Income, Poverty, and Health Insurance Coverage in the United States: 2011

By Carmen DeNavas-Walt, Bernadette D. Proctor, Jessica C. Smith
United States Census Bureau, September 2012
Health Insurance Coverage – 2011
48.6 million or 15.7% – people without health insurance
• 7.0 million – children under 18 uninsured
193.7 million or 63.9% – people covered by private health insurance
• 170.1 million or 55.1% – people covered by employment-based insurance
99.5 million or 32.2% – people covered by government health insurance
• 50.8 million or 16.5% – people covered by Medicaid
• 46.9 million or 15.2% – people covered by Medicare
Poverty
9.5 million or 11.8% – families living in poverty
• 31.2% – families with a female householder living in poverty
Income Inequality
Income inequality also increased between 2010 and 2011 when measured by shares of aggregate household income received by quintiles. The aggregate share of income declined for the middle and fourth quintiles. The share of aggregate income increased 1.6 percent for the highest quintile and within the highest quintile, the share of aggregate income for the top 5 percent increased 4.9 percent. The changes in the shares of aggregate income for the lowest two quintiles were not statistically significant.
http://www.census.gov/prod/2012pubs/p60-243.pdf

The numbers of uninsured decreased from 50.0 million in 2010 to 48.6 million in 2011. That might be good news for the net 1.4 million newly insured, but it is terrible news for the 48.6 million who remain without health insurance.
These numbers, of course, are transitional since new private coverage through the state insurance exchanges and the greater expansion of coverage under Medicaid will not take place until 2014. Even then, the new coverage will be either with private underinsurance plans (low actuarial value and inadequate subsidies) or with the chronically underfunded Medicaid program, with even greater impairment of health care access likely. Worse, 30 million will still have no coverage at all (CBO).
Perhaps even more shocking is that 31.2% of families with a female householder live in poverty – right here in the United States!
And income inequality? The aggregate share of household income has decreased for the middle and fourth quintiles. The middle class is being wiped out!
Of course we knew all this. So why aren’t we doing something about it? Howling in the wind doesn’t seem to be getting us very far.

By Meghan McCarthy
NationalJournal, September 10, 2012

President Obama has seized on Republican proposals to overhaul Medicare as a top campaign issue, saying that the GOP plan to add a private insurance option would end seniors’ guarantee of government health care. But behind the election-season politics, influential experts who have advised Obama on health care are open to a future for Medicare that includes competition among private insurance plans.

In e-mail exchanges with the staff of the White House-appointed  fiscal commission  that were obtained by National Journal, David Cutler and Jonathan Gruber, who have both advised Obama, gave qualified support to a Medicare voucher plan offered by Ryan and former Clinton budget director Alice Rivlin in talks to reduce the deficit.

Cutler and Gruber are both hot shots of the health economics world. Cutler is a professor at Harvard, Gruber at MIT. Both advised Obama on health care in the 2008 campaign, and both had major roles in helping develop Democrats’ 2010 health care law. When they offer counsel, the White House is listening.

Cutler now says he was only proposing an idea for Medicare if insurance exchanges are “shown to work well for the non-elderly population,” by getting people into good plans and lowering costs.

Gruber also said he approved of the Ryan-Rivlin plan in 2010 e-mails to fiscal-commission staff, as long as the insurance market reforms of the Democrats’ health care law are kept in place.

Gruber now says that economists don’t know enough yet to move the majority of Medicare enrollees into private-insurance plans.  As part of the effort to expand coverage to the uninsured, President Obama’s health care law would establish insurance exchanges for people younger than 65 to buy private health care. Gruber said that this is a better way of testing out new approaches, adding that it would be “stupid” to experiment first on the older and sicker Medicare population.

“We are getting better, but we are not quite there yet,” Gruber said in an interview. “But premium support is ultimately where we need to be.”

There are three key problems that still must be worked out, Gruber said. First, policymakers have to figure out how to keep insurance companies from cherry-picking healthy people and essentially forcing the sickest patients on to traditional Medicare, which would drain the program of money. Second, policymakers must find a way to make sure insurance companies design benefits so they are easy-to-understand for beneficiaries, and don’t trick seniors into buying more expensive plans that aren’t suitable for them. Third, they have to figure out just how quickly government checks for seniors to buy coverage could grow.

Still, Gruber said he could see Medicare becoming a premium-support-style plan within a five-year timetable, after the Affordable Care Act’s health insurance exchanges start enrolling an estimated 30 million people into insurance plans in 2014.

http://www.nationaljournal.com/healthcare/mixed-obama-message-on-medicare–20120910

Comment: 

By Don McCanne, MD

So Obama advisor, MIT Professor Jonathan Gruber, says, “premium support is ultimately where we need to be.” In other words, we should replace the traditional Medicare program with vouchers that would be used to purchase private plans. Let’s look at the three problems which he says must first be addressed.

He says that policymakers must figure out how to keep insurance companies from insuring the healthy and sending the sick to the traditional government program. Actually that is only one behavior that private insurers engage in to enhance their success as private businesses. They are always going to do everything that they can to maximize revenues and minimize spending, as any reasonable business would do. The drive for profits for passive investors is not in itself inherently evil, except when it is applied to our health care system. Manipulating sick patients for the prime purpose of generating profits is immoral. Investor-owned insurance companies need to be removed from our health care system.

Gruber also says that we have to figure out “just how quickly government checks for seniors to buy coverage could grow” under premium support. This is a problem inherent with government vouchers that cover only a part of the costs. Instead of directing efforts to control total health care costs, government stewards tend to control just the government spending, passively shifting the costs of health care inflation onto the patients. The financial burden on individuals is already too great, and this would make it even worse.

More subtle, but perhaps even more important, Gruber says that the design of insurance products should be easy to understand so that seniors are not tricked into buying “more expensive plans that aren’t suitable for them.” This statement represents one of the great fallacies of private health insurance markets, that somehow there is an insurance product that is just right for you wherein you will not have to pay for benefits that you’ll never use.

There are two problems with this. The obvious one is that future health care needs cannot be predicted. Major acute disorders or the future onset of chronic disease are unknowns. Plans need to be comprehensive to insure against these potential losses, even if you hope that you won’t ever need to use the coverage that is providing you security, though you probably will someday.

The other problem is that an ideal insurance system pools all risks and funds the risk pool equitably. It is less expensive because of the much greater administrative efficiency of a universal risk pool. It also eliminates financial barriers to appropriate health care. Maybe males don’t want maternity benefits. Maybe females don’t want coverage for prostate cancer. Maybe young adults don’t want coverage for cataracts. Maybe the elderly don’t want coverage for organ transplants. Maybe children don’t want coverage for vaccines, even of their parents want them to have it.

The point is that when you start designing plans for different populations – “only the coverage you need” – you break up the universal risk pool and introduce many of the inequities and inefficiencies that characterize our current dysfunctional financing system. The administrative inefficiencies of buying “only what you need” increases costs over the entire system and redistributes those costs inequitably.

There is no substitute for establishing a single universal risk pool, funding the pool equitably based on ability to pay, and using the pool to fund health care based on medical need. And that, in a nutshell, is what a single payer national health program does.

Mixed Message From Obama Advisers on Medicare

By Meghan McCarthy
NationalJournal, September 10, 2012
President Obama has seized on Republican proposals to overhaul Medicare as a top campaign issue, saying that the GOP plan to add a private insurance option would end seniors’ guarantee of government health care. But behind the election-season politics, influential experts who have advised Obama on health care are open to a future for Medicare that includes competition among private insurance plans.
In e-mail exchanges with the staff of the White House-appointed  fiscal commission  that were obtained by National Journal, David Cutler and Jonathan Gruber, who have both advised Obama, gave qualified support to a Medicare voucher plan offered by Ryan and former Clinton budget director Alice Rivlin in talks to reduce the deficit.
Cutler and Gruber are both hot shots of the health economics world. Cutler is a professor at Harvard, Gruber at MIT. Both advised Obama on health care in the 2008 campaign, and both had major roles in helping develop Democrats’ 2010 health care law. When they offer counsel, the White House is listening.
Cutler now says he was only proposing an idea for Medicare if insurance exchanges are “shown to work well for the non-elderly population,” by getting people into good plans and lowering costs.
Gruber also said he approved of the Ryan-Rivlin plan in 2010 e-mails to fiscal-commission staff, as long as the insurance market reforms of the Democrats’ health care law are kept in place.
Gruber now says that economists don’t know enough yet to move the majority of Medicare enrollees into private-insurance plans.  As part of the effort to expand coverage to the uninsured, President Obama’s health care law would establish insurance exchanges for people younger than 65 to buy private health care. Gruber said that this is a better way of testing out new approaches, adding that it would be “stupid” to experiment first on the older and sicker Medicare population.
“We are getting better, but we are not quite there yet,” Gruber said in an interview. “But premium support is ultimately where we need to be.”
There are three key problems that still must be worked out, Gruber said. First, policymakers have to figure out how to keep insurance companies from cherry-picking healthy people and essentially forcing the sickest patients on to traditional Medicare, which would drain the program of money. Second, policymakers must find a way to make sure insurance companies design benefits so they are easy-to-understand for beneficiaries, and don’t trick seniors into buying more expensive plans that aren’t suitable for them. Third, they have to figure out just how quickly government checks for seniors to buy coverage could grow.
Still, Gruber said he could see Medicare becoming a premium-support-style plan within a five-year timetable, after the Affordable Care Act’s health insurance exchanges start enrolling an estimated 30 million people into insurance plans in 2014.
http://www.nationaljournal.com/healthcare/mixed-obama-message-on-medicare–20120910

So Obama advisor, MIT Professor Jonathan Gruber, says, “premium support is ultimately where we need to be.” In other words, we should replace the traditional Medicare program with vouchers that would be used to purchase private plans. Let’s look at the three problems which he says must first be addressed.
He says that policymakers must figure out how to keep insurance companies from insuring the healthy and sending the sick to the traditional government program. Actually that is only one behavior that private insurers engage in to enhance their success as private businesses. They are always going to do everything that they can to maximize revenues and minimize spending, as any reasonable business would do. The drive for profits for passive investors is not in itself inherently evil, except when it is applied to our health care system. Manipulating sick patients for the prime purpose of generating profits is immoral. Investor-owned insurance companies need to be removed from our health care system.
Gruber also says that we have to figure out “just how quickly government checks for seniors to buy coverage could grow” under premium support. This is a problem inherent with government vouchers that cover only a part of the costs. Instead of directing efforts to control total health care costs, government stewards tend to control just the government spending, passively shifting the costs of health care inflation onto the patients. The financial burden on individuals is already too great, and this would make it even worse.
More subtle, but perhaps even more important, Gruber says that the design of insurance products should be easy to understand so that seniors are not tricked into buying “more expensive plans that aren’t suitable for them.” This statement represents one of the great fallacies of private health insurance markets, that somehow there is an insurance product that is just right for you wherein you will not have to pay for benefits that you’ll never use.
There are two problems with this. The obvious one is that future health care needs cannot be predicted. Major acute disorders or the future onset of chronic disease are unknowns. Plans need to be comprehensive to insure against these potential losses, even if you hope that you won’t ever need to use the coverage that is providing you security, though you probably will someday.
The other problem is that an ideal insurance system pools all risks and funds the risk pool equitably. It is less expensive because of the much greater administrative efficiency of a universal risk pool. It also eliminates financial barriers to appropriate health care. Maybe males don’t want maternity benefits. Maybe females don’t want coverage for prostate cancer. Maybe young adults don’t want coverage for cataracts. Maybe the elderly don’t want coverage for organ transplants. Maybe children don’t want coverage for vaccines, even of their parents want them to have it.
The point is that when you start designing plans for different populations – “only the coverage you need” – you break up the universal risk pool and introduce many of the inequities and inefficiencies that characterize our current dysfunctional financing system. The administrative inefficiencies of buying “only what you need” increases costs over the entire system and redistributes those costs inequitably.
There is no substitute for establishing a single universal risk pool, funding the pool equitably based on ability to pay, and using the pool to fund health care based on medical need. And that, in a nutshell, is what a single payer national health program does.

Obama More Flexible on Medicare Than Rhetoric Suggests

By Margot Sanger-Katz
NationalJournal, September 8, 2012
In his convention speech in Charlotte, President Obama vowed to block the Republican Medicare reform plan because “no American should ever have to spend their golden years at the mercy of insurance companies.”
But back in Washington, his Health and Human Services Department is launching a pilot program that would shift up to 2 million of the poorest and most-vulnerable seniors out of the federal Medicare program and into private health insurance plans overseen by the states.
The administration has accepted applications from 18 states to participate in the program, which would give states money to purchase managed-care plans for people who are either disabled or poor enough to qualify for both Medicare and Medicaid.
Obama’s 2010 health reform law allows experimentation in delivering health care at lower cost through demonstration projects. Many states would like permission to shift their entire population of so-called dual-eligible beneficiaries into the new plans. HHS has indicated that it will enroll about 2 million beneficiaries, out of about 7 million who qualify for full benefits from both government health programs.
California is already counting on more than $500 million in budget savings from its own program this year.
Potential cost savings are a big incentive for states. Patients who qualify for both federal health programs are a costly population and include many who need nursing-home care or other expensive services. About 40 percent of Medicaid’s costs go toward patients who are also eligible for Medicare. Advocates of the pilot program also say it could lead to better coordination of care for patients who often struggle to navigate the two different programs.
To get approval, states must guarantee that both Medicare and Medicaid would save money. They must also agree to accept a fixed payment to cover all care for each patient. While rules say the private plans must cover all standard Medicare benefits, they also waive many Medicare rules and leave insurer selection to the states.
Still, there is powerful opposition to the pilots among doctors, hospitals, nursing homes, patient groups, and key lawmakers, including Sen. Jay Rockefeller, D-W.Va., who wrote the provision in the health law that created the office in charge of the pilot program.
“I urge you to take immediate steps to halt this initiative as currently structured and to take the time necessary to develop a well-designed and thoroughly evaluated care coordination model for dual eligibles that meets the standards outlined in the law,” Rockefeller wrote in a letter to HHS.
The Medicare Payment Advisory Commission, a group of experts who advise Congress on Medicare policy, has also weighed in with an 11-page letter to HHS, warning that the speed and scope of the program raised questions about whether patients would receive the care they need.
The managed-care industry is gearing up for the expansion. Three large insurers have purchased companies that insure Medicaid beneficiaries. For years, states have been moving Medicaid patients into managed-care plans, with mixed results. But this pilot represents a new market: It is the first large program that would pool Medicare and Medicaid benefits in a single, state-administered plan.
“The problem with this population is that all the strategies that the health plans have been used to using historically are going to backfire,” said Chris Duff, executive director of the Disability Practice Institute, an umbrella organization for small programs that provide coordinated care to dual-eligibles. He warned that slashing provider rates, limiting visits, and using other conventional cost-control measures could lead to expensive hospitalizations for frail dual-eligible patients.
But the states are enthusiastic about the pilot programs and believe they will be able to provide better care at lower cost.
http://www.nationaljournal.com/healthcare/obama-more-flexible-on-medicare-than-rhetoric-suggests-20120908

And…

Assessing the Quality of California Dual Eligible Demonstration Health Plans

National Senior Citizens Law Center
May 2012
California has proposed a three-year demonstration project to enroll individuals dually eligible for Medicare and Medi-Cal (dual eligibles) into managed care. An analysis of both Medicare and Medi-Cal quality ratings for the eight health plans selected by the California Department of Health Care Services (DHCS) for the first phase of the project raises cause for concern.
Approved health plans in participating counties would be responsible for providing enrolled dual eligibles with all Medicare and Medi-Cal benefits and services, including all needed medical care, long-term services and supports, and behavioral health care, beginning in January 2013.
According to a DHCS report assessing the quality of health plans in the Medi-Cal Managed Care (MCMC) Program, seven of the eight plans received a global health plan rating of 1 out of 5 stars.
Looking at Medicare evaluations, two of the plans selected have received a notice of non-compliance from the Medicare program. One of those has been marked as a low-performing plan for three consecutive years and is at risk for termination of its Medicare contract. Another plan was recently sanctioned by Medicare as a result of beneficiary access problems. Medicare continues to restrict enrollment of dual eligibles into that plan. All eight proposed demonstration plans were found to be low-performing on a least one composite Medicare quality measure.
http://dualsdemoadvocacy.org/wp-content/uploads/2012/02/Plan-Ratings-Report-May-2012.pdf

President Obama is currently campaigning against the Republican proposal to privatize Medicare through a voucher program that would move Medicare patients into private plans. Yet, based on provisions in the Affordable Care Act, the administration is moving Medicare patients whose coverage also is supplemented with Medicaid (dual eligibles) into private managed care plans.
California has been a leader in health care financing innovations. Look at the head start that they have on this program. Seven of the eight plans they have selected to initiate the program have a global health plan rating of only 1 star out of 5!
These plans greatly limit patients’ choices of their providers and will undoubtedly impair access by eliminating choices of most other health care providers within the state. Having to transfer buses three times when you are very ill can make you question whether you have the access that the state has promised to you. And quality ratings? Forget it.
These low-income patients, under the law, have more coverage than do traditional Medicare patients… more, but worse. We can do far better. We can improve Medicare so that it includes the additional benefits provided by Medicaid. Then you wouldn’t need a special “dual eligible” program.
If the improved Medicare program included everyone, then you wouldn’t have to herd patients into inferior managed care programs just to save money (precisely what this new dual eligible program is designed to do). As a beneficent public monopsony, the improved Medicare program would save us all money while being in a position to demand quality throughout the health care delivery system. We couldn’t ask for more – for all of us!

Transformation of Health System Needed to Improve Care and Reduce Costs

Institute of Medicine
The National Academies, September 6, 2012

America’s health care system has become too complex and costly to continue business as usual, says a new report from the Institute of Medicine (Best Care at Lower Cost: The Path to Continuously Learning Health Care in America).

The costs of the system’s current inefficiency underscore the urgent need for a systemwide transformation. The committee calculated that about 30 percent of health spending in 2009 — roughly $750 billion — was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering.  By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state.

“The threats to Americans’ health and economic security are clear and compelling, and it’s time to get all hands on deck,” said committee chair Mark D. Smith, president and CEO, California HealthCare Foundation, Oakland. “Our health care system lags in its ability to adapt, affordably meet patients’ needs, and consistently achieve better outcomes. But we have the know-how and technology to make substantial improvement on costs and quality. Our report offers the vision and road map to create a learning health care system that will provide higher quality and greater value.”

http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=13444

And…

Best Care at Lower Cost: The Path to Continuously Learning Health Care in America

Institute of Medicine

Recommendations

Recommendation 1: The Digital Infrastructure
Improve the capacity to capture clinical, care delivery process, and financial data for better care, system improvement, and the generation of new knowledge.
 
Recommendation 2: The Data Utility
Streamline and revise research regulations to improve care, promote the capture of clinical data, and generate knowledge.

Recommendation 3: Clinical Decision Support
Accelerate integration of the best clinical knowledge into care decisions.

Recommendation 4: Patient-Centered Care
Involve patients and families in decisions regarding health and health care, tailored to fit their preferences.

Recommendation 5: Community Links
Promote community-clinical partnerships and services aimed at managing and improving health at the community level.
 
Recommendation 6: Care Continuity 
Improve coordination and communication within and across organizations.

Recommendation 7: Optimized Operations 
Continuously improve health care operations to reduce waste, streamline care delivery, and focus on activities that improve patient health.

Recommendation 8: Financial Incentives 
Structure payment to reward continuous learning and improvement in the provision of best care at lower cost.
 
Recommendation 9: Performance Transparency  
Increase transparency on health care system performance.

Recommendation 10: Broad Leadership  
Expand commitment to the goals of a continuously learning health care system.

http://www.iom.edu/~/media/Files/Report%20Files/2012/Best-Care/Best%20Care%20at%20Lower%20Cost_Recs.pdf

Best Care at Lower Cost: The Path to Continuously Learning Health Care in America (Full report – 360 pages):
http://books.nap.edu/openbook.php?record_id=13444

Comment:

By Don McCanne, MD

On release yesterday of the Institute of Medicine’s new report, “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America,” headlines throughout the nation proclaimed that the U.S. health system wastes about $765 billion a year. The articles reported that the Institute of Medicine has recommended an overhaul to recover this waste. So what is it that they recommend?

When you read their ten recommendations listed above, it is difficult to come to any other conclusion than that the efforts to produce this 360 page report have resulted in not much more than, well… platitudes.

The report does list strategies for each of the ten recommendations, but, perhaps oversimplified, much of it depends on information technology and really offers little hope that most of this waste could be recovered.

Instead of stumbling along towards trying to achieve a “learning health care system,” we should first adopt a single payer national health program. We would then have an efficient infrastructure to which the recommended strategies that are potentially beneficial could be applied.

Transformation of Health System Needed to Improve Care and Reduce Costs

Institute of Medicine
The National Academies, September 6, 2012
America’s health care system has become too complex and costly to continue business as usual, says a new report from the Institute of Medicine (Best Care at Lower Cost: The Path to Continuously Learning Health Care in America).
The costs of the system’s current inefficiency underscore the urgent need for a systemwide transformation. The committee calculated that about 30 percent of health spending in 2009 — roughly $750 billion — was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering.  By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state.
“The threats to Americans’ health and economic security are clear and compelling, and it’s time to get all hands on deck,” said committee chair Mark D. Smith, president and CEO, California HealthCare Foundation, Oakland. “Our health care system lags in its ability to adapt, affordably meet patients’ needs, and consistently achieve better outcomes. But we have the know-how and technology to make substantial improvement on costs and quality. Our report offers the vision and road map to create a learning health care system that will provide higher quality and greater value.”
http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=13444

And…

Best Care at Lower Cost: The Path to Continuously Learning Health Care in America

Institute of Medicine
Recommendations
Recommendation 1: The Digital Infrastructure
Improve the capacity to capture clinical, care delivery process, and financial data for better care, system improvement, and the generation of new knowledge.
Recommendation 2: The Data Utility
Streamline and revise research regulations to improve care, promote the capture of clinical data, and generate knowledge.
Recommendation 3: Clinical Decision Support
Accelerate integration of the best clinical knowledge into care decisions.
Recommendation 4: Patient-Centered Care
Involve patients and families in decisions regarding health and health care, tailored to fit their preferences.
Recommendation 5: Community Links
Promote community-clinical partnerships and services aimed at managing and improving health at the community level.
Recommendation 6: Care Continuity
Improve coordination and communication within and across organizations.
Recommendation 7: Optimized Operations
Continuously improve health care operations to reduce waste, streamline care delivery, and focus on activities that improve patient health.
Recommendation 8: Financial Incentives
Structure payment to reward continuous learning and improvement in the provision of best care at lower cost.
Recommendation 9: Performance Transparency
Increase transparency on health care system performance.
Recommendation 10: Broad Leadership
Expand commitment to the goals of a continuously learning health care system.
http://www.iom.edu/~/media/Files/Report%20Files/2012/Best-Care/Best%20Care%20at%20Lower%20Cost_Recs.pdf
Best Care at Lower Cost: The Path to Continuously Learning Health Care in America (Full report – 360 pages):
http://books.nap.edu/openbook.php?record_id=13444

On release yesterday of the Institute of Medicine’s new report, “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America,” headlines throughout the nation proclaimed that the U.S. health system wastes about $765 billion a year. The articles reported that the Institute of Medicine has recommended an overhaul to recover this waste. So what is it that they recommend?
When you read their ten recommendations listed above, it is difficult to come to any other conclusion than that the efforts to produce this 360 page report have resulted in not much more than, well… platitudes.
The report does list strategies for each of the ten recommendations, but, perhaps oversimplified, much of it depends on information technology and really offers little hope that most of this waste could be recovered.
Instead of stumbling along towards trying to achieve a “learning health care system,” we should first adopt a single payer national health program. We would then have an efficient infrastructure to which the recommended strategies that are potentially beneficial could be applied.

First, do no harm; second, nationalize

By Teryl Zarnow
The Orange County Register, August 19, 2012
(Dr. Don) McCanne, now 74, volunteers as a policy fellow for Physicians for a National Health Program, where he was a past president. His group favors a single-payer national health program often called “Improved Medicare for All.”
It’s not socialized medicine, just socialized insurance.
I can’t decide if the doctor is out of touch with reality or a prophet in blue jeans.
Link for full article:
http://www.ocregister.com/news/-183873-ocprint–.html

And…

Health care cure is an Rx for economic ruin

The Orange County Register
August 25, 2012
NEWPORT COAST, Anita Boyd:
Columnist Teryl Zarnow failed to do her homework. “First, do no harm; second, nationalize” [Aug. 19] would be better titled, “No choice for patients.” What was presented as a “news” article was a one-sided promotional piece for socialized medicine.
Perusing the online mission statement of “Physicians for a National Health Care Program,” one notes that “the program should be financed by truly progressive taxation,” and “views this campaign as part of the campaign for social justice in the United States.” Among its allied groups are All Unions Committee for Single Payer Healthcare, Progressive Democrats of America, and Healthcare-NOW!
The leadership, membership and network are particularly illustrative of those wishing to “change” America, including Kim Gandy and Terry O’Neill, past and present presidents of NOW, respectively; Medea Benjamin of Code Pink San Francisco. The California Nurses Association participates to “provide leadership in winning organized labor support for HR676,” which is the single-payer bill sponsored by John Conyers, D-Mich., in the House of Representatives.
The smiling Dr. Don McCanne and his cadre of liberal progressives speciously suggest that the “cure” for health care in America is another entitlement to be paid for through the income tax system, as if this country is not already $16 trillion in debt (not counting unfunded liabilities.) The state of our entitlement system is completely ignored: Social Security is operating in the red with more funds flowing out than in for the first time in our nation’s history, propped up by a “trust fund” consisting of IOU’s from the Treasury. Medicare will follow that scenario sooner, rather than later, now that Obamacare has siphoned $716 billion in funding from Medicare over the next 10 years. All of this while Dr. McCanne proposes to place yet another burden on the barely 50 percent of Americans who pay taxes, mostly to be borne on the backs of the middle class, for that is where one finds the real wealth of this country. McCanne’s “cure” for health care is a prescription for the financial collapse of this country.
Using Nobel Laureate Milton Friedman’s logic, a medical system that provides the best quality to the most must necessarily embrace free-market principles, but the free market is absent in our health care industry today. In 1945 Congress passed the McCarran-Ferguson Act, which exempted the business of medical insurance from federal antitrust laws.
Thus insurance companies may freely conspire to price-fix without legal repercussion, and consumers cannot readily compare prices for products and services. Coupled with expensive and unnecessary tests defensively prescribed to ward off meritless malpractice suits, our system is certainly sick, but it is not incurable. Just as the computer evolved from a slow, clunky but pricey desktop to a sleek, fast laptop at less than one-fourth the price of the original 30 years ago, competition and innovation can bring down the cost of health care, improve quality and enhance affordability. A free-market prescription begins with the embrace of free-market principles: repealing McCarran-Ferguson, posting prices for services and products, competition across state lines, tort reform and empowering the consumer.
The inevitable result of McCanne’s alternative is all too evident in the United Kingdom’s single-payer system, where months-long waits for simple surgeries are commonplace, and breast cancer patients were denied the use of life-saving Tamoxifen until public outrage became so loud that the government caved. How many lives were lost before this concession? There was no choice for patients under this plan. There will be none under Dr. McCanne’s.
http://letters.ocregister.com/2012/08/25/health-care-cure-is-an-rx-for-economic-ruin/

And…

How the U.S. should fix health care

The Orange County Register
September 5, 2012
SAN JUAN CAPISTRANO, Don McCanne, M.D., Senior Health Policy Fellow, Physicians for a National Health Program:
Letter-writer Anita Boyd [“Health care cure is an Rx for economic ruin,” Aug, 23], in responding to Teryl Zarnow’s column on me and my advocacy for single-payer reform [“First, do no harm; second, nationalize,” Aug. 19], stated, “Using Nobel Laureate Milton Friedman’s logic, a medical system that provides the best quality to the most must necessarily embrace free-market principles, but the free market is absent in our health-care industry today.”
She then proposes a “free-market prescription.” In doing so, she ignores Nobel Laureate Kenneth Arrow’s seminal work of a half century ago demonstrating that health care fails competitive market preconditions, and “when the market fails to achieve an optimal state, society will, to some extent at least, recognize the gap and nonmarket social institutions will arise attempting to bridge it.”
In 2004, I was on a panel debate with Milton Friedman discussing prescription drugs. In that debate he said, regarding the government’s defense of patents, “My initial reaction was to say, of course we want to let the market completely work, and instead of having the government defend the patent, let the patent owner defend it. But the more you look at it, the more you see that’s inconsistent.” He also acknowledged the importance of government in drug research. Even in Friedman’s view, pure free markets are an illusion.
Further, the oracle of free markets, Noble Laureate Friedrich A. Hayek, in “The Road to Serfdom,” wrote, “There is no reason why, in a society which has reached the general level of wealth ours has, (the certainty of a given minimum of sustenance) should not be guaranteed to all without endangering general freedom; that is: some minimum of food, shelter and clothing, sufficient to preserve health. Nor is there any reason why the state should not help to organize a comprehensive system of social insurance in providing for those common hazards of life against which few can make adequate provision.”
Every other wealthy nation provides comprehensive health care to virtually everyone, and they do it at a per person cost that averages close to half of what we spend. The secret is that they all use some form of social insurance, acknowledging the fact that health care markets inevitably fail for far too many with significant health care needs.
The Affordable Care Act of President Barack Obama supposedly relies on market principles by expanding competition of private health plans. Under the act, 30 million people will remain uninsured, inadequate health plans with low actuarial values will become the new standard and costs will continue to increase out of control. This is the most expensive of all possible models of health care reform, and yet falls miserably short of achieving a high-performance system. It is a mistake to pretend that markets will work since free markets do not and cannot possibly ever exist in health care, as the current reform effort once again demonstrates.
As Herbert Stein would say, the current status cannot continue. It is absolutely inevitable that eventually we will enact some form of social insurance. Although there are several possible models, the most likely for the United States will be our popular Medicare program, in an improved version. It would cover everyone. It would rely on progressive taxes to make it affordable based on ability to pay. It would improve efficiency, especially by eliminating the profound administrative waste that characterizes our current, fragmented, dysfunctional financing system. It would remove private insurer intrusions, returning choice in actual health care to the patient. Though a public social insurance program, it would perpetuate our private health care delivery system (i.e., it is not socialized medicine). Especially important is that it would exercise its purchasing power as a public monopsony, finally bending the cost curve to sustainable levels.
Much of the debate today includes distortions and exaggerations, driven by ideology. In this information age, the true facts are readily available. Instead of chasing after the ever-elusive fantasy of free markets in health care, we should join together in supporting the crafting of a bona fide social insurance program that works for all of us, based on solid health policy science.
http://letters.ocregister.com/2012/09/05/how-the-u-s-should-fix-health-care/

Comment by Quote of the Day reader Richard Krasner:
Don,
When I was in college studying political science, I learned that Orange County, CA was ground-zero for every extreme, right-wing organization tied to the right flank of the Republican Party, to wit, the John Birch Society, the Liberty Lobby, etc. It is was also the home of Richard Nixon, Ronald Reagan, the American Nazis, Robert Schuller (founder of Crystal Cathedral, a monument to rich, white Protestants like the Vatican in Rome), so it is no surprise that the hometown newspaper of the Republican Right in CA should denounce you and PNHP.
Take it as a badge of honor that such individuals who would let sick people die at the hands of corporate medicine and the insurance companies, who would kick poor people and the elderly off of Medicaid and Medicare, tell women what they could do with their bodies and their health care, and were in the forefront of the opposition to spending any money on AIDS research, have targeted you and the PNHP as just another “cadre of liberal progressives”.
Anita Boyd and those who like her, are infected with the vMeme of the “free market” can never except the fact as you so well point out, that there is no such thing as a pure free market, and as American history has shown, a mixed economy works best to provide the most beneficial outcomes for any solution to problems caused by the free market, and such opposition is usually the result of listening to the “rhetoric of intransigence” or to outright resentment that some people are getting “something for nothing”, or that her tax money is going to people she does approve of, but not to her.
They even yell “keep your hands off of my Medicare”, not realizing that is a government program that actually works. They also have an aversion to the word, “social”. It goes against the vMeme of “Rugged individualism” they have been infected by, and thus view the rest of society as not worthy of assistance when they cannot take care of themselves. Thus, as they did during the GOP primaries, they cheer when Ron Paul said that a person should die if they can’t afford health care, or failed to plan.
One day they will learn, but then again, some many never learn.