating it would be, how proud people would be of this country, if that were not an issue. Proud to know that the system would be there, ready for us, and the system was designed around the patients. I really think that’s completely attainable. I don’t think it’s that radical. I think it’s a very modest reform, if you will. It wouldn’t threaten anything – it would actually enhance life across the board. It would not only work but be a great thing for public pride.

HOST: There you go. Well said. If you want more information on this, here’s the website: pnhp.org, Physicians for a National Health Program. Dr. Coates, we love having you on the show. Let’s keep this conversation going. So maybe one of these days Congress will move forward and do the right thing.

COATES: Also, there are hundreds of unions that have endorsed H.R. 676 and it continues to be a great campaign. Let’s build the word of mouth about it in the union movement. We’re hopeful that the unions can show us the way forward.

HOST: So you keep up the fight, OK?

COATES: Thanks.

http://awfradio.com/todays-show-3-30-16/