Chapter – Page 646

Delaying Medicare eligibility is bad for health

By Austin Frakt and Aaron Carroll
The Incidental Economist, June 10, 2011

By now most of the blogosphere has weighed in on Joe Lieberman’s idea of increasing Medicare eligibility from age 65 to 67 (see Frakt, Klein, Volsky, Drum, Krugman). Most of the focus has been on how the delayed eligibility will affect overall health costs. Though federal costs may go down, overall costs would not, because most would just be shifted to seniors themselves. Cost isn’t everything, though. There’s something else delay would do: harm health.

This is not guesswork on our part; there’s clear evidence in the literature. In several papers, Michael McWilliams and colleagues found that utilization, spending, and outcomes for age-eligible Medicare beneficiaries differed for those who had been uninsured prior to turning 65 vs. those who had been insured. Their work was based on survey data, sometimes merged with Medicare claims. This is a relatively strong analytic approach since it exploits a discontinuity in coverage that potentially applies to nearly all individuals: the vast majority of the population enrolls in Medicare at age 65.

The authors found that, relative to those with insurance before age 65, those without insurance prior to Medicare eligibility spent much more money on health care after they became Medicare eligible. In other words, people wait to get care until their Medicare kicks in. This is bad both for health and for the federal government’s bottom line.

Delaying Medicare even longer would likely make this worse. People would forego care longer, health would suffer, and Medicare would pay for the consequences later.

Here’s the evidence in charts, extracted from McWilliams et al.’s papers (references listed at the end). First, from [1], we see that after age 65, uninsured adults with (chart A) and without (chart B) hypertension, heart disease, stroke, or diabetes all have a significant and improved change in trend in health status after obtaining Medicare. Insured adults, however, do not experience a change in trend. Medicare improved the health of the uninsured; delaying Medicare would delay that help.

Next, from [2] we see a similar phenomenon in doctor visits. Relative to the insured, those uninsured prior to age 65 visit the doctor more after obtaining Medicare eligibility.

From the same paper ([2]), here are the results on hospital admissions.

This shouldn’t surprise anyone. It makes sense. It’s hard to get affordable insurance as you approach age 65. If you’re lucky enough to have insurance, then you’re getting the care you need, so getting Medicare is nice, but not a huge change in your life. If you’re uninsured, though, then getting Medicare is a huge change. If you know you need care, and it’s expensive, then you will likely try and wait until the Medicare kicks in to get it. People do this all the time; the evidence above confirms it.

Raising the eligibility age will just force these people to wait longer.* If this somehow saved us money, then we suppose you could have a debate about its benefits and harms. Knowing that it will likely cost Medicare more, however, means that it’s entirely possible that delaying Medicare eligibility will cost more and lead to worse outcomes. That’s the worst of both worlds.

* McWilliams et al.’s analysis does not take into consideration the effect of health reform. Provided it stays on the books, the non-elderly will have different options in 2014. Still, the analysis shows the value of health insurance, and in particular of universal coverage.

References

[1] McWilliams JM, Meara E, Zaslavsky AM, Ayanian JZ. Health of previously uninsured adults after acquiring Medicare coverage. JAMA. 2007;298:2886-94.

[2] McWilliams JM, Meara E, Zaslavsky AM, Ayanian JZ. Use of health services by previously uninsured Medicare beneficiaries. N Engl J Med. 2007;357:143-53.

http://theincidentaleconomist.com/wordpress/delaying-medicare-eligibility-is-bad-for-health/

Nurses Union Keeps Pressure On Health Care Overhaul

By Jessica Marcy and Shefali S. Kulkarni
Kaiser Health News, June 10, 2011

Nurses converged on Washington in their fight against Wall Street this week.

Hundreds of nurses from across the country rallied to support broader access to health care and to call for higher taxes on corporations and the wealthy.

They gathered Tuesday near the White House and then picketed the U.S. Chamber of Commerce with large red banners that read: “RNs say Heal America, Tax Wall Street.” National Nurses United, the nation’s largest nurses union, sponsored the event to promote its “Main Street Contract for the American People,” a campaign that broadly calls for improved living conditions, including guaranteed health care, better wages and quality education.

They plan to rally on Wall Street later this month.

In response to the Washington rally, Blair Latoff, director of communications for the U.S. Chamber of Commerce, released the following statement: “The Chamber welcomes all voices to the debate, but the debate has to remain focused on creating American jobs and keeping our economy growing. Right now U.S. businesses are saddled with one of the highest corporate tax rates in the world, which is undercutting our global competitiveness.”

Some nurses spoke about the need for improved working conditions by increasing pay and enforcing adequate nurse-patient ratios. Many held signs that read: “I am a patient advocate” and “Medicare for all.” Participants finished the rally by gathering at a park near the Capitol, where Sen. Barbara Boxer, D-Calif., spoke about the need to protect Medicare and Sen. Bernie Sanders, I-Vt., told the crowd of red-shirted nurses that the nation needs a single payer system like that recently promoted in his own state.

Rose Ann DeMoro, executive director of National Nurses United, suggested that nurses offer a unique perspective on the struggles that patients and their families face because of the direct care they provide. “Everywhere the fallout of this system is felt, and it’s felt and experienced by the registered nurse,” she said.

Sue Gray, 51, who has been a nurse for more than 30 years and cares for cardiac surgery patients at Minneapolis Children’s Hospital, says that her own experience as a cancer patient has given her insight into the financial and emotional pressures that patients and their families experience. Diagnosed with breast cancer 12 years ago, Gray continues to work two days a week despite her cancer, which returned five years ago and has spread to her liver and bones. She does so to provide financial support and health insurance to her self-employed husband and three children.

“We really need to get some type of universal health care so that people going through my situation or families that I see at work that are struggling don’t have to worry about not getting health care,” Gray said.

Web version includes slideshow and audio of nurses’ demonstration in Washington: http://www.kaiserhealthnews.org/Slide-Shows/2011/National-Nurses-United-Washington.aspx

Request for candidates for Green Mountain Care Board

Most of you are aware of the important role that Deb Richter has played in advancing health care reform in the state of Vermont, where every effort is being made to bring Vermont in compliance with the policies and goals of a single payer system. The road in that direction has been rough and challenging, but that has not stopped the dedicated advocates of reform from moving forward.

Deb Richter is a member of the nominating committee for the Green Mountain Care Board. She has asked me distribute the following notice. Many members of this list either are or know people who are highly qualified to serve on this board. Applicants do not have to be Vermonters.

This is a great opportunity for qualified, dedicated individuals to contribute to these groundbreaking efforts to advance health care justice.

GREEN MOUNTAIN CARE BOARD MEMBER

State of Vermont

The State of Vermont is seeking candidates for the independent, five-member, Green Mountain Care Board that was established by Vermont’s landmark health care health reform law. The Board consists of a full-time Chair and four members.

Vermont’s health care reform law (Act 48, 2011 Session) sets out a process to move the state through several stages of health care system change leading to a publicly financed, universal health benefits program, Green Mountain Care, by 2017. When completed, the program will provide affordable access to high quality health care for all Vermonters, separate from their employment.

Board members will be exempt state employees. The Chair, who will be responsible for leading the process, will be a full time employee and will be paid $122,866. Side members will be .8 FTE (32 hours) and will be paid $81,910. Required qualifications can be found in the job description below. The Governor will make appointments to the Green Mountain Care Board by October 1, 2011 from a list of qualified candidates submitted to him by the Nominating Committee.

How to Apply
To obtain a complete job description, application form and find complete details about the application process, please visit:
http://humanresources.vermont.gov/GMCB_Search

Completed applications must be received no later than 2:00 p.m. on July 11, 2011.

Green Mountain Care Board Member Search:
http://humanresources.vermont.gov/GMCB_Search

Green Mountain Care Board Member Job Description:
http://humanresources.vermont.gov/sites/dhr/files/pdf/GMCB%20Job%20Description.pdf

Application for Candidates for Green Mountain Care Board:
http://humanresources.vermont.gov/sites/dhr/files/pdf/APPLICATION%20FOR%20GMCB%20CANDIDATES.pdf

(Although this is not an official message from PNHP, it is being distributed nevertheless because the Vermont effort represents significant progress towards the goal of achieving health care justice for all – a goal we share with the Vermont organizers. PNHP will continue its mission of advocating for a single payer national health program, without compromise.)

The Coming Crash Of The American Health Care System

By Rick Ungar
Forbes on-line, Jun. 9 2011

The American health care system, as we currently know it, is well into its final days.

Don’t get too excited, conservatives. It’s not Obama’s fault. Likewise, the final death throes of the status quo will not be the doing of Paul Ryan Medicare plan.

Indeed, none of this inevitability will be the result of the drama we Americans so love to inject into our politics.

It’s about the end of a business model that really hasn’t worked very well for at least a decade coupled with government’s responsibility-for better or for worse- to step in and provide essential services when nobody else can do so.

With all the complaining about Obamacare, social entitlements, etc., the truth is that government and private health insurers have played a cooperative role in how health care has been delivered to most Americans for nearly half a century.

In the process, they have learned how to regulate one another.

Private health insurers have kept government in check by spreading around huge sums of cash to fund political campaigns in order to get elected officials to do their bidding. When, from time to time, the public outcry against private health insurance’s abuses overwhelmed a politician’s ability to turn a blind eye, government imposed the occasional regulation to keep insurers from their most offensive practices.

But let’s not kid ourselves. The insurance companies have always been in the driver’s seat.

That’s about to end – not because public sentiment is deeply in favor of turning all health care over to the government, but because the private insurance companies no longer really care.

This from a recent Kaiser Family Foundation report –

Here’s one change few were talking about when the health overhaul law passed: It’s sent insurers – worried the law could stunt profits and growth – looking for new types of business.Where are they investing? In less-regulated companies that could yield strong profits and make the main business – insurance – more lucrative. The purchases also could increase insurers’ control over more parts of the health system.

Insurers have moved into technology, health-care delivery, physician management, workplace wellness, financial services and overseas ventures in wide-ranging efforts to mitigate the new rules imposed by the law. Since June 2009, seven of the nation’s largest insurers have made 25 major deals, and only six of those acquisitions run health plans, according to an analysis of data collected by FactSet Research Systems, a private company. At an investors meeting in February, Rick Jelinek, UnitedHealth Group’s top executive for emerging businesses, said the company’s future growth would be in services that are “much less regulated” than insurance plans.

In 2010, UnitedHealth Group bought ChinaGate, which helps bring medical treatments to market in China; Picis, a technology vendor specializing in clinical and financial management systems for hospital emergency departments and intensive care units; the medical screening company Wellness; and six other firms. In December, Aetna acquired Medicity, a business that helps hospitals share patient information. The federal government will reward hospitals and doctors with more than $30 billion in increased Medicaid and Medicare payments by 2015 for adopting electronic medical records, but only if they can share their data. Also in December, Humana bought Concentra, a Texas-based urgent- and occupational-care provider with clinics in 40 states. More than one-third of Humana members live within 10 miles of a Concentra clinic, making its services convenient for the insurer’s members. Last year it also bought a health coaching firm that helps employers keep workers healthy, and in February it partnered with a South African company to launch new wellness services in the United States.

The Humana story is particularly interesting. Once upon a time, Humana was a major player in the business of owning hospitals. Some years ago, they made a corporate decision to get out of the hospital business and focus on health insurance as that is where they believed the real profits were to be found.

Now, we see them going back in the other direction as they pursue businesses that will earn them more money than selling health insurance.

Get used to this – it will not be long until our major health insurers are no longer playing the game.

No doubt, some of you are already cussing out Obamacare for pushing the health insurance companies over the line.

But, if that is what you are thinking, you’re missing the real issue.

Obamacare, for all the bombast and baloney about socialism, etc., was really little more than a bill that followed much of the practices of the past. The government cracked down on some of the more distressing practices of the insurers – spending too little paying for actual health care while spending too much for advertising, administrative fees, big salaries, etc. – and, in return, the ACA cleared the way for many more people to enter into the private insurance market, particularly should the mandate hold up, creating many more customers for the insurers.

Depending upon whom you ask, the deal was either too good for the health insurance companies because we should have passed a public option or, better yet, Medicare for all, or the health insurance companies got hosed because they will no longer be able to earn the huge profits to which they’ve grown accustomed.

In many respects, both sides are right.

With the requirement that insurers be required to take on customers with previous medical problems – and the higher risk that comes from the same – plus the requirement that insurers spend 80% of every dollar they take in from their customers on actual health care benefits- the insurers are now freaked out over how they will earn enough profit to support their share prices – – and they are right to worry.

Does that mean that Obamacare was a mistake? Did the law push the private health insurance industry too far?

It was not a mistake.

If you follow health care insurance as closely as some of us do, you are all too aware of what the insurers were forced to get into in order to maintain profitability in the face of dramatically rising costs.

They found themselves having to play a very dirty game of hard ball. They would take a customer’s money, with pleasure, right up until the moment the customer had to call upon the insurer to pay off when the customer fell seriously ill. At that point in time, the health insurer would shift its focus to finding ways not to pay for the care the customer had always believed she would get each and every time she sent in a large premium check.

It was ugly – but the only way the health insurers figured they could keep their profits where they needed to be.

This is precisely what led to the element of Obamacare that requires insurers to now spend 80% of each premium dollar paying for actual health care. By so doing, the law disincentivizes insurers from cheating. If they don’t spend the 80%, the law forces them to repay a percentage of premiums to all of its customers.

Should Congress not have done this?

If you have never been sick, and just cannot believe that you or a family member on your policy will ever get sick, it’s easy to say that it was a mistake. If you don’t much care because you receive your health insurance as a benefit of employment and figure that the insurance company won’t mess with the group policy by refusing to pay your claim, you might not want to get too comfortable. Jobs go away and health care goes with them.

Of course this had to be done. To do otherwise would have been to allow insurers to continu
e cheating people at the very moment when they are most vulnerable.

That brings us to pre-existing conditions.

Should the government have cotinued to turn it’s back on the growing number of people who cannot get insurance at any price because the insurers business model cannot handle the risk in their business models?

Again, if you don’t think you’re ever going to be sick, maybe you aren’t concerned. If you are on a corporate policy, you can’t be denied your coverage so it’s all good. But, as noted, jobs disappear and if you believe that nobody in your family can ever fall seriously and expensively ill and lose the opportunity to be insured in the future, I have some junk real estate I’d like to discuss with you.

Further, that whole meme that suggests that if people don’t take care of themselves they should be forced to suffer the consequences, is complete nonsense. Serious and expensive illness is every bit as likely to be the result of genetic pre-disposition as it is likely to result from poor eating and exercising habits.

The government had to impose this requirement on the health insurers to forestall a genuine crisis.

The end result is that these items will prove to be the final straw in a failing private health insurance model that can no longer afford to be in the business – and it isn’t going to be long until the insurers bail out entirely leaving us all exposed and in trouble.

What then?

I only know one bank large enough to step in and take over the business.

It’s called the United States government.

So, whether your ideologically in favor of government single-payer care or ideologically convinced that is means Communism will have arrived, deal with it and start thinking about how to best perfect it. It won’t be long until it is the only system we have when it comes to America’s health care.

http://blogs.forbes.com/rickungar/2011/06/09/the-coming-crash-of-the-american-health-care-system/

Disturbing New Statistics Show Huge Percentage Of Financial Fraud Against U.S. Government Comes From Healthcare Industry

By Don Soeken
MichaelMoore.com, June 10, 2011

Ever wondered who the biggest culprits are, when it comes to defrauding the taxpayers of the United States?

The answer to that question may surprise you.

According to some shocking new statistics from the nonprofit Taxpayers Against Fraud (TAF) public interest group, the ranks of the admitted federal cheaters are occupied almost entirely by health insurers and the healthcare pharmaceutical industry.

That’s the clear and thoroughly disturbing conclusion to be found in a revealing TAF study of the “Top 20” fraud lawsuits (ranked by dollar amounts) to have been decided by court judgments or agreed-upon settlements in recent years. Amazingly, the list of penalty awards – as adjudicated under legal procedures mandated by the U.S. False Claims Act – contains no fewer than 19 healthcare or health insurance entities . . . and only a single financial entity who isn’t engaged in the business of health insurance or medical care.

Astonishing? You bet it is. Even a quick look at the list of recent fraud convictions and fraud case settlements involving the U.S. healthcare industry (to review them for yourself: www.taf.org) should be enough to make any alert taxpayer ask: Why haven’t all of these obvious fiscal abuses by healthinsurers and the pharmaceutical industry been reported in the news media . . . even as the entire nation continues to debate the future of healthcare reform?

As the Taxpayers Against Fraud website makes chillingly clear, some of America’s most best known and most trusted healthcare industry corporations are heading up the list of despicable cheaters whose conscienceless manipulation of federal health dollars has resulted in convictions or financial settlements with Uncle Sam.

Some appalling examples from the TAF “Top 20” list:

No. 1 Fraud Offender: Pfizer — $1 billion under the False Claims Act. Pfizer paid a total of $2.3 billion, of which $1.3 billion was a criminal fine for kickbacks and off-label marketing and $1 billion was paid under the False Claims Act.

No. 2 Fraud Offender: Tenet Heathcare — $900,000,000 under the False Claims Act. In July 2006, Tenet Healthcare agreed to pay the Federal Government $900 million for billing violations that included manipulation of outlier payments to Medicare, as well as kickbacks, upcoding, and bill padding.

No. 3 Fraud Offender: HCA — $731,400,000 under the False Claims Act.?In December 2000, HCA The Healthcare Company (formerly known as Columbia HCA), the largest for-profit hospital chain in the United States, pled guilty to criminal conduct and agreed to pay more than $840 million in criminal fines, civil penalties and damages for unlawful billing practices.

No. 4 Fraud Offender: Merck – $650,000 under the False Claims Act.?In January of 2008, Merck settled the very first nominal pricing fraud case in which the company was accused of taking kickbacks and violating Medicaid best price regulations for Vioxx (an arthritis drug), Zocor (a cholesterol drug), Pepcid (an acid-reflux drug), Cozaar (a hypertensive medication), Fosamax (a bone loss drug) Maxalt (a migraine medication) and Singulair (an asthma medication).

****

As you read through the “Top 20” list of fiscal malefactors who were either found guilty or agreed to settle in fraud cases against Uncle Sam, one fact stands out with startling clarity: 95 percent of these massively unprincipled cheaters were healthcare players . . . including some of the most venerated names in the pharmaceutical, hospital and health insurance industries.

Unfortunately, however, the taxpayers who are so frequently being bilked by these unscrupulous players haven’t been told that the record already shows how willing the U.S. healthcare industry is to stretch the rules and cheat the public in its ceaseless quest for grotesquely swollen profits.

As a Ph.D. social worker who has spent much of the past 30 years counseling and defending whistleblowers who dare to speak out against fraud against the U.S. government, I learned a long time ago that the U.S. healthcare industry can’t be trusted to provide adequate medical care for the citizenry, or even to obey the laws and regulations that protect the taxpayers from being defrauded.

Make no mistake: That disturbing list of “Top 20” awards against healthcare insurers and the Pharmaceutical industry shows clearly that we cannot leave healthcare to the “profit-oriented” insurance companies and the hospital chains whose greed and willingness to short-change consumers on care is now common knowledge everywhere.

The record shows clearly that allowing the insurers to dictate healthcare policy and healthcare costs can only produce disastrous results. A massive Harvard University study of treatment patterns among patients who were treated in hospital emergency rooms showed that “uninsured” patients were much more likely to die while in the hospital than those who were able to pay the sky-high premiums for adequate healthcare coverage. (To learn more about the study, click on: http://news.yahoo.com/s/hsn/uninsuredtraumapatientsmorelikelytodiestudy).

The first step on the road to getting healthcare reform right is to understand that we are not on a “level playing field,” and that the health industry will stop at nothing to protect its immense profits, regardless of the needless death and the needless suffering their behavior may cause the rest of us.

Donald R. Soeken,is a social worker with 40 years of professional experience; he is also founder of the nonprofit Whistleblower Support Fund – a public service organization that supports whistleblowers.

http://www.michaelmoore.com/words/mike-friends-blog/disturbing-new-statistics

Request for candidates for Green Mountain Care Board

This is a great opportunity for qualified, dedicated individuals to contribute to these groundbreaking efforts to advance health care justice.

GREEN MOUNTAIN CARE BOARD MEMBER

State of Vermont

The State of Vermont is seeking candidates for the independent, five-member, Green Mountain Care Board that was established by Vermont’s landmark health care health reform law. The Board consists of a full-time Chair and four members.

Vermont’s health care reform law (Act 48, 2011 Session) sets out a process to move the state through several stages of health care system change leading to a publicly financed, universal health benefits program, Green Mountain Care, by 2017. When completed, the program will provide affordable access to high quality health care for all Vermonters, separate from their employment.

Board members will be exempt state employees. The Chair, who will be responsible for leading the process, will be a full time employee and will be paid $122,866. Side members will be .8 FTE (32 hours) and will be paid $81,910. Required qualifications can be found in the job description below. The Governor will make appointments to the Green Mountain Care Board by October 1, 2011 from a list of qualified candidates submitted to him by the Nominating Committee.

How to Apply
To obtain a complete job description, application form and find complete details about the application process, please visit:
http://humanresources.vermont.gov/GMCB_Search

Completed applications must be received no later than 2:00 p.m. on July 11, 2011.

Green Mountain Care Board Member Search:
http://humanresources.vermont.gov/GMCB_Search

Green Mountain Care Board Member Job Description:
http://humanresources.vermont.gov/sites/dhr/files/pdf/GMCB%20Job%20Description.pdf

Application for Candidates for Green Mountain Care Board:
http://humanresources.vermont.gov/sites/dhr/files/pdf/APPLICATION%20FOR%20GMCB%20CANDIDATES.pdf

Medicare Saves Money

By Paul Krugman
The New York Times, June 13, 2011

Every once in a while a politician comes up with an idea that’s so bad, so wrongheaded, that you’re almost grateful. For really bad ideas can help illustrate the extent to which policy discourse has gone off the rails.

And so it was with Senator Joseph Lieberman’s proposal, released last week, to raise the age for Medicare eligibility from 65 to 67.

Like Republicans who want to end Medicare as we know it and replace it with (grossly inadequate) insurance vouchers, Mr. Lieberman describes his proposal as a way to save Medicare. It wouldn’t actually do that. But more to the point, our goal shouldn’t be to “save Medicare,” whatever that means. It should be to ensure that Americans get the health care they need, at a cost the nation can afford.

And here’s what you need to know: Medicare actually saves money — a lot of money — compared with relying on private insurance companies. And this in turn means that pushing people out of Medicare, in addition to depriving many Americans of needed care, would almost surely end up increasing total health care costs.

The idea of Medicare as a money-saving program may seem hard to grasp. After all, hasn’t Medicare spending risen dramatically over time? Yes, it has: adjusting for overall inflation, Medicare spending per beneficiary rose more than 400 percent from 1969 to 2009.

But inflation-adjusted premiums on private health insurance rose more than 700 percent over the same period. So while it’s true that Medicare has done an inadequate job of controlling costs, the private sector has done much worse. And if we deny Medicare to 65- and 66-year-olds, we’ll be forcing them to get private insurance — if they can — that will cost much more than it would have cost to provide the same coverage through Medicare.

By the way, we have direct evidence about the higher costs of private insurance via the Medicare Advantage program, which allows Medicare beneficiaries to get their coverage through the private sector. This was supposed to save money; in fact, the program costs taxpayers substantially more per beneficiary than traditional Medicare.

And then there’s the international evidence. The United States has the most privatized health care system in the advanced world; it also has, by far, the most expensive care, without gaining any clear advantage in quality for all that spending. Health is one area in which the public sector consistently does a better job than the private sector at controlling costs.

Indeed, as the economist (and former Reagan adviser) Bruce Bartlett points out, high U.S. private spending on health care, compared with spending in other advanced countries, just about wipes out any benefit we might receive from our relatively low tax burden. So where’s the gain from pushing seniors out of an admittedly expensive system, Medicare, into even more expensive private health insurance?

Wait, it gets worse. Not every 65- or 66-year-old denied Medicare would be able to get private coverage — in fact, many would find themselves uninsured. So what would these seniors do?

Well, as the health economists Austin Frakt and Aaron Carroll document, right now Americans in their early 60s without health insurance routinely delay needed care, only to become very expensive Medicare recipients once they reach 65. This pattern would be even stronger and more destructive if Medicare eligibility were delayed. As a result, Mr. Frakt and Mr. Carroll suggest, Medicare spending might actually go up, not down, under Mr. Lieberman’s proposal.

O.K., the obvious question: If Medicare is so much better than private insurance, why didn’t the Affordable Care Act simply extend Medicare to cover everyone? The answer, of course, was interest-group politics: realistically, given the insurance industry’s power, Medicare for all wasn’t going to pass, so advocates of universal coverage, myself included, were willing to settle for half a loaf. But the fact that it seemed politically necessary to accept a second-best solution for younger Americans is no reason to start dismantling the superior system we already have for those 65 and over.

Now, none of what I have said should be taken as a reason to be complacent about rising health care costs. Both Medicare and private insurance will be unsustainable unless there are major cost-control efforts — the kinds of efforts that are actually in the Affordable Care Act, and which Republicans demagogued with cries of “death panels.”

The point, however, is that privatizing health insurance for seniors, which is what Mr. Lieberman is in effect proposing — and which is the essence of the G.O.P. plan — hurts rather than helps the cause of cost control. If we really want to hold down costs, we should be seeking to offer Medicare-type programs to as many Americans as possible.

What Joe Lieberman got wrong on Medicare

By Mary von Euler
The Washington Post, June 14, 2011

Letters

Sen. Joseph I. Lieberman has it backward. While most people would agree with the senator that the wealthy should pay more for health care — applying progressive principles to Medicare funding — he also wants to achieve Medicare solvency by raising the eligibility age to 67, in other words, by serving fewer people and shutting the door to many who would be unable to secure affordable health insurance in the private market.

But, as most experts agree, our problem is the soaring cost of medical care, as a whole, not Medicare, which is the most frugal part of our non-system. And the only way to control medical costs is via a single-payer system that covers everyone, so the government has leverage to tamp down excessive costs and eliminate waste, including the wasteful costs devoted to private-insurance overhead.

Providing Medicare coverage for everyone, regardless of age, is the only way to provide quality health care to all Americans without bankrupting our country.

Mary von Euler resides in Bethesda, Md., and is secretary of Americans for Democratic Action.

http://www.washingtonpost.com/opinions/what-joe-lieberman-got-wrong-on-medicare/2011/06/13/AGbup9UH_story.html

Medicare stance downright cruel

By Steve Carlson
Superior (Wis.) Telegram, June 15, 2011

Letters

I read with great interest one of Congressman Sean Duffy’s remarks to the crowd gathered June 6, at the Superior Senior Center. As quoted by Business North, Duffy said, “We did not, did not become a great country from socialist entitlement systems.”

Huh?

Once again Duffy demonstrates that he is incapable of intelligent comment on important policy issues. An overwhelming percentage of the American people favor keeping Medicare just as it is. A sizable percentage would like to see the program expanded to include all Americans, which is probably the best way to preserve the program, extend coverage to everyone, and bring the costs of health care down going forward.

Physicians for a National Health Program has some great information available about national health insurance at www.pnhp.org. This is where the health care debate in this country should be going, and we desperately need politicians who can intelligently discuss these issues in an open, reasonable manner.

But it seems all Duffy can do is haul out his array of tired clichés, hackneyed phrases and inflammatory buzzwords, all so he and his fellow Ayn Rand worshippers can deliver our senior citizens into the clutches of a greedy and unscrupulous health insurance industry. That’s more than callous, it’s downright cruel.

Come November 2012, we need to elect a new representative and send Sean Duffy back to “The Real World.”

Steve Carlson resides in Trego, Wis.

http://www.superiortelegram.com/event/article/id/54800/group/Opinion/

Managed competition lessons from the Netherlands

Managed Competition for Medicare? Sobering Lessons from the Netherlands

By Kieke G.H. Okma, Ph.D., Theodore R. Marmor, Ph.D., and Jonathan Oberlander, Ph.D
The New England Journal of Medicine, June 15, 2011

Discussions about U.S. health care reform are often parochial, with scant attention paid to other countries’ experiences. It is thus surprising that in the ongoing debate over Medicare, some U.S. commentators have turned to the Netherlands as a model of regulated competition among private insurance companies. The Dutch experience is particularly relevant given the proposal by Congressman Paul Ryan (R-WI) to eliminate traditional Medicare and instead provide beneficiaries with vouchers to purchase private insurance.

It is easy to understand why Dutch health care — which does rely on regulated private insurance — would appeal to advocates of Medicare vouchers. Indeed, U.S. ideas about managed competition helped to shape health care reform in the Netherlands. But careful examination of the Dutch experience shows that insurance competition has not produced the expected benefits and in fact has created new problems, calling into question the merits of this reform model and its suitability for Medicare.

Before 2006, the Netherlands had a mixed health insurance system, with more than 60% of the population covered by mandatory social insurance, administered by nonprofit sick funds. The remaining population had private insurance, voluntarily purchased, and the uninsured rate was about 1.5%.

In 2006, the Netherlands replaced this arrangement with a mandated private insurance system similar to Switzerland’s. Under this reform, all legal residents of the Netherlands are required to purchase basic insurance from private insurers. Private plans are heavily regulated. They cannot turn down applicants, regardless of health status, and must charge community-rated premiums. A risk-equalization scheme varies payment to health plans according to their enrolled populations’ risk profiles. The aim is to reduce plans’ incentives to select profitable patients and ensure that plans with sicker, higher-cost populations are not financially penalized. Insurance plans are expected to compete on the basis of price and quality by selectively contracting with networks of hospitals, physicians, and other medical care providers.

Advocates of this system argued that competition among private insurers would reduce health care spending, enhance consumer choice, and improve the quality of care and the health system’s responsiveness to patients — arguments that are being repeated in the U.S. debate over Medicare. The reality of managed competition in the Netherlands, however, has not matched the rhetoric.

Four key points emerge from the Dutch experience. First, competition has not sharply slowed the rate of growth in health care spending. Health care expenditures continue to outpace general inflation, having increased at an average annual rate of 5% since 2006. At the same time, the total costs of health insurance for Dutch families, including premiums and deductibles, increased by 41%.

Reforms aimed at increasing and managing competition also produced high administrative costs and complexity. Administering premium subsidies for low-income people has proven expensive.

Second, some Dutch people remain uninsured, and there has been a substantial increase in the number of insured persons failing to pay their insurance premiums.

Third, the expansion of consumer choice has not worked as envisioned. Since 2007, only about 4% of the Dutch population, on average, has changed plans each year. Moreover, accelerating consolidation of the health insurance market has restricted meaningful choice of insurance plan. Currently, four insurance conglomerates control about 90% of the Dutch health insurance market. Recent polls suggest public dissatisfaction with private insurers, with 65% of insured people reporting that they have low or very low levels of trust in private plans.

Fourth, notwithstanding the rhetoric of competition, the Netherlands still relies heavily on regulation. Indeed, the Dutch case shows that competitive systems that seek to escape supposedly centralized, bureaucratic control of medical care paradoxically require sophisticated regulation and government intervention in order to work.

The comprehensiveness of health insurance in the Netherlands provides a critical contrast to the Ryan Medicare plan, which would erode the U.S. government’s contribution to the point that 65-year-old beneficiaries would pay about two thirds of medical costs themselves.

The myth that competition has been key to cost containment in the Netherlands has obscured a crucial reality. Health care systems in Europe, Canada, Japan, and beyond, all of which spend much less than the United States on medical services, rely on regulation of prices, coordinated payment, budgets, and in some cases limits on selected expensive medical technologies, to contain health care spending. Systemwide regulation of spending, rather than competition among insurers, is the key to controlling health care costs. The Netherlands, after all, spent much less on medical care than the United States with virtually universal insurance coverage long before it began experimenting with managed competition in 2006.

The Dutch experience provides a cautionary tale about the place of private insurance competition in health care reform. The Dutch reforms have fallen far short of expectations — a reminder that policy intentions should not be confused with outcomes and that managed competition is hardly a panacea. The idea that the Dutch reforms provide a successful model for U.S. Medicare to emulate is bizarre. The Dutch case in fact underscores the pitfalls of the casual use (and misuse) of international experience in U.S. health care reform debates.

http://healthpolicyandreform.nejm.org/?p=14712

Comment:

By Don McCanne, MD

The authors of this NEJM Perspective on lessons from the Netherlands – Kieke G.H. Okma, Ph.D., Theodore R. Marmor, Ph.D., and Jonathan Oberlander, Ph.D. – are highly credible authorities on comparative studies and the politics of health care reform. The facts they present are well documented, and the conclusion is so obvious that it is essentially a restatement of the facts: “Systemwide regulation of spending, rather than competition among insurers, is the key to controlling health care costs.”

To no surprise, some of the published responses in the NEJM have challenged the credibility of these noted authorities, and instead have chosen to reframe the discussion – presenting “free markets,” “competition” and “consumer choice” as if these were the facts. These critics dismiss the results in the Netherlands because their “managed competition” system failed to use free market principles.

Which is it? Do we adopt Netherlands-style managed competition because it allows private insurers to compete, even though that hasn’t been proven to be of benefit? Or do we reject all existing models and adopt a truly free market wherein patients pay for all health care with their own cash? Of course, that can’t work either because of the necessity of pooling funds, and as soon as you have introduced the insurance function, you have suppressed the “price-based signals” and distorted the market.

Of course, neither of these choices – framed in terms of “markets” – will work. What does work – framed in terms of thoroughly documented studies of functioning health systems – is “regulation of prices, coordinated payment, budgets, and in some cases limits on selected expensive medical technologies.” That requires a major role for government, as the Netherlands is rediscovering.

Although the authors present this as a lesson for Medicare, it is actuall
y a lesson for our entire health care system. Perhaps they anticipate when Medicare will be improved and then expanded to cover everyone. Let’s hope so.

Managed competition lessons from the Netherlands

Managed Competition for Medicare? Sobering Lessons from the Netherlands

By Kieke G.H. Okma, Ph.D., Theodore R. Marmor, Ph.D., and Jonathan Oberlander, Ph.D
The New England Journal of Medicine, June 15, 2011

Discussions about U.S. health care reform are often parochial, with scant attention paid to other countries’ experiences. It is thus surprising that in the ongoing debate over Medicare, some U.S. commentators have turned to the Netherlands as a model of regulated competition among private insurance companies. The Dutch experience is particularly relevant given the proposal by Congressman Paul Ryan (R-WI) to eliminate traditional Medicare and instead provide beneficiaries with vouchers to purchase private insurance.

It is easy to understand why Dutch health care — which does rely on regulated private insurance — would appeal to advocates of Medicare vouchers. Indeed, U.S. ideas about managed competition helped to shape health care reform in the Netherlands. But careful examination of the Dutch experience shows that insurance competition has not produced the expected benefits and in fact has created new problems, calling into question the merits of this reform model and its suitability for Medicare.

Before 2006, the Netherlands had a mixed health insurance system, with more than 60% of the population covered by mandatory social insurance, administered by nonprofit sick funds. The remaining population had private insurance, voluntarily purchased, and the uninsured rate was about 1.5%.

In 2006, the Netherlands replaced this arrangement with a mandated private insurance system similar to Switzerland’s. Under this reform, all legal residents of the Netherlands are required to purchase basic insurance from private insurers. Private plans are heavily regulated. They cannot turn down applicants, regardless of health status, and must charge community-rated premiums. A risk-equalization scheme varies payment to health plans according to their enrolled populations’ risk profiles. The aim is to reduce plans’ incentives to select profitable patients and ensure that plans with sicker, higher-cost populations are not financially penalized. Insurance plans are expected to compete on the basis of price and quality by selectively contracting with networks of hospitals, physicians, and other medical care providers.

Advocates of this system argued that competition among private insurers would reduce health care spending, enhance consumer choice, and improve the quality of care and the health system’s responsiveness to patients — arguments that are being repeated in the U.S. debate over Medicare. The reality of managed competition in the Netherlands, however, has not matched the rhetoric.

Four key points emerge from the Dutch experience. First, competition has not sharply slowed the rate of growth in health care spending. Health care expenditures continue to outpace general inflation, having increased at an average annual rate of 5% since 2006. At the same time, the total costs of health insurance for Dutch families, including premiums and deductibles, increased by 41%.

Reforms aimed at increasing and managing competition also produced high administrative costs and complexity. Administering premium subsidies for low-income people has proven expensive.

Second, some Dutch people remain uninsured, and there has been a substantial increase in the number of insured persons failing to pay their insurance premiums.

Third, the expansion of consumer choice has not worked as envisioned. Since 2007, only about 4% of the Dutch population, on average, has changed plans each year. Moreover, accelerating consolidation of the health insurance market has restricted meaningful choice of insurance plan. Currently, four insurance conglomerates control about 90% of the Dutch health insurance market. Recent polls suggest public dissatisfaction with private insurers, with 65% of insured people reporting that they have low or very low levels of trust in private plans.

Fourth, notwithstanding the rhetoric of competition, the Netherlands still relies heavily on regulation. Indeed, the Dutch case shows that competitive systems that seek to escape supposedly centralized, bureaucratic control of medical care paradoxically require sophisticated regulation and government intervention in order to work.

The comprehensiveness of health insurance in the Netherlands provides a critical contrast to the Ryan Medicare plan, which would erode the U.S. government’s contribution to the point that 65-year-old beneficiaries would pay about two thirds of medical costs themselves.

The myth that competition has been key to cost containment in the Netherlands has obscured a crucial reality. Health care systems in Europe, Canada, Japan, and beyond, all of which spend much less than the United States on medical services, rely on regulation of prices, coordinated payment, budgets, and in some cases limits on selected expensive medical technologies, to contain health care spending. Systemwide regulation of spending, rather than competition among insurers, is the key to controlling health care costs. The Netherlands, after all, spent much less on medical care than the United States with virtually universal insurance coverage long before it began experimenting with managed competition in 2006.

The Dutch experience provides a cautionary tale about the place of private insurance competition in health care reform. The Dutch reforms have fallen far short of expectations — a reminder that policy intentions should not be confused with outcomes and that managed competition is hardly a panacea. The idea that the Dutch reforms provide a successful model for U.S. Medicare to emulate is bizarre. The Dutch case in fact underscores the pitfalls of the casual use (and misuse) of international experience in U.S. health care reform debates.

http://healthpolicyandreform.nejm.org/?p=14712

Although the authors present this as a lesson for Medicare, it is actually a lesson for our entire health care system. Perhaps they anticipate when Medicare will be improved and then expanded to cover everyone. Let’s hope so.

How Libby, Montana, Got Medicare for All

By Kay Tillow
Firedoglake, June 15, 2011

In 2009 when the Washington Beltway was tied up with the health care reform tussle, Montana Democratic Senator Max Baucus, chairman of the all powerful Senate Finance Committee, said everything was on the table — except for single payer. When doctors, nurses and others rose in his hearing to insist that single payer be included in the debate, Baucus had them arrested. As more stood up, Baucus could be heard on his open microphone saying, “We need more police.”

Yet when Senator Baucus needed a solution to a catastrophic health disaster in Libby, Montana, and surrounding Lincoln County, he turned to the nation’s single-payer health care system, Medicare, to solve the problem.

Baucus’ problem was caused by a vermiculite mine that had spread deadly airborne asbestos, killing hundreds and sickening thousands in Libby and northwest Montana. The W.R. Grace Company that owned the mine denied its connection to the massive levels of mesothelioma and asbestosis and dodged responsibility for this environmental and health disaster. When all lawsuits and legal avenues failed, Baucus turned to our country’s single-payer plan, Medicare.

The single-payer plan that Baucus kept off the table is now very much on the table in Libby. Unknown to most of the public, Baucus inserted a section into the health reform bill that covers the suffering people of Libby, not just the former miners but the whole community – all covered by Medicare.

They don’t have to be 65 years old or more. They don’t have to wait until 2014 for the state exchanges. No 10-year rollout – it’s immediate. They don’t have to purchase a plan – this is not a buy-in to Medicare – it’s free. They don’t have to be disabled for two years before they apply. They don’t have to go without care for three years until Medicaid expands. They don’t have to meet income tests. They don’t have to apply for a subsidy. They don’t have to pay a fine for failure to buy insurance. They don’t have to hope that the market will make a plan affordable. They don’t have to hide their pre-existing conditions. They don’t have to find a job that provides coverage.

Baucus inserted a clause in the Affordable Care Act to make special arrangements for them in Medicare, and he didn’t wait for any Congressional Budget Office scoring to do it.

Less than two months after the passage of the health reform bill on March 23, 2010, Nancy Berryhill of the Social Security Administration in Denver joined personally in setting up an office in Libby to sign up these newly eligible people.

“This is a new thing,” Berryhill told the Missoulian. “No other group like this has ever been selected to receive Medicare.” Berryhill issued a nationwide alert to inform anyone who had lived or stayed in Lincoln County of their eligibility. She opened a storefront in Libby at the old downtown city hall where she signed up 60 people on the first day. She plastered the towns of Whitefish and Eureka with pamphlets explaining the program and added three new staffers to the office in Kalispell.

Berryhill said she did not know how much the care would cost. That kind of analysis was beyond her directive to sign the people up. There have been no reports of competition from the private for-profit Medicare Advantage plans. The sick are not profitable.

No one should begrudge the people of Lincoln County. The mine wastes were used as soil additives, home insulation, and even spread on the running tracks at local schools. Miners brought the carcinogens home on their clothes. The W.R. Grace Company dumped much of the cleanup costs onto the federal government. A June 17, 2009, order by the Environmental Protection Agency, the first of its kind, declared Lincoln County a public health disaster. The Libby Medicare provision in the health reform law is based on the area covered by that EPA order.

Baucus gave his reasons to The New York Times for its only story on this unique benefit: “The people of Libby have been poisoned and have been dying for a decade. New residents continue to get sick all the time. Public health tragedies like this could happen in any town in America. We need this type of mechanism to help people when they need it most.”

Health tragedies are happening in every town. Over 51 million have no insurance. Over 45,000 uninsured people die needlessly each year. Employers are cutting coverage and dropping plans. States in economic crisis are slashing both Medicaid and their employees’ plans. Nothing in last year’s reform law will mitigate the skyrocketing costs. Most insurance is threadbare and doesn’t cover. More than 50 percent of us now go without necessary care. As Baucus said of Medicare, “We need this mechanism to help people when they need it most.” We all need it now.

Bill Clinton recently stated that the U.S. could give coverage to all for $1 trillion a year less than we now pay if we adopted the system of any other advanced nation. (Unfortunately, he did not say this when it would have mattered most during the 1993 and 2009 health care reform debates.)

Other industrialized countries have found that to cover everyone for less they must remove the profit-making insurance companies. Congressman John Conyers has reintroduced H.R. 676, the Expanded and Improved Medicare for All Act, which does exactly that. There are 60 cosponsors. It would cover all medically necessary care for everyone including dental and drugs by cutting out the 30 percent waste and profits caused by the private insurers.

So as the Ryan Republicans try to destroy Medicare and far too many Democrats use the deficit excuse to suggest cuts in its benefits, let us counter with the Libby prescription to clean up the whole mess. Only a single payer, improved Medicare for All, can save and protect Medicare, rein in the costs, and give us universal coverage.

Medicare will celebrate its 46th birthday on July 30, 2011, and all are invited to join in the festivities. Medicare was passed in 1965 and implemented within less than a year. When we pass H.R. 676, this single-payer bill, we can all be enrolled in the twinkling of an eye.

Kay Tillow lives in Louisville, Ky., and is a leader of All Unions Committee for Single Payer Health Care – H.R. 676.

http://my.firedoglake.com/kaytillow/2011/06/15/how-libby-montana-got-medicare-for-all/

PNHP note: The following is a reply that Kay Tillow made to a reader in Libby, Mont., who questioned some of the assertions in her article. We reproduce her reply here (the reader’s name has been removed) because it sheds additional light on the situation there. Tillow also provides a number of useful citations.

Dear reader,

Your response to my article about Libby and Medicare was forwarded to me by the Physicians for a National Health Program.

The Medicare provision for Libby in the Affordable Care Act applies to the whole community not just the miners. Those who are eligible for Medicare immediately are defined by complex provisions in Amendment 1881 A made to the Social Security Act by the Affordable Care Act. That section lays out criteria for eligibility including the specifics diseases and conditions and the pilot programs that will provide additional benefits. Then this new law broadens that by stating that a person is eligible for Medicare who “is diagnosed with a medical condition caused by the exposure of the individual to a public health hazard to which an emergency declaration applies, based on such medical conditions, diagnostic standards, and other c
riteria as the Secretary specifies.”[1]

The law is complex. I wrote that the new provision “covers the suffering people of Libby” and linked that statement to the Social Security Administration’s (SSA) website for Libby[2] so that those who are interested can read the further detail.

Those in the Libby area who are diagnosed with an asbestos-related disease are immediately eligible, not just for asbestos-related symptoms, but for the full range of benefits that cover any Medicare recipient. The law includes a waiver of budget neutrality. This Medicare for Libby is an astounding provision, an amazing departure from any past practice of Medicare. There is no other instance of Medicare picking up coverage under any condition in a specific geographic region, and I do not understand any effort to minimize this benefit.

You assert that only 700 people so far have signed up for the benefit, but unfortunately the massive asbestos exposure of people in the region assures that many more will be diagnosed and become eligible. In the Washington Post of June 17, 2011, Tanis Hernandez of the Center for Asbestos Related Diseases asserted that more will sign up when the state-federal grant program ends this summer. Hernandez also stated that new cases are being diagnosed at the rate of four a week.

People in Libby and Troy do not have to be 65 to be eligible for Medicare. They don’t have to wait until 2014 for the state exchanges. They do not have to buy in to Medicare–Medicare Part A is free. To quote the SSA, “The Affordable Care Act provides certain individuals who were exposed to asbestos in Lincoln County, Montana: Free Medicare Hospital insurance (Part A).”[3] The SSA states further, “To qualify, you do not need to be age 65 or receive disability benefits. In addition, there is no waiting period, and you do not need to have worked and paid into Social Security or Medicare.”[4]

Unlike for the rest of the country, people in Libby and Troy do not have to have paid into Social Security and Medicare for a minimum number of quarters nor to have qualified for disability benefits. So the provision that Senator Baucus inserted into the Affordable Care Act breaks down the barriers so that people can get the care they need. Yes, Libby residents are to pay, like every other Medicare recipient in the country, for Medicare parts B and D, but there are also more special grants and pilot programs to assist the people of Libby. And, yes, the people of Libby deserve all of the care and compassion that our nation can give them. Nothing can restore to them the health that was stolen from them as the mine owners exploited their labor and polluted their beautiful region for profit.

I did not assert that “New residents continue to get sick all the time.” I was simply stating that Senator Max Baucus was quoted in New York Times as saying that. But, all too sadly, I believe that he is correct in this. The asbestos remains in many houses and gardens of the region—so much so that even after the clean up, the Environmental Protection Agency recommends that people do not disturb either the walls of homes or the soil. Region 8 of the Environmental Protection Agency states on its website that, “While EPA’s cleanup efforts have greatly reduced exposure, past and future exposures of amphibole asbestos may remain a public health concern in the area.”[5] That website was last updated in May of 2011.

According to a scholarly article[6] published in the Journal of Environmental and Public Health in 2009 written by Julie F. Hart et al., the danger remains in the forests of the region. “This research demonstrates the potential for airborne exposure and transport of AA (Amphibole Asbestos) in the Kootenai National Forest. These findings are especially relevant to those that work in the area and to the general public who may conduct recreational activities,” the authors state.

My statement that “other industrialized countries have found that to cover everyone for less they must remove the profit-making insurance companies,” is indeed true. Nobel Laureate economist Joseph Stiglitz said it well:

“The U.S. model of private health insurers has been proven inefficient and expensive. Rather than provide better healthcare at lower costs, insurance companies innovate at finding better ways of discrimination. They are inefficient because they are trying to figure out how to insure people who don’t need the cover and keep out people who need it. With many companies, they also need to spend on marketing and advertising. The incentives are all wrong and the transaction costs are very high and you have to give them a high profit. In health, social and private incentives are totally disparate. Competition does not work in healthcare especially in the health insurance market. Several countries like the U.K., France and Sweden have a single payer system, differing only in the organisation of healthcare delivery.”[7]

England, or the United Kingdom, covers all its people with a national health service. Private health insurance covers only 1 percent of health expenditures and is limited to supplementary areas. You assert that England has unsustainable costs, but in relation to health care costs in the U.S. that country is doing remarkably well. In 2007, the U.K. spent $2,990 per capita for health care while the U.S. spent $7,290. That means the U.K., with a national health service and only a tiny very limited private health insurance, spent 41 percent of what the U.S. spent per person.[8] Yet the U.K. outpaced the U.S. in life expectancy in 2009 by a full year.

The 30 percent in administrative waste and profits in the U.S. health system is caused by the private health insurers. According to the Physicians for a National Health Program, “Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes one-third (31 percent) of Americans’ health dollars.”[9]

The costs of administering the Medicare program have remained low over the years – less than 2 percent of program expenditures [10], according to research by the Kaiser Family Foundation. The private for-profit health insurers are fighting against the rules of the new Affordable Care Act that would limit them to 20 percent for some insurance, 15 percent for others, in administrative costs. In my state of Kentucky, the insurance commissioner asserts that the rate allowed for administrative costs is currently 35 percent and that any sudden shift to the 15 percent or 20 percent limit would cause undue hardship and force companies to leave the state. Clearly the private insurers are more costly, less efficient.

Contrary to your assertion that Medicare is unsustainable, it is the gigantic overhead of the private health insurers that is unsustainable. Research by the Physicians for a National Health Program shows that by moving
to a single payer system, our country could save $400 billion annually that could then be applied to expanding coverage for all of us and extending coverage to those who are uninsured. Such a program will be instituted when we pass Congressman John Conyers H.R. 676, Expanded and Improved Medicare for All Act.

At your suggestion I looked up information about Rulon Stacey and saw that in a news release about his new book “Over Our Heads,” he states, “Our current healthcare crisis was fueled by government intervention.”[11] The above data on Medicare versus private insurance show just the opposite—that the crisis is propelled by the domination of our system by private for profit insurance.

I agree that you live in a very beautiful area, and I do not seek in any way to deter the people of that region from finding the ways to reclaim a clean, healthful, environment in a new future. The courageous people who brought the problems to light are responsible for pointing a way forward. Clean up and health care are crucial to that.

It is informative for people in the country to know that Senator Max Baucus made certain that the people of Libby suffering from asbestos exposure did not have to buy into exchanges they could not afford nor wait endlessly. He chose the more efficient and effective single payer program, Medicare, to assure that they got care. He did that while ordering the arrest of single payer advocates for seeking to place improved Medicare for all on the table in the national health care debate, thereby denying the nation as a whole a chance to choose a vastly superior health plan that would cover us all while controlling the costs.

1. Sec. 1881A. [42 U.S.C. 1395rr-1] Medicare Coverage for Individuals Exposed to Environmental Health Hazards, (a) Deeming of Individuals as eligible for Medicare benefits. http://www.ssa.gov/OP_Home/ssact/title18/1881A.htm

2. http://www.ssa.gov/libby/

3. http://www.ssa.gov/libby/

4. http://www.ssa.gov/libby/

5. http://www.epa.gov/region8/superfund/libby/askepa.html

6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2799270/

7. http://timesofindia.indiatimes.com/home/opinion/edit-page/The-US-model-of-private-health-insurers-is-inefficient-expensive/articleshow/6989634.cms

8. Organisation for Economic Co-operation and Development, 2007

9. https://pnhp.org/resource/administrative-waste-consumes-31-percent-of-health-spending, https://pnhp.org/facts/single-payer-resources

10. http://www.kff.org/medicare/7731.cfm

11. https://pnhp.org/facts/single-payer-resources

12. http://www.studergroup.com/fsp/associated_files/over_our_heads_press_release.pdf