Columnist: If ‘Obamacare’ implemented, single-payer is next

By Don Finley
San Antonio Express-News, March 9, 2012
If President Obama’s health care reform act is fully implemented over the next two years, it will evolve into a Canadian-style single-payer system that will forever change the social contract between Americans and their government, a nationally syndicated columnist and physician predicted.
“It will change the country. If it is not repealed, we will be a different country when ‘Obamacare’ is fully implemented,” (Washington Post columnist and Fox News commentator Charles) Krauthammer said in an interview after speaking Thursday to a receptive crowd of mostly physicians and other health care professionals at a breakfast sponsored by the San Antonio Medical Foundation.
In his speech, Krauthammer predicted the complexity of the law eventually would doom it to failure, which would lead to a single-payer system within a decade.
“This is a new reform that when it kicks in within a couple of years will make the practice of medicine a nightmare,” he said. “If it’s not repealed, I guarantee you that within a decade we will have a single-payer system. And if I had to choose between Obamacare and a Canadian or British system, I’d choose the single-payer system. At least it would be rational.”
http://www.mysanantonio.com/news/local_news/article/Columnist-If-Obamacare-implemented-single-payer-3392700.php

And…

On the $1,000 Genome and the Future of Health Systems

By Reihan Salam
National Review Online, March 8, 2012
Back in 2009, I wrote a column that pivoted off of a really good 2007 column by economist Stephen Cecchetti which argued that the genomics revolution made single-payer inevitable. At the time, I argued that while the genomics revolution didn’t make single-payer inevitable, it would push health systems in the advanced market democracies towards a more coherent system for protecting against chronic illnesses and catastrophic medical expenditures.
Razib Khan, my go-to writer on these matters, adds the following: (Comments on the $1000 genome available at the link below)…
That is, the $1,000 genome will accelerate the growth of a broader innovative ecology that will transform medicine. Razib, incidentally, is a rare right-of-center supporter of single-payer health systems, and I’d love to hear his thoughts on the subject.
http://www.nationalreview.com/agenda/293003/1000-genome-and-future-health-systems-reihan-salam

Many conservatives have a good understanding of the beneficial features of the single payer model of health care financing, and several believe that it may be an inevitable imperative. As Charles Krauthammer states, “And if I had to choose between Obamacare and a Canadian or British system, I’d choose the single-payer system. At least it would be rational.”

By Carla K. Johnson
Associated Press, March 4, 2012

The Commonwealth Fund, a private foundation that sponsors health care research, estimates that 22 million Americans were contacted by collection agencies for unpaid medical bills in 2005. That increased to 30 million Americans in 2010.

Surprisingly, even after the bills have been paid off, the record of the collection action can stay on a credit report for up to seven years, dragging down credit scores and driving up the cost of financing a home. An estimated 3.4 million Americans have paid-off medical debt lingering on their credit reports, according to the Access Project, a research group funded by health care foundations and advocates of tougher laws on medical debt collectors.

Medical bills make up the majority of collection actions on credit reports, and most are for less than $250, according to Federal Reserve Board research.

Matt Ernst, a vice president at Mortgage Lenders of America in Overland Park, Kan., said medical collections frequently turn up on credit reports.

“We see a ton of them,” Ernst said. They have an impact on financing, he said, but even he didn’t realize how much until he learned that someone with a FICO score of 680 — which is considered good, but not excellent — will see their score drop up to 65 points because of a medical collection.

“I didn’t know a medical collection would hammer it that hard,” Ernst said.

It’s a problem for insured and uninsured alike. Outright billing mistakes, confusion over whether a claim will be paid by insurance and disputes between insurance companies and doctors — all can lead to medical bills being sent to collection agencies.

http://news.yahoo.com/medical-bills-wreck-credit-even-paid-off-183216201.html

Comment:

By Don McCanne, MD

In 2010, 30 million Americans were contacted by collection agencies for unpaid medical bills. Even if paid off, the resulting reduction in scores on credit reports often have serious negative financial consequences because of the perceived lower level of creditworthiness.

Imagine this occurring with a health care financing system that provides first dollar coverage, as with a single payer national health program. It wouldn’t. Bill collectors would be joining insurance administrators in trying to find more productive occupations that would provide greater value for our nation.

Medical bills can wreck credit, even when paid off

By Carla K. Johnson
Associated Press, March 4, 2012
The Commonwealth Fund, a private foundation that sponsors health care research, estimates that 22 million Americans were contacted by collection agencies for unpaid medical bills in 2005. That increased to 30 million Americans in 2010.
Surprisingly, even after the bills have been paid off, the record of the collection action can stay on a credit report for up to seven years, dragging down credit scores and driving up the cost of financing a home. An estimated 3.4 million Americans have paid-off medical debt lingering on their credit reports, according to the Access Project, a research group funded by health care foundations and advocates of tougher laws on medical debt collectors.
Medical bills make up the majority of collection actions on credit reports, and most are for less than $250, according to Federal Reserve Board research.
Matt Ernst, a vice president at Mortgage Lenders of America in Overland Park, Kan., said medical collections frequently turn up on credit reports.
“We see a ton of them,” Ernst said. They have an impact on financing, he said, but even he didn’t realize how much until he learned that someone with a FICO score of 680 — which is considered good, but not excellent — will see their score drop up to 65 points because of a medical collection.
“I didn’t know a medical collection would hammer it that hard,” Ernst said.
It’s a problem for insured and uninsured alike. Outright billing mistakes, confusion over whether a claim will be paid by insurance and disputes between insurance companies and doctors — all can lead to medical bills being sent to collection agencies.
http://news.yahoo.com/medical-bills-wreck-credit-even-paid-off-183216201.html

In 2010, 30 million Americans were contacted by collection agencies for unpaid medical bills. Even if paid off, the resulting reduction in scores on credit reports often have serious negative financial consequences because of the perceived lower level of creditworthiness.
Imagine this occurring with a health care financing system that provides first dollar coverage, as with a single payer national health program. It wouldn’t. Bill collectors would be joining insurance administrators in trying to find more productive occupations that would provide greater value for our nation.

By Robin A. Cohen, Ph.D.; Renee M. Gindi, Ph.D.; and Whitney K. Kirzinger, M.P.H.
CDC, National Center for Health Statistics, March 2012

Previous work has shown that in 2010, more than one in five Americans were in families reporting problems paying medical bills. In 2011, three new questions addressing financial burden of medical care were added to the National Health Interview Survey (NHIS) Family component. These questions addressed problems paying medical bills, paying medical bills over time, and having medical bills that cannot be paid at all.

In the first 6 months of 2011, one in three persons was in a family experiencing financial burden of medical care. One in 5 persons was in a family having problems paying medical bills, 1 in 4 persons was in a family paying medical bills over time, and 1 in 10 persons was in a family that had medical bills they were unable to pay at all.

http://www.cdc.gov/nchs/data/nhis/earlyrelease/financial_burden_of_medical_care_032012.pdf

Comment: 

By Don McCanne, MD

This new report adds to the profusion of policy studies confirming that Americans continue to experience financial burdens in paying their medical bills. Unfortunately, this problem will not go away after the Affordable Care Act is fully implemented.

Well over 20 million people will remain uninsured, and perhaps a third or more of our population will be under-insured, due to the low actuarial value plans to be offered in the exchanges, and especially due to the increasing prevalence of high-deductibles in employer-sponsored plans. In fact, under-insurance likely will soon be the norm.

Contrast that with John Conyers’ HR 676, the “Expanded and Improved Medicare for All Act,” which states, “The health care benefits under this Act cover all medically necessary services… No deductibles, copayments, coinsurance, or other cost-sharing shall be imposed with respect to covered benefits.”

For those who say we can’t afford this, many other nations provide all of their people comprehensive care with no out-of-pocket expenses, at an average cost of only half of what we are spending on health care.

We can’t afford not to do it.

Financial Burden of Medical Care: Early Release of Estimates From the National Health Interview Survey, January–June 2011

By Robin A. Cohen, Ph.D.; Renee M. Gindi, Ph.D.; and Whitney K. Kirzinger, M.P.H.
CDC, National Center for Health Statistics, March 2012
Previous work has shown that in 2010, more than one in five Americans were in families reporting problems paying medical bills. In 2011, three new questions addressing financial burden of medical care were added to the National Health Interview Survey (NHIS) Family component. These questions addressed problems paying medical bills, paying medical bills over time, and having medical bills that cannot be paid at all.
In the first 6 months of 2011, one in three persons was in a family experiencing financial burden of medical care. One in 5 persons was in a family having problems paying medical bills, 1 in 4 persons was in a family paying medical bills over time, and 1 in 10 persons was in a family that had medical bills they were unable to pay at all.
http://www.cdc.gov/nchs/data/nhis/earlyrelease/financial_burden_of_medical_care_032012.pdf

This new report adds to the profusion of policy studies confirming that Americans continue to experience financial burdens in paying their medical bills. Unfortunately, this problem will not go away after the Affordable Care Act is fully implemented.
Well over 20 million people will remain uninsured, and perhaps a third or more of our population will be under-insured, due to the low actuarial value plans to be offered in the exchanges, and especially due to the increasing prevalence of high-deductibles in employer-sponsored plans. In fact, under-insurance likely will soon be the norm.
Contrast that with John Conyers’ HR 676, the “Expanded and Improved Medicare for All Act,” which states, “The health care benefits under this Act cover all medically necessary services… No deductibles, copayments, coinsurance, or other cost-sharing shall be imposed with respect to covered benefits.”
For those who say we can’t afford this, many other nations provide all of their people comprehensive care with no out-of-pocket expenses, at an average cost of only half of what we are spending on health care.
We can’t afford not to do it.

By Danny McCormick, David H. Bor, Stephanie Woolhandler and David U. Himmelstein
Health Affairs, March 2012

Abstract

Policy-based incentives for health care providers to adopt health information technology are predicated on the assumption that, among other things, electronic access to patient test results and medical records will reduce diagnostic testing and save money. To test the generalizability of findings that support this assumption, we analyzed the records of 28,741 patient visits to a nationally representative sample of 1,187 office-based physicians in 2008. Physicians’ access to computerized imaging results (sometimes, but not necessarily, through an electronic health record) was associated with a 40–70 percent greater likelihood of an imaging test being ordered. The electronic availability of lab test results was also associated with ordering of additional blood tests. The availability of an electronic health record in itself had no apparent impact on ordering; the electronic access to test results appears to have been the key. These findings raise the possibility that, as currently implemented, electronic access does not decrease test ordering in the office setting and may even increase it, possibly because of system features that are enticements to ordering. We conclude that use of these health information technologies, whatever their other benefits, remains unproven as an effective cost-control strategy with respect to reducing the ordering of unnecessary tests.

http://content.healthaffairs.org/content/31/3/488.abstract

Comment: 

By Don McCanne, MD

Through the Affordable Care Act and through the Health Information Technology for Economic and Clinical Health (HITECH) provisions of the the American Recovery and Reinvestment Act of 2009, Congress wished to bring under control the ever escalating costs of health care in the United States. This study of physicians’ electronic access to prior imaging and lab results adds to other data that indicates that the cost containment measures were merely a wish list that have failed to improve value in our health care purchasing.

As an another example, a recent report of the Congressional Budget Office on Medicare’s demonstration projects on disease management, care coordination, and value-based payment revealed that “the evaluations show that most programs have not reduced Medicare spending: In nearly every program involving disease management and care coordination, spending was either unchanged or increased relative to the spending that would have occurred in the absence of the program.”

Instead of simply wishing that these ideas would control costs, we should adopt policies that we already know are effective. We know that the financing model of the Affordable Care Act – building on our fragmented system of private plans and public programs – is the most expensive model of financing health care, and yet a model that falls far short on universality, comprehensiveness and equity.

In contrast, single payer and health service models are the least expensive, and are the most successful in achieving universality, comprehensiveness and equity. Establishing a health service model through government takeover of our entire health care delivery system is not a model that is likely to gain political traction in the foreseeable future. On the other hand, improving Medicare and converting it into a single payer national health program is much more consistent with American views of equity, justice, and choice.

We should certainly encourage the continued evaluation and development of potentially beneficial measures such as the use of health information technology. Improvement in quality and efficiency should always be our goals. But in the overall picture, such efforts would amount to mere tweaks compared to a comprehensive overhaul of the health care financing system. Let’s move forward with an improved Medicare for all.

Giving Office-Based Physicians Electronic Access To Patients’ Prior Imaging And Lab Results Did Not Deter Ordering Of Tests

By Danny McCormick, David H. Bor, Stephanie Woolhandler and David U. Himmelstein
Health Affairs, March 2012

Abstract

Policy-based incentives for health care providers to adopt health information technology are predicated on the assumption that, among other things, electronic access to patient test results and medical records will reduce diagnostic testing and save money. To test the generalizability of findings that support this assumption, we analyzed the records of 28,741 patient visits to a nationally representative sample of 1,187 office-based physicians in 2008. Physicians’ access to computerized imaging results (sometimes, but not necessarily, through an electronic health record) was associated with a 40–70 percent greater likelihood of an imaging test being ordered. The electronic availability of lab test results was also associated with ordering of additional blood tests. The availability of an electronic health record in itself had no apparent impact on ordering; the electronic access to test results appears to have been the key. These findings raise the possibility that, as currently implemented, electronic access does not decrease test ordering in the office setting and may even increase it, possibly because of system features that are enticements to ordering. We conclude that use of these health information technologies, whatever their other benefits, remains unproven as an effective cost-control strategy with respect to reducing the ordering of unnecessary tests.

http://content.healthaffairs.org/content/31/3/488.abstract

Comment: 

By Don McCanne, MD

Through the Affordable Care Act and through the Health Information Technology for Economic and Clinical Health (HITECH) provisions of the the American Recovery and Reinvestment Act of 2009, Congress wished to bring under control the ever escalating costs of health care in the United States. This study of physicians’ electronic access to prior imaging and lab results adds to other data that indicates that the cost containment measures were merely a wish list that have failed to improve value in our health care purchasing.

As an another example, a recent report of the Congressional Budget Office on Medicare’s demonstration projects on disease management, care coordination, and value-based payment revealed that “the evaluations show that most programs have not reduced Medicare spending: In nearly every program involving disease management and care coordination, spending was either unchanged or increased relative to the spending that would have occurred in the absence of the program.”

Instead of simply wishing that these ideas would control costs, we should adopt policies that we already know are effective. We know that the financing model of the Affordable Care Act – building on our fragmented system of private plans and public programs – is the most expensive model of financing health care, and yet a model that falls far short on universality, comprehensiveness and equity.

In contrast, single payer and health service models are the least expensive, and are the most successful in achieving universality, comprehensiveness and equity. Establishing a health service model through government takeover of our entire health care delivery system is not a model that is likely to gain political traction in the foreseeable future. On the other hand, improving Medicare and converting it into a single payer national health program is much more consistent with American views of equity, justice, and choice.

We should certainly encourage the continued evaluation and development of potentially beneficial measures such as the use of health information technology. Improvement in quality and efficiency should always be our goals. But in the overall picture, such efforts would amount to mere tweaks compared to a comprehensive overhaul of the health care financing system. Let’s move forward with an improved Medicare for all.

Giving Office-Based Physicians Electronic Access To Patients’ Prior Imaging And Lab Results Did Not Deter Ordering Of Tests

By Danny McCormick, David H. Bor, Stephanie Woolhandler and David U. Himmelstein
Health Affairs, March 2012
Abstract
Policy-based incentives for health care providers to adopt health information technology are predicated on the assumption that, among other things, electronic access to patient test results and medical records will reduce diagnostic testing and save money. To test the generalizability of findings that support this assumption, we analyzed the records of 28,741 patient visits to a nationally representative sample of 1,187 office-based physicians in 2008. Physicians’ access to computerized imaging results (sometimes, but not necessarily, through an electronic health record) was associated with a 40–70 percent greater likelihood of an imaging test being ordered. The electronic availability of lab test results was also associated with ordering of additional blood tests. The availability of an electronic health record in itself had no apparent impact on ordering; the electronic access to test results appears to have been the key. These findings raise the possibility that, as currently implemented, electronic access does not decrease test ordering in the office setting and may even increase it, possibly because of system features that are enticements to ordering. We conclude that use of these health information technologies, whatever their other benefits, remains unproven as an effective cost-control strategy with respect to reducing the ordering of unnecessary tests.
http://content.healthaffairs.org/content/31/3/488.abstract

Through the Affordable Care Act and through the Health Information Technology for Economic and Clinical Health (HITECH) provisions of the the American Recovery and Reinvestment Act of 2009, Congress wished to bring under control the ever escalating costs of health care in the United States. This study of physicians’ electronic access to prior imaging and lab results adds to other data that indicates that the cost containment measures were merely a wish list that have failed to improve value in our health care purchasing.
As an another example, a recent report of the Congressional Budget Office on Medicare’s demonstration projects on disease management, care coordination, and value-based payment revealed that “the evaluations show that most programs have not reduced Medicare spending: In nearly every program involving disease management and care coordination, spending was either unchanged or increased relative to the spending that would have occurred in the absence of the program.”
Instead of simply wishing that these ideas would control costs, we should adopt policies that we already know are effective. We know that the financing model of the Affordable Care Act – building on our fragmented system of private plans and public programs – is the most expensive model of financing health care, and yet a model that falls far short on universality, comprehensiveness and equity.
In contrast, single payer and health service models are the least expensive, and are the most successful in achieving universality, comprehensiveness and equity. Establishing a health service model through government takeover of our entire health care delivery system is not a model that is likely to gain political traction in the foreseeable future. On the other hand, improving Medicare and converting it into a single payer national health program is much more consistent with American views of equity, justice, and choice.
We should certainly encourage the continued evaluation and development of potentially beneficial measures such as the use of health information technology. Improvement in quality and efficiency should always be our goals. But in the overall picture, such efforts would amount to mere tweaks compared to a comprehensive overhaul of the health care financing system. Let’s move forward with an improved Medicare for all.