PNHP

Support expanded Medicare for all

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 If Obamacare is to be repealed, it should be replaced by Improved and Expanded Medicare for All.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…

What would Martin Luther King Jr say?

By Dr. Martin Luther King Jr.
Medical Committee for Human Rights, March 25, 1966

“Of all the forms of inequality, injustice in health is the most shocking and inhuman.”

https://www.pnhp.org…

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Noam Chomsky: The US Health System Is an “International Scandal” — and ACA Repeal Will Make It Worse

By C.J. Polychroniou
Truthout, January 12, 2017

Selected quotes of Noam Chomsky:

First, it is important to remember that the US does not accept the Universal Declaration of Human Rights — though in fact the UDHR was largely the initiative of Eleanor Roosevelt, who chaired the commission that drafted its articles, with quite broad international participation.

The UDHR has three components, which are of equal status: civil-political, socioeconomic and cultural rights. The US formally accepts the first of the three, though it has often violated its provisions. The US pretty much disregards the third. And to the point here, the US has officially and strongly condemned the second component, socioeconomic rights, including Article 25.

Rejection of Article 25, then, is a matter of principle. And also a matter of practice. In the OECD [Organization for Economic Cooperation and Development] ranking of social justice, the US is in 27th place out of 31, right above Greece, Chile, Mexico and Turkey. This is happening in the richest country in world history, with incomparable advantages.

***

All of this is part of the background for the US departure in health care from the norm of the OECD, and even less privileged societies. But there are deeper reasons why the US is an “outlier” in health care and social justice generally. These trace back to unusual features of American history. Unlike other developed state capitalist industrial democracies, the political economy and social structure of the United States developed in a kind of tabula rasa. The expulsion or mass killing of Indigenous nations cleared the ground for the invading settlers, who had enormous resources and ample fertile lands at their disposal, and extraordinary security for reasons of geography and power. That led to the rise of a society of individual farmers, and also, thanks to slavery, substantial control of the product that fueled the industrial revolution: cotton, the foundation of manufacturing, banking, commerce, retail for both the US and Britain, and less directly, other European societies. Also relevant is the fact that the country has actually been at war for 500 years with little respite, a history that has created “the richest, most powerful, and ultimately most militarized nation in world history,” as scholar Walter Hixson has documented.

For similar reasons, American society lacked the traditional social stratification and autocratic political structure of Europe, and the various measures of social support that developed unevenly and erratically. There has been ample state intervention in the economy from the outset — dramatically in recent years — but without general support systems.

As a result, US society is, to an unusual extent, business-run, with a highly class-conscious business community dedicated to “the everlasting battle for the minds of men.” The business community is also set on containing or demolishing the “political power of the masses,” which it deems as a serious “hazard to industrialists” (to sample some of the rhetoric of the business press during the New Deal years, when the threat to the overwhelming dominance of business power seemed real).

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As for reasons, we can return to the more general question of social justice comparisons, but there are special reasons in the health care domain. To an unusual extent, the US health care system is privatized and unregulated. Insurance companies are in the business of making money, not providing health care, and when they undertake the latter, it is likely not to be in the best interests of patients or to be efficient. Administrative costs are far greater in the private component of the health care system than in Medicare, which itself suffers by having to work through the private system.

Comparisons with other countries reveal much more bureaucracy and higher administrative costs in the US privatized system than elsewhere. One study of the US and Canada a decade ago, by medical researcher Steffie Woolhandler and associates, found enormous disparities, and concluded that “Reducing U.S. administrative costs to Canadian levels would save at least $209 billion annually, enough to fund universal coverage.”

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The facts about public support for universal health care receive occasional comment, in an interesting way. When running for president in 2004, Democrat John Kerry, The New York Times reported, “took pains .. to say that his plan for expanding access to health insurance would not create a new government program,” because “there is so little political support for government intervention in the health care market in the United States.” At the same time, polls in The Wall Street Journal, Businessweek, The Washington Post and other media found overwhelming public support for government guarantees to everyone of “the best and most advanced health care that technology can supply.”

But that is only public support. The press reported correctly that there was little “political support” and that what the public wants is “politically impossible” — a polite way of saying that the financial and pharmaceutical industries will not tolerate it, and in American democracy, that’s what counts.

***

Implicit submission is not imposed by laws of nature or political theory. It is a choice, at least in societies such as ours, which enjoys the legacy provided by the struggles of those who came before us. Here power is indeed “on the side of the governed,” if they organize and act to gain and exercise it. That holds for health care and for much else.

http://www.truth-out.org…

***

Comment:

By Don McCanne, M.D.

Of the OECD nations, the United States ranks near the bottom in health care justice. And yet Congress is moving forward with legislative action that likely would further diminish justice within our health care system. On this day dedicated to Martin Luther King Jr, it seems appropriate to ask what he would say. Well, we already know because he did say, “Of all the forms of inequality, injustice in health is the most shocking and inhuman.”

Noam Chomsky explains the appalling truth of how this could be in the United States – the wealthiest nation on earth. Yet, he explains, we do not have to accept health care injustice since power is on the side of the governed if we organize and act to gain and exercise it.

Republican Healthcare Plan: Skimpier, Meaner Obamacare

The Affordable Care Act has become the symbol of a health care status quo that long pre-dated it, but the Democrats refusal to acknowledge the ACA’s shortcomings and advocate for a truly universal system cost them many voters, says Dr. Steffie Woolhandler

By Sharmini Peries
The Real News Network, Jan. 15, 2017

[ TRANSCRIPT ]

SHARMINI PERIES: It’s The Real News Network. I’m Sharmini Peries, coming to you from Baltimore.

The Affordable Healthcare Act, also known as Obamacare, is in the crosshairs of the Republican majority Congress and the incoming Trump Presidential Administration. During his first press conference since winning the election, President-elect Donald Trump said the replacement for Obamacare following its repeal would essentially be immediate, even within the hour, he said. Let’s have a look.

(video clip)

DONALD TRUMP: Almost simultaneously, shortly thereafter, a plan. It will be repeal and replace. It will be essentially simultaneously. It will be various segments, you understand, but will most likely be on the same day or the same week, but probably the same day, could be the same hour.

(end video clip)

SHARMINI PERIES: The House of Representatives and Senate have also approved measures to begin gutting the Affordable Healthcare Act, however, the Republicans have not yet presented a plan for it replacement. Massachusetts Senator Elizabeth Warren took to the floor earlier this week to speak out against the repeal, saying it would sacrifice progress made towards the improvement of health care in the United States. Let’s have a look.

(video clip)

ELIZABETH WARREN: Democrats and nonpartisan government officials have worked for years here in Washington to try to make this health system work and we’ve made real progress.

Now, Republicans in Congress are ready to throw away these years and years of progress. They’re ready to threaten the collapse of our insurance markets. They are ready to threaten the health and the safety of millions of Americans simply to make a political point. They are ready to repeal and run.

(end video clip)

SHARMINI PERIES: Here to discuss the fate of Obamacare and the future of our health care system is Dr. Steffie Woolhandler.

Dr. Woolhandler is a distinguished university professor at City University of New York’s Hunter College and she’s a primary-care physician in the South Bronx. She was for many years a professor of Medicine at Harvard Medical School where she still serves as a lecturer in Medicine.

Dr. Woolhandler is a co-founder and board member of Physicians for a National Health Program, which consists of 20,000 physicians. Thank you so much for joining us today.

STEFFIE WOOLHANDLER: My pleasure.

SHARMINI PERIES: So, many Democrats are criticizing the Republicans for not having a plan to replace Obamacare. Some Republican Senators, however, have given some indication that some aspects of it will be kept intact.

For example, Rand Paul, Republican Senator from Kentucky, has said that he supports keeping the provision that allows children to remain in their parents’ healthcare until age 26. It also seems that Republicans will make changes for covering pre-existing conditions. Let’s have a look at what Rand Paul had to say.

(video clip)

RAND PAUL: My goal is that there are about 11 million people in the individual insurance market. I want every one of them to be able to buy insurance as part of a group in an association market. So, the goal would be that the people most affected by pre-existing conditions, small businesses and individuals, they would no longer have to have that problem because they would be put into big groups and they would be able to buy insurance as part of a large insurance pool.

SHARMINI PERIES: So, Steffie, what do you think Republicans will propose and what do you think of reducing health care costs in general, which is what they say is their objective?

STEFFIE WOOLHANDLER: Well, we think that the Republicans will probably maintain the basic structure of the Affordable Care Act but they’ll just make it much skimpier and much meaner with high co-payments and deductibles, particularly for poor people who can’t afford to pay those co-payments and deductibles.

I think the biggest effects will be on folks who are getting Medicaid because the Republicans are committed to making Medicaid into a much skimpier, meaner program.

There will also be effects on other Americans, as your clips indicate. We’re likely to see the Republicans allowing children up to the age of 26 to stay on their parents’ health insurance. You know, that’s helpful but it only helped a couple million people; that’s not a large amount of Americans who are affected by that.

As for the pre-existing conditions, we do expect that the pre-existing condition protections will be weakened under any Republican proposal. Rand Paul was talking about something called high-risk pools. Those have been tried multiple times in the past and do not work to get coverage for people with pre-existing conditions.

Representative Ryan and his blueprint for the Republican reforms, which he issued last summer, was talking about while giving you some pre-existing condition protections – but only if you were able to maintain continuous health coverage. And for many people – I mean, including myself – it’s been very hard to make sure that you have continuous coverage and never miss a day or a week or a month in terms of health coverage, given how fragmented and chaotic the insurance system is, even for middle class people like me; that’s been occasionally hard.

So, I think most people with pre-existing conditions will find that, you know, if they have to change insurance and miss even a day of coverage, they no longer have pre-existing condition protections.

So, we’re expecting that kids-up-to-age-26 provision to stay in the Republican Bill. The pre-existing condition provisions, even though they’re very popular, are going to be hard for the Republicans to support and I think they’ll go away.

And I do think that people, everyone, is going to be facing insurance with higher co-payments, higher deductibles, narrower networks but that’s going to be particularly a problem for poor people.

SHARMINI PERIES: Dr. Woolhandler, you essentially support a single-payer system and I suppose the organization you represent does as well.

What is it that you’re proposing that is directly in conflict to what the Republicans, or what Trump’s new administration, might have available for us to replace Obamacare?

STEFFIE WOOLHANDLER: Okay. Well, we have always advocated moving forward from the Affordable Care Act to Universal Coverage through a single-payer system. We advocated that all during the Democratic Administration and we continue to advocate for that now.

Of course, Republicans want to move backward to a system where the 20 million people who got coverage under Obamacare are being threatened. But we’re saying, “No, let’s build on Obamacare. Let’s move forward to a single-payer system.”

Single-payer is also known as “Improved Medicare for All” and that’s a simple public system like traditional Medicare, where everyone is automatically enrolled. Everyone is automatically covered from the day you’re born to the day you die.

You pay for the healthcare system out of taxes and then once you pay your taxes, you know, whether you pay them or not, frankly, but once you’re an American, you’re eligible to get your care at any doctor or hospital without co-payments or deductibles. That is not pie in the sky; that’s a kind of system that they have in other developed countries like Canada or Scotland, where everyone is covered for all medically-necessary care. They have complete free choice of doctor or hospital and they end up living longer and spending less than we do on care.

And, of course, that was the type of system that was advocated by Bernie Sanders during his presidential campaign. It’s a system that, you know, when you ask Americans in polls, more than half of them say, “That’s what I want. I want a Medicare for All-Type System”. And yet, we’re obviously not about to get that from the Republicans. We’re likely to see something like the Affordable Care Act only much meaner, much skimpier and much more expensive.

SHARMINI PERIES: Right. One of the things that I could not understand is apparently the crowd that Donald Trump appealed to was just ordinary people; working-class people, unemployed and so on.

So, when you look at his rallies and the kind of people he spoke to in those rallies, what is their opposition to the Affordable Care Act?

STEFFIE WOOLHANDLER: Well, the Affordable Care Act has come to be a symbol of the health-care status quo and the health-care status quo is completely unacceptable.

I mean, our organization says that: the high co-payments; the high deductibles; the narrow networks; the overall high costs that people face; the economic insecurity of having this fragmented private health insurance system — that is completely unacceptable. So, Trump said that, and actually Representative Ryan is saying that. When they talk about Obamacare, they talk about the high deductibles and co-payments.

Now that problem pre-dated Obamacare. Obamacare did not cause that. That was something that existed before. And yet the Obamacare legislation did not solve that problem.

You know, it did some good stuff. It gave health insurance to 20 million people. But there are 290 million other Americans — 91% of the population – who really got nothing out of Obamacare. They did not see their own coverage improve and they’re still facing these high co-payments and deductibles.

So, that’s what President-elect Trump spoke to among white, working-class people is the real unhappiness about real problems that persist in the health care system.

And, of course, the big mistake the Democrats made was by saying that they were going to defend the status quo and pretending that Obamacare had solved the problem when it really hadn’t. It helped a little bit but it had not solved the problem and the American people, you know, three years into the full implementation of Obamacare at the end of 2016 said, “That’s not true. You have not solved the problems. We have these problems” and President-elect Trump made it look like that was the fault of the Obamacare legislation.

What the Democrats needed to be saying then and need to be saying now is, “We are moving forward from Obamacare to truly universal care to single-payer plan;” that would have energized the electorate, that would have really provided something for white, working-class people and would have helped prevent this very disastrous swing of white, working-class families into the Trump, you know, the ranks of Trump voters.

I will add, though, as many of you know, affluent people did also vote for Trump and droves of traditional Republican constituencies all stuck with Trump despite his vulgar and racist statements and behavior.

SHARMINI PERIES: All right. So, this week we’ve seen a slew of hearings for the confirmation of Donald Trump’s cabinet and we are set to endure more of his agency’s picks over the next few weeks.

But the Department of Health and Human Services is going to Representative Tom Price with this appointment. What do you expect with his tenure? Does he have a certain track record in terms of this issue and, specifically, when it comes to say, Medicare, what can we expect?

STEFFIE WOOLHANDLER: Okay. Well, Tom Price has supported repeal of the ACA consistently. He has supported acceleration of the privatization of the Medicare program. We do have a partial privatization of the Medicare program already through the Medicare Advantage, but he wants to accelerate that through a full voucher system, where all you get from Medicare is a voucher and you have to add some of your own money and go out and buy private insurance with it. I’m not sure that he’s going to succeed with that voucher plan. The Republicans have been pushing the voucher plan for several decades and never really got much traction with it because it’s extremely unpopular with seniors.

But he’s likely to encourage this other method of privatization through the so-called Medicare Advantage Plans, which are private insurance companies that contract with Medicare to provide a full-Medicare package of benefits to Medicare enrollees. And the way he’ll do that is he’ll give more money to private insurance plans, more taxpayer money to private insurance plans. He’ll decrease some of the rules and regulations that are really consumer protections.

So, I do think he will further privatize Medicare. I’m not sure he’s going to get his voucher plan through.

I do want to say that Tom Price did train as a physician but he does not speak for the physician community. The majority of physician organizations have actually opposed him. Unfortunately, the AMA endorsed him. But most other physician organizations have opposed him. There will be thousands of physicians’ signatures opposing him.

And, in fact, polls are showing the majority of the physician community does endorse the idea of some form of non-profit national health insurance.

So, Tom Price, despite his training as a physician, does not represent the views of physicians. He represents the views of the extreme right-wing of the Republican Party.

SHARMINI PERIES: Right. While all these discussions are going on and the Democrats are coming across as big defenders of Obamacare and public health care, there is the question of whether Democrats will actually support legislation that would challenge both insurance giants and pharmaceutical companies and lead to a single-payer system, as you advocate.

In fact, earlier this week 13 Democrats, including New Jersey Senator Cory Booker, voted against legislation that would have permitted importation of drugs from Canada. This would have helped negotiate to lower drug prices.

What do you think the Democrats will do given the situation they are now going to be faced with? And will they actually end up doing what you say: move towards a single-payer system?

STEFFIE WOOLHANDLER: Well, the Democrats, like the Republicans, get a lot of their campaign contributions from corporate donors and two of the most powerful industries in the country are Big Pharma and Big Insurance.

So, the Democrats have been pretty meek, if you will, in not really wanting to confront Big Pharma and Big Insurance. Nonetheless, they have historically been better on these issues than the Republicans and certainly, Price and the Trump Administration is committed to making things easier on Pharma, on giving more money to Pharma, more money to the insurance giants at the expense of the American consumer.

I think that the Democrats are going to need to take a more aggressive stance toward protecting the American people from the profit-seeking behavior of Big Pharma and Big Insurance if they’re ever going to win back the White House. And I think, hopefully, they’ll see that. They’ll look at the lessons from the last election and realize that unless the Democrats can do something for the working class that actually improves the situation of working families; that makes their health care more affordable, that makes drugs more affordable, that makes them more secure economically. Unless the Democrats have a platform that does this, they’re not going to be able to win back over those traditional Democratic voters.

You know, and I do see some pretty hopeful signs on the horizon. For instance, Senator Sanders has been integrated into the Democratic leadership. Senator Elizabeth Warren’s role in the Democratic Party has been strengthened. Many of the actions that are planned around opposing the repeal of the Obamacare legislation include calls for moving forward to universal health care. We’ve heard those things from many senators and congressmen who, in the past, seemed like they were okay just defending the status quo in the form of the Affordable Care Act.

So, I do see signs that traditional Democrats and traditional Democratic constituencies will be moving toward a more, let’s say, aggressive stance to protecting the American people.

SHARMINI PERIES: All right, Dr. Steffie Woolhandler. I thank you so much for the great work that you’re doing on behalf of all of us. We look forward to having you back on The Real News.

STEFFIE WOOLHANDLER: My pleasure.

SHARMINI PERIES: And thank you for joining us on the Real News Network.

***

Dr. Steffie Woolhandler is professor at the CUNY School of Public Health at Hunter College and visiting professor of medicine at Harvard Medical School, where she co-directed the general internal medicine fellowship program and practiced primary care internal medicine at Cambridge Hospital.

Dr. Woolhandler earned her bachelor’s degree from Stanford University,  a medical degree from Louisiana State University, and a master’s degree from the University of California. She worked in 1990-1991 as a Robert Wood Johnson Foundation health policy fellow at the Institute of Medicine and the U.S. Congress.

Dr. Woolhandler is a frequent speaker and has written extensively on health policy, administrative overhead and the uninsured. She has authored more than 50 research articles on health care access and financing. A co-founder and board member of Physicians for a National Health Program, Dr. Woolhandler co-edits PNHP’s newsletter and is a principal author of PNHP articles published in the JAMA and the New England Journal of Medicine in conjunction with Dr. David Himmelstein.

http://therealnews.com…

Medicare coverage for all

By Thomas Clairmont, M.D.
Seacoastonline.com (Portsmouth, N.H.), Letters, Jan. 13, 2017

Your editorial on Jan. 9 stated “There is no health-care reform that will lower premiums, cut deductibles and increase choice all at the same time.”

That is totally untrue and it is embarrassing that such tripe should be presented to the public who are overpaying and underutilizing health care services.

Expansion of Medicare to cover every citizen comprehensively, equitably, affordably, with a lifetime portable policy, does indeed lower premiums, eliminates deductibles, and offers full choice of your doctor and hospital. In fact, no other plan can work. Every major country provides full lifetime coverage to all of their citizens at less than half of what we are paying in the United States. None permit the price gouging occurring today. None have bankruptcy related to medical care.

There are several plans readily available for review. Senator Sanders, who won 22 states and might have won if not for the chicanery of the DNC, presented his plan night after night to rousing audiences. You can read his ideas on his website or in his new book “Our Revolution.” University of Massachusetts Economics Professor Friedman argues that “Medicare for All saves billions.” Physicians for a National Health Program have their ideas encapsulated in HR 676. Every plan includes you fully for life and includes dental health and mental health and prescriptions.

Why hasn’t the media presented these ideas for your consideration?

Why do Democrats and Republicans oppose full coverage for all of their constituents?

Why wouldn’t you want to have a plan that costs less than 10 percent of your income for total coverage that is permanent?

Health care and its costs are on the minds of every citizen almost every day. Expanding Medicare to cover all of you makes sense to me. Apparently not doing it makes cent$ for those who don’t. What other reason is their opposition?

Dr. Thomas Clairmont resides in Portsmouth.

http://www.seacoastonline.com…

Less expensive and far better

By Suzanne Lindgren
The Osceola (Wis.) Sun, Jan. 13, 2017

In a trio of tweets last week, President-elect Donald Trump announced that he was ready for an improved plan for health insurance in America.

“The Democrats,” he wrote on Thursday, “lead by head clown Chuck Schumer, know how bad ObamaCare is and what a mess they are in. Instead of working to fix it, they do the typical political thing and BLAME. The fact is ObamaCare was a lie from the beginning. … It is time for Republicans & Democrats to get together and come up with a healthcare plan that really works — much less expensive & FAR BETTER!”

With all the international traveling Trump does, I’m sure he knows that a model for a much less expensive & FAR BETTER plan already exists: single payer.

Such a system would replace private insurance with a single fund to pay doctors and hospitals. Yes, that fund would probably be run by a government agency, but most countries with a single payer system also keep some aspects of private insurance.

I lived in Canada for a few years in my late teens and early twenties, and was always astounded by the ease with which Canadians visited the doctor.

They didn’t have to check to see whether the doctor they wanted to visit was included in their plan. They didn’t obsess over the potential bill and whether they could afford it. They didn’t fill out piles of paperwork to get coverage and then research which particular maladies were covered by their plan and which weren’t.

They just went.

I was jealous. I still am.

Our system is not only expensive, it’s confusing, time consuming, and diverts funds to a middleman who often seems to be trying to keep us from getting the benefits we pay for.

The average Canadian receives better care than the average American and, on the whole, their single-payer system costs less than our labyrinthine market of insurance providers.

This hit home after Strummer’s birth when I spent hours (what felt like several days’ worth) on hold and filling out forms to organize his insurance.

I was thankful I had a break from work to attend to the matter, but I would have much rather been focusing my attention on my child. It almost made it worse that I knew it didn’t have to be this way — and in many places, it isn’t.

My guess is you have your own story of frustration with the system we have in place. I don’t think many are happy with it.

In fact, a 2016 Gallup Poll found that a majority of Americans, 58 percent, were in favor of replacing the Affordable Care Act with a federally funded system.

Although Democrats were more likely to support the idea, with 73 percent in favor, a significant number of Republicans, 41 percent, were on board too.

That’s not entirely surprising. Although single-payer would mean an increase in taxes, it would be balanced by the elimination of premiums and out-of-pocket costs. For employers it seems like an even bigger win, with savings multiplied by the number of employees.

Single-payer — dubbed Medicare for All by proponents — may not be the system Trump has in mind, but it seems like a good time to voice support for a plan people want — one that’s proven itself to be “much less expensive & FAR BETTER” than what we have now.

I welcome your response to this editorial column: editor@osceolasun.com.

Suzanne Lindgren is editor of The Osceola Sun.

http://www.osceolasun.com…

ACA repeal will kill people

By Barbara R. Casper, M.D.
The Courier-Journal (Louisville, Ky.), Jan. 13, 2017

I am a physician who has cared for uninsured and underinsured patients for my entire 31 years of practice. In the past I have written editorials in support of the Affordable Care Act and with the likelihood of its repeal without a viable replacement I feel that I need to provide a voice for my patients who will be adversely affected by this change.

People need to understand that not having insurance kills people. I have seen this in my own practice prior to the ACA. I cared for a patient who refused to come to the doctor in spite of an obvious cancer until it was so advanced that there was little we could offer her but comfort care. She was too young for medicare, had to quit her job to care for an ailing husband and was concerned that they might lose their house if she incurred medical bills. She may have lost her house but sadly she did lose her life.

My personal experience with the implementation of the ACA is that patients can now afford their medications and their preventive care. This has resulted in many of my patients now having their chronic illnesses such as diabetes and hypertension under control. This has significant economic benefits to our communities in that the cost of catastrophic care for the consequences of these diseases left unchecked are much more expensive, not only in dollars spent but in suffering. My experience has been verified by a study published in JAMA Internal Medicine where a comparison of health care in Kentucky, Arkansas and Texas was completed. Kentucky and Arkansas both expanded medicaid while Texas did not. The results indicate that in Kentucky and Arkansas the number of emergency room visits decreased, the visits to primary care physicians increased as did compliance with medications. This was in contrast to Texas where patients are still obtaining their health care through the emergency department. This is what the law was intended to do.

This is not a perfect law – some folks did not benefit from the expansion of Medicaid or the subsidies and now have higher deductibles and limited options for plans. The law could be improved but the Republicans have focused so much on the repeal that nothing has been accomplished. It is interesting that now that they have the votes to actually repeal the law, no viable replacement has been discussed. They have had seven years to develop their own plan. My own personal opinion is that a single-payer system – Medicare for all would be the best possible replacement.

A recent poll indicated that only 20 percent of the public is in support of the repeal of the ACA. For me, this is NOT a political issue – it is an issue of caring for my patients. I have had many discussions with patients in my office recently who are concerned about losing their insurance and I have difficulty reassuring them. I will continue to care for them – it seems to me that our elected officials do not.

Barbara R. Casper, M.D., is a professor of medicine at the University of Louisville.

http://www.courier-journal.com…

High premiums in non-group insurance markets

Identifying Causes and Possible Remedies

By Linda J. Blumberg and John Holahan
Urban Institute, January 2017

The Issue

The authors note that premiums are not high in all areas, and that many areas with large recent premium increases reflect needed corrections to very low premiums in the early years of reform. However, in sources with high premium levels, the causes differ, as should appropriate solutions.

Key Findings

The first potential problem is that sicker people are more likely to enroll in marketplace plans;

The second, premiums tend to be higher if an insurer or provider group has a monopoly in their area; and

Third, inadequate risk adjustment, i.e., moving premium dollars from insurers with low-cost enrollees to insurers with high-cost enrollees, may also be a factor leading to high premiums in some areas.

Conclusion

Marketplaces in many areas throughout the United States have experienced high premiums and insurer attrition for the 2017 plan year. In this brief, we identify three potential sources of these difficulties, not all of which exist in all markets, and we emphasize that some markets continue to work competitively and without any significant difficulties.

First, some ACA-compliant nongroup insurance markets have enrolled a population with above-average health care risks relative to a broad cross section of the nonelderly population (e.g., the population enrolled in employer-based insurance). In these cases, above-average claims have led to high and increasing premiums and losses for some insurers that were large enough to force them out of the market. Second, some markets have high insurer and/or provider concentration. The exercise of monopoly or near-monopoly power in these markets can lead to high provider payment rates and high premiums. Third, in some markets, the risk-adjustment system may not have sufficiently shared health care risk across insurers within the nongroup insurance market, either moving too much money away from lower-cost insurers or moving too little money toward higher-cost insurers. In such cases, insurers may have increased premiums to compensate for their losses. An inadequate risk-adjustment system could also induce all insurers in a market to increase premiums because they fear that they may be selected against but not receive appropriate compensation through the risk-adjustment mechanism.

In this paper, we argue that each problem requires a different approach. Some policies may be implemented in some states and substate areas and not in others. However, a more uniform national strategy could incorporate a range of policies that collectively could address all these problems, with policies designed to be binding only in the specific areas where they are warranted. Because different markets have different problems, some policy solutions will be essential in some markets and have little or no impact in others. Implementing these policies nationally would obviate the need to design and legislate policies on an ongoing basis as market conditions change over time.

To address the problem of low enrollment and adverse selection against the entire nongroup market in an area, first, we suggest a significant increase in outreach and enrollment assistance and more generous premium tax credits and cost-sharing assistance. Second, penalties for not obtaining health insurance may also be increased, once coverage is made more affordable with increased financial assistance. Third, there should be a permanent reinsurance program funded from a broad-based source (e.g., general revenues or a tax on all insurance plans and stop-loss plans sold to self-insuring employers) that would subsidize nongroup insurance market plans with extremely high claims (e.g., $1 million or more).

Fourth, there should be increased regulation of sales of non-ACA-compliant nongroup insurance products (e.g., short-term policies, disease-specific policies, indemnity plans). These products are most attractive to those in relatively good health. Phasing them out, eliminating them entirely, or assessing them in order that they share in the risk of the ACA compliant market, will make individuals more likely to purchase ACA compliant plans and improve the risk pool. Finally, fixing the family glitch and lowering the Medicaid eligibility threshold to 100 percent of the FPL would also increase marketplace enrollment while improving the private nongroup insurance pools’ risk profiles.

In principle, the problems of insurer and provider concentration could be solved with a public insurance option, but this would be extremely difficult to implement. For starters, the government would have to develop a large new organization, and the approach is certain to face opposition from the insurance industry. An alternative that could be more politically palatable (at least to insurers) is a cap on provider payment rates paid by any ACA-compliant nongroup insurer within a particular market (e.g., Medicare plus some percentage). Insurers could develop networks at lower provider payment rates, but providers would be prohibited from charging nongroup insurers above the statutory limit. This would be more attractive than a public option to insurers, though many providers would probably be opposed to any legislation limiting their payment rates (even though these limits would apply to the fairly small population enrolled in nongroup coverage). In markets where provider payment rates are already low (e.g., those with high levels of competition), this policy would have little or no effect. But it could have a significant effect in markets where few insurers compete or where providers have significant market power and insurers have little or no negotiating leverage.

Problems with the risk-adjustment mechanism may persist even after CMS implements improvements in 2017. The inclusion of prescription drug use in the risk-adjustment formula is a step in the right direction. Other improvements are beyond the scope of this paper and require additional research. However, we believe the approach proposed by the Obama administration for 2018, which would add a reinsurance-type component for insurers incurring extremely high claims in a given year, could be very helpful.

Ideally, the federal government would adopt an array of these policies and apply them nationwide. As noted above, not all would be binding in all markets in any particular year. But implementing each policy on an as-needed basis in each particular time and place would leave the overall program vulnerable to political challenges, market instability, and logistical delays. However, in the face of federal inaction, individual states could choose to implement the specific policies that apply to them. These mechanisms should lead to increased enrollment, a fairer distribution of risk among insurers, greater insurer participation in ACA-compliant nongroup markets, more stable risk pools, and more predictable increases in premiums year to year.

http://www.rwjf.org…

Full report (9 pages):
http://www.rwjf.org…

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Comment:

By Don McCanne, M.D.

Linda Blumberg and John Holahan explain why premiums in non-group insurance markets can be high, and they suggest policies that can improve the stability of premiums. The proposals would increase the administrative complexity in our system when we are already tremendously overburdened with administrative excesses, and, further, they are designed to protect the private insurance industry – an approach in which providers and patients are considered a nuisance which must be accommodated to benefit the insurers.

The key findings – adverse selection, insurer or provider monopolies, and inadequate risk adjustment – would not be issues under a well designed single payer national health program. Our policy community is well meaning when they try to fix the the serious faults with our fragmented, dysfunctional financing system, but they do a disservice to all of us when they continue to exclude the single payer model from their policy briefs.

What would states do with greater flexibility through Medicaid block grants?

Both State, Feds May Seek Changes To Medicaid

By Shamane Mills
Wisconsin Public Radio, January 11, 2017

Wisconsin hopes to change Medicaid in several ways. The Walker administration would like participants to undergo drug testing, charge smokers more and put time limits on how long people could use Medicaid.

Gov. Scott Walker’s entitlement reforms come as top Republicans in Washington, D.C. are pushing for states to get federal block grants they could spend as they wish on Medicaid.

http://www.wpr.org…

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Missouri lawmakers seek to convert Medicaid to block grant

By David A. Lieb, AP
St. Louis Post-Dispatch, January 11, 2017

Not waiting for President-elect Donald Trump to act first, some Missouri Republican lawmakers are pressing for a health care overhaul that could convert the state’s Medicaid program into a block grant from the federal government.

Missouri Sen. David Sater said the state’s more than $9 billion Medicaid program — called MO HealthNet — is beset by “runaway spending” and lacks “personal accountability and responsibility.”

The Missouri legislation seeks to address that by requesting federal approval for the block grant to be adjusted for inflation, growth in the Medicaid rolls and other economic and demographic factors. It also seeks approval to potentially implement work requirements for able-bodied Medicaid enrollees and to require co-payments, premiums or health savings accounts for patients to “reward personal responsibility.”

http://www.stltoday.com…

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Comment:

By Don McCanne, M.D.

There are two main reasons that the Republicans want to convert Medicaid to block grants for the states. Instead of paying a percentage of Medicaid costs, block grants can be set at an amount of payment that is lower and that does not increase at the same rate as health costs, thus shifting Medicaid costs from the federal government to the states. Also, the states are given much greater leeway on how the block grant funds can be spent, reducing federal regulatory oversight.

Many state governments are concerned about the reduced funding that would be available for health care for the low-income sector. Most states operate on very tight budgets and would have difficulty assuming a significantly greater proportion of the costs. Some states simply do not have an adequate tax base that would support the needs of these individuals. Federal funding is much more equitable and egalitarian.

Granting greater leeway on how the Medicaid funds would be spent is very appealing to state ideologues. There is a push today to require greater personal responsibility through policies such as drug testing, penalizing smokers, failure to meet work requirements, requiring financial responsibility through premiums, cost sharing, and required contributions to health savings accounts in this population that has no discretionary income, and perhaps ejecting individuals from the program simply because they have been on it long enough.

These politicians seem to look upon Medicaid beneficiaries as people who are less  deserving because of their welfare status that they believe is due to their own volition. They believe that simply requiring more personal responsibility is the solution, except for those more severely handicapped. Most health professionals who work with these patients know differently and understand why they qualify for Medicaid.

But think of how it would be under a single payer national health program. Everyone would receive essential health care services regardless of socioeconomic status. The politicians certainly expect to have their care when they need it. Why shouldn’t everyone have the same expectation?

Social risk factors and performance measurements

Report to Congress: Social Risk Factors and Performance Under Medicare’s Value-Based Purchasing Programs

United States Department of Health and Human Services
Office of the Assistant Secretary for Planning and Evaluation, December 2016

Background

There is growing recognition that social risk factors – such as income, education, race and ethnicity, employment, community resources, and social support – play a major role in health. Despite ongoing efforts, significant gaps remain in health and in life expectancy based on income, race, ethnicity, and community environment.

At the same time, the health care system is increasingly moving towards higher levels of provider accountability for the quality, outcomes, and costs of care. Value-based or alternative payment models, which tie payment to the quality and efficiency of health care delivered, are in place in nearly all Medicare settings, including in hospitals, outpatient settings, and post-acute facilities.

These two issues are intersecting. If beneficiaries with social risk factors have worse health outcomes because the providers they see provide low-quality care, value-based purchasing could be a powerful tool to drive improvements in care and reduce health disparities. However, if beneficiaries with social risk factors have worse health outcomes because of elements beyond the quality of care provided, such as the social risk factors themselves, value-based payment models could do just the opposite. If providers have limited ability to influence health outcomes for beneficiaries with social risk factors, they may become reluctant to care for beneficiaries with social risk factors, out of fear of incurring penalties due to factors they have limited ability to influence.

This report, mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014 or the IMPACT Act (P.L. 113-185), shares empirical analysis using existing Medicare data to help address these questions and provides considerations for policymakers while additional work using other data sources continues.

Findings

FINDING 1: Beneficiaries with social risk factors had worse outcomes on many quality measures, regardless of the providers they saw, and dual enrollment status was the most powerful predictor of poor outcomes.

FINDING 2: Providers that disproportionately served beneficiaries with social risk factors tended to have worse performance on quality measures, even after accounting for their beneficiary mix. Under all five value-based purchasing programs in which penalties are currently assessed, these providers experienced somewhat higher penalties than did providers serving fewer beneficiaries with social risk factors.

Strategies and Considerations

STRATEGY 1: Measure and Report Quality for Beneficiaries with Social Risk Factors

Consideration 1: Consider enhancing data collection and developing statistical techniques to allow measurement and reporting of performance for beneficiaries with social risk factors on key quality and resource use measures.

Consideration 2: Consider developing and introducing health equity measures or domains into existing payment programs to measure disparities and incent a focus on reducing them.

Consideration 3: Prospectively monitor the financial impact of Medicare payment programs on providers disproportionately serving beneficiaries with social risk factors.

STRATEGY 2: Set High, Fair Quality Standards for All Beneficiaries

Consideration 1: Measures should be examined to determine if adjustment for social risk factors is appropriate; this determination will depend on the measure and its empirical relationship to social risk factors.

Consideration 2: The measure development community should continue to study program measures to determine whether differences in health status might underlie the observed relationships between social risk and performance, and whether better adjustment for health status might improve the ability to differentiate true differences in performance between providers.

STRATEGY 3: Reward and Support Better Outcomes for Beneficiaries with Social Risk Factors

Consideration 1: Consider creating targeted financial incentives within value-based purchasing programs to reward achievement of high quality and good outcomes, or significant improvement, among beneficiaries with social risk factors.

Consideration 2: Consider using existing or new quality improvement programs to provide targeted support and technical assistance to providers that serve beneficiaries with social risk factors.

Consideration 3: Consider developing demonstrations or models focusing on care innovations that may help achieve better outcomes for beneficiaries with social risk factors.

Consideration 4: Consider further research to examine the costs of achieving good outcomes for beneficiaries with social risk factors and to determine whether current payments adequately account for any differences in care needs.

Conclusions

Social factors are powerful determinants of health. In Medicare, beneficiaries with social risk factors have worse outcomes on many quality measures, including measures of processes of care, intermediate outcomes, outcomes, safety, and patient/consumer experience, as well as higher costs and resource use. Beneficiaries with social risk factors may have poorer outcomes due to higher levels of medical risk, worse living environments, greater challenges in adherence and lifestyle, and/or bias or discrimination. Providers serving these beneficiaries may have poorer performance due to fewer resources, more challenging clinical workloads, lower levels of community support, or worse quality.

The scope, reach, and financial risk associated with value-based and alternative payment models continue to widen. There are three key strategies that should be considered as Medicare aims to administer fair, balanced programs that promote quality and value, provide incentives to reduce disparities, and avoid inappropriately penalizing providers that serve beneficiaries with social risk factors. Measuring and reporting quality for beneficiaries with social risk factors, setting high, fair quality standards for all beneficiaries, and the provision of targeted rewards and supports for better outcomes for beneficiaries with social risk factors, may help ensure that all Medicare beneficiaries can achieve the best health outcomes possible.

Next Steps

The findings outlined in this report represent only the beginning of a body of necessary work around fair and accurate quality measurement in the context of Medicare’s increasing use of value-based purchasing programs. The IMPACT Act lays out specific additional requirements for Study B, including the examination of specific social risk factors not currently available in Medicare data such as health literacy, limited English proficiency, and Medicare beneficiary activation (the degree to which beneficiaries have the knowledge, skill, and confidence to manage their health and health care). Based on the findings in this report, future work may also include examining the impact of measuring and accounting for functional status or frailty on the relationship between social risk factors and performance, and identifying care innovations associated with the achievement of good health outcomes for beneficiaries with social risk factors.

Full report (374 pages):
https://aspe.hhs.gov…

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Comment:

By Don McCanne, M.D.

One of the problems with the various pay-for-performance schemes is that social risk factors play a major role in health care outcomes. Dedicated physicians and hospitals who take care of patients with greater social risks tend to be penalized for factors over which they have no direct control. This 374 page ASPE report was generated at the request of Congress to define this problem and consider solutions.

Skim reading this report leads to the conclusion that the approach to evaluating the role of social risk factors in payment systems using value-based purchasing, alternative payments models and other forms of payment innovation results in profound administrative complexity, with all of its waste, and yet it is still not very effective in correcting payment injustices. And this 374 pages is only the bare beginning of a “a body of necessary work around fair and accurate quality measurement in the context of Medicare’s increasing use of value-based purchasing programs.”

We continue to head down the wrong path. Our target should be to establish universality in health care while financing the system equitably with a system that reduces administrative waste. Instead you would think, based on the responses of the policy community and government bureaucrats, that the problem is that we do not have enough administrative oversight, so they propose more and more and more!

Instead we should reduce administrative waste by establishing a single payer national health program and improve value through global budgets, negotiated payment rates, and administered pricing, plus separate budgeting of capital distribution and system capacity. The latter should help to improve care for patients with higher social risk factors, though we do need to improve social programs that would better address the fundamental factors resulting in otherwise amenable social risks.

Politicians ignore Medicare for all

By F. Douglas Stephenson, LCSW
Gainesville (Fla.) Sun, Jan. 11, 2017

In the current Affordable Care Act debate, the mainstream media has ignored a solution standing in plain sight. It is a more efficient and affordable system for universal coverage in the public interest: single-payer national health insurance. Instead, we are being led by politicians beholden to big-money interests serving the greed of today’s medical-industrial-Big Pharma-Big-Insurance complex.

The Republicans want to repeal much of the ACA and replace it with something similar. The Democrats want to preserve ACA pretty much as it is. From the global perspective, we’ll still be left with a highly dysfunctional health care financing system that will not cover everyone while perpetuating inadequate coverage for many of those who are insured.

Our health-care financing system is still in shambles. Tens of millions remains uninsured. The insured have increasing difficulties in obtaining care in the narrow provider networks, while facing financial hardship because of the insurers shifting ever-more risk onto the patients. Both political parties want to make this a choice between protecting the shambles versus making them even worse through Republican replacement policies that would further weaken health-care coverage.

The true replacement choice needs to be between accepting or tweaking a system in shambles or moving on to a well-designed single payer system — an improved Medicare for all that would provide affordable, accessible health care for everyone.

The ACA could be replaced by a publicly financed national health insurance program like the one outlined in H.R. 676, a bill filed in the last Congress. This legislation would fully cover health/medical care for all Americans, and significantly lower costs by eliminating the private health insurance industry with its massive overhead and immense profits.

H.R. 676, “The Expanded & Improved Medicare for All Act,” would establish a unique American universal health insurance program with single-payer financing. The bill would create a publicly financed, privately delivered health care system that improves and expands the existing Medicare program to all U.S. residents, and all residents living in U.S. territories.

The goal of the legislation is to ensure that all Americans will have access, guaranteed by law, to the highest quality and most cost effective health care services regardless of their employment, income or health care status. In short, health care becomes a fundamental human right, with no financial barriers or financial harm resulting from seeking care.

With at least 20 million uninsured Americans, and many millions more who are underinsured, the time has come to change our inefficient and costly fragmented non-system of health care. The current for-profit health care system in the U.S. is not financially sustainable over the long run, hence the need for a unique nonprofit, universal single-payer health care system.

University of Massachusetts economics professor Gerald Friedman estimates that under the single-payer system created by H.R. 676, “the U.S. could save an estimated $592 billion annually by slashing the administrative waste associated with the private insurance industry ($476 billion) and reducing pharmaceutical prices to European levels ($116 billion).”

He wrote that in 2014, the savings would have been “enough to cover all 44 million uninsured and upgrade benefits for everyone else. No other plan can achieve this magnitude of savings on health care. Specifically, the savings from a single-payer plan would be more than enough to fund $343 billion in improvements to the health system such as expanded coverage, improved benefits, enhanced reimbursement of providers serving indigent patients, and the elimination of co-payments and deductibles in 2014.”

A Medicare-for-all system would vastly simplify how the nation pays for care; improve patient health; restore free choice of physician, mental health and other health professionals; eliminate co-pays and deductibles; and yield substantial savings for individuals, families and the national economy.

As Dr. Robert Zarr, past president of Physicians for a National Health Program, a nonprofit research and educational group of 20,000 doctors nationwide, said: “The global evidence is very clear: single-payer financing systems are the most equitable and cost-effective way to assure that everyone, without exception, gets high-quality care.”

F. Douglas Stephenson, LCSW, LMFT, BCD, is a retired clinical social work psychotherapist in Gainesville.

http://www.gainesville.com…