PNHP

Time For A New Debate On Health Care

Time For A New Debate On Health Care

By John Nichols
National Public Radio, Jan. 21, 2011

Americans are divided over the question of how best to reform a dysfunctional health care system.
 
But the new Republican majority in the U.S. House of Representatives entertains no doubt about what must be done: the for-profit insurance industry must be restored to its “proper” place as the determiner of who gets care — and how much they will have to pay.
 
In the first major vote of the new Congress, the House voted 245-189 in favor of repealing the modest health care reforms implemented last year. All 242 House Republicans voted for repeal, as did three Democrats. All 189 “no” votes were cast by Democrats.
 
House Speaker John Boehner and his fellow Republican caucus leaders claimed that the vote represented the will of the American people.
 
But did it?
 
Survey research suggests that, while Americans are overwhelmingly supportive of health care reform, they are not sure the reform cobbled together by President Obama and the last Congress is the proper fix. According to a new Washington Post/ABC News poll, the country is divided three ways: 33 percent for complete repeal of the measure adopted last year, 35 percent for partial repeal and 30 percent for no repeal.
 
A new poll conducted for Associated Press finds that “strong opposition to the law stands at 30 percent, close to the lowest level registered in…surveys dating to September 2009.”
 
All the surveys suggest that the American people are deeply divided with regard to the debate about repeal — not feverishly determined to scrap the existing law, as so many House Republicans are claiming as they argue this week in favor of a symbolic repeal vote.
 
But those “headline” numbers don’t begin to tell the whole story, however.
 
What about the tens of millions of Americans who are dissatisfied with the current law but who recognize that the whole debate about repealing it is a political show primarily designed to satisfy talk-radio hosts while exciting insurance-industry campaign donors?
 
The Americans who oppose repeal but who refuse to buy into the fantasy that the health care system has been sufficiently reformed are right. And there are a lot of them. According to the Associated Press poll, 43 percent of Americans want the government to do more to re-engineer the existing health care system.
 
That’s millions more than favor the repeal proposed by Republican leaders.
 
That level of support for more radical reform is the great untold story of the current debate.
 
The American people are not fools.
 
Substantial numbers of them understand that what is called “health care reform” by Democrats and “Obamacare” by Republicans is, in fact, a compromise proposal that, at most, addresses the worst abuses of the nation’s for-profit insurers and health providers while outlining a framework for genuine reform.
 
Unfortunately, Congress did not take the next and necessary step toward creation of a system that provides all Americans with high-quality health care while holding down costs — which now eat up 17 percent of the country’s GDP.
 
Rather, Republicans in the House used their new majority to push for a return to the bad old days when insurance companies executives were deemed to have an absolute right to their multimillion-dollar bonuses but children and people with pre-existing conditions were deemed to have a right only to beg for charity.
 
If the House debate on repeal of health care served a purpose, it was to illustrate the deep divide between those who believe the highest priority is to preserve insurance-industry profits and those who worry about sick kids.
 
Congresswoman Sheila Jackson Lee (D-Texas) summed the whole charade up with her usual precision, when she invited House Republicans to consider their responsibility to represent not just corporations but the common good. “So I would argue that my good friends — some of them are new and I appreciate their newness — I appreciate their desire to keep a commitment to constituents — but when you come to the Congress, you have to govern, you have to look at the whole of America,” she declared during the extended debate on repealing the legislation that the House approved by a narrow margin last year. “And therefore, looking at the whole of America, you need to look at the crux; the crux is saving lives.”
 
The congresswoman bluntly rejected the notion that repeal is the economic necessity Republicans suggest. Instead, she proposed, preserving reforms that protect the most vulnerable is a life-and-death necessity. “Frankly, I would just say to you, this is about saving lives. Jobs are very important; we created jobs,” explained Jackson Lee. “But even the title of their legislation, H.R. 2, ‘job-killing’ — this is killing Americans if we take this away, if we repeal this bill.”
 
That’s a credible argument, to be sure.
 
But what of real reform? What about the changes that might get to the heart of the matter of ending the profiteering that makes health care so expensive and inaccessible?
 
Congressman Dennis Kucinich (D-OH) brought the right perspective to the debate when he reminded the House that “everyone knows that health insurance companies make money by not providing health care. After all, they are in the insurance business. They are not charities. With as many as 129 million Americans suffering from pre-existing conditions, insurance companies want Congress to repeal health care reform. The provisions which require covering people with pre-existing conditions would eventually cut into insurance company profits.”
 
Kucinich warned that: “Repeal means Americans will continue to pay more for insurance but get less, that is, if they can afford health care insurance in the first place.”
 
But the co-author of “Medicare for All” legislation that would extend the Medicare system to all Americans, regardless of age, did not stop there.
 
“The very idea of health care reform solely within the context of a for-profit system has been more than problematic. Today, 50 million Americans have no health insurance.  What are we going to do for them?” said Kucinich. “Rather than waste time on debating how much reform insurance companies will permit — if any — it is time to change the debate. It is time to end the for-profit health care model. It is time for not-for-profit health care, single-payer, universal, Medicare for All — with an emphasis on wellness and personal responsibility.”
 
John Nichols writes about politics for The Nation magazine as its Washington correspondent. He is a contributing writer for The Progressive and In These Times and the associate editor of the Capital Times, the daily newspaper in Madison, Wisconsin.

http://www.npr.org/2011/01/20/133074314/the-nation-time-for-a-new-debate-on-health-care

eHealth technology not ready for prime time

The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview

By Ashly D. Black, Josip Car, Claudia Pagliari, Chantelle Anandan, Kathrin Cresswell, Tomislav Bokun, Brian McKinstry, Rob Procter, Azeem Majeed, Aziz Sheikh
PLoS Medicine
January 18, 2011

Editors’ Summary

Background

There is considerable international interest in exploiting the potential of digital health care solutions, often referred to as eHealth — the use of information and communication technologies — to enhance the quality and safety of health care. Often accompanied by large costs, any large-scale expenditure on eHealth — such as electronic health records, picture archiving and communication systems, ePrescribing, associated computerized provider order entry systems, and computerized decision support systems — has tended to be justified on the grounds that these are efficient and cost-effective means for improving health care. In 2005, the World Health Assembly passed an eHealth resolution (WHA 58.28) that acknowledged, “eHealth is the cost-effective and secure use of information and communications technologies in support of health and health-related fields, including health-care services, health surveillance, health literature, and health education, knowledge and research,” and urged member states to develop and implement eHealth technologies. Since then, implementing eHealth technologies has become a main priority for many countries. For example, England has invested at least £12.8 billion in a National Programme for Information Technology for the National Health Service, and the Obama administration in the United States has committed to a US$38 billion eHealth investment in health care.

Why Was This Study Done?

Despite the wide endorsement of and support for eHealth, the scientific basis of its benefits — which are repeatedly made and often uncritically accepted—remains to be firmly established. A robust evidence-based perspective on the advantages on eHealth could help to suggest priority areas that have the greatest potential for benefit to patients and also to inform international eHealth deliberations on costs. Therefore, in order to better inform the international community, the authors systematically reviewed the published systematic review literature on eHealth technologies and evaluated the impact of these technologies on the quality and safety of health care delivery.

What Did the Researchers Do and Find?

The researchers divided eHealth technologies into three main categories: (1) storing, managing, and transmission of data; (2) clinical decision support; and (3) facilitating care from a distance. Then, implementing methods based on those developed by the Cochrane Collaboration and the NHS Service Delivery and Organisation Programme, the researchers used detailed search strategies and maps of health care quality, safety, and eHealth interventions to identify relevant systematic reviews (and related theoretical, methodological, and technical material) published between 1997 and 2010. Using these techniques, the researchers retrieved a total of 46,349 references from which they identified 108 reviews. The 53 reviews that the researchers finally selected (and critically reviewed) provided the main evidence base for assessing the impact of eHealth technologies in the three categories selected.

In their systematic review of systematic reviews, the researchers included electronic health records and picture archiving communications systems in their evaluation of category 1, computerized provider (or physician) order entry and e-prescribing in category 2, and all clinical information systems that, when used in the context of eHealth technologies, integrate clinical and demographic patient information to support clinician decision making in category 3.

The researchers found that many of the clinical claims made about the most commonly used eHealth technologies were not substantiated by empirical evidence. The evidence base in support of eHealth technologies was weak and inconsistent and importantly, there was insubstantial evidence to support the cost-effectiveness of these technologies. For example, the researchers only found limited evidence that some of the many presumed benefits could be realized; importantly, they also found some evidence that introducing these new technologies may on occasions also generate new risks such as prescribers becoming over-reliant on clinical decision support for e-prescribing, or overestimate its functionality, resulting in decreased practitioner performance.

What Do These Findings Mean?

The researchers found that despite the wide support for eHealth technologies and the frequently made claims by policy makers when constructing business cases to raise funds for large-scale eHealth projects, there is as yet relatively little empirical evidence to substantiate many of the claims made about eHealth technologies. In addition, even for the eHealth technology tools that have proven to be successful, there is little evidence to show that such tools would continue to be successful beyond the contexts in which they were originally developed. Therefore, in light of the lack of evidence in relation to improvements in patient outcomes, as well as the lack of evidence on their cost-effectiveness, the authors say that future eHealth technologies should be evaluated against a comprehensive set of measures, ideally throughout all stages of the technology’s life cycle, and include socio-technical factors to maximize the likelihood of successful implementation and adoption in a given context. Furthermore, it is equally important that eHealth projects that have already been commissioned are subject to rigorous, multidisciplinary, and independent evaluation.

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000387#pmed.1000387-Garg1

Comment: 

By Don McCanne, MD

Digital health care solutions, or eHealth, include electronic health records, picture archiving and communication systems, ePrescribing, associated computerized provider order entry systems, and computerized decision support systems. These researchers performed a systematic review of the systematic reviews of eHealth published since 1997, providing us with a perspective of the impact that eHealth has had on the quality and safety of health care.

What did they find?

“Our systematic review of systematic reviews on the impact of eHealth has demonstrated that many of the clinical claims made about the most commonly deployed eHealth technologies cannot be substantiated by the empirical evidence. Overall, the evidence base in support of these technologies is weak and inconsistent, which highlights the need for more considered claims, particularly in relation to the patient-level benefits, associated with these technologies. Also of note is that we found virtually no evidence in support of the cost-effectiveness claims.”

This is of particular importance right now as health care providers and institutions are gearing up to establish accountable care organizations (ACOs), as called for in the Patient Protection and Affordable Care Act (PPACA). Although various models of ACOs are being developed, all of them have in common interconnectivity through eHealth. In fact, the simplest form is the so-called virtual ACO which is nothing more than isolated, independent practices connected through eHealth.

Since eHealth provides the fundamental framework through which ACOs function, it is important to be sure that we have it right. But w
e’re not certain. The authors report that eHealth systems have proven to be beneficial when carefully designed in house for a handful of large institutions, but the evidence is simply not there for most systems in use today.

The reason that our politicians included ACOs in the PPACA is that theoretically they would help to control health spending primarily through the transparencies, efficiencies and error reduction of eHealth. Yet there is “virtually no evidence in support of the cost-effectiveness claims.”

We have to get health care costs under control. Maybe someday eHealth will help with that, but we’re definitely not there now. It is certainly fine to continue with studies of ACOs and eHealth, but for cost containment, we should move immediately to policies that have been proven to be effective – a single payer national health program, aka an improved Medicare for all.

Vermont single-payer proposals a 'major step in right direction': doctors group

FOR IMMEDIATE RELEASE
January 21, 2011

Contact:
Deborah Richter, M.D.
Ali Thebert, Vermont Physicians for a National Health Program, ali@pnhp.org
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org

MONTPELIER, Vt. – Longtime reform advocate and Vermont family physician Dr. Deborah Richter hailed Wednesday’s report of health system expert William Hsiao to the Vermont Legislature, particularly Hsiao’s findings that a single-payer system would be the best remedy for what he called the state’s “broken” and “unsustainable” way of paying for care.

“Dr. Hsiao’s team of researchers found that a streamlined, single-payer system for financing health care would save money by reducing excess paperwork and bureaucracy, cover everyone in Vermont with no increase in health spending, reduce or eliminate patient co-pays, promote job growth and economic development, and control costs,” Richter said.

“Although the devil is in the details, the broad outlines of his single-payer proposals are very promising,” she said. “They represent a major step in the right direction.

“This thoughtful, evidence-based approach to solving our state’s health care problems – an approach that involves our new governor, our congressional delegation and state lawmakers poised to take swift, positive action to translate reform proposals into law – stands in stark contrast to the noisy goings-on in Washington this week,” Richter said, alluding to the Republican party’s symbolic vote in the House to repeal the federal health law.

While her overall attitude toward Hsiao’s draft report was very positive, Richter said that her group, the Vermont chapter of Physicians for a National Health Program, would be making recommendations to improve the single-payer models to maximize administrative savings and strengthen cost control even further. After a period of public comment, a final report from Hsiao is due Feb. 17.

“Only a one-payer system can maximize the efficiencies and cost savings,” Richter said. “So it will be important to fully incorporate Medicare and Medicaid into the system as soon as possible. We will also be recommending the use of single-payer tools like separate operating and capital budgets for hospitals.”

“Optimally, a single-payer program would also prohibit the participation of investor-owned, for-profit delivery systems, which studies show drive up costs and produce worse medical outcomes,” she said.

Hsiao is a professor of economics at the Harvard School of Public Health and an internationally recognized authority on health care systems. Last year he and his team were commissioned by the Legislature to analyze three models for state health reform, including a single-payer model, where private insurers are excluded from the system and all medical bills are paid by a single public or quasi-public authority.

In his presentation to Vermont lawmakers, Hsiao outlined the three models: a public single-payer plan, a plan that builds on the new federal health law but adds a so-called public option, and his team’s recommended plan.

Hsiao’s team found that the “public option” plan would yield the poorest results, having only a very modest impact on reducing costs and having almost no impact on reducing the number of the uninsured.

While citing the merits of a publicly administered single-payer plan, Hsiao’s team ended up by recommending a “public-private hybrid single-payer” model that would be managed by an independent board and that would contract-out the job of claims processing to private and public bidders. A private company like Vermont Blue Cross Blue Shield, for example, could be hired to process the claims, as is done currently by Medicare.

Richter likes the idea of the independent board and says physicians in Vermont favor single payer because it’s the only approach that gives them a voice and negotiating power – something they lack with insurers today. Single payer will also benefit the state’s physicians by simplifying billing and giving them a choice of practice options. “It will make primary care very attractive in Vermont,” she said. “We’ll be able to choose where we want to practice and patients will be able to freely choose their doctors.”

She also would like to see the enactment of a plan that provides for comprehensive care.

Richter practices family medicine in Montpelier, and has pushed for single payer in Vermont for more than two decades. She is a past president of Physicians for a National Health Program, a nationwide organization of 18,000 doctors who favor single-payer national health insurance, commonly referred to as an improved Medicare for all.

“Dr. Hsiao has performed an extraordinary service,” Richter said. “Vermont has an historic opportunity to lead the nation on fundamental health reform.”

Vermont: A Health System for the 21 Century
Dr. William Hsiao’s slideshow presentation before Vermont State Legislature, January19, 2011

Statement by William C. Hsiao before Vermont State Legislature
January 19, 2011

Achieving Affordable Universal Health Care in Vermont
Full report: Act 128, Health System Reform Design
Submitted by WILLIAM C. HSIAO, PhD, FSA; STEVEN KAPPEL, MPA; JONATHAN GRUBER, PhD; and a team of health policy analysts
January 19, 2011

Physicians for a National Health Program (www.pnhp.org) is an 18,000-member organization of doctors who advocate for a nonprofit, single-payer national health insurance program for the United States. To speak with a physician/spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.

eHealth technology not ready for prime time

The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview

By Ashly D. Black, Josip Car, Claudia Pagliari, Chantelle Anandan, Kathrin Cresswell, Tomislav Bokun, Brian McKinstry, Rob Procter, Azeem Majeed, Aziz Sheikh
PLoS Medicine
January 18, 2011

Editors’ Summary

Background

There is considerable international interest in exploiting the potential of digital health care solutions, often referred to as eHealth — the use of information and communication technologies — to enhance the quality and safety of health care. Often accompanied by large costs, any large-scale expenditure on eHealth — such as electronic health records, picture archiving and communication systems, ePrescribing, associated computerized provider order entry systems, and computerized decision support systems — has tended to be justified on the grounds that these are efficient and cost-effective means for improving health care. In 2005, the World Health Assembly passed an eHealth resolution (WHA 58.28) that acknowledged, “eHealth is the cost-effective and secure use of information and communications technologies in support of health and health-related fields, including health-care services, health surveillance, health literature, and health education, knowledge and research,” and urged member states to develop and implement eHealth technologies. Since then, implementing eHealth technologies has become a main priority for many countries. For example, England has invested at least £12.8 billion in a National Programme for Information Technology for the National Health Service, and the Obama administration in the United States has committed to a US$38 billion eHealth investment in health care.

Why Was This Study Done?

Despite the wide endorsement of and support for eHealth, the scientific basis of its benefits — which are repeatedly made and often uncritically accepted—remains to be firmly established. A robust evidence-based perspective on the advantages on eHealth could help to suggest priority areas that have the greatest potential for benefit to patients and also to inform international eHealth deliberations on costs. Therefore, in order to better inform the international community, the authors systematically reviewed the published systematic review literature on eHealth technologies and evaluated the impact of these technologies on the quality and safety of health care delivery.

What Did the Researchers Do and Find?

The researchers divided eHealth technologies into three main categories: (1) storing, managing, and transmission of data; (2) clinical decision support; and (3) facilitating care from a distance. Then, implementing methods based on those developed by the Cochrane Collaboration and the NHS Service Delivery and Organisation Programme, the researchers used detailed search strategies and maps of health care quality, safety, and eHealth interventions to identify relevant systematic reviews (and related theoretical, methodological, and technical material) published between 1997 and 2010. Using these techniques, the researchers retrieved a total of 46,349 references from which they identified 108 reviews. The 53 reviews that the researchers finally selected (and critically reviewed) provided the main evidence base for assessing the impact of eHealth technologies in the three categories selected.

In their systematic review of systematic reviews, the researchers included electronic health records and picture archiving communications systems in their evaluation of category 1, computerized provider (or physician) order entry and e-prescribing in category 2, and all clinical information systems that, when used in the context of eHealth technologies, integrate clinical and demographic patient information to support clinician decision making in category 3.

The researchers found that many of the clinical claims made about the most commonly used eHealth technologies were not substantiated by empirical evidence. The evidence base in support of eHealth technologies was weak and inconsistent and importantly, there was insubstantial evidence to support the cost-effectiveness of these technologies. For example, the researchers only found limited evidence that some of the many presumed benefits could be realized; importantly, they also found some evidence that introducing these new technologies may on occasions also generate new risks such as prescribers becoming over-reliant on clinical decision support for e-prescribing, or overestimate its functionality, resulting in decreased practitioner performance.

What Do These Findings Mean?

The researchers found that despite the wide support for eHealth technologies and the frequently made claims by policy makers when constructing business cases to raise funds for large-scale eHealth projects, there is as yet relatively little empirical evidence to substantiate many of the claims made about eHealth technologies. In addition, even for the eHealth technology tools that have proven to be successful, there is little evidence to show that such tools would continue to be successful beyond the contexts in which they were originally developed. Therefore, in light of the lack of evidence in relation to improvements in patient outcomes, as well as the lack of evidence on their cost-effectiveness, the authors say that future eHealth technologies should be evaluated against a comprehensive set of measures, ideally throughout all stages of the technology’s life cycle, and include socio-technical factors to maximize the likelihood of successful implementation and adoption in a given context. Furthermore, it is equally important that eHealth projects that have already been commissioned are subject to rigorous, multidisciplinary, and independent evaluation.

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000387#pmed.1000387-Garg1

Digital health care solutions, or eHealth, include electronic health records, picture archiving and communication systems, ePrescribing, associated computerized provider order entry systems, and computerized decision support systems. These researchers performed a systematic review of the systematic reviews of eHealth published since 1997, providing us with a perspective of the impact that eHealth has had on the quality and safety of health care.

What did they find?

“Our systematic review of systematic reviews on the impact of eHealth has demonstrated that many of the clinical claims made about the most commonly deployed eHealth technologies cannot be substantiated by the empirical evidence. Overall, the evidence base in support of these technologies is weak and inconsistent, which highlights the need for more considered claims, particularly in relation to the patient-level benefits, associated with these technologies. Also of note is that we found virtually no evidence in support of the cost-effectiveness claims.”

This is of particular importance right now as health care providers and institutions are gearing up to establish accountable care organizations (ACOs), as called for in the Patient Protection and Affordable Care Act (PPACA). Although various models of ACOs are being developed, all of them have in common interconnectivity through eHealth. In fact, the simplest form is the so-called virtual ACO which is nothing more than isolated, independent practices connected through eHealth.

Since eHealth provides the fundamental framework through which ACOs function, it is important to be sure that we have it right. But we’re not certain. The authors report that eHealth systems have proven to be beneficial when carefully designed in house for a handful of large institutions, but the evidence is simply not there for most systems in use today.

The reason that our politicians included ACOs in the PPACA is that theoretically they would help to control health spending primarily through the transparencies, efficiencies and error reduction of eHealth. Yet there is “virtually no evidence in support of the cost-effectiveness claims.”

We have to get health care costs under control. Maybe someday eHealth will help with that, but we’re definitely not there now. It is certainly fine to continue with studies of ACOs and eHealth, but for cost containment, we should move immediately to policies that have been proven to be effective – a single payer national health program, aka an improved Medicare for all.

Insurance Execs Not Happy with Hsiao’s Single Payer

By Russell Mokhiber
Single Payer Action, January 20, 2011

Harvard Professor William Hsiao is a single payer supporter.

Twenty years ago, he helped push through a single payer system for Taiwan.

And now, he wants to do something similar in Vermont.

Over the past couple of months, Hsiao has been working feverishly – with a team of 20 researchers – to finish a report to the Vermont legislature on how to best implement a single payer system for the state.

Yesterday, he delivered his 132-page report.

And at the beginning of his one hour presentation to the legislature in Montpelier, he made it clear that “what I’m going to present is not necessarily popular for everyone.”

“Recently I was talking to an insurance executive,” Hsiao said.

“And I asked him if he was in favor of spending $50 billion to manufacture a new shuttle to the moon.”

“And he says – yes, if you will go.”

That got a chuckle out of the gathered legislators.

But clearly, the insurance industry is not at all pleased with Hsiao.

They are watching events in Vermont carefully.

The newly elected Governor – Peter Shumlin – ran on a single payer platform.

Shumlin said that in his first conversation with Hsiao last year, Hsiao told him that he had “given up on America.”

“I told him we are Vermonters,” Shumlin said. “We think independently. We take care of each other, and we do things that others dare not do.”

The Vermont legislature tasked Hsiao with putting forth and analyzing three proposals.

A pure single payer government run system.

The current system with a public option.

And Hsiao’s preferred system – a single payer system run by an independent board.

While Hsiao is not explicit about this in his report, the bottom line is clear – under Hsiao’s single payer proposals, the private health insurers in Vermont would be out of the business of marketing and selling basic health insurance.

That’s why the insurance industry would prefer to see Hsiao headed to the moon than on the ground speaking before the Vermont state legislature.

“Our analysis of the three health insurance companies with significant operations in Vermont – Blue Cross Blue Shield of Vermont, MVP, and Cigna – was much more limited than our analysis of other groups, partly because much of Act 128 has fairly clear implications for those companies,” Hsiao writes in his report.

“It is reasonably safe to assume that health insurance companies would oppose any major health system reform that reduces their autonomy in financing and paying for health care, increases government’s role, and/or introduces new competitors to their market.”

“However, given Vermont’s history with reforms such as guaranteed-issue, community-rating, and the Blueprint program, it must be noted that the remaining health insurers in Vermont – especially those run as non-profits – are likely more accustomed and potentially more open than insurers elsewhere to working with state-led regulations. In addition, a continued market for supplementary insurance would generate ongoing opportunities for private insurance in the state.”

“It is possible that one or more companies may be interested in partnering with the state and substantially reforming their business model in order to continue to operate in Vermont.”

And in fact, Vermont’s largest insurer – Blue Cross Blue Shield – with 75 percent of the state’s health insurance business – signaled yesterday that it might be interested in taking Hsiao at his word.

“If there’s a single payer system, we’d like to be the single payer,” Leigh Tofferi, the Blue Cross-Blue Shield lobbyist in Vermont told vtdigger.org.

But Hsiao warned of another possible insurance industry reaction.

“Of course, the opposite is also possible – that an industry with deep pockets nationally will oppose reforms due to the threats they pose to the Vermont market and other markets that could follow Vermont’s lead,” Hsiao wrote.

There’s not a mention of the report in today’s big three newspapers – the New York Times, the Wall Street Journal or the Washington Post.

Early indications are that supporters of a pure government run single payer system are willing to accept Hsiao’s public/private compromise.

Physicians for a National Health Program’s (PNHP) Deb Richter told vtdigger.org that while a government administered system “makes the most sense in terms of good policy,” the system doesn’t have to be controlled by the government to be effective.

And PNHP’s Don McCanne said that “although advocates of the pure single payer model will find some problems with this report on a reform proposal for Vermont, there is very good news in this analysis. The report emphatically confirms the superiority of the single payer model in ensuring that everyone is included while containing health care costs.”

“One very serious deficiency is that they decided to leave in place Medicare and Medicaid, primarily because of existing barriers to move them into a single payer system,” McCanne wrote. “Thus their proposal is not a single payer system. Leaving these programs in place sacrifices some of the important single payer efficiencies.”

“Within the next couple of days, we’ll have a clearer concept of where the single payer community should be on this report. Tentatively, it seems that it deserves our support, but support that is qualified by strong advocacy to make it right by such measures as including comprehensive benefits, and rolling in and eliminating Medicare and Medicaid,” McCanne said.

Governor Shumlin’s office is reportedly drafting legislation that will be introduced soon.

Clearly, Shumlin hasn’t given up on America.

Or at least on Vermont.

http://www.singlepayeraction.org/blog/?p=2687

Medicare Advantage plans work the float

Rollup Review of Impact on Medicare Program for Investment Income That Medicare Advantage Organizations Earned and Retained From Medicare Funds in 2007

Office of Inspector General
U.S. Department of Health & Human Services
January 18, 2011

If Federal requirements had been established to delay prepayments to Medicare Advantage organizations (MA organizations) until after the beginning of the beneficiary’s coverage period by the same number of days that we estimated that MA organizations held Medicare funds, the Medicare Part A and Part B trust funds (which finance the Medicare Advantage program) could have earned approximately $450 million of interest income in calendar year (CY) 2007. Alternatively, if Federal requirements had been established to require MA organizations to reduce their revenue requirements in their bid proposals to account for anticipated investment income, the Medicare program could have saved an estimated $376 million that the 457 MA organizations that were included in our sampling frame earned in CY 2007.

We recommended that CMS evaluate these audit results and either (1) pursue legislation to adjust the timing of Medicare’s prepayments to MA organizations to account for the time that these organizations invest Medicare funds before paying providers for medical services or (2) develop and implement regulations that require MA organizations to reduce their revenue requirements in their bid proposals to account for anticipated investment income. CMS did not concur with our recommendation.

http://oig.hhs.gov/oas/reports/region7/71001080.asp

Comment: 

By Don McCanne, MD

Simply stated, the private Medicare Advantage plans receive hundreds of millions of dollars by investing advance payments of taxpayer funds used to pay their health care claims. This is not unusual since all insurers work the float. The longer they can hold on to premiums before they pay out benefits, the greater the returns from investing those funds. It is so commonplace that the Centers for Medicare and Medicaid Services did not concur with the Inspector General’s recommendation to pursue changes to recover that investment income.

The opportunity cost of interest-free cash advances to private insurers is yet one more cost of our flawed system of health care financing. It is a very real cost, amounting to hundreds of millions of dollars just for the private Medicare Advantage plans alone. This is just one more reason that we should establish our own public insurance program – an improved Medicare for all.

No Room in NYT for Single-Payer Doctors, but Right-Wing Cranks Are OK

By Peter Hart
Fairness & Accuracy in Reporting, 01/20/2011

When I saw the headline (1/19/11), “Vocal Physicians Group Renews Health Law Fight,” I thought maybe–just maybe–the New York Times might be talking about Physicians for a National Health Program, the group comprised of “18,000 physicians, medical students and health professionals who support single-payer national health insurance.”

But no. The Times story is about the Association of American Physicians and Surgeons, a 3,000-member organization that is on the far right of the healthcare debate, and is garnering coverage now because they support repeal of the new healthcare law. How far? These excerpts from the Times piece should give you some idea:

Founded in 1943, the Association of American Physicians and Surgeons opposed the creation of Medicaid and Medicare. A decade ago, it was among groups that unsuccessfully urged the United States Supreme Court to release post-mortem photographs of a former Clinton administration official, Vincent Foster. In its brief, the group argued that an independent inquiry was necessary to confirm that Mr. Foster, whose death was attributed to suicide, was not murdered.

And:

Its internal periodical has published studies arguing that abortion increases breast cancer risks, a tie rejected by an expert panel of the National Cancer Institute, as well as reports linking child vaccinations to autism, a discredited theory. Another report, “Illegal Aliens and American Medicine,” contended that illegal immigrants not only brought disease into this country but benefited if their babies were born with disabilities.

“Anchor babies are valuable,” that 2005 report stated, using a negative term for children born in America to illegal immigrants. “A disabled anchor baby is more valuable than a healthy one.”

Now perhaps the angle here is that since repeal is in the news, this group deserves coverage. And citing their extremist positions on an array of subjects might be useful for readers who want to know what sorts of folks are backing repeal.

But in the broader debate over healthcare, single-payer advocates like PNHP are largely sidelined. A search of Times coverage in the Nexis news database shows that PNHP usually shows up only in the letters section. A June 11, 2009 article, “Doctors’ Group Opposes Public Insurance Plan,” focused on opposition to the public option from the likes of the American Medical Association; it included a passing reference to PNHP.

It makes sense for the healthcare debate to include the voices of doctors and other caregivers. But that discussion needs to include those who support single-payer.

Medicare Advantage plans work the float

Rollup Review of Impact on Medicare Program for Investment Income That Medicare Advantage Organizations Earned and Retained From Medicare Funds in 2007

Office of Inspector General
U.S. Department of Health & Human Services
January 18, 2011

If Federal requirements had been established to delay prepayments to Medicare Advantage organizations (MA organizations) until after the beginning of the beneficiary’s coverage period by the same number of days that we estimated that MA organizations held Medicare funds, the Medicare Part A and Part B trust funds (which finance the Medicare Advantage program) could have earned approximately $450 million of interest income in calendar year (CY) 2007. Alternatively, if Federal requirements had been established to require MA organizations to reduce their revenue requirements in their bid proposals to account for anticipated investment income, the Medicare program could have saved an estimated $376 million that the 457 MA organizations that were included in our sampling frame earned in CY 2007.

We recommended that CMS evaluate these audit results and either (1) pursue legislation to adjust the timing of Medicare’s prepayments to MA organizations to account for the time that these organizations invest Medicare funds before paying providers for medical services or (2) develop and implement regulations that require MA organizations to reduce their revenue requirements in their bid proposals to account for anticipated investment income. CMS did not concur with our recommendation.

http://oig.hhs.gov/oas/reports/region7/71001080.asp

Simply stated, the private Medicare Advantage plans receive hundreds of millions of dollars by investing advance payments of taxpayer funds used to pay their health care claims. This is not unusual since all insurers work the float. The longer they can hold on to premiums before they pay out benefits, the greater the returns from investing those funds. It is so commonplace that the Centers for Medicare and Medicaid Services did not concur with the Inspector General’s recommendation to pursue changes to recover that investment income.

The opportunity cost of interest-free cash advances to private insurers is yet one more cost of our flawed system of health care financing. It is a very real cost, amounting to hundreds of millions of dollars just for the private Medicare Advantage plans alone. This is just one more reason that we should establish our own public insurance program – an improved Medicare for all.