Chapter – Page 685

Funding for health care law next big battle

By Robert Reich
San Francisco Chronicle
Sunday, January 23, 2011

Forget the symbolic vote to repeal health care. Republicans don’t have the votes to override President Obama’s sure veto.

The real move happens later, when Republicans try to cut the money needed to implement the law’s requirement that all Americans buy health insurance.

On its face, it’s a smart tactic. The individual mandate is the linchpin of the heath care law because it spreads the risks. Without the participation of younger or healthier people, private insurers won’t be able to take on older or sicker customers with pre-existing medical conditions, or maintain coverage indefinitely for people who become seriously ill. The result would be to unravel the health care law, which presumably is what many Republicans seek.

The mandate is also the least popular aspect of the law. According to a December 9-12 ABC News/Washington Post survey, 60 percent of the public opposes it. While most want to prevent insurers from dropping coverage when customers become seriously ill, they don’t like the idea of the government requiring them to buy coverage. The mandate not only offends libertarian sensibilities, but it also worries some moderates and liberals who fear private insurers will charge too much because of insufficient competition in the industry.

And the mandate is most vulnerable to legal challenge. In the first major ruling on the new law, announced Dec. 13, Judge Henry E. Hudson of the federal district court in Richmond, Va., struck it down, calling the mandate an “unbridled exercise of federal police powers” and an overreach of the Constitution’s Commerce Clause. The U.S. government is appealing that decision.

There’s a lesson for Democrats in all this.

The federal government wouldn’t be nearly as vulnerable to these political and legal obstacles had the health care law been built upon the framework of Social Security or Medicare – public insurance financed by payroll taxes.

Not only are these programs enormously popular (“Don’t take away my Medicare!” was a rallying cry among some conservative populists during the debates over the health care law), but they also rest on a more widely accepted relationship between the individual, the government and the market.

Americans are accustomed to paying for public insurance through their payroll taxes. Such payments aren’t viewed as federal mandates that encroach upon individual freedoms, or as payoffs to private companies likely to make even more money from mandatory purchases of their products, but as well-deserved entitlements.

Indeed, the biggest problem with Social Security and Medicare is they’re so popular that politicians have had a hard time trimming their benefits to match payroll-tax revenues.

For 60 years, the battle over health care reform has been waged over these two ways of spreading costs and risks: either through payroll taxes and public insurance, or mandated purchases from private insurers.

For most of those six decades, Democrats advocated the former. Harry Truman’s initial plan for adding health insurance to Social Security was defeated, but Lyndon Johnson’s Medicare succeeded. Apart from George W. Bush’s drug benefit, which was also based on this Democratic framework, Republicans have been on the side of mandated purchases from private insurers.

In 1974, Richard Nixon’s proposed Comprehensive Health Insurance Plan would have required private employers to provide their employees with comprehensive health insurance coverage purchased from private insurers. (An employer mandate is tantamount to an individual mandate in that employees are forced to pay it indirectly, via lower wages.) Sen. Edward Kennedy simultaneously proposed universal coverage financed through Social Security taxes, essentially copying Medicare. Neither plan succeeded, but Nixon’s framework redefined the idea of national health insurance from then onward.

Obama and a majority of Democrats in the last Congress opted for the Republican model even though many Democrats preferred a single-payer system – Medicare for all – or at the very least a public option. Most polls showed that the public favored such an option. But the White House hoped for Republican support and wanted to ward off opposition from health insurers and pharmaceutical companies by promising them some 30 million additional customers.

The current Republican attack on mandatory coverage shows that Democrats who wanted a single-payer system should have stuck to their guns.

Perhaps they’ll have another chance. If the Republican attack is successful, single-payer will be the only alternative. And it’s the system Americans seem to prefer – payroll taxes and public insurance.

Robert Reich, former U.S. secretary of labor, is professor of public policy at UC Berkeley and the author of the new book “Aftershock: The Next Economy and America’s Future.” He blogs at www.robertreich.org.

Physicians for a National Health Program Tour Oregon to Promote Single Payer Health Care, February 2011

The Oregon Chapter of Physicians for a National Health Program (PNHP) and Mad As Hell Doctors (MAHD) will follow up on their landmark 2009 national tour and 2010 California tours with spirited rallies in Linn and Lincoln Counties during February. Their program will feature music by bluegrass singer and composer Bob Wickline of Fox Island, Washington; documentary videos by Paul Hochfeld M.D.; testimony by physicians and nurses; and “Mad As Heck Minutes” by audience members on camera and on screen.

The doctors and nurses will start in Albany on Sunday, February 13, 6:30-8 p.m. at the Two Rivers Market, then go to Eugene for a parade starting at 5 p.m. and rally at 6 p.m. (place tba), hit the beach at Florence on Tuesday, Feb. 15, 6-8 p.m. at the Siuslaw Public Library, then Newport on Wednesday, Feb. 16, 7-9 p.m., at the Newport Visual Arts Center 2nd floor conference room, 777 NW Beach Drive (across from the Nye Beach Turnaround). Then it’s on to Lincoln City on Thursday, Feb. 17, 6:30 p.m., at the Lincoln City Cultural Center.2150 NE Oar Place.

PNHP is a group of physicians, nurses, ancillary health providers, and other concerned citizens advocating for an improved and expanded Medicare program to provide financially sustainable universal health coverage for all Americans. In September 2009, PNHP doctors traveled 6,000 miles through America’s heartland from Portland, OR to Washington, D.C., stopping at over 40 venues in 22 states. After appearances on the Ed Schultz Show (MSNBC), Keith Olberman (MSNBC), Democracy Now! and interviews on dozens of other media outlets, the group is continuing its unique approach and activist flair to advocate for Single Risk Pool, Improved Medicare-for-all.

PNHP contends that the Patient Protection and Affordable Care Act (P-PACA) does too little to protect the health and livelihood of patients and their families. P-PACA serves to further entrench the current medical-industrial complex with an unsustainable cost spiral within our health care system.PNHP further contends that, while the Oregon Health Policy Board, a result of House Bill 2009, has proposed critical improvements in Oregon’s health care system, these improvements will be achievable only under a Single Risk Pool, Improved Medicare-for-all plan.

PNHP is hitting the road again over the next several months to carry its message throughout Oregon. More information is available at www.pnhp.org/states/oregon and www.madashelldoctors.com.

You can also interact with 11,000 friends on www.facebook.com/MadDrs.

Mike Huntington, Physicians for a National Health Program, (541) 745-5635, mchuntington@comcast.net

Single-payer advances from Vermont to California to D.C.

January 24, 2011

Dear PNHP colleagues and friends,

The movement for fundamental health reform is making important advances “on the ground” in Vermont and elsewhere. Here’s a roundup of recent developments.

1. Vermont – draft report on single payer released, doctors speak out

2. H.R. 676 national single-payer bill reintroduced

3. California – medical students lobby for single payer

4. “Deadly Spin” author, former Cigna executive, on book tour

5. Kentucky honors MLK with single-payer forum

1. Harvard economist and architect of Taiwan’s single-payer health care system, William Hsiao, Ph.D., testified before the Vermont Legislature last week in support of a single-payer-like system. Hsiao was commissioned by the Legislature to design three options for health care reform for Vermont. Read the comments of Dr. Don McCanne, PNHP’s senior health policy fellow, on Hsiao’s report here.

Vermont’s congressional delegation (Senators Bernie Sanders and Patrick Leahy, along with Rep. Peter Welch) announced plans to introduce federal legislation that would allow Vermont to get waivers from the new federal health law and implement a single-payer health reform as soon as 2014. Vermont’s new governor, Peter Shumlin, also reiterated his strong support for a single-payer system.

PNHP’s Dr. Deb Richter, a Vermont family physician who has spent more than two decades working for single payer, said “the stars are aligned” for fundamental health care reform in Vermont. “The broad outlines of Dr. Hsiao’s single-payer proposals are very promising,” she said. “They represent a major step in the right direction.” (Read the comments of Richter and other Vermont doctors about the excessive paperwork in practicing medicine here.)

ACTION:

If you haven’t already signed the physicians’ petition to the Vermont Legislature to enact single payer, please do so today.

Vermont physicians are gathering at the Statehouse this Thursday, Jan. 27, to make the case for single payer with state lawmakers. For more information, visit www.vermontforsinglepayer.org. Medical students are rallying in Vermont on March 26. Contact Jenny@pnhp.org for more information.

2. H.R. 676, the “Expanded and Improved Medicare for All Act,” will be reintroduced by Rep. John Conyers (D-Mich.) early this week.

ACTION:

PNHP activists are encouraged to speak with their congresspersons about becoming co-sponsors of this hallmark national single-payer legislation, H.R. 676. (Each congressional session requires fresh co-sponsorship. Sponsors in the last session are listed here.) The congressional switchboard number is (202) 224-3121.

3. In California, hundreds of medical students and other health professionals-in-training flooded the steps of the Capitol for Student Lobby Day, urging state lawmakers to support the state single-payer bill sponsored by Sen. Mark Leno, SB 810. Californians are continuing to press forward with their single-payer bill and are encouraged by the recent departure of Gov. Arnold Schwarzenegger, who twice vetoed the Legislature’s approval of the legislation.

4. “Deadly Spin” author and insurance industry whistle-blower Wendell Potter spoke at a very successful event hosted by PNHP’s Indiana chapter, Hoosiers for a Commonsense Health Care Plan. The event, featuring Potter and a showing of Michael Moore’s movie “Sicko,” drew over 415 people.

Potter is on a speaking tour on his book “Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans.” PNHP chapters in New York City, Tennessee and several other states have also hosted or helped build impressive turnouts for Potter’s events.

5. PNHP President Dr. Garrett Adams and Kentuckians for Single Payer Health Care observed Dr. Martin Luther King Jr.’s birthday with a forum on single payer at the Louisville Urban League. The forum featured former PNHP president Dr. Claudia Fegan (“Dr. King said the time is always right to do what’s right”), Mayor Greg Fischer, Rep. John Yarmuth, and the head of the Falls City Medical Society, Dr. Joyce Howell, among others. Dr. Fegan also spoke to enthusiastic audiences at the Presbyterian Theological Seminary, a physicians’ luncheon and a potluck for activists. See this article in the Louisville Courier-Journal and visit www.kyhealthcare.org for more details.

There’s much more that we could report, both from chapters and from tasks forces like our Divestment group, but for the moment we want to stress that PNHP is continuing to make progress – and that we rely on you and others like you for support. Everything we do hinges on your continuing support. If you haven’t made a tax-deductible donation to PNHP recently, please do so today.

Cordially,

Quentin Young, M.D.
National Coordinator

Mark Almberg
Communications Director

Vermont doctors say patient needs are buried in paperwork

By Kevin O’Connor
Times Argus (Barre-Montpelier, Vt.), Jan. 23, 2011

RUTLAND — Middlebury’s Dr. Jack Mayer knows that most patients want health care reform to cut rising prices. But he, along with a growing group of Vermont medical providers, hopes to point a scalpel at piles of related paperwork.

Back in 1976 when Mayer opened his first pediatric office in the tiny northernmost town of Enosburg Falls, the Bronx native often bartered his services for eggs, firewood or knitted afghans.

In a larger community and practice 35 years later, Mayer now works with two fellow physicians, a nurse practitioner and two full-time billing clerks who process claims for more than 200 insurance plans.

“Every company has its own paperwork, payment schedules and policies about what it will cover,” says Mayer, who notes that such overhead eats upward of 30 percent of U.S. medical expenses. “The administrative costs of my practice are enormous and don’t go toward improving health or patient care.”

Mayer isn’t alone in his assessment. So many Vermont medical professionals have similar concerns, the Legislature — now contemplating several plans to change the state’s health care system — will hold a public hearing in Montpelier this week to receive their testimony.

“What I hear from all my colle
agues is, ‘For every hour I put into clinical care, I put another into paperwork,’” says Dr. Deborah Richter, a Cambridge physician. “They can’t give the care that patients need because of these obstacles.”

Richter is president of the Vermont Health Care for All campaign, which for almost a decade has pushed for what a state consultant proposed last week: a single-payer system to provide medical coverage to all residents.

Richter wasn’t sure if her peers would respond when the Legislature — welcoming public comment through Feb. 3 — invited them to speak Thursday from noon to 2 p.m. at the Statehouse. So far 50 colleagues have confirmed they’ll be there.

“These are busy doctors,” she says, “but they’re willing to talk.”

Nothing but billing

Take Dr. Adam Sorscher, an 18-year primary care physician who juggles work at Central Vermont Medical Center in Berlin, Dartmouth-Hitchcock Medical Center in Lebanon, N.H., (the New Hampshire hospital is Vermont’s second-largest health care provider) and the Good Neighbor Health Clinic in White River Junction. He finds problems wherever he goes.

“I see people at the clinic who have neglected preventive care because of the high cost,” Sorscher says, “and then we have to provide therapies that are more expensive and wouldn’t have been necessary if the health care system was better organized.”

Or consider Dr. William Eichner, an eye specialist who opened his Middlebury practice in 1976 and has added branches in Rutland and Ticonderoga, N.Y. To do so, he has increased his staff to 20 — three of whom focus solely on financial paperwork.

“They don’t greet patients, they don’t handle charts,” the ophthalmologist says. “They do nothing but handle billing and insurance claims.”

That frustrates more and more doctors. Richter points to a 2006 survey she sent to Vermont’s 840 primary care physicians. Of the 300 who responded, four out of five agreed with such statements as “Unnecessary paperwork increasingly is taking away more of my time from my patients” and “I don’t find the intrusion from outside managers and companies helpful.”

Providers say the resulting costs are pricing out more and more patients.

“I feel ashamed we’re the last developed country in the world not to have universal health care,” Eichner says. “I feel a moral imperative that everyone has access and that it be affordable.”

‘Have to kowtow’

Burlington’s Dr. Peggy Carey recalls when, lacking health insurance in her 20s, she was diagnosed with diabetes. Inspired by a nutrition course she took to deal with her diagnosis, she went to medical school and now works as a family doctor in a group practice.

“I wanted to change the system,” says the former English teacher turned 19-year physician.

Carey belongs to the doctor-led Vermont for Single Payer campaign and Physicians for a National Health Program. But she fights her biggest battles inside her practice.

“The majority of the paperwork that comes to me is not in reference to patient care,” she says, “but to what insurance plans allow or don’t allow.”

The problem isn’t limited to physical health. Psychiatrist Dr. Alice Silverman moved to St. Johnsbury two decades ago because the state’s rural Northeast Kingdom lacked enough mental health workers. Today she’s president of the Vermont Psychiatric Association — yet remains one of her region’s few resources.

“I’ve had a waiting list for years,” she says, “and there’s no one else I can refer to.”

Even so, insurance hurdles keep more people out of Silverman’s office.

“I may have someone who’s suicidal, but insurers say they have to see a provider in network, even when there is no one in network,” she says. “In psychiatry, people feel embarrassed enough — to have to call and get approval is a real obstacle. I spend 30 percent of my time trying to get care authorized.”

Burlington’s Dr. Joe Lasek, another psychiatrist, can relate. He works at the Howard Center, a private, nonprofit human service agency that takes care of his billing paperwork. But he still must tackle other insurance issues.

“If I try to get diagnostic tests or follow-up treatment for my patients, insurance companies can say no,” he says. “I have sick and sometimes suicidal patients who aren’t getting care.”

Such problems are keeping other professionals out of the business. Lasek’s wife has a medical degree.

“One of the main reasons she’s not practicing is these hassles,” her husband says. “I have other friends who are pulling back their hours or retraining in another field.”

Berlin’s Dr. Stuart Williams says a growing number of his colleagues support change. The 30-year practitioner is on the board of the Vermont Academy of Family Physicians, which found that a majority of members surveyed favor a single-payer system.

“It seems that physicians have capitulated responsibility to insurers,” Williams says. “We’ve become second tier when we recommend a procedure to a patient and have to kowtow to prior approval and paperwork to put that care in place.”

Different answers

Doctors may agree on the problem, but they aren’t united on the solution. While the Vermont Psychiatric Association has endorsed a single-payer plan, Williams — a member of the council of the Vermont Medical Society — says other medical specialists haven’t voiced a formal position.

Single-payer supporters believe state involvement will eliminate private insurers’ profit motives for questioning care. But they know that skeptics fear government interference.

“People worry that outsiders would be making decisions,” Sorscher says, “but important decisions already are being made by corporate entities.”

Proponents also point to the federal Medicare health insurance program, which, even with its own funding problems, estimates its overhead to be about 3 percent — a tenth of that of private insurers.

“It works for everyone over 65,” Eichner says. “Why not make it universal?”

Back in Middlebury, Mayer says physicians of all political opinions may complain about paperwork, but ultimately they’re most concerned about patients.

“If we as a nation take as a basic premise that health care should be a universal right of all citizens, equally, like Medicare, we will figure out an equitable way to pay for that,” he says. “My decision-making is impacted when I have to think about a person’s personal economics and how much some treatment will cost them. It’s just not fair for those financial considerations to get between me and the care my pediatric patients deserve.”

Global hospital payments by private insurers?

Blue Cross CEO says providers must control costs, or else

By Robert Weisman
The Boston Globe
January 23, 2011

The chief executive of Blue Cross Blue Shield of Massachusetts, the state’s largest health insurer, is calling on hospitals and doctors to step up efforts to contain health care costs, warning that those insisting on traditional fee-for-service contracts will face level or reduced payments from his company.

Andrew Dreyfus, who took the helm at Blue Cross Blue Shield in August, last week sent a letter to more than 400 leaders of hospitals and physicians practices, applying pressure on them to switch to a global payment plan.

Dreyfus’s letter acts as “both a threat and a promise,’’ said Stuart H. Altman, health policy professor at Brandeis University. “He’s saying to the hospitals, you can do better under global payments. But he’s also saying, if you don’t want to do it, if you’re more comfortable with the fee-for-service system, forget it, we’re going to come down on you.’’

http://www.boston.com/business/healthcare/articles/2011/01/23/blue_cross_ceo_says_providers_must_control_health_care_costs_or_else/

Comment:

By Don McCanne, MD

One of the advantages of a single payer system, as envisioned by PNHP, is that hospitals can be placed on global budgets. They are paid periodically a flat budgeted amount based on legitimate operating expenses, just as other public service institutions, such as the fire department, are funded. This relieves the hospital of the high costs and administrative burden of itemizing a multitude of charges for each individual patient – not to mention that it does away with the $15 charge for a Tylenol or $35 charge for a Band-Aid.

Considering the efficiencies of global budgeting it might seem that the decision of Blue Cross Blue Shield of Massachusetts to switch to global payments for hospitals is a giant step toward single payer. It might seem that, but it isn’t.

Under a single payer system, all legitimate costs are budgeted (with separate budgeting of capital improvements), and payments made accordingly. With a global payment made by a single insurer in a multi-payer system, it is difficult to decide which costs should be allocated to that insurer. Furthermore, the insurer really doesn’t care.

A large insurer like Blue Cross Blue Shield will use its leverage to negotiate down its global payments in a secretive, proprietary process, while leveraging risk adjustment to its own advantage (“our privately insured patients are healthier than your sick Medicare patients”). Smaller insurers would be at a competitive disadvantage because of a lack of leverage and an excessive administrative burden per beneficiary. Public payers such as Medicare and Medicaid would continue to do what they already do, regardless of any agreements the hospitals work out with the private payers. Thus the inefficiencies, inequities, and administrative excesses of our current, fragmented, public and private financing system would be perpetuated.

We keep hearing that if we don’t do this, or if we don’t do that, we are going to have single payer. The problem is that if we do this, or do that, anything as long as it isn’t single payer, we’re only going to delay the inevitable. Wouldn’t it be much smarter to end the suffering and hardship now by enacting a single payer system, especially since it’s inevitable anyway?

Global hospital payments by private insurers?

Blue Cross CEO says providers must control costs, or else

By Robert Weisman
The Boston Globe
January 23, 2011

The chief executive of Blue Cross Blue Shield of Massachusetts, the state’s largest health insurer, is calling on hospitals and doctors to step up efforts to contain health care costs, warning that those insisting on traditional fee-for-service contracts will face level or reduced payments from his company.

Andrew Dreyfus, who took the helm at Blue Cross Blue Shield in August, last week sent a letter to more than 400 leaders of hospitals and physicians practices, applying pressure on them to switch to a global payment plan.

Dreyfus’s letter acts as “both a threat and a promise,’’ said Stuart H. Altman, health policy professor at Brandeis University. “He’s saying to the hospitals, you can do better under global payments. But he’s also saying, if you don’t want to do it, if you’re more comfortable with the fee-for-service system, forget it, we’re going to come down on you.’’

http://www.boston.com/business/healthcare/articles/2011/01/23/blue_cross_ceo_says_providers_must_control_health_care_costs_or_else/

Vermont doctors say patient needs are buried in paperwork

By Kevin O’Connor
Times Argus (Barre-Montpelier, Vt.), Jan. 23, 2011

RUTLAND — Middlebury’s Dr. Jack Mayer knows that most patients want health care reform to cut rising prices. But he, along with a growing group of Vermont medical providers, hopes to point a scalpel at piles of related paperwork.

Back in 1976 when Mayer opened his first pediatric office in the tiny northernmost town of Enosburg Falls, the Bronx native often bartered his services for eggs, firewood or knitted afghans.

In a larger community and practice 35 years later, Mayer now works with two fellow physicians, a nurse practitioner and two full-time billing clerks who process claims for more than 200 insurance plans.

“Every company has its own paperwork, payment schedules and policies about what it will cover,” says Mayer, who notes that such overhead eats upward of 30 percent of U.S. medical expenses. “The administrative costs of my practice are enormous and don’t go toward improving health or patient care.”

Mayer isn’t alone in his assessment. So many Vermont medical professionals have similar concerns, the Legislature — now contemplating several plans to change the state’s health care system — will hold a public hearing in Montpelier this week to receive their testimony.

“What I hear from all my colleagues is, ‘For every hour I put into clinical care, I put another into paperwork,’” says Dr. Deborah Richter, a Cambridge physician. “They can’t give the care that patients need because of these obstacles.”

Richter is president of the Vermont Health Care for All campaign, which for almost a decade has pushed for what a state consultant proposed last week: a single-payer system to provide medical coverage to all residents.

Richter wasn’t sure if her peers would respond when the Legislature — welcoming public comment through Feb. 3 — invited them to speak Thursday from noon to 2 p.m. at the Statehouse. So far 50 colleagues have confirmed they’ll be there.

“These are busy doctors,” she says, “but they’re willing to talk.”

Nothing but billing

Take Dr. Adam Sorscher, an 18-year primary care physician who juggles work at Central Vermont Medical Center in Berlin, Dartmouth-Hitchcock Medical Center in Lebanon, N.H., (the New Hampshire hospital is Vermont’s second-largest health care provider) and the Good Neighbor Health Clinic in White River Junction. He finds problems wherever he goes.

“I see people at the clinic who have neglected preventive care because of the high cost,” Sorscher says, “and then we have to provide therapies that are more expensive and wouldn’t have been necessary if the health care system was better organized.”

Or consider Dr. William Eichner, an eye specialist who opened his Middlebury practice in 1976 and has added branches in Rutland and Ticonderoga, N.Y. To do so, he has increased his staff to 20 — three of whom focus solely on financial paperwork.

“They don’t greet patients, they don’t handle charts,” the ophthalmologist says. “They do nothing but handle billing and insurance claims.”

That frustrates more and more doctors. Richter points to a 2006 survey she sent to Vermont’s 840 primary care physicians. Of the 300 who responded, four out of five agreed with such statements as “Unnecessary paperwork increasingly is taking away more of my time from my patients” and “I don’t find the intrusion from outside managers and companies helpful.”

Providers say the resulting costs are pricing out more and more patients.

“I feel ashamed we’re the last developed country in the world not to have universal health care,” Eichner says. “I feel a moral imperative that everyone has access and that it be affordable.”

‘Have to kowtow’

Burlington’s Dr. Peggy Carey recalls when, lacking health insurance in her 20s, she was diagnosed with diabetes. Inspired by a nutrition course she took to deal with her diagnosis, she went to medical school and now works as a family doctor in a group practice.

“I wanted to change the system,” says the former English teacher turned 19-year physician.

Carey belongs to the doctor-led Vermont for Single Payer campaign and Physicians for a National Health Program. But she fights her biggest battles inside her practice.

“The majority of the paperwork that comes to me is not in reference to patient care,” she says, “but to what insurance plans allow or don’t allow.”

The problem isn’t limited to physical health. Psychiatrist Dr. Alice Silverman moved to St. Johnsbury two decades ago because the state’s rural Northeast Kingdom lacked enough mental health workers. Today she’s president of the Vermont Psychiatric Association — yet remains one of her region’s few resources.

“I’ve had a waiting list for years,” she says, “and there’s no one else I can refer to.”

Even so, insurance hurdles keep more people out of Silverman’s office.

“I may have someone who’s suicidal, but insurers say they have to see a provider in network, even when there is no one in network,” she says. “In psychiatry, people feel embarrassed enough — to have to call and get approval is a real obstacle. I spend 30 percent of my time trying to get care authorized.”

Burlington’s Dr. Joe Lasek, another psychiatrist, can relate. He works at the Howard Center, a private, nonprofit human service agency that takes care of his billing paperwork. But he still must tackle other insurance issues.

“If I try to get diagnostic tests or follow-up treatment for my patients, insurance companies can say no,” he says. “I have sick and sometimes suicidal patients who aren’t getting care.”

Such problems are keeping other professionals out of the business. Lasek’s wife has a medical degree.

“One of the main reasons she’s not practicing is these hassles,” her husband says. “I have other friends who are pulling back their hours or retraining in another field.”

Berlin’s Dr. Stuart Williams says a growing number of his colleagues support change. The 30-year practitioner is on the board of the Vermont Academy of Family Physicians, which found that a majority of members surveyed favor a single-payer system.

“It seems that physicians have capitulated responsibility to insurers,” Williams says. “We’ve become second tier when we recommend a procedure to a patient and have to kowtow to prior approval and paperwork to put that care in place.”

Different answers

Doctors may agree on the problem, but they aren’t united on the solution. While the Vermont Psychiatric Association has endorsed a single-payer plan, Williams — a member of the council of the Vermont Medical Society — says other medical specialists haven’t voiced a formal position.

Single-payer supporters believe state involvement will eliminate private insurers’ profit motives for questioning care. But they know that skeptics fear government interference.

“People worry that outsiders would be making decisions,” Sorscher says, “but important decisions already are being made by corporate entities.”

Proponents also point to the federal Medicare health insurance program, which, even with its own funding problems, estimates its overhead to be about 3 percent — a tenth of that of private insurers.

“It works for everyone over 65,” Eichner says. “Why not make it universal?”

Back in Middl
ebury, Mayer says physicians of all political opinions may complain about paperwork, but ultimately they’re most concerned about patients.

“If we as a nation take as a basic premise that health care should be a universal right of all citizens, equally, like Medicare, we will figure out an equitable way to pay for that,” he says. “My decision-making is impacted when I have to think about a person’s personal economics and how much some treatment will cost them. It’s just not fair for those financial considerations to get between me and the care my pediatric patients deserve.”

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

What did they find?

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.

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.

Comment:

Blue Cross CEO says providers must control costs, or else

Comment:

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

Comment:

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