PNHP

Health Care for All Colorado will try for 2014 ballot with universal, single-payer plan

Health Care for All Colorado will try for 2014 ballot with universal, single-payer plan

By Michael Booth
The Denver Post, Daily Dose blog, May 21, 2013

Health Care for All Colorado will shoot for a 2014 statewide ballot vote rather than 2013, supporters have decided.

The progressive cause has launched an education effort across the state, but decided to take the extra year to gather support and earn enough of the tens of thousands of signatures it would need to make the ballot, said director Donna Smith.

One of the group’s slogans is that health care is a right, not a commodity. Most supporters are backers of “Obamacare” reforms passed by Congress in 2010, but argue they don’t go far enough to guarantee health care to all citizens. In Colorado alone, hundreds of thousands of people will remain without health insurance because of gaps left in undocumented residents, workers changing jobs, and those who risk a penalty in refusing to buy insurance.

Health Care for All would put a payroll tax on all residents according to their income and asset levels. It would also ask Medicare and Medicaid, which use federal and state dollars to pay for more than a million state residents, to issue waivers allowing their funds to be pooled with the health care tax. A single administration would then make payments to health care providers like doctors and hospitals, on a common set of benefits.

A separate effort for a somewhat similar system was dropped in this past Legislature by Sen. Irene Aguilar of south Denver, a Democrat who also believes Obamacare did not go far enough. Because she wanted the Legislature to refer the issue to voters, Aguilar would have needed a two-thirds vote, including highly reluctant Republicans. She apparently was not able to win that extra support.

http://blogs.denverpost.com/health/2013/05/21/health-care-for-all-colorado-will-try-for-2014-ballot-with-universal-single-payer-plan/3249/

10,000 signatures for universal health care

By Tanique Williams
Legislative Gazette (Albany, N.Y.), May 21, 2013
   
New Yorkers from across the state — including hundreds of doctors, nurses, patients, labor unions, community organizations, faith groups, and seniors — delivered 10,000 signatures supporting a single-payer health care bill sponsored by Assemblyman Richard Gottfried, D-Manhattan, and Sen. Bill Perkins, D-Harlem.

The press conference was coordinated with Healthcare-NOW NYC, Hunger Action Network of New York State, Physicians for a National Health Program (New York Metro chapter), Single Payer New York, and Statewide Senior Action.

“These signatures are a testament to the dedication of New Yorker all across this great state to reach out to members of their communities and help build the grassroots movement it will take to make healthcare a human right in New York,” said Katie Robbins, an organizer with Healthcare-Now.

The New York Health bill (A.5389-a/S.2078-a) —”an act to amend the public health law and the state finance law”— would expand health coverage to all New Yorkers regardless of age, income, or employment status, and would control costs by implementing a single-payer, universal healthcare system, its supporters say.

The bill has 74 co-sponsors in Assembly and 17 in the Senate.

“The affordable care act has made some important improvements in how we organize and pay for health care in this country but it still leaves us and our health care, and our wallets, in the hands of insurance companies—with their premiums, and their administrative costs, and deductibles, and co-pays, and limited network, and denials of payment for the care we need. We can do better and New York can do better,” said Gottfried, chair of the Assembly Health Committee.

“President Obama during [his] campaign said that no American should have to spend their golden years at the mercy of insurance companies, and I agree with that, but I want to know why that is only for golden years. We can get better health care, more affordable health care, more fairly paid for, for every single New Yorker if we enact the New York Health bill to provide universal, publicly sponsored, publicly funded, single-payer health coverage. We want to get this bill to the floor of the Assembly this year for a vote,” he said.

Under the legislation, there would be no premiums, co-payments, or deductibles, and coverage would be publicly funded. Advocates said they would like to see the bill passed in the Assembly, in the Senate, and signed by the governor.

Perkins began his speech with a call and response of “you’re heath is your wealth.”

“We not only want to get [the New York Health bill] passed in the Assembly, we also want to get it passed in the Senate, and most importantly, we want the governor to sign the bill. In fact if we could, we would ask the governor to advocate [and] make sure it gets passed in the Assembly; to advocate [and] make sure it gets passed in the Senate; to be standing there with us so that our wealth, our health, is not compromised,” Perkins said.

New York Hunger Action Network Executive Director Mark Dunlea said health care costs are “one of the three big bills” that send people to emergency food programs.

“When Massachusetts enacted their insurance mandate, many low-income residents found they had less access to health care services. It is immoral that the rich country in the world still refuses to treat health care as a basic human right, even while we spend far more money on health care per capita than countries with universal access,” Dunlea said.

The 10,000 signatures were delivered to the offices of Gov. Andrew Cuomo, Senate Republican Leader Dean Skelos, R-Rockville Centre, Independent Democratic Conference head Sen. Jeff Klein, D- Bronx, and Assembly Speaker Sheldon Silver, D-Manhattan.

http://www.legislativegazette.com/Articles-Top-Stories-c-2013-05-21-83855.113122-10000-signatures-for-universal-health-care.html

Some unions protest Obamacare’s impact on multiemployer health plans

By Kay Tillow
Firedoglake, May 21, 2013

The Affordable Care Act (ACA) of 2010, also known as Obamacare, presents challenges to the  multiemployer plans through which some unions bargain collectively to provide health care insurance for their members. These plans, often called Taft-Hartley plans, currently cover about 26 million workers, families, and retirees. Unless there is a major regulatory change made by Health and Human Services, these union negotiated plans will be struck a harsh blow once the exchanges go into effect in 2014.

A quiet effort by many unions to persuade the Obama administration to make this change is now becoming very public.

In an op-ed published in The Hill, Joseph T. Hansen, president of the United Food and Commercial Workers (UFCW), said:

“But as currently interpreted, the ACA would block these plans from the law’s benefits (such as the subsidy for lower-income individuals and families) while subjecting them to the law’s penalties (like the $63 per insured person to subsidize Big Insurance). This creates unstoppable incentives for employers to reduce weekly hours for workers currently on our plans and push them onto the exchanges where many will pay higher costs for poorer insurance with a more limited network of providers. In other words, they will be forced to change their coverage and quite possibly their doctor. Others will be channeled into Medicaid, where taxpayers must pick up the tab.

“In addition, the ACA includes a fine for failing to cover full-time workers but includes no such penalty for part-timers (defined as working less than 30 hours a week). As a result, many employers are either reducing hours below 30 or discontinuing part-time health coverage altogether. This is a cut in pay and benefits workers simply cannot afford. For example, a worker making $10 an hour that has his or her schedule cut by six hours a week would lose $3,100 a year in income. With millions of workers impacted, this would have a devastating effect on our economy.”

The effort of unions to persuade the Obama administration to change the regulations in order to resolve the problems was reported in the Jan. 30 edition of The Wall Street Journal.

“Top officers at the International Brotherhood of Teamsters, the AFL-CIO and other large labor groups plan to keep pressing the Obama administration to expand the federal subsidies to these jointly run plans, warning that unionized employers may otherwise drop coverage.”

“We are going back to the administration to say that this is not acceptable,” said Ken Hall, general secretary-treasurer for the Teamsters, according to the WSJ article.

Many unions have been working through the National Coordinating Committee for Multiemployer Plans (NCCMP) to find a solution. In a memorandum to the Department of Health and Human Services, the NCCMP stated:

“If subsidies are available only for plans purchased through Exchanges, employers contributing to multiemployer plans will face tremendous economic pressure to stop contributing to multiemployer plans. … Many employers will feel the need to drop coverage and access the subsidies to remain competitive.”

On April 16, the United Union of Roofers, Waterproofers and Allied Workers International President Kinsey M. Robinson issued a statement calling for a repeal or complete reform of President Obama’s Affordable Care Act. He stated that the union has supported President Obama for both terms in office but that the union’s concerns “over certain provisions in the ACA have not been addressed, or in some instances, totally ignored.

“In the rush to achieve its passage,” Robinson continued, “many of the Act’s provisions were not fully conceived, resulting in unintended consequences that are inconsistent with the promise that those who were satisfied with their employer sponsored coverage could keep it. These provisions jeopardize our  multiemployer health plans, have the potential to cause a loss of work for our members, create an unfair bidding advantage for those contractors who do not provide health coverage to their workers, and in the worst case, may cause our members and their families to lose the benefits they currently enjoy as participants in  multiemployer health plans.”

The Cornell University Industrial and Labor Relations School recently held a special workshop on “The Affordable Care Act: Impact on Multiemployer Plans.” The materials from that educational event are available here.

So far there is no adequate answer from the Obama administration to the efforts of unions to resolve the issues. The state exchanges must be in place by October of 2013 so that they are ready to go by Jan. 1, 2014.

Many of the unions involved contend that regulations for the ACA could be written to allow the employers that pay into these union negotiated plans to receive the same subsidies that employers will receive in the exchanges. So far, that has not happened.

This is one of many conundrums that face unions as the costs of health care in our corporate-controlled, profit-oriented system make the maintenance of health benefits increasingly difficult to achieve.

This growing crisis underlines the need for unions to press for passage of H.R. 676, Expanded and Improved Medicare for All, national single-payer health insurance. H.R. 676 has been reintroduced by Congressman John Conyers, D-Mich., into the 113th Congress and has 42 co-sponsors. This real solution awaits a dynamic, massive, in-the-streets movement that makes sound health policy also politically feasible.

Such a solution would improve the lives of all workers by assuring that everyone has all medically necessary care with no co-pays and no deductibles. Even dental care and long-term care are covered.

Private for-profit health insurance companies and the massive waste they cause would be removed. Unions would free their health care from corporate control as labor has done in other industrialized countries where some form of publicly funded single-payer care is guaranteed. Care would be expanded and costs brought under control. By leading this fight for universal care, unions would once again prove that social justice can be achieved through the leadership of the nation’s organized workers.

With all of labor harmed by the attacks in Wisconsin, the “right to work for less” in Michigan and Indiana, a host of Koch-sponsored legislation in states across the country, and the brutal assault on pensions, what better way to fight back than to use labor’s vast grassroots mobilizing clout to promote H.R. 676?

The union movement will grow as it leads this vital struggle. Labor has always led progress for workers, and that progress also lifts up the nation.

http://my.firedoglake.com/kaytillow/2013/05/21/some-unions-protest-obamacares-impact-on-multiemployer-health-plans/

Does Medicare Overpay Private Plans? The Debate Heats Up

By John Wasik
Medicare NewsGroup, May 21, 2013

The debate on whether Medicare Advantage (MA) is reducing health care costs is intensifying.

A recently released analysis of government data by America’s Health Insurance Plans (AHIP), the main health insurance lobby, found that seniors enrolled in MA plans in California and Nevada had better health outcomes than patients enrolled in Traditional Medicare.

The group, in examining data from the Agency for Healthcare Research and Quality (AHRQ), claims that MA patients had fewer readmissions and overall days in the hospital and better control of diabetes and dehydration than Traditional Medicare patients. AHIP said their study revealed that, as compared to Traditional Medicare:

* Hospital days were reduced by 30 percent in California and 23 percent in Nevada for Medicare Advantage beneficiaries;
* MA readmissions in the same quarter for the same condition were 15 percent less in California and 33 percent less in Nevada;
* In both states, MA seniors were 6 percent less likely to be admitted to the hospital for conditions described by AHRQ as “potentially avoidable,” such as dehydration, urinary tract infection, or uncontrolled diabetes;
* MA patients spent an average of 18 percent fewer days in the hospital and had an average of 27 percent fewer visits to the emergency room;
* MA beneficiaries experienced a 42 percent lower rate of hospital readmissions; and
* MA beneficiaries had 13 percent fewer avoidable admissions.

The AHIP study comes on the heels of several government findings that MA is actually proving to be more expensive than Congress intended. In March, a MedPAC report stated that MA cost about 14 percent more person than Traditional Medicare. The Congressional Budget Office has estimated that Medicare will spend more than $54 billion more for MA payments than what it spends for fee-for-service care.

Private insurers currently serve about 27 percent of Medicare recipients. Instead of running a fee-for-service model, they employ managed care and often offer more covered services than Traditional Medicare. The current MA program started in 2003 with the Medicare Modernization Act; before that law, there were Medicare HMOs. The theory behind introducing managed care to Medicare was that closer attention to patients with chronic diseases and a capping of provider expenses would lower overall costs.

GAO Report Found Overpayments

Earlier this year, Bloomberg reported that Medicare was considering an $11 billion cut in MA payments but that it was rebuffed after an intense, faux grassroots lobbying effort by the health insurance industry. That was after the Government Accountability Office (GAO) discovered that MA providers were overpaid by up to $5 billion from 2010 to 2012. The GAO, criticizing Medicare’s “risk scores” for calculating payments, presented the findings to the Centers for Medicare & Medicaid (CMS), which did not comment.

The health insurance industry, represented by AHIP, welcomed the rate-cut rescission. In a statement, Karen Ignani, AHIP president, said:

“By being responsive to the more than 160 members of Congress from both parties who raised concerns about the impact of the proposed payment rate on seniors, CMS has taken an important step to help stabilize Medicare Advantage at a time when the program is facing significant challenges. We are currently reviewing the final rate announcement and will continue to work with policymakers in both parties to strengthen this critically important part of Medicare that provides high-quality, affordable coverage to more than 14 million   seniors and people with disabilities.”

AHIP had argued that trimming MA subsidies would have hurt beneficiaries by cutting benefits and raising premiums from $50 to $90 per month. In mounting a multistate, multimedia campaign, AHIP persuaded more than 40,000 MA recipients to call Congress to oppose the cuts.

New Study Charges Overbilling

On the other side of the MA debate, a physicians’ group is charging that MA providers are overbilling. According to a recent study by Physicians for a National Health Program (PNHP), a Chicago-based group advocating for a single-payer health system, Medicare overpaid private carriers $282 billion between 1985 and 2012. The group studied payments to Medicare Advantage insurers and predecessors.

The PNHP study claims that managed care has resulted in excessive billing to Medicare that pays private insurers based on estimated annual costs per patient, which was around $10,000 in 2012. But the study’s authors assert that the insurers have consistently found ways to game the system, including:

* The selective enrollment of healthier beneficiaries before 2004, or what PNHP calls “old cherry-picking.” Under the previous payment formula that was in effect until 2004, Medicare paid private plans a premium that was risk-adjusted only for a few demographic factors, such as age, gender, disability, Medicaid eligibility (a proxy for poverty), and whether an enrollee resided in a nursing home. Hence a healthy 70-year-old man would be charged the same premium as his sicker 70-year-old neighbor. Private plans used marketing, benefit design, enrollment office location, and other techniques to recruit the healthier and discourage  the sicker seniors from enrolling.
* Gaming of Medicare’s more complex risk-adjustment scheme, known as Hierarchical Condition Categories (HCCs). Since 2004, private plans have been selectively enrolling beneficiaries with very mild cases of the medical conditions included in the HCC risk-adjustment formula. Such patients have, on average, substantially lower costs than the risk-adjusted premium payment that Traditional Medicare pays the private plan on their behalf. PNHP refers to this as “new cherry-picking.”
* Congressionally mandated overpayments included in the 2003 Medicare Modernization Act (MMA), such as duplicate payments for indirect medical education. The provisions that generated these overpayments were tacked onto the MMA after heavy lobbying by the private insurance industry.
* Bonus payments from the $8.3 billion CMS Medicare Advantage Quality Bonus Payment Demonstration, an expansion of the $3 billion in quality bonuses contained in the Affordable Care Act (ACA). This demonstration awards bonuses to plans covering more than 90 percent of MA beneficiaries and offsets more than one-third of the cuts to MA overpayments mandated by the ACA between 2012 and 2014. According to the GAO, the demonstration is so poorly designed that it will generate almost no useful findings to improve quality.
* Duplicate payments for private plan members who receive all or part of their care at Veterans Health Administration facilities. Medicare pays the private plan a full premium payment no matter how much of a patient’s care is delivered (and paid for) by the Veterans Affairs (VA). In an extreme case, a senior might receive all care at a VA, making the premium given to the private plan pure profit. In 2009, 8.3 percent of all MA enrollees were enrolled in the VA.

How will the CMS act on the GAO and PNHP reports? Will it seek a further revision in its MA payment program? Or will it defer action indefinitely? At the very least, the Department of Health and Human Services Office of Inspector General should examine the payments and provide another level of oversight.

If government auditors verify the PNHP’s claims, it may undermine calls to further privatize the system. What if insurers are deliberately recruiting younger, healthier recipients into their plans? How then do MA beneficiaries compare to the general Medicare population? What do these MA plans spend on marketing?

Given the growing toxic environment in Washington and the fact that MA has become a political football, it’s unlikely t
hat the CMS or Congress will act before the 2014 elections, delaying a closer look.

John Wasik writes for The Medicare NewsGroup.

http://medicarenewsgroup.com/context/understanding-medicare-blog/understanding-medicare-blog/2013/05/21/does-medicare-overpay-private-plans-the-debate-heats-up

Evolving Role of Emergency Departments

The Evolving Role of Emergency Departments in the United States

By Kristy Gonzalez Morganti, Sebastian Bauhoff, Janice C. Blanchard, Mahshid Abir, Neema Iyer, Alexandria Smith, Joseph V. Vesely, Edward Okeke, Arthur L. Kellermann
RAND Health, May 20, 2013

To develop a more complete picture of how EDs (emergency departments) contribute to our modern health care system, the Emergency Medicine Action Fund asked RAND to conduct this mixed-methods study.

Key findings include the following:

• Between 2003 and 2009, inpatient admissions to U.S. hospitals grew at a slower rate than the population overall. However, nearly all of the growth in admissions was due to a 17 percent increase in unscheduled inpatient admissions from EDs. This growth in ED admissions more than offset a 10 percent decrease in admissions from doctors’ offices and other outpatient settings. This pattern suggests that office-based physicians are directing to EDs some of the patients they previously admitted to the hospital.

• In addition to serving as an increasingly important portal of hospital admissions, EDs support primary care practices by performing complex diagnostic workups and handling overflow, after-hours, and weekend demand for care. Almost all of the physicians we interviewed—specialist and primary care alike—confirmed that office-based physicians increasingly rely on EDs to evaluate complex patients with potentially serious problems, rather than managing these patient themselves.

• As a result of these shifts in practice, emergency physicians are increasingly serving as the major decisionmaker for approximately half of all hospital admissions in the United States. This role has important financial implications, not only because admissions generate the bulk of facility revenue for hospitals, but also because inpatient care accounts for 31 percent of national health care spending.

• Although the core role of EDs is to evaluate and stabilize seriously ill and injured patients, the vast majority of patients who seek care in an ED walk in the front door and leave the same way. Data from the Community Tracking Study indicate that most ambulatory patients do not use EDs for the sake of convenience. Rather, they seek care in EDs because they perceive no viable alternative exists, or because a health care provider sent them there.

• Medicare accounts for more inpatient admissions from EDs than any other payer. To gain insight into whether care coordination makes a difference in the likelihood of hospital admission from an ED, we compared ED admission rates among Medicare beneficiaries enrolled in a Medicare Choice plan versus beneficiaries enrolled in Medicare fee-for-service (FFS). We found no clear effect on inpatient admissions overall, or on a subset of admissions involving conditions that might be considered “judgment calls.”

• Irrespective of the impact of care coordination, EDs may be playing a constructive role in constraining the growth of inpatient admissions. Although the number of non-elective ED admissions has increased substantially over the past decade, inpatient admissions of ED patients with “potentially preventable admissions” (as defined by the Agency for Healthcare Research and Quality) are flat over this time interval.

Our study indicates that: (1) EDs have become an important source of admissions for American hospitals; (2) EDs are being used with increasing frequency to conduct complex diagnostic workups of patients with worrisome symptoms; (3) Despite recent efforts to strengthen primary care, the principal reason patients visit EDs for non-emergent outpatient care is lack of timely options elsewhere; and (4) EDs may be playing a constructive role in preventing some hospital admissions, particularly those involving patients with an ambulatory care sensitive condition. Policymakers, third party payers, and the public should be aware of the various ways EDs meet the health care needs of the communities they serve and support the efforts of ED providers to more effectively integrate ED operations into both inpatient and outpatient care.

http://www.rand.org/pubs/research_reports/RR280.html

Comment:

By Don McCanne, M.D.

This RAND Health report provides an excellent perspective on how emergency departments (EDs) have evolved into institutions providing a greater central role in health care delivery. It is a particularly valuable report because it sets aside many misperceptions about ED functions – misperceptions that can lead to flawed policy recommendations.

It is crucial that we continue to assess and recommend improvements in the health care delivery system. This report reflects the benefit of such an approach since EDs have expanded their roles in very beneficial ways. As they continue to evolve, integration with both inpatient and outpatient care should become more efficient, especially from the perspective of benefiting patients.

The current focus of policy reform seems to be not so much on the improvement of health care delivery, but rather on mechanisms that supposedly would slow the growth in health care spending. Accountable care organizations, bundling of payments, innovative insurance designs such as those that erect financial barriers to care, are the types of policy approaches that will have very little impact on overall costs while inappropriately expanding the administrative excesses of our dysfunctional system.

This report is well worth downloading. As you read it, you can see many opportunities to further expand the progress that we have seen through the evolving improvements in the role of EDs in our health care system. Thinking about how further improvement in integrating their role with both inpatient and various community outpatient services can help us envision further opportunities to achieve the goals of a high-performance system.

An example of the misguided and misdirected emphasis on innovative payment reform is the failure to find any clear effect on inpatient admissions when comparing the public Medicare program with the much more expensive private Medicare Advantage plans. Payment innovation is simply not where it’s at.

We need to get this right. Let’s continue to work on fixing the health care delivery system so that it works best for patients. That is the key to improving value in health care. It will work as long as we adopt a financing system that is designed exclusively to fund a high-performance health care system (single payer), as opposed to one that is designed to keep policy wonks and insurance administrators employed in bringing us ever-expanding payment innovations that we don’t want (Obamacare).

‘We need health care for all’: Dr. Steve Auerbach on Fox News

Dr. Steve Auerbach, a pediatrician in New York City and a member of the executive board of the N.Y. Metro chapter of Physicians for a National Health Program, appeared on the “Stossel Show” on Fox Business News on April 25. This 7-minute video segment, moderated by host John Stossel, features a debate between Dr. Auerbach and Dr. Lee Hieb, an orthopedic surgeon, on the theme of “Free market vs. government health care.”

Some employers, insurers conspire on bare-bones plans

Employers Eye Bare-Bones Health Plans Under New Law

By Christopher Weaver and Anna Wilde Matthews
The Wall Street Journal, May 19, 2013

Employers are increasingly recognizing they may be able to avoid certain penalties under the federal health law by offering very limited plans that can lack key benefits such as hospital coverage.

Benefits advisers and insurance brokers—bucking a commonly held expectation that the law would broadly enrich benefits—are pitching these low-benefit plans around the country. They cover minimal requirements such as preventive services, but often little more. Some of the plans wouldn’t cover surgery, X-rays or prenatal care at all.

Federal officials say this type of plan, in concept, would appear to qualify as acceptable minimum coverage under the law, and let most employers avoid an across-the-workforce $2,000-per-worker penalty for firms that offer nothing.

The idea that such plans would be allowable under the law has emerged only recently. Some benefits advisers still feel they could face regulatory uncertainty. The law requires employers with 50 or more workers to offer coverage to their workers or pay a penalty. Many employers and benefits experts have understood the rules to require robust insurance, covering a list of “essential” benefits such as mental-health services and a high percentage of workers’ overall costs.

But a close reading of the rules makes it clear that those mandates affect only plans sponsored by insurers that are sold to small businesses and individuals, federal officials confirm. That affects only about 30 million of the more than 160 million people with private insurance, including 19 million people covered by employers, according to a Citigroup Inc. C +0.20% report. Larger employers, generally with more than 50 workers, need cover only preventive services, without a lifetime or annual dollar-value limit, in order to avoid the across-the-workforce penalty.

Such policies would generally cost far less to provide than paying the penalty or providing more comprehensive benefits, say benefit-services firms.

Administration officials confirmed in interviews that the skinny plans, in concept, would be sufficient to avoid the across-the-workforce penalty. Several expressed surprise that employers would consider the approach.

Firms now offering low-cost policies known as mini-meds, generally plans that cap benefits at low levels, could favor the tactic. Companies sought federal health department waivers to cover nearly four million with mini-meds and other similar plans, which will be barred next year. Some employers are “thinking of this as a replacement for the mini-med plan,” said Tracy Watts, national leader for health-care reform at Mercer, a consulting unit of Marsh & McLennan Cos.

San Antonio-based Bill Miller Bar-B-Q, a 4,200-worker chain, will replace its own mini-med with a new, skinny plan in July. The new plan… will cover only preventive services, six annual doctors’ visits and generic drugs. X-rays and tests at a local urgent care chain will also be covered. It wouldn’t cover surgeries or hospital stays.

Tex-Mex restaurant chain El Fenix also said it would offer limited plans to its 1,200 workers, covering doctors visits, preventive care and drugs, but not hospital stays or surgery.

http://online.wsj.com/article/SB10001424127887324787004578493274030598186.html

Comment:

By Don McCanne, M.D.

Imagine health insurance not covering hospitalizations nor surgery. Yet this is still possible because the Affordable Care Act applies the essential health benefit requirement only to plans for small businesses and individuals and not to larger employers.

This has opened up the opportunity for a conspiracy between larger employers who could care less whether or not their employees have health insurance and private insurers who are quite willing to sell these almost worthless bare-bones products as long as there is a profitable market for them.

The solution is obvious. Cover all care that people need, and then provide that coverage to everyone, automatically. Maybe these uncaring employers might not like that, but when the taxes to pay for an equitable system are obligatory, they would get used to the idea of their employees being able to obtain health care when they need it. Not such a bad idea after all, especially when their competitors are treated the same.

OECD report on income inequality and poverty

Growing risk of inequality and poverty as crisis hits the poor hardest

OECD, May 15, 2013

Income inequality increased by more in the first three years of the crisis to the end of 2010 than it had in the previous twelve years, before factoring in the effect of taxes and transfers on income, according to new OECD report and data.

After taxes and transfers, the richest 10 per cent of the population in OECD countries earned 9.5 times the income of the poorest 10 per cent in 2010, up from 9 times in 2007. The gap is largest in Chile, Mexico, Turkey, the United States and Israel, and lowest in Iceland, Slovenia, Norway and Denmark.

Gini Coefficient (higher = greater inequality)
0.316  OECD average (after taxes and transfers)
0.380  United States (after taxes and transfers)
0.499  United States (before taxes and transfers)
0.320  Canada (after taxes and transfers)
0.447  Canada (before taxes and transfers)

Relative Income Poverty Rates
11.1%  OECD average (after taxes and transfers)
17.4%  United States (after taxes and transfers)
28.4%  United States (before taxes and transfers)
11.9%  Canada (after taxes and transfers)
26.0%  Canada (before taxes and transfers)

http://www.oecd.org/newsroom/growing-risk-of-inequality-and-poverty-as-crisis-hits-the-poor-hardest-says-oecd.htm

OECD report (8 pages): http://www.oecd.org/els/soc/OECD2013-Inequality-and-Poverty-8p.pdf

Comment:

By Don McCanne, M.D.

Compared to the average member nation of the Organization for Economic Cooperation and Development (OECD), the United States has higher levels of poverty and a greater inequality in income.

This OECD report does demonstrate that taxes and transfers (social welfare programs) do reduce the gap, but when you compare the United States and Canada on the amount of redistribution that takes place as a result of these policies, you see that we are much less equitable than Canada.

Although our politicians claim that our taxes are too high and that we need to cut social programs, these results suggest the opposite – that we need more progressive taxes and more generous social benefit programs – maybe like Canada’s single payer Medicare program.

Medicare for All?

By Chuck Thompson
PhillyBurbs.com, May 16, 2013

Nearly two years ago, I turned 65 and signed up for Medicare. I was actually dreading this move as one often fears change, particularly when it relates to health care plans. For nearly 16 years, my wife and I operated our own consulting company and paid in excess of $14,000 a year in health care premiums. When the cost threatened to bury us, my wife got a job with a private company that provided health care coverage for her and me. With her company’s plan acting as the supplement for Medicare when I turned 65, I soon learned that I would be receiving basically the same kind of coverage that I had for decades before on private plans.

Recently I took some time to read volumes of material on the development of Medicare. Basically it was part of the general discussion of the need for universal health care in the United States that dated back to 1911 when the British National Health Insurance program was enacted. A concerted effort to pass medical care for the elderly – which led to the enactment of the program known as Medicare – took more than two decades to come to fruition. It was opposed by the usual gang of conservatives employing their typical scare tactics, with a heavy dose of the money needed to employ an army of lobbyists coming from the American Medicine Association, the doctors’ NRA.

Was Medicare immediately hailed as a major tool in the improvement of medical care in America? Not quite. According to a column written by the Washington Post’s Ezra Klein, after Lyndon Johnson was elected and started the final push for Medicare, a Harris poll found only a minority of Americans, 46%, supported a federal plan to extend health care to the aged. “Today, of course,” Klein points out, “Medicare is overwhelmingly popular.” And it has proved to be a major boon to the very doctors who fought against it for so many years. It has also proved, in my estimation, that government can do a much better job regulating and providing quality, affordable medical care than can private industry.

Medicare may have been a major leap forward, but the U.S. continued to stand almost entirely alone among developed nations that lack universal health care. The Affordable Care Act, passed in 2010 and still in the implementation phase, will go a long way in meeting the needs of the rest of the people, without affecting people who are happy with the plans they currently have.

In the final analysis, however, I wonder how long people will be happy with their current health care plans. Flash back to my wife obtaining medical coverage from her employer. Initially, we were very content with the Blue Cross/Blue Shield Personal Choice plan with limited co-pays and the ability to go to any doctor or specialist of our choice. Ultimately, that plan became too expensive for her employer and last year it evolved into a plan with a $4,000 deductible that had to be met before it started to pick up any of the costs for hospitalization, doctors or prescriptions. I learned from my pharmacist that this is becoming very commonplace among employer health care plans. They should be called insurance for catastrophic illnesses and not much else.

Recently, her company downsized and she was laid off. She applied for COBRA insurance for herself and I started looking into supplement plans for me. Through AARP, I got a supplement plan that has very low co-pays for doctor visits (actually none at all for my family physician and no higher than $20 for specialists), and prescription coverage for a premium of less than $160 per month (compared to the almost $500 a month she has to pay for the COBRA plan).

In other words, what I have now is actually superior to and costs far less than what we had under Blue Cross/Blue Shield Personal Choice years ago. There is some merit to the argument that the U.S. could have achieved universal health care with much less hue and cry if it had just expanded Medicare to cover all. But, hell, that would have been socialized medicine, and we can’t have that.

Chuck Thompson is a former Middletown Township supervisor, journalist and marketing consultant. He has worked on a number of political campaigns and most recently was a team staging leader for the Obama campaign. He has published his first novel, McCurry’s War, which is based on his experience as a voice intercept operator in Berlin in the late ‘60s. Contact him at chuckthompson@comcast.net.

http://www.phillyburbs.com/blogs/politically_astute/medicare-for-all/article_b9e024ca-ba78-5583-a2c2-bbb8f4b40304.html

Rough sailing ahead for health care reform, but it’s not our only option

By Dr. Philip Caper
Bangor Daily News, May 16, 2013

You know another storm is brewing when Washington politicians start looking for somebody else to blame for problems they themselves created.

That’s what happened recently at a Senate budget hearing when Finance Committee Chairman Max Baucus unloaded on Kathleen Sebelius, President Barack Obama’s health and human services secretary. He berated her for failing to adequately educate the public or competently implement the 2,000-plus page Patient Protection and Affordable Care Act, or Obamacare. During the hearing, Baucus worried aloud about “a huge train wreck coming down” if the Obama administration didn’t clean up its act. Other Democrats soon piled on.

Aside from being known as one of the most prolific producers of lobbyists from among his staffers in the Senate, Baucus is probably best known as one of Obamacare’s prime architects.

Baucus is right to worry that the law may in fact run into extreme turbulence. It is far too complex. It has too many moving and interdependent parts to be smoothly implemented by anybody, no matter how talented or highly motivated, and it is too controversial.

There are a lot of people in and out of Congress — about 50 percent of Americans, according to the latest polls — who do not want to see the law implemented and will find ways to sabotage it. The law itself provides no shortage of opportunities to do so.

First, there is the challenge of setting up the health insurance exchanges in every state, when almost half the states, including Maine, have indicated no interest in doing it themselves. In those states, that job will fall on the federal government.

Then there is the law’s expansion and standardization of Medicaid — optional for each state, since the Supreme Court last year found making it mandatory to be unconstitutional. A large number of Republican governors, including Maine’s, have so far shown little interest in expanding that program.

The law also intends to expand the federal Community Health Center program. Republicans and others opposed to an expansion of government can be relied on to resist funding that program every chance they get. They will also resist expanding funding for the law’s subsidies for the purchase of private insurance.

In addition, the complexity of the law has created a huge number of unknowns. Each unknown creates plenty of opportunities for mischief in the future. Some examples: How many healthy young people will sign up for the exchanges (thus keeping premiums down for others) instead of simply paying or dodging the tax penalties? How many businesses will choose not to hire that 50th employee to avoid the mandatory coverage provisions of the law?

It now appears that federal subsidies in the exchanges may apply only to employees, and not dependents. How will this affect employees’ willingness to sign up for increasingly expensive family health insurance coverage? How will mid-year changes in employment or income affect the operation of the program and those covered by it? How will labor mobility be affected by this new system, and how will that affect the general economy?

There are lots more unknowns, but you get the idea. Complexity, not implementation, is the underlying pathology of Obamacare. Congress, not the administration, bears the brunt of the responsibility for that.

Mr. Baucus surely knew about this at the time of the law’s passage. After his own constituents in Libby, Mont., became uninsurable by private insurance due to industrial pollution with carcinogens and were unable to get the courts to hold the polluters responsible, Baucus came to the rescue. He simply tucked a little provision into the massive health reform bill making affected Montanans eligible for — you guessed it — Medicare.

No health insurance exchanges for these hardworking folks. Nothing but the best for Libby. By taking the simple, direct and most efficient route to expanding health-care coverage, Mr. Baucus did the right thing by his constituents. But Baucus made sure that everybody else had to settle for Obamacare.

It has been observed that “Americans will always do the right thing, once they’ve exhausted all alternatives.” I’m not holding my breath waiting for Congress to revisit health care reform anytime soon. But there is a lot we can do here in Maine to make health care a human right. Under the new law’s provisions we, like Vermont, can begin to move down a path to universal coverage in our state starting in 2017.

In some ways, we’re not as lucky as Vermont. Unlike Vermont, we have a large for-profit insurance presence in Maine. That means there’s a lot of money at stake. There will therefore be a lot of resistance.

But unlike Vermont, in addition to our ability to replace politicians who fail to act in the interests of the majority, we can use the initiative and referendum processes to express the people’s will directly.

It won’t be easy. But all we need is for most of us to have a common understanding of what to do and the will to do it. Are we up for it?

Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at pcpcaper21@gmail.com.

http://bangordailynews.com/2013/05/16/health/rough-sailing-ahead-for-health-care-reform-but-its-not-our-only-option/

Redistributive function of Canada's single payer

Publicly Financed Health Care in Canada: Who Pays and Who Benefits Over a Lifetime?

Canadian Institute for Health Information, May 2013

Conclusion

All Canadian taxpayers contribute to publicly financed health care, regardless of their use of the system. Publicly funded health care services are available to all on the basis of need, regardless of ability to pay. When we look at the relationship over a lifetime, only the most affluent (the top 20%) contribute significantly more to health care than they receive. For other income groups, the value received from publicly funded health care is approximately the same as or more than the value of taxes paid to fund those services. The redistributive effect of publicly funded health care in Canada is a 16% reduction in the income gap between the highest- and lowest-income groups. Without the publicly financed health system, the lowest-income Canadians would be at risk of going without needed health care or of being impoverished by paying for it.

https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC2192

Comment:

By Don McCanne, M.D.

This report from Canada demonstrates one of the more important functions of a well designed single payer system. To ensure access while preventing impoverishment, financing must be redistributive, because health care costs are unaffordable for moderate and low income individuals and families. Not only does the redistributive financing ensure universal access, it also ameliorates, to a limited extent, the impact of the worsening Gini coefficient (measure of income inequality).

Oregon's single-payer activists keep dream of universal health care alive

A separate measure, giving state sponsorship of a comprehensive study on universal healthcare financing, makes its way through the Committee on Ways & Means

By Christopher David Gray
The Lund Report, May 15, 2013

SALEM, Ore. — Wes Brain was uninsured last winter when a tonsillectomy showed signs of throat cancer. He qualified for the high-risk Oregon Medical Insurance Pool, which the state has administered through Regence BlueCross BlueShield.

But gaining access to that insurance soon proved a big obstacle for the Ashland resident, when Regence erroneously told him he hadn’t submitted his driver’s license.

“Denial and delay, denial and delay are the way these insurance companies work. They make money this way,” Brain vented to the House Health Committee on Tuesday. He had previously lost his daughter after a nine-year struggle with leukemia while contending with insurance companies over access to necessary health care services.

Eventually, his policy was approved. He paid $2,400 — three month’s premium. His doctor ordered a PET scan for March 1. But then Regence came back and told him no, he’d have to wait until March 1 to even begin authorization.

His clock was ticking. His throat cancer could be spreading.

He enlisted his local Rep. Peter Buckley, D-Ashland, to help him. He got the state Insurance Division on his case.

They came through. He received his PET scan, and spent four days at Oregon Health & Science University, receiving additional tonsil surgery. “They cut the hell out of me,” said Brain, who’s now cancer-free.

“There is no way that Regence should have delayed my care at all,” Brain added. “That’s how they do business. They kill people doing it. Let’s get them the hell out of it, and let’s pass this bill.”

Buckley and 23 other Democrats have signed on to support House Bill 2922, which would throw out the private health insurance industry and set up a single-payer health insurance system administered by the Oregon Health Authority.

The bill has no chance of passage this session, but House Health Committee Chairman Rep. Mitch Greenlick allowed fellow Portland Democrat and chief sponsor Rep. Michael Dembrow to lead single-payer health care advocates in an informational public hearing.

Brain and other activists aired their support for a privately delivered, government-sponsored health system that would revolutionize Oregon health care and make it similar to health systems in Japan, Europe, Canada and the rest of the developed world.

HB 2922 closely parallels House Bill 3510 from the 2011 session, but at 76 pages, it’s 30 percent longer than the previous measure, repealing newly acted reforms such as Cover Oregon, which offers subsidized private insurance for people with moderate incomes.

No Republicans have yet come on board as supporters, but the single-payer bill has twice as many sponsors this session from Democrats across the state, including rural districts as well as Portland and Eugene. Two of the state’s largest unions – the Oregon Nurses Association and the Oregon Education Association – have also thrown their support behind the measure.

Study Bill Moves Forward

Dembrow has also sponsored House Bill 3260, which had a budget hearing on Tuesday. That bill, which passed unanimously earlier this session from the House Health Committee, would solicit $250,000 to $600,000 in private funds to comprehensively study how best to implement universal health care in Oregon.

The study will look at several different options, including single-payer, a public option and the basic health plan envisioned for low-income people who wouldn’t qualify for Medicaid by the Affordable Care Act.

Chunhuei Chi, a professor at Oregon State University’s College of Public Health and Human Sciences, told The Lund Report the study would aim for transparency, be replicable and available for peer review. The Oregon Health Authority could either choose Oregon State or another entity to conduct the study.

Previously, Health Care for All Oregon, which supports the single-payer bill, had considered asking the Northwest Health Foundation to conduct such a study. But according to Dembrow, a state-sanctioned study would lend more credibility.

Earlier, he told The Lund Report that while he expects single payer the best route to universal health care, he believes the underlying bill is written well enough to turn into the best solution for Oregon, and he will support its recommendations.

“This is exactly the way it’s done,” said Sen. Elizabeth Steiner Hayward, D-Portland, who favors doing such a study but has not come out in support of the single-payer option. “I like that you’ve laid out a menu of options, and that it doesn’t make a predetermined decision,” she added, calling the study outcome-based rather than motivated by political ideology.

Contrasting Systems

Alan Journet, a retired professor and dual British-U.S. citizen, pointed out that in Great Britain, socialized medicine is so popular even Conservative icon, former Prime Minister Margaret Thatcher, was a big supporter.

While living in the U.S., he came down with cancer and was given two months to live, absent treatment. “Thanks to insurance, I didn’t have to worry much about the cost of treatment, but I did constantly have to worry about the insurance company approving doctor-recommended treatment,” Journet said.

Journet said he felt lucky — his insurance company approved his treatment, unlike his sister-in-law who fell ill earlier.

“Her insurance company denied treatment, and she died,” Journet said. “We often hear the complaint that we should fear government functionaries making decisions on treatment, as though we are better served having insurance company functionaries make such decisions, employees whose income encourages denying treatment and generating a sizable profit.”

Dembrow said his passion for single-payer health care started following the birth of his two children. His daughter, who was born in France, received exemplary care, including house calls from physicians for just a small co-payment and a tax taken out of the family paychecks.

His son, on the other hand, was born in Indiana. At the time, insurance companies weren’t required to cover infants for the first 30 days of their life. His son had a digestive abnormality called pyloric stenosis that required surgery. A graduate student at the time, Dembrow and his wife had to deplete their savings to pay for the care.

“The contrast of those experiences have committed me to try to do things differently in this country,” Dembrow said.

Dembrow praised the reform efforts of Gov. Kitzhaber to deliver health care for the poor through coordinated care organizations and also lauded many of the aspects of the Affordable Care Act, including the expanded Oregon Health Plan and the insurance exchange. Yet, he said these reforms fall far short of an equitable universal health care system.

“We’ll continue to have jobs kept temporary or part-time for no good reason other than to keep workers from being eligible for coverage,” he said. “Our system will still rely on private insurance companies who charge high administrative fees, create administrative burdens for doctors and other health care professionals, and whose primary interest is their own profits. … At best what we’re going to continue to have an expensive, complicated patchwork system.”

http://www.thelundreport.org/resource/single_payer_activists_keep_dream_of_universal_healthcare_alive