PNHP

The Right Thing for the Wrong Reason

The Right Thing for the Wrong Reason

By Marcia Angell
Room for Debate, The New York Times, June 17, 2012

If the Supreme Court strikes down the Affordable Care Act’s mandate to buy insurance, it will have done the right thing for the wrong reason. The court’s Republican majority will have used the Constitution as an excuse to undermine President Obama. (Anyone who still thinks the Supreme Court is not a political body hasn’t been paying attention.)

But the mandate is a terrible idea. It requires people to buy a commercial product from investor-owned businesses at whatever price the companies set. The point of health reform was to expand coverage while reining in the unsustainable inflation in costs. Yet, in making the insurance industry the linchpin of his reform plan, Obama ensured that health costs would grow even faster. By throwing the industry millions of new customers and billions of federal dollars, the law with its mandate is inherently inflationary. No health reform can work if it’s not affordable. As premiums mount, so will deductibles and co-payments, until many Americans will have insurance that they can’t afford to use (which is the current situation in Massachusetts).

So if the mandate is struck down, I will not be sorry. We will no longer be tempted to think we’ve solved the problem of providing universal care. The rest of the law will probably go down with it or unravel (even though there is no reason why the provision to extend Medicaid, which accounts for fully half the additional coverage, couldn’t stand alone).

We should see this as an opportunity to undertake real health reform. The only way to provide health care to all Americans at an affordable cost is by instituting some form of publicly administered nonprofit system like those in other advanced countries. After all, they manage to provide universal care at less than half the cost. I favor expanding Medicare (our single-payer subsystem) gradually by lowering the eligibility age one decade at a time, while phasing out for-profit health facilities.

Just as it is irresponsible for Republicans to oppose the Affordable Care Act to weaken the president, it is irresponsible for Democrats to support it for short-term political reasons. We need to evaluate it on its merits, and I believe it fails.

Marcia Angell, M.D., is a senior lecturer in social medicine at Harvard Medical School. She is the former editor in chief of The New England Journal of Medicine.

http://www.nytimes.com/roomfordebate/2012/06/17/what-will-change-after-the-supreme-courts-health-care-ruling/striking-down-the-individual-mandate-is-right-and-wrong

There’s a Better Way

By David Himmelstein and Steffie Woolhandler
The New York Times, Room for Debate, June 17, 2012

Occupy Wall Street wasn’t born in time for the 2009 health care debate. But that debate was a quintessential display of the power and privilege of the 1 percent.

Drug and insurance firms dictated the terms of reform: “do it our way or do nothing at all.” The result was a lopsided bargain: the American people were allowed to expand Medicaid, ship a few scraps to community health centers and impose feeble insurance regulations. Insurers got hundreds of billions of taxpayer dollars and a mandate ordering the middle class to buy their defective products.

The plan’s demise would offer peril and possibility. The corporate-backed “do nothing at all” option would perpetuate disaster: about 50,000 annual deaths from the lack of insurance; about 800,000 medical bankruptcies each year, mostly among families with coverage; a continuing spiral of rising costs and shrinking coverage; and continuing assaults on Medicare. But we need not meekly acquiesce to the dictates of the 1 percent.

A single-payer reform — a public, national health insurance plan that pays virtually all medical bills — would fix the health care mess; and, like Medicare, it’s clearly constitutional. Single-payer would save $400 billion wasted each year on insurers’ overhead and the paperwork burden they impose on doctors and hospitals. It could redirect this money to cover the uninsured and upgrade coverage for the rest of the 99 percent. As nations with single-payer systems have found, cutting out the insurance middlemen and driving a hard bargain with drug firms makes universal coverage affordable and lowers death rates. And single-payer would restore Americans’ right to choose any doctor and any hospital.

Of course, the impetus for such measures can’t come from inside boardrooms or the Beltway. The overturning of the Obama reform could add fuel to the Occupy impulse, stoking the broad social movement that’s essential for achieving real health care reform, and for rebuilding American democracy. Certainly, many doctors and nurses will be prepared to join our patients in the streets.

David Himmelstein, M.D., and Steffie Woolhandler, M.D., M.P.H., are internists and professors of public health at the City University of New York. They are co-founders of Physicians for a National Health Program.

Equal opportunity? Not in health care

By Li-hsia Wang and Henry Abrons
San Francisco Chronicle, Letters, June 6, 2012

The California HealthCare Foundation’s report on Medi-Cal (“Recipients give Medi-Cal mostly high marks,” May 31) might lead Chronicle readers to believe that low-income residents feel secure in California’s safety net for health care.

As doctors who served low-income families, we have strong convictions that Medi-Cal has design flaws that must be addressed. Medi-Cal reimbursements to providers are so low that patients often have difficulty finding a doctor for primary care, and access to specialists can be particularly difficult.

In many urban areas, Medi-Cal recipients receive health care mainly at overburdened county hospitals and community health centers where dedicated staff and administrators are continually challenged by inadequate funding and threats of further cutbacks. We view the stories told by Medi-Cal recipients as testaments to their individual resiliency and not an assurance that society is providing them with full access to high-quality care.

In spite of our lofty ideal of equal opportunity, the United States is unique among industrialized countries in segregating our poor in a separate and definitely not equal health insurance program. Isn’t it time we provided one high standard of universal health care? We need an improved and expanded Medicare for all.

Li-hsia Wang, M.D. and Henry Abrons, M.D., reside in Berkeley, Calif.

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2012/06/05/EDDD1OT1EM.DTL#ixzz1xWPChjxQ

Dr. Claudia Chaufan: Hispanics worst served by Affordable Care Act

By Silvia Casabianca
VOXXI News, June 18, 2012

An Argentinean medical doctor, Claudia Chaufan arrived in California as a single mom of a 7-year-old in 1997. She had been accepted to a one-year postgraduate training in science and medical communication. Destiny had it that she’d fall in love with a man that eventually became her husband, and with a cause that is now her passion.

She changed plans and stayed in the United States to get a doctorate in sociology at the University of California in Santa Cruz and now works as an assistant professor of sociology and health policy at the Institute for Health and Aging of the Department of Social and Behavioral Sciences at the University of California in San Francisco.

Chaufan gives presentations on diabetes and on comparative health policies, and writes for the general public and for expert audiences in the United States and abroad. She is also active in professional and community organizations, among them the Physicians for a National Health Program (PNHP).

Experiencing a single-payer health care system

Chaufan just returned from teaching a one-term course on Comparative Health Care Systems at the Taipei Medical University in Taiwan. There she got to experience first hand what she preaches about every day – that single-payer health care systems might be the best option.

“We had just arrived in Taiwan and my husband had this extremely bad headache,” Chaufan recalls. “I thought he had a ruptured brain aneurysm. The next day the headache was still there. I didn’t know what to do. We were staying next door to the hospital where I was teaching. We walked into the emergency room and I said we needed a doctor who could rule out the possibility of such and such.”

After a wait of only 20 minutes a doctor came. He agreed that an aneurysm was a possibility and ordered a CAT scan right away.

Fortunately the results were negative.

“The whole ordeal took us barely 90 minutes,” said Chaufan who was ready to pay in cash whatever the cost of the services were. Even though she knew the system really well, she had never experienced it by herself and she was surprised when she got the bill.

“I was thinking to myself, a CAT scan costs thousands in the United States. They asked us for our insurance card and we said we didn’t have one. They charged us $205. Two doctors had seen my husband, plus the stay at the hospital, and all they had asked us for was a name and an address!”

The medical system is simply not there for Hispanics

Before setting her residence in California, Chaufan’s medical practice had focused on clinical diabetes. She had attended medical conferences in the United States and briefly visited public hospitals.

Since in Argentina the health care system is underfunded, when compared, the hospitals in the U.S. looked great, clean and spacious to Chaufan.

“I thought they were wonderful,” Chaufan said. “I had seen unequal access to care in my country and thought the system here was great.”

But then she started to hear stories from people.

An NGO hired her to do diabetes education with Latino communities and she found that immigrants – documented or undocumented – had basically no access to health care.

“I felt embarrassed to talk to these people. How do you tell them to go eat broccoli when they could hardly make ends meet? Economy has not been working for them. It’s not the crisis. They live in a recession forever! They can’t even pay for transportation [to go to the doctor], and if they have a car, it’s falling apart.”

Chaufan decided to quit this job.

“I realized the problem was not education, it was poverty,” Chaufan said. “The medical system was simply not there. These people needed strips to test their blood sugar, they needed medication!”

Affordable Care Act (ACA) is not the way out

Chaufan started to rethink the health care system in the United States. She saw the problems and wanted to participate in solutions but didn’t know how until she found the PNHP.

“ACA doesn’t grant equal access to health – it excludes undocumented immigrants, who would not be allowed to buy insurance even with their own money,” said Chaufman. “People need to know that Latinos are the worst-served, and will be the worst affected by the reform.”

“If ACA is overturned, in whole or in part, I predict that the ‘liberal’ media is only going to talk about the role of the ‘bad Republican’ opposition, and ignore that 50 PNHP doctors (myself included) presented an Amicus Brief that also challenges the constitutionality of ACA,” she added. “And we did not do it because we are pushing for an imaginary free health care market, but because we wanted to make the point that you can bring universal affordable care to all Americans with a publicly financed health care system.

“They won’t mention that, because it is not in their interest. Everybody, Democrats, Republicans and the media are in bed with insurance companies and Big Pharma.”

Chaufan believes the ACA would institutionalize the worst of the current health care system.

“It makes people buy their junk. Even if it were universal insurance, as it is presented, with 26 million that will not be covered – according to a 2019 estimate – it’s underinsurance.”

The Argentinean health care system is underfunded and not strong, Chaufan said, but there exists a public hospital network where everybody can go.

“As a medical student, I went to one of those hospitals for services. Everyone who walks in gets care,” she said. “Non-profit mutual funds created by unions offer services to the community. There are also prepaid medical services, not cheap but never the horror that I see here with the price for tests, seeing a doctor, pharmaceuticals.”

The Affordable Care Act won’t eliminate financial barriers, she affirmed.

“Every country has a standard, including Taiwan,” Chaufan said. “If it’s publicly financed, the government says, you put a certain percentage of your salary, we buy services in bulk, buy for the whole country or the whole province, like in Canada. Here, we don’t know – it all depends on the individual insurance … that, the administration will not change.”

http://voxxi.com/dr-claudia-chaufman-hispanics-worst-served-affordable-care-act/

Massachusetts model fails to provide financial security for the sick

SICK IN MASSACHUSETTS: Views on Health Care Costs and Quality

Harvard School of Public Health/WBUR/Blue Cross Blue Shield of Massachusetts Foundation/Robert Wood Johnson Foundation
June 2012
This poll examines the views of sick adults in Massachusetts regarding the cost and quality of health care in the state as well as their perceptions about their own health care in the past year. “Sick” adults in Massachusetts (27% of adults) are defined as those who said they had a serious illness, medical condition, injury, or disability requiring a lot of medical care or had been hospitalized overnight in the previous 12 months. Focusing on the experiences and opinions of those who have had significant recent medical care yields special insight into the current problems and opportunities facing Massachusetts’ health care system.
Today most sick adults in Massachusetts see the cost of health care as a serious problem for the state, and they view the problem as having gotten worse over the past five years. Sick adults are more troubled by costs than they are by quality.
Although Massachusetts has nearly universal health insurance coverage, the costs of health care are a serious financial problem for many sick adults and their families. Some sick adults report having been refused medical care for financial or insurance reasons. Additionally, some sick adults say they did not get needed medial care because they could not afford it. Taken together, these finding suggest that insurance coverage does not protect some Massachusetts residents against the financial hardships of illness, likely reflecting recent trends in higher deductibles and co-payments.
http://www.scribd.com/doc/96682782/Sick-in-Massachusetts

This survey is particularly important because it provides the real life health care financing experiences of patients who have serious medical problems – precisely those for whom the system should be designed to serve.
In Massachusetts, “Forty percent of sick adults in the state said the out-of-pocket costs of medical care are a ‘very serious’ (16%) or ‘somewhat serious’ (24%) problem for them.” Obviously the financing system is not serving well those individuals with major medical needs.
Another significant finding: “About a quarter of sick adults (24%) who have been insured at any time during the past year say they have had a problem with their insurance paying a hospital, doctor, or other health care provider in the past 12 months.” Thus the insurers are not doing their job either.
Since the Affordable Care Act uses a financing design similar to that of Massachusetts, we can anticipate the same miserable performance for the nation, or more likely even worse because of other design flaws in ACA.
At a minimum, we should expect the health care financing system to work well for those with serious problems. The ACA design won’t cut it. We really do need a single payer national health program that would work well for all of us.

Small businesses support beneficial health reform policies

Small Business Owners’ Views on Implementing the Affordable Care Act

Small Business Majority
June 14, 2012

Executive Summary

The rising cost of health insurance has been and continues to be one of the biggest problems facing American small business owners. To help relieve them of that financial burden, the Affordable Care Act was signed into law on March 23, 2010—a piece of legislation that is already reining in Americans’ health coverage costs. More than two years later, the law’s fate rests in the hands of nine Supreme Court justices who are expected to issue their decision this month in the case against the law. According to scientific opinion polling, only one-third of small business owners would like to see them overturn it. On the other hand, half would like to see it upheld with, at most, only minor changes. This support grows after learning more details about its key provisions.
 
The poll, conducted in eight states with diverse political profiles—Florida, Illinois, Louisiana, Michigan, Missouri, New York, Texas and Virginia—found that once small business owners hear more about the healthcare law, their support for keeping it intact—either as is or with minor changes—rises to a 56% majority, while the desire for repeal falls to 28%—a 2:1 margin. Moreover, entrepreneurs strongly support many of its key provisions affecting small business owners.

One of the law’s crucial components, which has tremendous small business support, is the health insurance exchange—an online marketplace where small business owners will be able to pool their buying power when they purchase coverage. By a striking 8:1 ratio, owners say they would use their state exchange or at least consider using it, compared to those who say they would not consider using it when they provide benefits. The majority of entrepreneurs find possible features of the exchange very appealing, and, by a 2:1 ratio, they support their state applying for federal funds to set one up.

Furthermore, half of entrepreneurs report they’d be more likely to purchase insurance through the exchange beginning in 2014 when the small business tax credit will be available only to those using the exchange. That’s more than three times the number (14%) who say they’d be less likely to purchase from the exchange. Of respondents who fall into the basic qualification parameters for the tax credit, more than half are already taking advantage of it. Of eligible employers who aren’t claiming it, nearly half say it’s because they are not aware it exists. And nearly half of entrepreneurs say that if their company qualified for the credit, they would be more likely to provide or continue providing healthcare to their employees.

Significant majorities of small business owners also support nearly all the other provisions we asked them about: medical loss ratio, rate review, pre-existing condition exclusion bans, eliminating annual dollar limits on insurance benefits, preventing rating based on health status or sex and more.

Finally the poll revealed a strong interest (67%) in workplace wellness programs, if these programs would help lower coverage costs.

http://www.smallbusinessmajority.org/small-business-research/downloads/Small_Business_Owners_Views_on_ACA.pdf

Comment: 

By Don McCanne, MD

Rather than asking about a broad spectrum of health reform policies, this poll was limited to questions about policies contained in the Affordable Care Act. From this poll no conclusions can be drawn about opinions of policies specific to single payer, but we can conclude that small business owners clearly do want reform that serves them and their employees better than the status quo in health care.

It remains our task to inform them that the policies of the single payer model will serve them far better than the meager policies of the Affordable Care Act. The majority of small business owners would support an improved Medicare for all if they had a clear understanding of the policies behind it, since it’s far better for them than ACA.

Let’s get to work and let them know the possibilities.

Poorer nations push for universal health coverage as U.S. squabbles

By Philip Caper, M.D.
Bangor Daily News (Maine), June 14, 2012

A few weeks ago, an article by Noam Levey of the Los Angeles Times caught my eye. It was titled “Global Push to Guarantee Health Coverage Leaves U.S. Behind” and it described how “even as Americans debate whether to scrap President Obama’s health care law and its promise of guaranteed health coverage, many far less affluent nations are moving in the opposite direction — to provide medical insurance to all citizens.”

Among those other countries are China, Thailand, Mexico, Rwanda and Ghana. The article went on to explain that, “Two decades ago, many former communist countries in Eastern Europe and elsewhere dismantled their universal health care systems amid a drive to set up free-market economies. But popular demand for insurance protection has fueled an effort in nearly all of these countries to rebuild their systems. Similar pressure is coming from the citizens of fast-growing nations in Asia and Latin America, where rising living standards have raised expectations for better services.”

Many other countries are moving full speed ahead to guarantee health care for all their citizens, not only because it is morally and ethically right but because it is a powerful economic development tool that will ensure these countries have healthy populations and an efficient and effective health care system.

Meanwhile, the U.S. seems stuck in a state of political paralysis and may soon move full speed astern. What explains this striking and unfortunate example of American exceptionalism?

I attribute it to motivators often used to explain the behavior of Wall Street: fear and greed.

I would also add a third: ignorance. There are those who still believe (or claim to), despite all the evidence to the contrary, that the U.S. has the best health care system in the world. This belief is demonstrably contradicted, both by the facts and everyday experience. We have the most expensive health care system in the world and some of the fanciest technology, but our arrangement for getting health services to our people ranks far down the scale, behind about 40 other countries.

Fear is a major factor in the political stalemate we are now witnessing surrounding health care reform. About 50 million people in the U.S. are uninsured and increasing numbers are badly underinsured. Bankruptcies and other financial hardships due to medical costs are becoming more and more common.

Despite this, we are treated almost daily to distracting arguments, many unfounded and ridiculous, about “death panels,” “government tyranny,” “rationing” and other largely mythical or irrelevant threats to our well-being. Some of the critics responsible for these fear tactics are simply misinformed, but others are dissembling to pursue obstructionist political agendas.

Much of the fear-mongering around the health care reform debate is induced by the second motivator: greed. Health care in the U.S. is almost a $3 trillion industry. It is credibly estimated that about a third of our spending does not contribute to the health of our people in any meaningful way. The proof is that other wealthy nations provide health care to their people for about half of what we spend yet get better results.

Elimination (or more accurately redirection) of some of that money would mean moving funds away from a few people and toward the rest of us, thereby reducing the income of influential industries such as large pharmaceutical and medical supply companies and corporate providers of health care services. Many of these companies are enjoying windfall profits thanks to American public policy. Greed and the political muscle that goes with money are a major source of resistance to changes that would benefit the vast majority of Americans.

Our market-driven health care system is disintegrating. Many are being harmed in the process. How can people of good conscience allow this to continue? We need to change the ways we finance, pay for and deliver health care.

Our for-profit insurance and delivery systems must be transformed (not just reformed) into nonprofit ones, like most other countries. Coverage must be expanded to include everybody. Firm, fair and effective cost controls need to be put in place. In order for widespread support for such a system to be sustained, everyone must be in the same system.

In other words, we must replace our existing system sustained by fear, greed and ignorance with one that is fair, inclusive, efficient, effective and mission-driven. Such transformation has occurred elsewhere. Given the political will, we in the U.S., including Maine, could do it too. We’d all be much better off.

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/2012/06/14/health/poorer-nations-push-for-universal-health-coverage-as-u-ssquabbles/

Small businesses support beneficial health reform policies

Small Business Owners’ Views on Implementing the Affordable Care Act

Small Business Majority
June 14, 2012
Executive Summary
The rising cost of health insurance has been and continues to be one of the biggest problems facing American small business owners. To help relieve them of that financial burden, the Affordable Care Act was signed into law on March 23, 2010—a piece of legislation that is already reining in Americans’ health coverage costs. More than two years later, the law’s fate rests in the hands of nine Supreme Court justices who are expected to issue their decision this month in the case against the law. According to scientific opinion polling, only one-third of small business owners would like to see them overturn it. On the other hand, half would like to see it upheld with, at most, only minor changes. This support grows after learning more details about its key provisions.
The poll, conducted in eight states with diverse political profiles—Florida, Illinois, Louisiana, Michigan, Missouri, New York, Texas and Virginia—found that once small business owners hear more about the healthcare law, their support for keeping it intact—either as is or with minor changes—rises to a 56% majority, while the desire for repeal falls to 28%—a 2:1 margin. Moreover, entrepreneurs strongly support many of its key provisions affecting small business owners.
One of the law’s crucial components, which has tremendous small business support, is the health insurance exchange—an online marketplace where small business owners will be able to pool their buying power when they purchase coverage. By a striking 8:1 ratio, owners say they would use their state exchange or at least consider using it, compared to those who say they would not consider using it when they provide benefits. The majority of entrepreneurs find possible features of the exchange very appealing, and, by a 2:1 ratio, they support their state applying for federal funds to set one up.
Furthermore, half of entrepreneurs report they’d be more likely to purchase insurance through the exchange beginning in 2014 when the small business tax credit will be available only to those using the exchange. That’s more than three times the number (14%) who say they’d be less likely to purchase from the exchange. Of respondents who fall into the basic qualification parameters for the tax credit, more than half are already taking advantage of it. Of eligible employers who aren’t claiming it, nearly half say it’s because they are not aware it exists. And nearly half of entrepreneurs say that if their company qualified for the credit, they would be more likely to provide or continue providing healthcare to their employees.
Significant majorities of small business owners also support nearly all the other provisions we asked them about: medical loss ratio, rate review, pre-existing condition exclusion bans, eliminating annual dollar limits on insurance benefits, preventing rating based on health status or sex and more.
Finally the poll revealed a strong interest (67%) in workplace wellness programs, if these programs would help lower coverage costs.
http://www.smallbusinessmajority.org/small-business-research/downloads/Small_Business_Owners_Views_on_ACA.pdf

Rather than asking about a broad spectrum of health reform policies, this poll was limited to questions about policies contained in the Affordable Care Act. From this poll no conclusions can be drawn about opinions of policies specific to single payer, but we can conclude that small business owners clearly do want reform that serves them and their employees better than the status quo in health care.
It remains our task to inform them that the policies of the single payer model will serve them far better than the meager policies of the Affordable Care Act. The majority of small business owners would support an improved Medicare for all if they had a clear understanding of the policies behind it, since it’s far better for them than ACA.
Let’s get to work and let them know the possibilities.

Artificially creating dysfunctional competition through limited-network plans

Navigating the Health Care Maze

By Abby Goodnough
The New York Times, June 12, 2012

Even if the Supreme Court strikes down the federal mandate, many people believe that some form of exchanges could still be crucial to expanding coverage in a number of states. In Massachusetts, insurers bid to participate in the Connector — offering plans that include some level of hospitalization, prescription drugs, maternity care and other services deemed essential by the state — and the Connector uses its market leverage and unique guidelines to promote innovation and competition among them.

“It can — and it has — helped people find more affordable options than they otherwise knew existed,” said Glen Shor, executive director of the Connector.

A vast majority of the people who have gotten insurance through the Connector since the economic downturn began have not had to worry about deductibles because they qualify for subsidized coverage. In that program, the big challenge has been keeping costs down as enrollment has steadily climbed.

One strategy has been to reward the lowest-cost insurers in Commonwealth Care, the subsidized program, by driving customers to them. (For example, people who pay no premium because of their income can choose between the two lowest-cost insurers.) Some insurers have responded by limiting which doctors and hospitals customers can use.

Such limitations are controversial, but Mr. Shor said limited-network plans are just the kind of cost-saving innovation that exchanges are well-positioned to bring about by promoting competition in the market.

http://www.nytimes.com/2012/06/13/us/navigating-the-health-care-maze.html?pagewanted=2&hpw&pagewanted=all

Comment: 

By Don McCanne, MD

One of the greatest strategic errors in this entire health care reform process has been to fixate on the promotion of competition in the health care market. An example of how deviant this has been is the push to expand limited-network plans.

Think about it. What we want is our choice of hospitals and our health care professionals. What the insurance industry has done is to package their own selection of hospitals and professionals into limited networks, and then prohibit our access to out-of-network care unless we pay prohibitive financial penalties. For this, collectively we are paying even more in wasteful administrative costs. It is totally illogical to pay for extra administrative services designed to artificially take away our choices in the health care market.

Think of what it would be like if we did that with housing. Imagine the government mandating us to select a residential benefits plan. Suppose when we were ready to rent or purchase a residence the third party administrative agency told us that we could have access to only residential buildings within their limited network, though we would have our choice of bronze, silver, gold or platinum houses or apartments. Adding to the insult, collectively we would have to pay extra to this administrative agency that artificially takes away our choices.

What if third parties in the private market were able to corner the food industry and contract with them to create artificial limited-network food plans, with a government mandate that we had to select one of the plans? Within the segregated food market you could shop bronze, silver, gold or platinum selections based on the food insurance premium paid. You could shop outside of the segregated markets, but only by paying large financial penalties.  Again, collectively we would be paying extra to meet the costs of this intrusive third party administrator that would be taking away our choices.

Shifting competition in food markets from producers and retailers to an artificial third party administrator, or shifting competition in housing from the builders or landlords to an artificial third party administrator is about as logical as shifting competition in health care from the hospitals and professionals to an artificial third party administrator, all of which would charge us extra for taking away our choices. We wouldn’t tolerate that in food or housing. Why should we continue to tolerate it in health care?

Another word about our obsession with competition. The policy community recognizes that much of the dysfunction in health care is related to fragmentation of our system – both in financing and in health care delivery. Efforts are being made to integrate health services to provide an efficient, coordinated flow of health care. These efforts require cooperation between the various sectors of the health care delivery system. Competition is a divisive, destructive, evil force when it occurs within a system that should be joining together in cooperation for the public good.

Private insurers compete. Public administrators cooperate. In health care, we need more cooperation. ‘Nuff said?

The Supreme Court Should Rule with the People

By Margaret Flowers and Kevin Zeese
Dissident Voice, June 13, 2012

Six years after Massachusetts enacted the state version of Obama’s health law, the people of Massachusetts are not happy.  According to a June 11th poll in Massachusetts, 78% of patients say the cost of care in Massachusetts is a serious problem and 63% say it has gotten worse in the last five years.  Patients report longer waits, higher premiums, higher co-pays and are less satisfied with health care. The number of bankruptcies due to medical illnessand costs has continued to increase in Massachusetts too.

Despite what the corporate media report, Romney-Care, on which Obama-Care is modeled, is not working.

Americans want the Supreme Court to find the Obama law unconstitutional. More than two-thirds of Americans hope the Supreme Court will overturn some or all of the 2010 health care law, according to a June 7th New York Times-CBS poll. A mere 24% said they hoped the court “would keep the entire health care law in place.” Forty-one percent of those surveyed said the court should strike down the entire law, and another 27% said the justices should overturn only the individual mandate, the requirement that people purchase private insurance if they are not insured or pay a fine.

Overturning the entire law may have less of an impact now that three of the nation’s largest insurers, UnitedHealth, Aetna and Humana, say they will continue popular provisions such as allowing young adults under 26 to gain coverage under their parents’ plans and covering preventive care.

And overturning the law may provide an opportunity to push for a real solution to the ongoing health care crisis, to finally create a national universal and publicly-financed health insurance such as improved Medicare for All.

Perhaps this time around the nation could have a real debate about proven solutions to the fundamental problems causing the health care crisis. Private for-profit insurance and medical corporations are at the heart of that crisis. It was these corporations that heavily influenced and in some cases wrote the Obama health legislation so that it enhanced their profit margins.

For example, emails and other documents recently released by congressional investigative committees find that the Obama administration worked closely with the Pharmaceutical industry, agreeing to a back-room deal that protected their profits by opposing the re-importation of prescription medicines at lower prices. Re-importation was something President Obama supported in his 2008 campaign when he criticized the Republicans’ behind-closed-doors deals with Big Pharma.

Further the White House coordinated their $150 million advertising campaign with major pharmaceutical companies. And nearly $70 million was spent through two Super PACs — political action committees — organized by White House officials. Advocacy groups like Families USA and the unions coordinated their advertising with the White House and Big Pharma too.

The Obama law will not control costs, provide universal coverage or improve the quality of health care. More and more commentators are recognizing thatthere is a constitutional way to do so – remove two words “over 65” from the Medicare law.  This would cover every American and be a major step toward improving health outcomes in the United States.

In an amicus curae brief, we joined 50 doctors to make the case that Congress has already demonstrated it can regulate health care markets effectively by implementing single payer systems such as Medicare or the Veterans Health Administration.

We argued that the mandate was obviously unconstitutional, otherwise Congress could “reform” any failing private industry – whether it be automobiles, coal, pharmaceuticals or any other – by enacting legislation requiring that every American purchase the industry’s goods or services in exchange for some perceived public good the industry provides. As some of the justices noted in oral argument, this would change the relationship between citizen and government. Indeed, forcing the purchase of products is crony capitalism on steroids.

The brief demonstrates the superior efficiencies of single-payer systems. Only 2% of Medicare’s dollars go to administration and overhead, compared to private insurance which spends 16.7%. Under a single payer system, overall administrative costs would fall from the current 33% of health care spending to less than 5%, saving hundreds of billions of dollars. In fact, studies conducted by the nonpartisan General Accounting Office and the nonpartisan Congressional Budget Office have consistently concluded that if a national single payer system were implemented in the United States, administrative cost-savings alone would be enough to guarantee universal coverage without increasing overall health care spending

The brief shows that the cost of Medicare has increased more slowly than the cost of health care generally and more slowly than the cost of private insurance. And Medicare is rated highly by senior citizens, who are its primary beneficiaries.  51% of seniors give their health insurance an “excellent” rating.

Single payer has been supported by super majorities of the American people for more than a decade. This silenced majority of Americans who wanted real universal health care under a national health plan may get another opportunity to push for what they want if the Supreme Court rules with the people and against crony capitalist health care.

Medicare for all saves lives and saves money. Say ‘No’ to Romney/Obama health care and ‘Yes’ to Medicare for all now.

Margaret Flowers, a pediatrician, Kevin Zeese, an attorney, are both are advocates for single payer health care and the co-direct, ItsOurEconomy.US which filed an amicus brief along with Single Payer Action and 50 doctors urging the court to find the mandate unconstitutional. [PNHP note: Physicians for a National Health Program took no position on the constitutionality of the ACA.]

http://dissidentvoice.org/2012/06/the-supreme-court-should-rule-with-the-people/

Artificially creating dysfunctional competition through limited-network plans

Navigating the Health Care Maze

By Abby Goodnough
The New York Times, June 12, 2012
Even if the Supreme Court strikes down the federal mandate, many people believe that some form of exchanges could still be crucial to expanding coverage in a number of states. In Massachusetts, insurers bid to participate in the Connector — offering plans that include some level of hospitalization, prescription drugs, maternity care and other services deemed essential by the state — and the Connector uses its market leverage and unique guidelines to promote innovation and competition among them.
“It can — and it has — helped people find more affordable options than they otherwise knew existed,” said Glen Shor, executive director of the Connector.
A vast majority of the people who have gotten insurance through the Connector since the economic downturn began have not had to worry about deductibles because they qualify for subsidized coverage. In that program, the big challenge has been keeping costs down as enrollment has steadily climbed.
One strategy has been to reward the lowest-cost insurers in Commonwealth Care, the subsidized program, by driving customers to them. (For example, people who pay no premium because of their income can choose between the two lowest-cost insurers.) Some insurers have responded by limiting which doctors and hospitals customers can use.
Such limitations are controversial, but Mr. Shor said limited-network plans are just the kind of cost-saving innovation that exchanges are well-positioned to bring about by promoting competition in the market.
http://www.nytimes.com/2012/06/13/us/navigating-the-health-care-maze.html?pagewanted=2&hpw&pagewanted=all

One of the greatest strategic errors in this entire health care reform process has been to fixate on the promotion of competition in the health care market. An example of how deviant this has been is the push to expand limited-network plans.
Think about it. What we want is our choice of hospitals and our health care professionals. What the insurance industry has done is to package their own selection of hospitals and professionals into limited networks, and then prohibit our access to out-of-network care unless we pay prohibitive financial penalties. For this, collectively we are paying even more in wasteful administrative costs. It is totally illogical to pay for extra administrative services designed to artificially take away our choices in the health care market.
Think of what it would be like if we did that with housing. Imagine the government mandating us to select a residential benefits plan. Suppose when we were ready to rent or purchase a residence the third party administrative agency told us that we could have access to only residential buildings within their limited network, though we would have our choice of bronze, silver, gold or platinum houses or apartments. Adding to the insult, collectively we would have to pay extra to this administrative agency that artificially takes away our choices.
What if third parties in the private market were able to corner the food industry and contract with them to create artificial limited-network food plans, with a government mandate that we had to select one of the plans? Within the segregated food market you could shop bronze, silver, gold or platinum selections based on the food insurance premium paid. You could shop outside of the segregated markets, but only by paying large financial penalties.  Again, collectively we would be paying extra to meet the costs of this intrusive third party administrator that would be taking away our choices.
Shifting competition in food markets from producers and retailers to an artificial third party administrator, or shifting competition in housing from the builders or landlords to an artificial third party administrator is about as logical as shifting competition in health care from the hospitals and professionals to an artificial third party administrator, all of which would charge us extra for taking away our choices. We wouldn’t tolerate that in food or housing. Why should we continue to tolerate it in health care?
Another word about our obsession with competition. The policy community recognizes that much of the dysfunction in health care is related to fragmentation of our system – both in financing and in health care delivery. Efforts are being made to integrate health services to provide an efficient, coordinated flow of health care. These efforts require cooperation between the various sectors of the health care delivery system. Competition is a divisive, destructive, evil force when it occurs within a system that should be joining together in cooperation for the public good.
Private insurers compete. Public administrators cooperate. In health care, we need more cooperation. ‘Nuff said?

2012 health care spending, including administration

National Health Expenditure Projections: Modest Annual Growth Until Coverage Expands And Economic Growth Accelerates

By Sean P. Keehan, Gigi A. Cuckler, Andrea M. Sisko, Andrew J. Madison, Sheila D. Smith, Joseph M. Lizonitz, John A. Poisal and Christian J. Wolfe
Health Affairs, June 2012

2012

$2,809.0 billion – NHE (National Health Expenditures)

$8,952.8 – NHE per capita

17.9% – NHE as percent of GDP

$37.5 billion – Government administration (Note d)

$162.6 billion – Net cost of health insurance (Note e)

d  Includes all administrative costs (federal, state, and local employees’ salaries; contracted employees, including fiscal intermediaries; rent and building costs; computer systems and programs; other materials and supplies; and other miscellaneous expenses) associated with insuring individuals enrolled in the following public health insurance programs: Medicare, Medicaid, Children’s Health Insurance Program, Department of Defense, Department of Veterans Affairs, Indian Health Service, workers’ compensation, maternal and child health, vocational rehabilitation, Substance Abuse and Mental Health Services Administration, and other federal programs.

e  Net cost of health insurance is calculated as the difference between calendar year premiums earned and benefits paid for private health insurance. This includes administrative costs and, in some cases, additions to reserves; rate credits and dividends; premium taxes; and plan profits or losses. Also included in this category is the difference between premiums earned and benefits paid for the private health insurance companies that insure the enrollees of the following public programs: Medicare, Medicaid, Children’s Health Insurance Program, and workers’ compensation (health portion only).

Conclusion

For 2011 through 2013, the lingering effects of the economic recession and modest recovery, mostly in the form of limited growth in incomes, are expected to continue to constrain health spending growth. In 2014 the coverage expansions laid out in the Affordable Care Act for Medicaid and for private health insurance are expected to increase the growth rate for health spending to 7.4 percent, with notable increases expected in spending on physician services and prescription drugs for newly insured patients. By the end of the projection period, higher income growth and the continuing shift of baby boomers into Medicare are expected to cause health spending to grow roughly two percentage points faster than overall economic growth, which is about the same differential experienced over the past thirty years.

http://content.healthaffairs.org/content/early/2012/06/11/hlthaff.2012.0404.abstract

Comment:  

By Don McCanne, MD

This is the annual report that is used most often as a resource for our health care spending.

The numbers to remember for 2012:

National Health Expenditures:  about $2.8 trillion

Health spending per capita:  about $9000

Spending as a percent of GDP:  about 18%

After the transitions of the next decade, health care spending is expected to continue to grow two percentage points faster than overall economic growth – the same differential experienced over the past thirty years. It makes you wonder when Herbert Stein’s principle will kick in (essentially, if it can’t go on, it won’t).

Since we are seeing an increase in the political rhetoric divided over whether the government or markets should be the dominant force in health care financing, it is worthwhile looking at the total administrative costs of these two approaches to financing health care. Although government spending accounts for about half of all health care spending, we are paying private insurers more than four times as much in administrative costs and profits as we are spending on government administration of health insurance programs.

It is true that the net cost of private health insurance includes the administrative costs of private Medicare Advantage plans and private Medicaid and CHIP managed care plans, but this does not begin to account for the four fold differences in total administrative costs between public and private insurance.

Keep this in mind during the national debate over the Affordable Care Act this political season, which will continue to take place regardless of the Supreme Court decision. One side will argue that we need to encourage free markets of private plans plus private options for Medicare. The other side will argue that we need exchanges to provide choices of private plans, while continuing to offer private Medicare Advantage plans. The one side will talk about private markets while condemning the government, whereas the other side simply will avoid rhetoric referencing the government while touting the virtues of nominal ACA reforms of the private insurers. Both sides are wrong!

We need to get rid of the private insurers and switch to a publicly administered single payer national health program. Besides, then we can address more effectively our health care costs that continue to increase at a rate two percent above the growth in our economy – a rate that is intolerable when compounded year after year.