PNHP

Health care debate a dull but worthwhile topic

Health care debate a dull but worthwhile topic

By Charles McMahon
Opinion column, Seacoastonline.com (N.H.), Feb. 28, 2011

PORTSMOUTH, N.H. — Health care is not sexy.

The ongoing debate over health care coverage lacks all of the necessary components of what I would consider to be a sexy and spicy news story. Not only does it lack elements of mystery and suspense, but there is very little room for intrigue and excitement.

Unlike an occasional crime story or investigative report, issues pertaining to health care rarely seem to drum up a lot of interest and almost never end up in the newspaper’s online most-viewed list.

In other words, a headline that reads “Health care plan explained” doesn’t necessarily jump off the page and suck readers in.

While I’ll be the first to acknowledge my lack of excitement when asked to cover something related to health care, that doesn’t necessarily mean I don’t understand and appreciate its importance and the place it has in the news.

I doubt many readers would argue against the fact that making health care affordable and accessible are perhaps some of the most important issues facing Americans today.

I think the more than 50 Seacoast residents who showed up to the public library Wednesday night for a presentation called Health Care Reform in 2011 and Beyond would agree with me.

The need for a conversation on further reform in the area of health care was made very evident this week in Portsmouth.

On one front, you had Dr. Thomas Clairmont asking the City Council to endorse debate on a movement to create a single-payer system.

In his plea to the city, Clairmont said the move could save the city some major money given the fact that insurance premiums have risen on average over 10 percent every year since 2000.

Having practiced medicine in Portsmouth since 1980, Clairmont said if nothing is done now, the rate of increase, compounding every year, will bring Portsmouth taxpayers a health care bill of $40.4 million in 2020 and $127 million in 2030.

The city could hit $1 billion for health care in 2050, according to Clairmont.

Katie Robbins, national organizer for Healthcare-NOW!, was in Portsmouth as well this week, helping promote the passage of the national, single-payer health care legislation.

Robbins said Portsmouth was perfect for the debate because of how progressive the community is. Not only would the single-payer system allow for universal and guaranteed health coverage for all U.S. citizens, but it would also provide for comprehensive health coverage filled with choices and would be good for the economy, Robbins said.

Currently, nearly one-third of all Americans are either uninsured or underinsured, Robbins said, adding that the proposed system would help solve that problem.

While I don’t proclaim to know everything about health care, I think ideas like creating a single-payer system may have some merit.

Perhaps we’ve reached a point in society where we have no other choice but to look outside of the box and consider all options.

I think City Councilor Bob Lister said it best when he stood up before the crowd of people Wednesday night and proclaimed the so-called fixed costs were a major speed bump in developing a fiscally responsible budget.

“It diverts our mission,” he said.

Lister said he attended the event because he knew it was time to look at other options. He should be applauded for that.

Portsmouth Herald reporter Charles McMahon can be reached at 570-2234 or cmcmahon@seacoastonline.com.

Healthcare scare tactics sickening

By Steven Cotterill
Letters, The Shepherdstown (W.Va.) Chronicle, Feb. 18, 2011

So many myths are found within the letter from Mr. Schmidt that appeared in The Shepherdstown Chronicle on 02/04/11 that it is very hard to know exactly where to begin.

Given however that I have intimate knowledge of the British system of healthcare (I lived in England until the age of 18, since coming to America in 1983 have travelled back numerous times, and have many family members over there still), I will start with Mr. Schmidt’s contention that the failed British healthcare system is in the process of being dismantled.

Not only is this a complete fallacy, but the British, quite rightly, remain as proud of their system of healthcare delivery as many Americans are of representative democracy or jazz. The larger fallacy in Mr. Schmidt’s letter regarding England is that some type of nationalized healthcare system results in complete socialized medicine, which in turn leads to socialism itself. The last time I checked England presently has a coalition government consisting mainly of members of the conservative party, with some liberals added to complete the numbers needed for holding office. Even the very conservative Margaret Thatcher, in her time in office in the 1980s, only tinkered with the efficiency of the national healthcare system, and never seriously considered abandoning it altogether.

A more centralized healthcare system, which the healthcare reform act of last year didn’t even come close to approaching, no more represents the beginnings of socialism than reading Nietzsche turns you into a nihilist. The one does not lead to the other.

The last myth about nationalized healthcare found within Mr. Schmidt’s letter is that it would lead to government bureaucrats rationing care based on age and quality of life issues. In England today doctors make all decisions about healthcare, not government bureaucrats. Unfortunately in America today we actually have rationing, and most insidiously of all, it is based not on doctors’ opinions, but on private insurance profit.

The danger of Mr. Schmidt’s letter, and similar ones found throughout print media in the last few years, is that it promotes the completely false idea that the healthcare legislation act passed in 2010 led to the government take over of healthcare. Even the millions of us who wish for a system of “Improved Medicare for All” (publicly funded, privately delivered), also known as “Single Payer,” don’t want to see government running the healthcare system, and rather see the 2010 legislation as yet another handout for the private insurance industry.

The sadness of Mr. Schmidt’s letter is that the scare tactics used by him and others over the healthcare debate of recent years, hurts millions of Americans who desperately need quality care delivered at low cost. This has been achieved in England, Canada, France and a host of other advanced industrialized nations, without the creeping socialism mentioned in Mr. Schmidt’s letter. If we are not careful this country will slide back into the Red Scare era of the late 1940s and 1950s, when name calling and “guilt by association” destroyed lives and families, and prevented social progress seen in many European countries at the time, from occurring in America until many years later.

Steven Cotterill is a resident of Charles Town, W.Va.

http://shepherdstownchronicle.com/page/content.detail/id/501737/Healthcare-scare-tactics-sickening.html

Single-payer health care system ideal for Alaskans

By DR. JULIAN GONZALEZ
Anchorage Daily News, Feb. 25, 2011

It seems Gov. Sean Parnell has drunk the tea party Kool-Aid about health care reform in order to be “Republican Fashionable.” You would think he would at least consider the health care reform instituted by fellow Republican and former governor Mitt Romney in Massachusetts, a plan not unlike the Patient Protection and Affordable Care Act (PPACA). But, that’s OK, because only 14 percent of Massachusetts physicians think their state’s model would be viable for the rest of the country (Massachusetts Medical Society “Physician Workforce Survey”, 2010). However, 66 percent preferred either a single-payer plan or a private-public insurance option.

In a sense, I’m in the governor’s camp in that I also don’t like the PPACA, or “Obamacare” as it is affectionately known, but not for the same reasons. Basically, it doesn’t go far enough; it doesn’t increase accessibility, quality of care or contain medical costs. Alaska can do better, though, it can do what Vermont is planning: getting a federal waiver and implementing a single-payer program.

Multiple studies by independent organizations such as the Commonwealth Fund and Organization For Economic Cooperation And Development (OECD), have compared the health care outcomes of industrialized countries and have demonstrated that for the high cost of our health care, $7,290 per capita, the highest of all the developed countries (Canada comes next with $4,790) we consistently trail in health outcomes such as life expectancy at birth, asthma mortality, infant mortality rate, chronic disease care, etc., as well as access to affordable, quality care.

Gov. Parnell seems to believe that clinging to the present status quo of insurance-dominated health care, and the addition of technology, such as electronic medical records and telemedicine, neither which has been shown to improve health outcomes, will take care of our problems. But insurance companies are the problem. It’s because of insurance companies that people are more likely to incur higher medical expenses, spend more time on paperwork, have more claims denied, have more health care dollars go to administrative work and profits, and limit both physician and patient choices in their needed health care. Insurance companies are a profit-driven middleman that produces nothing.

In 2009, in the middle of one of our worst economic periods, the five largest health insurers, CIGNA, Humana, WellPoint, United Health and Aetna, garnered combined record profits of $12.2 billion; up 56 percent from the previous year. How many people lost their homes due to medical bills or were denied claims during that same time period?

Last year there were 50.7 million Americans who were uninsured, an increase of 4.3 million per the Census Bureau. Alaska was one of 16 states that experienced a big jump in the uninsured (109, 000 in 2006 versus 122,000 in 2009). Here in Anchorage we have a growing community of seniors on Medicare who cannot find a primary doctor as more and more in the private sector stop taking Medicare. There are also a large immigrant population, a homeless population and many people with chronic diseases that find themselves in the same situation. Most are relegated to a community clinic that is underfunded, understaffed, and overwhelmed where patients have difficulty getting an appointment. Many end up in the emergency rooms.

All this means increased long-term costs to the society because of diseases missed and chronic-care issues that were not adequately addressed.

“Socialized medicine” was coined by the insurance industry when President Truman proposed single-payer health care in the 1950s; it’s time to put that bogeyman to rest. We already have vibrant single-payer plans in Alaska in the Native Health Care system, the military and the V.A., which cover a large portion of our 700,000 people, and give quality care. If we are truly as independent and unique as we Alaskans like to think of ourselves, we should encourage our governor and legislators to act creatively and boldly. A single payer health care plan is smart, efficient, cost effective, humane and takes the burden off of employers and business. Let’s drink water … it’s healthier than Kool-Aid.

Julian Gonzalez is a family physician who has worked in Native care, military care and trained in a country with universal health care coverage. He is a member of Physicians for Social Responsibility (PSR), Physicians for Human Rights (PHR) and Physicians for a National Health Program (PNHP). He lives in Anchorage.

http://www.adn.com/2011/02/25/1723361/single-payer-health-care-system.html

When health insurance isn't for sale

Letters
The New York Times, Feb. 28, 2011

The key phrase in Donna Dubinsky’s article (“Money Won’t Buy You Health Insurance”) is, “If we are not going to have universal coverage.” Any reform that doesn’t offer nonprofit, quality, affordable universal access is inferior and fraught with serious problems, not to mention the complexity and unfairness of for-profit insurance.

Until we reform Medicare and create Medicare for all, including the option to buy private insurance as we do with public and private education, the nation will suffer with the ever-growing injustices of the lack of access to care for more and more Americans, skyrocketing inflation of health care costs and the worst outcomes among all the developed nations on the planet.

Jerry Frankel
Houston
The writer is a urologist.

http://www.nytimes.com/2011/02/28/opinion/l28health.html

Whistleblower says insurers will try to undermine single-payer

Wendell Potter alleges the health insurance industry did everything in its power to discredit the movie “SICKO”

By Mel Huff
VtDigger.com, Feb. 26, 2011

Montpelier, Vt. — Vermonters should be prepared for a campaign by health insurance companies to undermine public support for single-payer health care, an industry whistleblower declared at a Statehouse hearing Thursday.

Wendell Potter, who until 2008 was a public relations executive for CIGNA, said he witnessed such a campaign in 2007, when industry pollsters reported for the first time that a majority of Americans felt the government should play a more direct role in health care.

Industry leaders feared that the public would begin demanding the kind of comprehensive reform now being considered in Vermont, Potter said, and their fear was compounded by the release of Michael Moore’s documentary “SICKO.”

Potter told lawmakers and health care reform advocates at the Statehouse that as an industry insider at CIGNA he observed the orchestration of an extraordinary clandestine effort to discredit Moore’s film and the single-payer health care model it promoted.

In the spring of 2007, Potter took part in a secret meeting with other major insurance companies at CIGNA’s corporate headquarters in Philadelphia. In addition to an update from the pollsters, the meeting included presentations by an industry trade group — America’s Health Insurance Plans (AHIP) and a huge communications firm, APCO Worldwide, he said. The reason for the secrecy was to conceal the insurers’ alarm about Moore’s film and the shift in public opinion, according to Potter.

AHIP and APCO Worldwide presented the executives with a 23-page strategic plan called “Ensuring Accurate Perceptions of the Health Insurance Industry,” which Potter said was designed to neutralize the effects of Moore’s film.

Potter read from a copy of the “playbook” for how to control the message in a crucial dispute. The strategic plan advised:

    * “Reframe the debate: Mount campaign against a government-run health care system”
    * “Define the health insurance industry as part of the solution”
    * “Develop talking points …”
    * “Highlight horror stories of government run systems”
    * “Create an ad that would show Democrats’ likely response to a single-payer proposal; float the ad on the Internet and encourage conservatives to donate money to the allied organizations to support running the ad”
    * “Produce vignettes of victims of single-payer systems; distribute it on websites via conservative bloggers and YouTube.”

Audiences were targeted, he said, and “free market allies” identified — Health Care America, the American Enterprise Institute, the Heritage Foundation, the Cato Institute and other ideological sympathizers who “will have a vested interest in critiquing single-payer health care.” Unlikely allies, such as medical specialty groups, were also identified.

Given the extraordinary effort that the industry’s leaders invested into discrediting “SICKO,” Potter said single-payer supporters should expect that insurers are certainly aware of what is going on in Vermont. “They have probably already developed a much more comprehensive plan than this one to try to derail what’s going on here in Montpelier,” Potter said. “I have no doubt about it. They do not want you to succeed.

“You will not even be aware they’re behind it,” he added. “The industry’s communications strategists will want the campaign to be perceived as a grassroots movement arising to oppose lawmakers in favor of a single-payer plan.”

Sen. Richard McCormack, D-Windsor, remarking on the uniformity of the rhetoric of right-wing talk-show hosts, asked if it was coordinated.

“Absolutely,” Potter replied. Communications strategists give “messaging” to talk show producers, and lobbyists give talking points to friendly members of Congress and the media.

They spend large sums testing words with focus groups, and they’re experts at message discipline,” he observed. He noted that the phrase, “government takeover of health care” featured prominently in the 2007 SiCKO campaign. Then last year in the health care reform vote, almost every Republican who spoke about the bill on the House floor used the same phrase, Potter noted.

A key element of the strategy is to develop a simple message and get as many people as possible to use the same words over and over again. With enough repetition, some people will come to believe even assertions that are not true, he said. He cited the example of “death panels.”

Potter predicted that in Vermont, the health insurance industry’s strategy would include trying to influence the news media, and getting people to write op-eds and letters to the editor, to blog and to call into radio programs. “It will be the perception of a grassroots organization, but it will be organized behind the scenes by the insurance industry,” he said.

“They go to great lengths to launder money to avoid detection,” Potter said, tracing the money trail. A health insurance company will give a portion of a policy holder’s premium to AHIP, the trade group, which hires a public relations firm like APCO Worldwide to set up front groups like Health Care America, leaving no trace of insurance company involvement in the fake grassroots organizations, he said. And because it’s not mentioned on either AHIP’s or APCO’s website, he said, no one — except for people at the two companies — knows there’s a relationship between them.

Potter said you can find out some information about a “grassroots” nonprofit from its federal 990 form. You can also call the person listed as the media contact on the nonprofit’s website and ask where his or her office location is.

If the media contact for Health Care America is honest, Potter said, he will tell you that he’s sitting at his desk at APCO Worldwide, because he’s not — and never was — an employee of Health Care America: Health Care America and organizations like it exist only on paper.

Potter once tried to find the office listed on Health Care America’s 990 form.

“It’s one of these virtual office settings where people can pay money to have a real street address. They don’t have an office there, but they can use that address,” he said, “and if they want to have a meeting there, they can pay to rent a conference room. If you check to see how many people are at this address, you usually will see that there are dozens of people that share that same address.”

Potter predicted that next year — an election year — the health insurance industry’s political strategy will be to try to change the governor and the makeup of the legislature in Vermont, just as last year it tried to change the makeup of Congress. “They were successful in flipping the House of Representatives and reducing the Democratic majority in the Senate,” he observed.

“It’s going to be important to find out who’s behind the money that’s coming in to influence Vermont,” he said. “They will spend an enormous amount of money to influence the elections in 2012 here. There’ll be political advertising for candidates that are willing to deliver the industry’s messaging, and there will be negative campaigns against lawmakers who vote for single-payer legislation.”

Potter noted that the health insurance industry funneled $86 million in one year through the U.S. Chamber of Commerce to influence the health care reform debate. The U.S. Chamber and Business Roundtable are long-term allies of the health insurance industry, he said: The chief executive officers of Aetna, CIGNA, WellPoint a
nd Humana are Business Roundtable members.

Shortly after the campaign against SiCKO was launched, Potter began working on a white paper whose purpose was to downplay the problem of the country’s uninsured. (They now number 51 million.) That summer he took a trip to Tennessee to visit relatives, and while he was there, he had an experience that turned the industry’s statistical abstractions into flesh-and-blood reality.

He was listening to the radio when he heard about a health care “expedition” in a nearby town. It was run by Remote Area Medical, a relief organization that flies doctors and other health care volunteers to under-served areas to provide medical care. (Originally they flew to Africa and the Amazon, but now 65 percent of RAM’s expeditions are to counties in this country, Potter said.)

The next morning, Potter grabbed his camera, borrowed his father’s car and drove to the fairgrounds where the expedition was being held. He was stunned by what he saw: people — some from as far away as Ohio — standing in soaking rain in lines that stretched out of sight; people being treated in open tents and animal stalls. They could have been people he grew up with. Most of them had jobs, but either their employers didn’t provide health insurance or else their plans had high deductibles.

Potter had become increasingly uncomfortable as he realized that insurance companies were trying to move people like these into high-deductible plans. Some policy-holders couldn’t afford to see a doctor or buy medications after paying their insurance premium.

One company in Maine, Potter said, is selling a plan with a $30,000 deductible. “That is where the insurance industry wants to take us all. They make money hand over fist when they can get us into these plans. Seeing what I saw was one of the factors that made me decide to quit my job.”

Potter says he’s not advocating a single-payer versus a public option. His goal is to make Vermonters aware of the propaganda campaign that will be unleashed on them, if not this year, next year.

“This is going to be a multi-year project for you all, and this is going to give the insurance industry and its allies a lot of opportunities to try to turn public opinion against what you’re trying to do,” he said.

“It’s almost stunning what you’re trying to do,” he added. You were the first to abolish slavery. Maybe you can be the first to abolish insurance.”

Potter’s visit was sponsored by Vermont Health Care for All, UVM United Academics, United Professions AFT Vermont, the AFL-CIO and Vermont Physicians for a National Health Program.

http://vtdigger.org/2011/02/26/story-video-whistleblower-says-insurers-will-try-to-undermine-single-payer/

Beware of "Commercial ACOs"

The HMO in Your Future

By John Goodman
National Center for Policy Analysis, John Goodman’s Health Policy Blog
February 28, 2011

(Brief excerpts only)

… you are likely to be in an ACO (accountable care organization) at some point in the future and it’s probably going to happen sooner than you think.

ACOs are sometimes said to be the brain child of Elliott Fisher, who heads the Dartmouth Atlas Project. But as Uwe Reinhardt pointed out the other day, the idea is actually an old idea. It’s called Kaiser Permanente.

… the non-evidence based approach of the Obama administration will force everybody into the same model.

So how do we explain the administration’s commitment to ACOs? Whether they raise or lower costs, whether they raise or lower quality, there is one thing that ACOs will indisputably accomplish. They will drive doctors into organizations where their behavior can be controlled. For the first time in our history, both the practice of medicine and the way money is spent on medical care will fall under federal control.

ACOs are the portal through which we will all march toward a truly nationalized health care system.

Use this link to access John Goodman’s full blog entry:
http://healthblog.ncpa.org/the-hmo-in-your-future/

Comment:

By Don McCanne M.D.

Will accountable care organizations (ACOs) provide the portal that will lead us to a nationalized health care system?

There is a sharp contrast between ACOs as defined under the Medicare Shared Savings Program in the Affordable Care Act (ACA) and the commercial ACOs that already exist or are being formed throughout the nation.

Commercial ACOs are primarily an extension of private sector managed care models of health care financing and delivery, except with the hope of less regulatory oversight of the market concentration that they hope to gain. These organizations are largely entrepreneurial in nature (even if non-profit) with the primary goal of making money. Since virtually all stakeholders are driven by profits, these will be the predominant models of ACOs.

The government version of Medicare shared savings ACOs is merely a model to discount Medicare services and then split the savings between the providers and the government (i.e., half of a discount). Who in their right mind would want to corner that market? The government version will be a dud.

It is not the federal government through the Affordable Car Act that is going to bring us ACOs. It is the private sector. This is hardly a portal to nationalized health care, but it is a reincarnation – on steroids – of the models from the age of managed care that caused us so much distress in the fairly recent past. Any hope of cost containment will vanish as these organizations drive prices ever higher.

Our only hope to slow our outrageous health care cost escalation is to do what all other industrialized nations have done. We need to establish some form of a public monopsony through the application of a universal social insurance program. A publicly-financed and publicly-administered single payer system would be the most efficient and most equitable model.

Comment originally posted at John Goodman’s Health Policy Blog: http://healthblog.ncpa.org/the-hmo-in-your-future/comment-page-1/#comment-86801

Beware of “Commercial ACOs”

The HMO in Your Future

By John Goodman
National Center for Policy Analysis, John Goodman’s Health Policy Blog
February 28, 2011

(Brief excerpts only)

… you are likely to be in an ACO (accountable care organization) at some point in the future and it’s probably going to happen sooner than you think.

ACOs are sometimes said to be the brain child of Elliott Fisher, who heads the Dartmouth Atlas Project. But as Uwe Reinhardt pointed out the other day, the idea is actually an old idea. It’s called Kaiser Permanente.

… the non-evidence based approach of the Obama administration will force everybody into the same model.

So how do we explain the administration’s commitment to ACOs? Whether they raise or lower costs, whether they raise or lower quality, there is one thing that ACOs will indisputably accomplish. They will drive doctors into organizations where their behavior can be controlled. For the first time in our history, both the practice of medicine and the way money is spent on medical care will fall under federal control.

ACOs are the portal through which we will all march toward a truly nationalized health care system.

Use this link to access John Goodman’s full blog entry:
http://healthblog.ncpa.org/the-hmo-in-your-future/

Will accountable care organizations (ACOs) provide the portal that will lead us to a nationalized health care system?

There is a sharp contrast between ACOs as defined under the Medicare Shared Savings Program in the Affordable Care Act (ACA) and the commercial ACOs that already exist or are being formed throughout the nation.

Commercial ACOs are primarily an extension of private sector managed care models of health care financing and delivery, except with the hope of less regulatory oversight of the market concentration that they hope to gain. These organizations are largely entrepreneurial in nature (even if non-profit) with the primary goal of making money. Since virtually all stakeholders are driven by profits, these will be the predominant models of ACOs.

The government version of Medicare shared savings ACOs is merely a model to discount Medicare services and then split the savings between the providers and the government (i.e., half of a discount). Who in their right mind would want to corner that market? The government version will be a dud.

It is not the federal government through the Affordable Car Act that is going to bring us ACOs. It is the private sector. This is hardly a portal to nationalized health care, but it is a reincarnation – on steroids – of the models from the age of managed care that caused us so much distress in the fairly recent past. Any hope of cost containment will vanish as these organizations drive prices ever higher.

Our only hope to slow our outrageous health care cost escalation is to do what all other industrialized nations have done. We need to establish some form of a public monopsony through the application of a universal social insurance program. A publicly-financed and publicly-administered single payer system would be the most efficient and most equitable model.

Comment originally posted at John Goodman’s Health Policy Blog: http://healthblog.ncpa.org/the-hmo-in-your-future/comment-page-1/#comment-86801

Sec. Sebelius promotes consumer-directed health plans

Letter from Secretary Kathleen Sebelius replying to Republican governors

U.S. Department of Health and Human Services
February 24, 2011

As a former governor, I can appreciate your interest in having flexibility to establish an exchange that meets the unique needs of your state and its residents.

Your letter identified four areas for greater state flexibility. Specifically, you called for the ability to (1) exercise maximum flexibility to operate exchanges, and in particular to select the insurers that will participate in the exchange, (2) give states authority to determine essential health benefits that participating plans must offer, (3) waive provisions that might inhibit the availability of consumer-driven plans and health savings accounts (HSAs), and (4) enroll Medicaid beneficiaries into private plans without HHS approval. In each of these areas, the Affordable Care Act offers better opportunities than the current marketplace and gives governors and legislatures broad flexibility to capitalize on those opportunities in reshaping state marketplaces for the 21st century.

*  Selection of Qualified Plans in the Exchanges. In a majority of states today, a small number of health insurance issuers dominate the market, sometimes offering only a single plan or product. In implementing their exchanges, states have the option to allow all insurers to participate in the exchanges (the Utah model), or they can be more active purchasers in shaping available choices (the Massachusetts model). Either way, the exchanges will stimulate broader competition, and consumers will end up with more and better choices.

*  Essential Health Benefits. In today’s market, many individuals and families have limited health insurance options available to them. The number and quality of options typically depend on applicants’ age and health status, and employees of small businesses often have only a single choice. Exchanges will expand consumer choice and give consumers the information they need to comparison shop among their expanded choices. All plans in the individual and small group markets – inside or outside of the exchanges – will provide essential health benefits, which, by law, will be modeled after what a typical employer currently provides today in the private sector. But the law and how states implement it allow a diversity of plan types and benefit designs in exchanges, and states continue to have the option to require coverage of specific, additional benefits.

*  Consumer-Driven Plans. Low-cost, high-deductible plans, including those coupled with HSAs, are growing in popularity. The cost sharing limits required by the essential health benefits package mirror the current out-of-pocket maximum for HSAs under the Internal Revenue Code. Exchanges will offer new choices for consumers because health insurance issuers may offer a variety of plans with broad parameters; consumers who are willing to accept higher cost-sharing in exchange for lower premiums may purchase different levels of coverage. The “bronze” plans and catastrophic coverage for young adults will provide opportunities for expanding enrollment in consumer-driven plans coupled with HSAs. At the same time, exchanges will also improve consumer awareness of options by making it easier to compare plans.

*  Medicaid Flexibility. The Affordable Care Act expands and simplifies Medicaid coverage and provides states with more opportunities to align Medicaid with private health insurance. More specifically, the law permits states to restructure Medicaid coverage to look more like typical private employer coverage, as Medicaid managed care organizations and commercial insurers move into each other’s markets and create new opportunities to enhance continuity of care across Medicaid and commercial populations.

http://www.kaiserhealthnews.org/Stories/2011/February/25/~/media/Files/2011/HHS%20Gov%20Letter%20Feb%2024.pdf?wpisrc=nl_wonk

And…

NOTE TO: Medicare Advantage Organizations, Prescription Drug Plan Sponsors, and Other Interested Parties

Centers for Medicare and Medicaid Services
February 18, 2011

Section H. End of Medicare Advantage Medical Savings Account (MSA) Plan Demonstration Program

In a July 13, 2006, Federal Register Notice (CMS-4123-N) we announced the availability of an opportunity to participate in an MA MSA demonstration project. In the Federal Register notice we said that waivers provided under our demonstration authority would allow interested entities to offer products that more closely resemble high deductible health plans that are offered in conjunction with health savings accounts to the non-Medicare population. We initially established a deadline of July 21, 2006, for applicants that wanted to participate in the MA MSA demonstration program for 2007. We also asked applicants that wanted to participate in the program in 2008 to submit a notice of intent to us as soon as possible.

Overall we had one applicant that participated in the MSA demonstration program in calendar year 2007. There has been no activity under this demonstration program since then. We are not seeking extension of this demonstration program and will not accept applications for participation in this program for plan years 2012 and thereafter.

http://www.cms.gov/MedicareAdvtgSpecRateStats/Downloads/Advance2012.pdf

And…

Nearly Half Of Families In High-Deductible Health Plans Whose Members Have Chronic Conditions Face Substantial Financial Burden

By Alison A. Galbraith1, Dennis Ross-Degnan, Stephen B. Soumerai, Meredith B. Rosenthal, Charlene Gay and Tracy A. Lieu
Health Affairs
February 2011

High-deductible health plans — typically with deductibles of at least $1,000 per individual and $2,000 per family — require greater enrollee cost sharing than traditional plans. But they also may provide more affordable premiums and may be the lowest-cost, or only, coverage option for many families with members who are chronically ill. We surveyed families with chronic conditions in high-deductible plans and families in traditional plans to compare health care–related financial burden — such as experiencing difficulty paying medical or basic bills or having to set up payment plans. Almost half (48 percent) of the families with chronic conditions in high-deductible plans reported health care–related financial burden, compared to 21 percent of families in traditional plans.

http://content.healthaffairs.org/content/30/2/322.abstract

Comment: 

By Don McCanne, MD

To appease the Republican governors, HHS Secretary Kathleen Sebelius has attempted to reassure them that they will have considerable flexibility in qualifying insurance plans for the exchanges, in defining optional benefits for the plans, and in privatizing Medicaid. Perhaps the most alarming flexibility being granted to the governors is the ability to offer consumer-driven plans within the exchanges. Why is that a problem?

In her letter, Kathleen Sebelius offers up the bronze plans in the exchanges and the catastrophic plans for young adults as providing opportunities for expanding enrollment in consumer-driven plans. The bronze plans have an actuarial value of only 60 percent, meaning that an average of 40 percent of health care costs must be paid out of pocket. (The inadequate subsidies for silver plans is another topic not addressed here.) The way that both bronze plans and catastrophic plans achieve lower premiums is by
requiring very high deductibles. That is a serious problem.

The current issue of Health Affairs has yet one more article adding to the great body of policy studies on high-deductible plans showing, once again, why they are an inappropriate method of financing health care. This study demonstrates that half of families with chronic conditions in high-deductible plans report health care related financial burdens.

The fact that these plans can be offered with a health savings account (HSA) does not improve the individual’s financial security since these funds still must come from the individual who either funds the HSA to draw on later, or draws the funds from other savings, or, more likely, simply doesn’t have the funds when needed to pay the deductible. An unfunded or depleted HSA is of no value.

Although Republicans have been supportive of the consumer-directed approach of high-deductible plans with HSAs, there is almost unbelievable irony when we look at another favorite of theirs – the privatized Medicare Advantage plans that replace traditional Medicare coverage. Under the Bush administration a Medicare Advantage Medical Savings Account demonstration project was established, duplicating this consumer-directed approach within the Medicare program. Last week HHS announced that this program was being terminated because of a lack of activity. Obviously consumer-directed does not equate with consumer-demanded.

High-deductible plans are under-insurance products that create financial hardships for people who develop health care needs. It is disappointing that Secretary Sebelius is presenting them as an “opportunity.” They’re an opportunity to lose your shirt if you get sick.

We could have done so much better… and still can.

Sec. Sebelius promotes consumer-directed health plans

Letter from Secretary Kathleen Sebelius replying to Republican governors

U.S. Department of Health and Human Services
February 24, 2011

As a former governor, I can appreciate your interest in having flexibility to establish an exchange that meets the unique needs of your state and its residents.

Your letter identified four areas for greater state flexibility. Specifically, you called for the ability to (1) exercise maximum flexibility to operate exchanges, and in particular to select the insurers that will participate in the exchange, (2) give states authority to determine essential health benefits that participating plans must offer, (3) waive provisions that might inhibit the availability of consumer-driven plans and health savings accounts (HSAs), and (4) enroll Medicaid beneficiaries into private plans without HHS approval. In each of these areas, the Affordable Care Act offers better opportunities than the current marketplace and gives governors and legislatures broad flexibility to capitalize on those opportunities in reshaping state marketplaces for the 21st century.

*  Selection of Qualified Plans in the Exchanges. In a majority of states today, a small number of health insurance issuers dominate the market, sometimes offering only a single plan or product. In implementing their exchanges, states have the option to allow all insurers to participate in the exchanges (the Utah model), or they can be more active purchasers in shaping available choices (the Massachusetts model). Either way, the exchanges will stimulate broader competition, and consumers will end up with more and better choices.

*  Essential Health Benefits. In today’s market, many individuals and families have limited health insurance options available to them. The number and quality of options typically depend on applicants’ age and health status, and employees of small businesses often have only a single choice. Exchanges will expand consumer choice and give consumers the information they need to comparison shop among their expanded choices. All plans in the individual and small group markets – inside or outside of the exchanges – will provide essential health benefits, which, by law, will be modeled after what a typical employer currently provides today in the private sector. But the law and how states implement it allow a diversity of plan types and benefit designs in exchanges, and states continue to have the option to require coverage of specific, additional benefits.

*  Consumer-Driven Plans. Low-cost, high-deductible plans, including those coupled with HSAs, are growing in popularity. The cost sharing limits required by the essential health benefits package mirror the current out-of-pocket maximum for HSAs under the Internal Revenue Code. Exchanges will offer new choices for consumers because health insurance issuers may offer a variety of plans with broad parameters; consumers who are willing to accept higher cost-sharing in exchange for lower premiums may purchase different levels of coverage. The “bronze” plans and catastrophic coverage for young adults will provide opportunities for expanding enrollment in consumer-driven plans coupled with HSAs. At the same time, exchanges will also improve consumer awareness of options by making it easier to compare plans.

*  Medicaid Flexibility. The Affordable Care Act expands and simplifies Medicaid coverage and provides states with more opportunities to align Medicaid with private health insurance. More specifically, the law permits states to restructure Medicaid coverage to look more like typical private employer coverage, as Medicaid managed care organizations and commercial insurers move into each other’s markets and create new opportunities to enhance continuity of care across Medicaid and commercial populations.

http://www.kaiserhealthnews.org/Stories/2011/February/25/~/media/Files/2011/HHS%20Gov%20Letter%20Feb%2024.pdf?wpisrc=nl_wonk

And…

NOTE TO: Medicare Advantage Organizations, Prescription Drug Plan Sponsors, and Other Interested Parties

Centers for Medicare and Medicaid Services
February 18, 2011

Section H. End of Medicare Advantage Medical Savings Account (MSA) Plan Demonstration Program

In a July 13, 2006, Federal Register Notice (CMS-4123-N) we announced the availability of an opportunity to participate in an MA MSA demonstration project. In the Federal Register notice we said that waivers provided under our demonstration authority would allow interested entities to offer products that more closely resemble high deductible health plans that are offered in conjunction with health savings accounts to the non-Medicare population. We initially established a deadline of July 21, 2006, for applicants that wanted to participate in the MA MSA demonstration program for 2007. We also asked applicants that wanted to participate in the program in 2008 to submit a notice of intent to us as soon as possible.

Overall we had one applicant that participated in the MSA demonstration program in calendar year 2007. There has been no activity under this demonstration program since then. We are not seeking extension of this demonstration program and will not accept applications for participation in this program for plan years 2012 and thereafter.

http://www.cms.gov/MedicareAdvtgSpecRateStats/Downloads/Advance2012.pdf

And…

Nearly Half Of Families In High-Deductible Health Plans Whose Members Have Chronic Conditions Face Substantial Financial Burden

By Alison A. Galbraith1, Dennis Ross-Degnan, Stephen B. Soumerai, Meredith B. Rosenthal, Charlene Gay and Tracy A. Lieu
Health Affairs
February 2011

High-deductible health plans — typically with deductibles of at least $1,000 per individual and $2,000 per family — require greater enrollee cost sharing than traditional plans. But they also may provide more affordable premiums and may be the lowest-cost, or only, coverage option for many families with members who are chronically ill. We surveyed families with chronic conditions in high-deductible plans and families in traditional plans to compare health care–related financial burden — such as experiencing difficulty paying medical or basic bills or having to set up payment plans. Almost half (48 percent) of the families with chronic conditions in high-deductible plans reported health care–related financial burden, compared to 21 percent of families in traditional plans.

http://content.healthaffairs.org/content/30/2/322.abstract

To appease the Republican governors, HHS Secretary Kathleen Sebelius has attempted to reassure them that they will have considerable flexibility in qualifying insurance plans for the exchanges, in defining optional benefits for the plans, and in privatizing Medicaid. Perhaps the most alarming flexibility being granted to the governors is the ability to offer consumer-driven plans within the exchanges. Why is that a problem?

In her letter, Kathleen Sebelius offers up the bronze plans in the exchanges and the catastrophic plans for young adults as providing opportunities for expanding enrollment in consumer-driven plans. The bronze plans have an actuarial value of only 60 percent, meaning that an average of 40 percent of health care costs must be paid out of pocket. (The inadequate subsidies for silver plans is another topic not addressed here.) The way that both bronze plans and catastrophic plans achieve lower premiums is by requiring very high deductibles. That is a serious problem.

The current issue of Health Affairs has yet one more article adding to the great body of policy studies on high-deductible plans showing, once again, why they are an inappropriate method of financing health care. This study demonstrates that half of families with chronic conditions in high-deductible plans report health care related financial burdens.

The fact that these plans can be offered with a health savings account (HSA) does not improve the individual’s financial security since these funds still must come from the individual who either funds the HSA to draw on later, or draws the funds from other savings, or, more likely, simply doesn’t have the funds when needed to pay the deductible. An unfunded or depleted HSA is of no value.

Although Republicans have been supportive of the consumer-directed approach of high-deductible plans with HSAs, there is almost unbelievable irony when we look at another favorite of theirs – the privatized Medicare Advantage plans that replace traditional Medicare coverage. Under the Bush administration a Medicare Advantage Medical Savings Account demonstration project was established, duplicating this consumer-directed approach within the Medicare program. Last week HHS announced that this program was being terminated because of a lack of activity. Obviously consumer-directed does not equate with consumer-demanded.

High-deductible plans are under-insurance products that create financial hardships for people who develop health care needs. It is disappointing that Secretary Sebelius is presenting them as an “opportunity.” They’re an opportunity to lose your shirt if you get sick.

We could have done so much better… and still can.

Speaker promotes single-payer health care system in Portsmouth

By SCOTT E. KINNEY
Foster’s Daily Democrat (N.H.), Feb. 24, 2011

PORTSMOUTH — Nearly 60 city residents gather in the Levinson Meeting Room of the Portsmouth Public Library Wednesday night to educate themselves on the continued fight for a single-payer health care system.

Katie Robbins, national coordinator of Healthcare-NOW!, addressed the crowd espousing the benefits of a proposed single-payer system she said would not only provide savings for those in need of care but accessibility to all.

Healthcare-NOW! is an advocacy organization focused on the American health care system, and moving for the passage of national, single-payer healthcare legislation.

“I see great injustice in our health care system,” she said.

Robbins added while recent legislation has made steps to improve the system, the struggle for proper, affordable care carries on.

“Within 10 years, 23 million Americans are expected to be uninsured,” she said. “The crisis continues.”

Robbins pointed to the current system, which she said is controlled by private insurance companies, which in turn drive up prices to increase profits, all to the detriment of the insured.

“The existence of private insurance companies is preventing us from moving to a socially responsible, single-payer system,” she said.

Robbins cited Vermont, where discussions are currently under way to change the state health care system to a single-payer model, as an example of how such a system can work at the local level.

City Councilor Bob Lister was among the crowd Wednesday.

He said, speaking for himself, not on behalf of the board, “We know what the cost of health care is doing to the city budget. It really diverts our mission.”

Lister said he was present at the evening meeting to educate himself and understand the options.

Those in attendance were asked to join the national group and to get the word out about a single-payer health care system.

More information about Healthcare-NOW! can be found at www.healthcare-now.org.

http://www.fosters.com/apps/pbcs.dll/article?AID=/20110224/GJNEWS_01/702249753

Look to Canada

Letters, Boston Herald, Feb. 25, 2011

In response to your editorial “Single-payer fan ‘fesses up” (Feb. 23) that suggests a single-payer health care program in our state would bring long wait times, I would point to Canada, which delivers health outcomes as good as ours for half the price per person. The median wait time for cardiac surgery in Ontario is not months, but 16 days. And those patients are not left with bills that lead to medical bankruptcy. As a doctor, I agree with Terry Dougherty in his support for single-payer care.

— Susanne L. King, Lenox, Mass.

http://news.bostonherald.com/news/opinion/letters/view/20110225look_to_canada/

Shumlin outlines health care plan

By John Flowers
Addison County (Vt.) Independent, Feb. 24, 2011

MIDDLEBURY, Vt. — Gov. Peter Shumlin told Porter Medical Center officials on Tuesday to be patient in weathering what he believes will be a short-term financial storm en route to a new, single-payer health care system he said will bring long-term success and financial sustainability to the industry.

Shumlin, who took office last month, made his remarks at Porter’s annual meeting before a crowd of more than 100 hospital physicians, staff, consumers and board members who have voiced many concerns about recent state and federal health care policy that has included under-reimbursement through the Medicaid program and an ever increasing medical provider tax.

Such policy, Porter officials contend, helped create a $2 million loss for the medical center last fiscal year and the prospect of another big loss this year.

Shumlin said that in the short-term, he has little choice but to consider increases in such areas as the provider tax on hospitals and home health agencies, an assessment he said helps leverage federal Medicaid dollars. He said the state is facing a fiscal year 2012 revenue shortfall of around $176 million.

“I am trying to balance the need of balancing the budget and taking care of our most vulnerable citizens while maintaining the ability to draw down federal dollars,” Shumlin said.

Meanwhile, the governor is banking on the Legislature passing a single-payer health care plan he believes will cut medical costs, provide better service and ensure more predictable payments to providers.

That single-payer system must accomplish three things, according to Shumlin:

• Treat health acre “as a right and not a privilege.”

• Make sure that the health care follows the patient and that it not be a responsibility of the employer.

“That’s a huge jobs creator,” Shumlin said of taking the health insurance burden off employers. It is a factor the governor said could “reverse the osmosis on the bridge” of Vermonters going across the border for the tax advantages of New Hampshire.

Shumlin rejected suggestions that Vermont would see a huge influx of health care-dependent people if it adopts a single-payer system. He argued that Vermont is already a popular destination point for those seeking benefits that currently include Dr. Dynasaur, Catamount Health and the Vermont Health Access Plan.

“We’ve got the best plan in the country; it’s just that we can’t afford it,” Shumlin said.

“Small, rural hospitals will not survive,” he added of the current system. “You can’t ask (Porter President) Jim Daily and others to run a railroad in a system where you get 40 cents on the dollar from one customer, 50 cents on the dollar from another and every blue moon someone walks in the door and gives you a dollar for a dollar’s work. It doesn’t work.”

• Cost-containment. The governor suggested a few ideas to help achieve lower costs, including issuing citizens a health card that would record the medical service they received and the amount due. The card would also provide complete access to medical records. Shumlin said the medical card could save around 9 cents on each medical dollar spent by reducing the current bureaucracy involved with insurance company payments.

“This is basically using technology to contain costs and get rid of waste,” Shumlin said.

The governor also suggested the medical industry move from a fee-per-service system to one in which the provider is compensated for keeping people healthy.

“The perils are huge; I get it,” Shumlin said. “There are landmines everywhere.”

But he said the dangers of not pursuing a single-payer plan would be far worse. He said Vermont spent $2.5 billion on health care eight years ago. That sum has risen to $5 billion this year and is projected to go up by another $1.6 billion by 2015.

“The current system is just not sustainable,” Shumlin said.

He added there will be several deal-breakers for any health care bill that arrives on his desk. Shumlin said he won’t sign legislation that costs more money, that doesn’t contain health care costs, that allows insurance companies to become a hindrance to quality care, that rations services, or that perpetuates the current billing bureaucracy.

“If we can get this one right, by 2014, I am convinced we will grow jobs, grow economic opportunities,” Shumlin said.

Clearly, not everyone who listened to Shumlin’s talk in Middlebury College’s McCardell Bicentennial Hall was sold on his plan. Several Porter officials questioned Shumlin’s math and the wisdom of state government taking an even larger role in an industry upon which it has already foisted economic challenges. Porter Hospital laid off four workers earlier this month with the prospect of additional reductions in the future. Daily noted that he has been walking through the Porter campus lately with a serious eye on what the institution can do without.

But Shumlin reiterated sweeping change will be necessary to reverse an unsustainable course.

“What’s killing Porter is what’s killing every health care entity in the state,” Shumlin said. “It is the reimbursement system, it is the amount of resources we are throwing at it and that fact that Vermont businesses and individuals can’t keep up. We are all moving to higher and higher deductibles throughout insurance plans for more and more money.”

http://www.addisonindependent.com/201102shumlin-outlines-health-care-plan