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What did Jesus really say?

What did Jesus really say?

Two months ago, this doctor was delivering babies. Now he’s at the nexus of the Obamacare fight

By Lev Facher
STAT, March 3, 2017

Dr. Roger Marshall was delivering babies in December. By January, he found himself across a breakfast table from Tom Price, offering emotional support to the Georgia congressman as he endured a contentious confirmation process to become the top health official in the new Trump administration.

Marshall, a few months ago just another doctor from Kansas, is now Congressman Roger Marshall.

Marshall has joined the GOP Doctors Caucus, a group of 16 lawmakers with health care backgrounds who have put themselves at the center of the effort to unwind the Affordable Care Act.

Marshall is as quick as any Republican to slam Obamacare, claiming firsthand experience of its effects from his time at Great Bend Regional Hospital in central Kansas. He helped grow the hospital from a four-bed surgical clinic to the full-service, physician-owned facility it is today.

Like many other Republicans, Marshall said he wants the health care system to rely on the free market rather than Obamacare’s regulations. He measures success in how many people can afford to leave the Medicaid program and enter the private insurance market.

The law’s Medicaid expansion, which Kansas has not adopted despite support from many hospitals, including some of Marshall’s former colleagues, is one of the big sticking points for Republicans. Many GOP-led states adopted it and want to see it preserved in some form.

Marshall doesn’t believe it has helped, an outlook that sheds light on how this new player in Washington understands health policy.

“Just like Jesus said, ‘The poor will always be with us,’” he said. “There is a group of people that just don’t want health care and aren’t going to take care of themselves.”

https://www.statnews.com…

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Old Testament

Deuteronomy 15:11

11 For the poor will never cease out of the land; therefore I command you, You shall open wide your hand to your brother, to the needy and to the poor, in the land.

New Testament

Mark 14:1-10

1 It was now two days before the Passover and the feast of Unleavened Bread. And the chief priests and the scribes were seeking how to arrest him by stealth, and kill him; 2 for they said, “Not during the feast, lest there be a tumult of the people.” 3 And while he was at Bethany in the house of Simon the leper, as he sat at table, a woman came with an alabaster flask of ointment of pure nard, very costly, and she broke the flask and poured it over his head. 4 But there were some who said to themselves indignantly, “Why was the ointment thus wasted? 5 For this ointment might have been sold for more than three hundred denarii, and given to the poor.” And they reproached her. 6 But Jesus said, “Let her alone; why do you trouble her? She has done a beautiful thing to me. 7 For you always have the poor with you, and whenever you will, you can do good to them; but you will not always have me. 8 She has done what she could; she has anointed my body beforehand for burying. 9 And truly, I say to you, wherever the gospel is preached in the whole world, what she has done will be told in memory of her.” 10 Then Judas Iscariot, who was one of the twelve, went to the chief priests in order to betray him to them.

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Comment:

By Don McCanne, M.D.

Dr. Roger Marshall, freshman congressman from Kansas, has already exposed his compromised sense of medical ethics by participating in the establishment of a for-profit, physician-owned private hospital – a prime example of the perversities of the medical-industrial complex. But then he had to bring Jesus into it, saying, “The poor will always be with us.” Marshall says that he doesn’t believe that Medicaid has helped the poor because they “just don’t want health care and aren’t going to take care of themselves.”

In the Old Testament, the Scriptures record that the Lord said, “For the poor will never cease out of the land; therefore I command you, You shall open wide your hand to your brother, to the needy and to the poor, in the land.”

In the New Testament, which presumably is Marshall’s source in the Scriptures since he was quoting the words of Jesus himself, Jesus did say, “For you always have the poor with you
”  But Jesus continued (conveniently omitted by Marshall), “
 and whenever you will, you can do good to them.” It seems as though Marshall does not will to do good to the poor. (Though, in context, would Marshall have thought the ointment was wasted? Probably not if it would otherwise have gone to the poor – a point with which those writing or translating the Scriptures thought Jesus might agree. An enigma.)

What I knew about Jesus was derived mostly in my childhood when I attended the Pilgrim Congregational Church in Pomona, California (choir practice on Tuesdays, Boys Brigade on Thursdays, Sunday School Sunday mornings followed by singing in the children’ choir in our church services). I have been forever grateful for the  moral lessons that I learned from the Scriptures, including from the words of Jesus. In my earlier years of awakening I was saddened to see that some of the elders in our church – some of the wealthiest people in town – did not seem to have a commitment to what my perceptions were of what Jesus was trying to teach us, so I left the church. My salvation is that I have found that these moral principles hold just as solidly in the secular world and are practiced by my friends in the social justice movement regardless of their personal religious beliefs or lack thereof. Truth is truth, and fundamental morality exceeds all boundaries.

But when a physician – a profession with ethics dating back to the Hippocratic traditions – uses the words of Jesus to tell us that Medicaid – a public program to help the poor with medical needs – has not helped since they don’t want health care and are not going to take care of themselves anyway, then he must be a hypocrite. Jesus would have turned over the tables in the business offices of his physician-owned hospital. We certainly do not want him, nor his colleagues of like mind, making moral judgements as to how legislation defining how to finance health care for all in America should be crafted.

Why Republicans should support universal health care

By Roger LaBonte, M.D.
The Tennessean, March 3, 2017

President Donald Trump has indicated he wants to repeal and replace Obamacare.

His recent statements before the election seem to indicate his desire for a market-based solution. Several recent articles and editorials have demonstrated how dysfunctional our health care system is, principally by its reliance on the insurance-industrial complex.

Every attempt to correct and improve the system by legislation has given the health-insurance industry new incentives and ways to game the system for its own profit motive. Obamacare has turned out to be no different.

The rate increases in Tennessee of 44 percent to 62 percent, approved last year, and similar increases in other states have shifted more and more cost to employers who are mandated to provide coverage and in turn must pass this on to their employees. Employers should be in rebellion at their increasing cost of providing health care for employees as is currently mandated.

I do not understand why many businesses continue to support our current system. In fact, the only businesses that gain anything by this system of employer-provided health care are the insurance companies themselves, which continue to show huge profits while sucking profits from others.

Many of the newly under-insured will be surprised by what they do not have when they try to access health care. The insurance executives who say they cannot weather the losses incurred by their participation in the health-care marketplaces are still raking in profits for their executives. Shareholders are basically just confirming their unwillingness to include those in most need of health insurance in their risk pools.

Some enlightened businessmen have come to that conclusion, including Richard Master, CEO of MCS Industries, Inc., who has supported single-payer national health insurance.

Many years ago, as a successful businessman, Trump had expressed the opinion that the best business solution to our dysfunctional health care system would be a national health care system with universal coverage for everyone, paid through taxes. I agree with his assessment at that time and hope that he will go back to considering this solution.

Imagine what that would do for the Republican Party’s popularity given that greater than 75 percent of our citizens want universal coverage. Under such an egalitarian and utilitarian system taxes would certainly go up for individuals and businesses, but the amount saved by not having to pay health insurance premiums, co-pays, deductibles, co-insurance and other hidden fees would more than compensate businesses and individuals for the increase in taxes.

With Republicans now in control of all branches of government, let’s hope they can achieve universal healthcare for everyone while lowering the cost to everyone.  Much of the rest of the world has shown us that universal health care is achievable at reasonable costs. More importantly we cannot identify as a caring nation until we properly care for the least among us.

Roger S. LaBonte, M.D. is president of the West Tennessee Chapter of Physicians for a National Health Program.

http://www.tennessean.com…

The G.O.P. and Health Care

By Caroline Poplin, M.D.
The New York Times, Letters, March 3, 2017

Re: “The Hole Republicans Dug” (column, Feb. 28):

David Leonhardt is right. If Republicans want to provide health insurance through “free market” competition, their solution will have the same problems as the Affordable Care Act: Healthy, low-risk families will be forced to buy costly policies more expensive than they need, to cover the expenses of the 5 percent of people responsible for some 50 percent of health care costs, with money left over for insurer profits.

A significant infusion of federal money will be required, contrary to Republican philosophy. If the government pays less, people will have to pay more; insurers or providers must accept less; or people will lose coverage. There is no way to square this circle.

What Americans want and need is not affordable health insurance, but necessary health care. Our fundamental problem is that American health care is expensive, which reduces access. Insurers have done little to reduce cost — look at the skyrocketing prices of drugs — and instead have probably increased it.

If we want all Americans to get the health care they need, the only system we can afford is some version of Medicare for all, with negotiated or regulated prices, just like the rest of the developed world.

Caroline Popline, M.D., J.D., is a primary care physician. She resides in Bethesda, Md.

https://www.nytimes.com…

Don’t repeal and replace the ACA, rethink it

By Laura McClure 
The Daily Star (Oneonta, N.Y.), March 3, 2017 

Donald Trump and fellow Republicans rode into office, in part, on a wave of understandable anger at our complicated, expensive and unfair health care system. Much of the fury was focused on the Affordable Care Act, also known as Obamacare. Republicans promised to quickly “repeal and replace” the law.

But in a closed-door meeting in Philadelphia just after Trump’s inauguration, GOP lawmakers were filled with doubt, the Washington Post reported. How were they going to get rid of Obamacare without causing millions of Americans to lose their health care coverage? How on Earth were they going to keep insurance premiums affordable? 

Our new local member of Congress, John Faso, was at the meeting. He worried about the political heat he’d get if Republicans tried to defund Planned Parenthood as part of the ACA repeal.

“Health insurance is going to be tough enough for us to deal with without having millions of people on social media come to Planned Parenthood’s defense,” he said. 

Faso is right to be worried about the impact of ACA repeal. Without the law, an estimated 2.7 million New York state residents would lose their health care coverage — including 5,785 people in Otsego County and 4,461 people in Delaware County.

The state budget would take a $3.7 billion hit. (Be aware that if you are getting health insurance through Medicaid or got your insurance through the New York State of Health exchange, your coverage is at risk.) Repealing ACA without having a better plan in place would endanger millions of people. 

But as of this writing, Republicans don’t have a consensus plan for replacing Obamacare. It’s not a comfortable spot to be in, and that’s probably one reason why many Republican legislators appear to be hiding from their constituents. They’re avoiding potentially explosive town hall meetings filled with people who are afraid they’re about to lose their health insurance.

As of this writing, Rep. Faso has scheduled no public events during the Congressional recess, which is usually legislators’ time for connecting with voters. Although Faso voted “yes” on a recent resolution to open up ACA repeal, he says he wants to “fix” ACA rather than repeal it.

Yet “repeal” is still the word on the lips of Faso’s Republican colleagues. Just before the recess, House Republican leaders came out with a sketch of a health plan to give lawmakers something to say to constituents.

The plan would slash the state funding that helps low-income people and their families get health insurance through Medicaid. And it would replace the ACA’s subsidies for insurance with tax credits and health savings accounts — devices that are helpful mainly to people with higher incomes. In other words: if you’re struggling to make ends meet, this plan is scary.

House Speaker Paul Ryan has gone even further by arguing that Republicans should privatize Medicare and turn it into an ACA-like “marketplace” of private plans. This would essentially mean the end of guaranteed quality health insurance for seniors. 

That would be an even bigger catastrophe, and would take us in the opposite direction from which we need to go. Instead of ditching Medicare, we should improve it and expand it. We should replace Obamacare — with Medicare for all. 

The good thing about Obamacare was that it rescued some 20 million Americans from being uninsured. (Though tragically, another 28 million people are still uncovered.) It also forbid insurance corporations, both inside and outside the ACA, from excluding people because of prior health conditions, and it ensured some preventive care.

The bad thing was that rather than repair our broken system, Obamacare propped it up. The plan was a deal the Obama administration cut with the health insurance corporations, the pharmaceutical corporations, and the medical industry: The government would guarantee them more customers by requiring Americans to buy their wares, in exchange for imposing new rules on their businesses.

Propping up our current health care system, and defending ACA as the best we can do, is wrong both morally and strategically. We have the industrialized world’s worst-performing health care system. It is far more costly than any other system, and has poorer results.

Anyone who has to use our health care system extensively (ACA included) knows its nightmarish complexity and irrationality. We slog our way through the inexplicable claims, rules, and exclusions. We sweat over ever-rising premiums, gigantic deductibles, and mounting out-of-pocket expenses. We’re caught in billing wars between health insurance corporations and hospitals, both trying to profit from our illness. Since most of the people who use the health care system heavily are sick, elderly or both, navigating through this expensive mess is overwhelming, if not impossible. 

Republicans’ proposals would make the system even worse by inviting even more profiteers and administrators into the system and by forcing millions more low-income Americans (the great majority from working families) to go without insurance altogether.

Under a single-payer health care system, everyone would be covered through one insurer: the federal government. We’d all have Medicare, which would guarantee coverage for all. Health care itself would still be provided by a range of public, nonprofit, and private clinics, hospitals and doctors. 

A December 2015 Kaiser poll found that 58 percent of Americans support a single-payer plan. Bernie Sanders’ vocal support for single-payer is one reason he beat his opponent, Hillary Clinton, in the Democratic primary in almost every county in upstate New York. (Sanders got 61% of the vote to Clinton’s 39% in Delaware County. In Otsego County, it was 59% to 40%.) 

Believe it or not, Donald Trump once supported single-payer. He wrote in his 2000 book “The America We Deserve:” “We must take care of our own. We must have universal health care 
 The Canadian-type, single-payer system in which all payments for medical care are made to a single agency (as opposed to the large number of HMOs and insurance companies with their diverse rules, claim forms, and deductibles) 
 helps Canadians live longer and healthier than Americans.” 

Although Trump has since changed his tune about single-payer, he still seems to crave its results. Just before his inauguration, Trump described his dream health care plan: “We’re going to have insurance for everybody,” he told the Washington Post. “It will be in a much-simplified form. Much less expensive and much better 
 They’ll be beautifully covered.” Yes. That would be single-payer. 

Democrats and independents, take heart: If you believe in single-payer health care, fight for it. Republicans, join us. You and your loved ones deserve high-quality health care, too. Everybody in, nobody out.

http://www.thedailystar.com…

Rep. Cooper addresses ACA concerns in Nashville town hall

By Nikki McGee
Fox 17 Nashville, March 3, 2017

Congressman Jim Cooper held a town hall in Nashville Friday after a contentious week in Washington.

New policies from the Trump Administration on immigration, healthcare and the environment dominated the discussion at the meeting. Some also voiced their concerns on President Trump’s cabinet picks.

Out of these issues, Rep. Cooper said the people of Tennessee seem to be most concerned about health care.

“They’re not necessarily fond of Obamacare, but they don’t want to lose the good parts of Obamacare,” Cooper said. “They’re deeply worried, they don’t know what a republican replacement would be.”

The president of the Physicians for a National Health Care Program attended the meeting to talk about the state of healthcare and offer a solution. Dr. Carol Paris is advocating to expand Medicare and come up with a system that makes it available to everyone.

“It is a publicly funded, privately delivered way of financing health care,” Paris said. “For people over 65, it is a very well loved program. It could be improved and we could extend and expand it from birth to death.”

Legislation is in place to repeal the Affordable Care Act, which is one of President Donald Trump’s top campaign promises. Cooper said he’s concerned about what will replace it.

“In the latest news reports, Rand Paul, a republican, went all over Capitol Hill looking for the republican plan, couldn’t find it,” Cooper said. “Steny Hoyer, a democrat, tried to do the same thing, couldn’t find it. That’s pretty scary when apparently there’s going to be a vote on it next and nobody’s even seen the plan. That’s not a good way to govern.”

Other Tennessee leaders, however, said they feel very strongly about repealing ACA.

“If the federal government is in the driver’s seat for regulating individual health choices, competition cannot exist,” Congressman Marsha Blackburn said in a statement earlier this month. “Therefore, it’s important that we allow states and consumers more flexibility in purchasing a health plan that it truly tailored to their needs.”

Paris said she’s seen the need to improve insurance options for patients first hand.

“The American People are having to choose to forego other household expenses and even food to pay for health care.”

Friday’s town hall is one of five community discussions Cooper has hosted since the beginning of the year and he says he wants his constituents to feel that their concerns are being heard.

“The times are a little bit scary right now, but America’s been through way worse than this,” Cooper said. “We’ll get through this. We just need to be kind to each other and to pay attention to the news and not jump to conclusions, but try to do the right thing for the country.”

http://fox17.com…

A single-payer health-care system is needed

By Jonathan Michels
Winston-Salem (N.C.) Journal, March 3, 2017

Ten years ago, I began transporting sick patients at Forsyth Medical Center. Transporters are some of the hardest working and least recognized workers in the hospital. My job was to transfer patients as smoothly and comfortably as possible onto a clean gurney and transport them to the radiology department. Deceptively simple, transporting turned out to be a crash course in humanity. I decided to pitch in as best as I could.

The very first patient I went to transport by myself died in front of me. My astonishment about the patient’s death amused my seasoned co-workers, who helped me understand that the hospital is a place where sometimes people come to die.

“Why is this happening to me?” asked another patient, terminally ill with cancer. Her words hung in the air as I settled her back into bed. I had no answer for her then, and I still don’t.

Transporting overdose victims, some of them younger than me, underscored the fragility of life. And watching stroke patients relearn basic skills like feeding themselves or walking taught me about the resilience of the human body and spirit. Hope Jahren, the celebrated geobiologist and author, echoed my response when she wrote, “Working in the hospital teaches you that there are only two kinds of people in the world: the sick and the not sick. If you are not sick, shut up and help.”

Medicine has changed a lot even in the short time since I began transporting patients. Despite the much-vaunted health-care reform of 2010, the Affordable Care Act, medicine is still driven by profit, not progress.

Twenty of the highest-paid CEOs included in the Standard & Poor’s 500 index hailed from health-care or pharmaceutical companies, according to a 2016 report from the Associated Press and Equilar. Health-care executives continued raking in millions of dollars in salaries and bonuses in the wake of the Great Recession, while I joined hundreds of other health-care workers who were escorted out of the hospital in a massive layoff. The people who remained, many of whom come to work every day to care for the sick and the helpless (and yes, for a paycheck), increasingly feel the pressure of doing more work with fewer resources.

Now a premedical student at UNC-Greensboro, my health-care experience has shown me that sometimes it’s simply not enough to pitch in and help patients on a case-by-case basis. In order to effectively care for our patients, we need to implement a health-care system that meets the needs of everyone and allows medical providers to do their jobs without the intrusion of hospital administrators or private insurance company executives.

Our health-care system is at a crossroads. While the ACA made some improvements around the edges of our health-care system, it clearly wasn’t enough. We need to go beyond the ACA to a single-payer system, an improved Medicare for all. In January, U.S. Rep. John Conyers of Michigan introduced H.B. 676, which would implement an improved and expanded Medicare-for-all.

More than a decade ago, Donald Trump preached the sensibility of covering all Americans in his book, The America We Deserve.

“We must have universal healthcare,” Trump wrote. “I’m a conservative on most issues but a liberal on this one.”

The proposed replacement program put forth by U.S. House Speaker Paul Ryan and Health and Human Services secretary Tom Price gives tax credits for people to buy private insurance and doles out block grants to states to replace the Medicaid expansion provision under the ACA. Critics believe the changes will put more financial burden upon American families and ultimately reduce the number of uninsured.

“Although Republicans’ proposals seem unlikely to achieve President Trump’s triple aim (more coverage, better benefits, and lower costs), single-payer reform could,” wrote Dr. Steffie Woolhandler and Dr. David Himmelstein in the Annals of Internal Medicine.

A single-payer system would eliminate for-profit insurance companies and replace them with a non-profit, public-payer system. It would be privately run but government funded just like Medicare, saving billions in administrative costs and giving doctors the freedom of practicing medicine without intrusion. Patients would no longer pay high deductibles or co-pays and there would be no fear of losing health insurance if someone loses their job.

Rather than jettison any recently-won gains in health-care coverage, let’s push the president to renew his support for universal care — and hope that Congress follows suit with H.B. 676.

The only way to get back to the real business of health care — caring for our patients — is to enact universal health care.

Jonathan Michels is a local radiology technologist.

http://www.journalnow.com…

Affordability continues to deteriorate; CALL FOR ACTION!

Polling Data Note: Beyond the ACA, the Affordability of Insurance Has Been Deteriorating Since 2015

Kaiser Family Foundation, March 2, 2017

The debate about the future of the Affordable Care Act and its individual insurance marketplaces may be taking the focus off the affordability challenges facing the broader population, most of whom get their health coverage through employers, Medicare or Medicaid.

New survey findings from the Kaiser Family Foundation show that health care has become somewhat less affordable even among those with health insurance. Since 2015, larger shares of people with health insurance say they have a difficult time affording their health care costs: from 27 percent to 37 percent for premiums, 34 percent to 43 percent for deductibles, and from 24 percent to 31 percent for copays and prescription drugs.

Other findings include:

* About three in 10 adults (29%) report someone in their household has had problems paying medical bills in the past year, often with real consequences. For example, among those reporting problems paying medical bills, seven in 10 (73%) report cutting back spending on food, clothing, or basic household items, while about six in 10 report using up all or most of their savings (61%) or taking an extra job or working more hours (58%) to pay their bills.

* Concerns about cost are also affecting whether and when some people seek health care. For example, a quarter (27%) of the public says that they or a family member living in their household put off or delayed getting health care they needed in the past year due to costs, and nearly as many say they skipped a recommended medical test or treatment (23%) or did not fill a prescription (21%).

* Nearly half of Americans (45%) say they would have difficulty paying an unexpected $500 medical bill. This includes those who say they wouldn’t be able to pay it at all (19%), those who would put it on a credit card and pay it off over time (20%) and those who would have to borrow money from a bank, payday lender, family or friends (7%). Among the uninsured and those with lower incomes, more than three in ten say they would not be able to pay a $500 bill at all.

* Significant shares of the public say they are “very worried” about not being able to afford health care services they think they need (25%), losing their health insurance (22%), or not being able to afford prescription drugs (21%). Overall, half say they are at least somewhat worried that they won’t be able to afford needed health care services.

Designed and analyzed by public opinion researchers at the Kaiser Family Foundation, the polls were conducted from December 13-19, 2016 and February 13-19, 2017.

http://kff.org…

Full report:
http://kff.org…

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Comment:

By Don McCanne, M.D.

At first blush this looks like just another one of those reports that shows that our health care financing system is not working as well as we would like it to. In fact, this is horrendous news. Let’s look at what this means.

This is brand new data collected after the Affordable Care Act (ACA) has been fully implemented. It provides a cross section of all sectors of the insured and uninsured, not just those in the ACA exchanges. The largest sector is those with employer-sponsored coverage – the mainstay of health insurance.

This survey shows that affordability continues to deteriorate, in spite of the benefits of ACA. More individuals and families are having problems paying medical bills to the extent that they have depleted their savings and are cutting back on other household essentials, including food!

Everyone should have the health care that she or he needs. Health care has become outrageously expensive. The health care financing system should be designed to allow people to circumnavigate the financial barriers to care. But what have we done instead?

For the majority of us we have turned the problem of high health care costs over to the private health insurers, pretending that they can use market forces to control health care costs for us. But what are they doing? They are protecting their own market for their insurance products by keeping their insurance premiums more or less affordable, but they are doing that by creating the very financial barriers from which insurance should be protecting us. Very high deductibles, coinsurance, copays, restricted benefits, narrow networks that create financial barriers to out-of-network physicians and hospitals – all are designed to shift health care financing from the insurance premiums to the pockets of patients. That’s great for the insurers but a disaster for patients.

And what is President Trump, HHS Secretary Price, and Congress offering us now? They have decided to reject the concept of guaranteed health care for all and replace it with the guarantee of ACCESS to insurance products and health care that we cannot afford. Some legislators are considering tax credits, but less that the subsidies under ACA. Affordability is already deteriorating and their proposals will only accelerate that deterioration.

We are already spending $3.2 trillion which is more than enough to provide quality care for everyone. But to do that we need to change to a financing system that would improve the allocation of these resources. A well designed single payer system would recover over $500 billion in wasted administrative services which would be enough to fill in the voids in care today. Also, we do not need to perpetuate cruel policies that block access to care by making it unaffordable in that other single payer tools can control spending in a patient-friendly manner (global budgeting, negotiated rates, bulk purchasing, budgeting of capital improvements, etc.).

Next week the House Energy and Commerce Committee is going to mark up the repeal and replace legislation. Their legislation would only make us even more susceptible to depleting our savings and forgoing basic essentials because of mounting medical bills.

This is catastrophic. It is time for a massive virtual march on Washington. We need far more than the National Mall could accommodate. This needs to go viral. We are all inundated with messages that we need to support health care for all – messages that you can click to donate a nominal amount. Bullshit! This is not simply about the administrative costs of our well-meaning advocacy organizations. This is about the health of our nation.

We need action! Now! Mobilize all of these groups that profess to support health care justice for all. Bombard Washington with 50 million demands for an improved Medicare for all. No, make that 100 million. They seem to be deaf in Washington.

Seriously, leaders of advocacy groups should organize conference calls today to initiate a process by which we could bombard Washington with electronic messages this weekend. The legislation moves forward next week. Remember that depleted savings and hunger are the default option.

My Turn: Republicans should choose true reform of health care

By Robert S. Kiefner, M.D.
Concord (N.H.) Monitor, March 2, 2017

With the impending repeal of the Affordable Care Act, the Republican-controlled House and Senate have a unique opportunity to initiate truly universal and affordable health care through their support of “Medicare for all.”

In a commentary published last month in the Annals of Internal Medicine, Drs. Steffie Woolhandler and David Himmelstein report that a streamlined, publicly financed, privately delivered health care system would save in the realm of $500 billion annually. The breakdown includes $220 billion saved on paperwork and insurance overhead, $150 billion saved on hospital billing and administration, $75 billion saved on doctors’ billing and upward of $113 billion saved by aggressive bargaining with drug companies.

The value to the American consumer in terms of health and financial security? Priceless.

Sadly, Rep. Paul Ryan and Health and Human Services Secretary Tom Price have other ideas.

In their campaign not only to discredit Obamacare but to inadvertently make it look terrific in retrospect, the Republicans are looking to send our good citizens off on a health care scavenger hunt, equipped with a few meager tax credits and vouchers with which to purchase their overpriced and confounding private insurance policies.

The Republican proposals run the gamut from being merely inadequate to astonishingly inane, and clearly favor the wealthy. They are recommending that the age for Medicare eligibility be raised to 67 while simultaneously reducing Medicare funding, and that states accept inadequate “block grants” for their Medicaid populations.

Further, the speaker and his clueless colleagues would permit the sale of “mini-med” insurance plans with their mere illusion of coverage, and more tax breaks for health savings accounts with a wink to the more affluent taxpayer. By encouraging the interstate sale of insurance, the Republicans would undermine the already tenuous state-based consumer protections.

We have seen that for-profit models generally do not work in the world of health care. Patients cannot shop around for the “best deal” when they are ill or in crisis. Given the lack of transparency, real costs are impossible to discern and we all have had experience with a health care system that is difficult to access and impossible to negotiate. (“Your call is very important to us. The next representative will be able to serve you in approximately 34 minutes. Please enjoy another loop of music certain to make your head explode.”)

If we transition to a single-payer system, typical of all other industrialized countries, we could afford to cover everyone for outpatient and hospital care as well as medications and dental care, without the burden of increasing deductibles and co-pays.

Lobbyists for insurance companies and Big Pharma are spending billions of dollars each year to convince us (and especially Congress) that any move to publicly financed health care is wrong, as if the current system is working perfectly.

Now is the time to move forward, to build upon the gains achieved by the ACA toward a more comprehensive system with serious cost controls and universal coverage.

Relative to businesses, the taxes involved in financing this system would tend to be predictable, stable and significantly less than businesses are already paying for employee coverage. By eliminating the competitive disadvantage of our health care costs, we will be able to market our goods and services at a lower cost relative to other countries, while enjoying a healthier workforce. Sound good, Mr. President? We can even say that it’s your idea.

Building a wall of indifference between wealthy and poor patients looks to be the outcome of current “replacement” proposals. The Republican leadership must be convinced that they need to lead the effort toward true reform, and not be led like lemmings into the abyss.

Robert S. Kiefner is a family physician in Concord.

http://www.concordmonitor.com…

Obamacare meeting bends toward single-payer solutions

By Jon Kelvey
Carroll County (Md.) Times, March 2, 2017

More than 150 people packed the St. Paul’s United Church of Christ fellowship hall Thursday night for an often boisterous town hall meeting on the future of the Affordable Care Act, also known as Obamacare.

While Republican lawmakers have long been critical of President Barack Obama’s signature legislative achievement and President Donald Trump has promised to repeal and replace the law, the ACA has also seen its fair share of criticism from supporters and those on the left. Thursday’s event, organized by local progressive advocacy group Carroll CAN, was billed as a nonpartisan opportunity to discuss the law’s flaws, its virtues and its future.

That discussion began with a panel made up of local and regional health professionals and advocates: Tammy Black, executive director of Westminster-based community health clinic Access Carroll; Ed Singer, health officer at the Carroll County Health Department; Gary Honeman, assistant administrative director at Carroll County Youth Services Bureau; and Francine Hahn, a former navigator with the Maryland Health Connection, made up the local panelists. Kalie Potter, regional director regional manager for the Door to Healthcare, and Dr. Margaret Flowers, former Green Party candidate for the Senate seat now occupied by Sen. Chris Van Hollen, were the more regional representatives.

In opening remarks and in response to prepared questions, most of the panelists were in agreement — there was much to like about the Affordable Care Act, but some things it needed to do better.

“The uninsured rate has dropped by more than one-third since the [Affordable Care Act] was put in place,” Singer said. “There are, however, some flaws in the system.”

Singer’s concerns centered around the financial sustainability of the program, due to a lower than expected number of young, healthy people signing up for insurance, as well as the lack of effective coverage. Many people, he said, have purchased a lower-tier insurance plan only to find they cannot afford their deductibles if they develop a chronic condition such as cancer.

“The other thing we have had a huge problem with is the opioid crisis,” Singer said. “Low-level plans require a special waiver and it’s often difficult to get these clients into treatment to begin with.”

Hahn, who helped people sign up for insurance as a navigator, said it was gratifying to see people get insurance, especially through the expansion Medicaid programs to cover low-income people who otherwise could not afford insurance, an experience she shares with Black.

“We had [a] significant number of people who were the first people in their entire family’s history to ever have insurance,” Black said of enrolling patients at Access Carroll. “Ever. They didn’t know what to do with it.”

But even Hahn, who enthusiastically supported the health care law, said there were problems that needed to be addressed, such as what navigators called “the family glitch.”

When considering whether a family was still eligible to purchase a tax subsidized plan when one parent was offered insurance through an employer, the test was whether the cost of the employer plan was affordable for just one parent, not the entire family. This sometimes leaves one parent out in the cold.

“She has affordable health insurance,” Hahn said, “Dad is going to have to pay full price on the health exchange.”

Flowers, rather than critiquing any one piece of the Affordable Care Act, attacked it as an insufficient compromise and that the best fix would be to expand Medicare coverage to all citizens — a single payer national insurance model such as in Canada.

“Private health insurance companies 
 are actually financial institutions that are investor-owned and have a responsibility to investors to prove as much profit to investors as possible,” she said. “We have to understand that private health insurance is not here to pay for our health care — they are an obstacle.”

That was a view apparently shared by many in the crowd, who gave Flowers loud applause, if not the emissaries of elected representatives in attendance.

Sens. Ben Cardin and Chris Van Hollen sent representatives who expressed their bosses’ support for the Affordable Care Act, and Karen Robb, from Van Hollen’s office, noted the senator is in favor of a single-payer model even if not actively pursuing it at the moment.

A staff member from Rep. Jamie Raskin’s office told the crowd that the congressman not only supports a single-payer system, but that he has signed on to support HR 676, a bill in the House of Representatives that would enact such a system, to thunderous applause.

A representative of Rep. Andy Harris told the crowd she was there to listen and would take down the information of anyone interested in communicating with the congressman.

The crowd, when the time came for a question-and-answer session, were not so circumspect or bipartisan.

“When we call the police, we don’t have any expectation that when we call 911 we will have to show our Visa card,” said Mel Brennan, who lives in Westminster.

He felt there was a certain hypocrisy to accepting tax-supported public safety but not public health. “Nobody is a socialist that supports a community fire department.”

Kevin Zeese, of Baltimore, used the mic to attack Van Hollen and Cardin for not pushing harder for a single-payer system, given that they had asserted, in statements by their representatives, that they believed health care to be a human right.

“A human right is not compatible with a commodity,” he said.

And then there was Kelley Gordon, of Hampstead, whose grandson Rhett was born with cystic fibrosis and whose family lives with anxiety that the protections of the Affordable Care Act will be repealed.

She recognized, she told the crowd, that the Affordable Care Act was not enough, but even she had concerns about single payers — she’s been calling Canadian officials trying to understand how that system would work for her grandson and she’s not certain yet what it would look like.

What Gordon asked was that elected officials take a look.

“There are working systems all over the globe,” she said. “Our leaders have got to look around the world. … And do what’s right to protect people like my beautiful little grandson.”

http://www.carrollcountytimes.com…

So now what is President Trump’s position on health care reform?

Trump’s Speech to Congress

The New York Times, February 28, 2017

Transcript of section on health care (12 references to “Applause” omitted):

Tonight, I am also calling on this Congress to repeal and replace Obamacare …

… with reforms that expand choice, increase access, lower costs and at the same time provide better health care.

Mandating every American to buy government-approved health insurance was never the right solution for our country.

The way to make health insurance available to everyone is to lower the cost of health insurance, and that is what we are going to do.

Obamacare premiums nationwide have increased by double and triple digits. As an example, Arizona went up 116 percent last year alone. Gov. Matt Bevin of Kentucky just said Obamacare is failing in his state, the state of Kentucky, and it’s unsustainable and collapsing.

One third of the counties have only one insurer, and they’re losing them fast, they are losing them so fast. They’re leaving. And many Americans have no choice at all. There’s no choice left.

Remember when you were told that you could keep your doctor and keep your plan? We now know that all of those promises have been totally broken. Obamacare is collapsing, and we must act decisively to protect all Americans.

Action is not a choice; it is a necessity. So I am calling on all Democrats and Republicans in Congress to work with us to save Americans from this imploding Obamacare disaster.

Here are the principles that should guide Congress as we move to create a better health care system for all Americans.

First, we should ensure that Americans with pre-existing conditions have access to coverage and that we have a stable transition for Americans currently enrolled in the health care exchanges.

Secondly, we should help Americans purchase their own coverage, through the use of tax credits and expanded health savings accounts, but it must be the plan they want, not the plan forced on them by our government.

Thirdly, we should give our state governors the resources and flexibility they need with Medicaid to make sure no one is left out.

Fourth, we should implement legal reforms that protect patients and doctors from unnecessary costs that drive up the price of insurance and work to bring down the artificially high price of drugs and bring them down immediately.

And finally, the time has come to give Americans the freedom to purchase health insurance across state lines …

… which will create a truly competitive national marketplace that will bring costs way down and provide far better care. So important.

Everything that is broken in our country can be fixed. Every problem can be solved. And every hurting family can find healing and hope. Our citizens deserve this, and so much more, so why not join forces and finally get the job done and get it done right?

On this and so many other things, Democrats and Republicans should get together and unite for the good of our country and for the good of the American people.

https://www.nytimes.com…

***

Comment:

By Don McCanne, M.D.

Although President Trump has previously offered no specifics on his proposals for health care reform, he has said that his plan would provide “insurance for everybody
much less expensive and much better” (Washington Post, January 15, 2017). In this speech he calls for “reforms that expand choice, increase access, lower costs and at the same time provide better health care.” But then, what are the specifics of his proposal?

* Eliminate the mandate to purchase insurance: All honest policy analysts agree that would significantly increase the numbers of uninsured – not exactly a policy approach to cover everyone.

* Lower the cost of health insurance: Assuming health care costs remain the same, the only way you can reduce insurance premiums is through various innovations that shift more of the costs to the plan beneficiaries. Making an insurance plan more affordable impairs access to care because of the financial barriers created by the higher out-of-pocket expenses.

* Americans with pre-existing conditions should have access to coverage: The key word here is “access.” In December, the Republicans decided that they would drop the guarantees of health care coverage and instead insure access to coverage. They merely mean that will ensure that plans would be available in the market by relaxing the requirements that plans face today. Having access to an inadequate or unaffordable plan does not mean that you have access to affordable health care.

* Tax credits for purchasing coverage: Although he has not defined the tax credits here, the leading Republican proposal is that the tax credit would be based on age and not on income. Lower- and middle-income individuals may find that the tax credit is not adequate to make their share of the premium affordable – thus increasing the numbers of uninsured. If the tax credit is not refundable those who pay little if any taxes could not afford to purchase insurance.

* Expanded health savings accounts: People who do not have enough income to save some for cash reserves would not have enough to make deposits into a health savings account (HSA). The only distinguishing feature of HSAs over other savings is that HSA deposits are deductible from income for tax purposes. This form of “tax expenditure” is highly regressive since the wealthy benefit and the poor do not. Expanding the amount of the allowable contributions to HSAs benefits the wealthiest of us, using our tax money to reduce their net out-of-pocket expenses. This is a tax policy that directs the benefit to exactly the wrong place.

* Americans purchase the plan they want, not the plan forced on them: They would eliminate essential health benefits and actuarial floors, making much less expensive plans available, but plans that would expose many to financial disaster should significant health needs develop.

* Give our state governors the resources and flexibility they need with Medicaid: They would convert state payments for Medicaid to block grants or per capita caps, either of which enable the federal government to reduce transfers to the states. “Resources and flexibility they need” apparently means granting the states fewer resources so they can have the flexibility to throw more patients off of their Medicaid programs.

* Implement legal reforms that protect patients and doctors from unnecessary costs: This is the old saw that somehow malpractice costs are a major contributor to our national health care spending; they are not, though we do need tort reform. But that needs to be reform that protects patients who are harmed, not reform that allows physicians to escape their responsibilities. Rather we need to civilize the process through alternate dispute resolution.

* Bring down the artificially high price of drugs: Yes, but that requires a regulatory role of government, whereas the Republicans are reducing regulation, pretending that somehow the magic of the marketplace will put a lid on drug prices. But it is the market that is bringing us six figure drug prices.

* Freedom to purchase health insurance across state lines: Not only does this reduce plans to their lowest common denominator, preventing state insurance commissioners from exercising adequate control over renegade insurers, but also the insurers do not want to face the administrative costs of setting up provider networks and marketing their plans in regions that would not be profitable to them.

If Trump’s plan looks familiar, it is. These proposals are the same old proposals that the Republicans have been tossing around for years. These are the proposals of Ryan’s two white papers and the recent “leaked” legislative draft that the Republicans quickly dismissed because of the blow back they received. Also it resembles the previous legislation introduced by HHS Secretary Tom Price when he was in Congress.

Trump has been meeting with Price and has promised releasing his formal proposals in three or four weeks, though Trump wants them in two weeks. These meetings have led Trump to say that reforming health care is “unbelievably complex
 nobody knew that health care could be so complicated.” But this speech is ominous. The Republican/Price/Trump proposals will reduce the federal guarantees of affordable health care, resulting in greater numbers of uninsured and in greater out-of-pocket costs that will be unaffordable for many more.

It looks like Trump’s promise of “insurance for everybody
 much less expensive and much better” is deceptive. Insurance for everybody means access to insurance, not actually being insured. Much less expensive means insurance that does not protect your financial assets, it you have any. Much better means that you have a choice of purchasing worthless plans, if you call that better.

This deception reaches a plane that we have to call it for what it is
a lie. He could have fulfilled his promise by bringing us an improved Medicare for all.

Chicago UAW Local 551 endorses H.R. 676, Improved Medicare for All

Single Payer News, Feb. 28, 2017

At its February meeting, UAW Local 551, which represents workers at Ford’s Chicago Assembly Plant, endorsed H.R. 676, Congressman John Conyers’ national single-payer legislation, the Expanded and Improved Medicare for All Act.

UAW Local 551 Vice President Scott Houldieson reports that the local “made note that negotiations over healthcare continue to consume a large portion of the money the union negotiates over. This holds back wages and pensions.”

“We also believe in Social Justice for all workers,” said Houldieson. “Because of this we know that a single-payer system covering every American from cradle to grave is the moral thing to do.”

Houldieson says that the local “took guidance from the delegates to the 35th Constitutional Convention which set International UAW policy. At that convention we debated our support for the Affordable Care Act, noting that while the Act was a step in the right direction, we still believe National Single-Payer Health Care is the proper remedy.”

The Chicago Assembly Plant, where UAW Local 551 workers build the Ford Taurus, Ford Explorer, and the Police Interceptor, is the company’s oldest continually-operated automobile manufacturing plant. The local also represents workers at Voith, ABM, and USA.

Hale Landes of IBEW Local 134 reports that the Labor Outreach Committee of the Illinois Single-Payer Coalition initiated the discussion of endorsement of H.R. 676 with the UAW local.

The resolution passed the UAW Local 551 Executive Board unanimously and was approved by the membership with the approval of the Board minutes. The full resolution is below:

UAW Local 551 Resolution to Support Single-Payer Health Care

WHEREAS, the delegates to the 35th Constitutional Convention while supporting the Affordable Care Act (ACA) as a good beginning step stated; We remain convinced that a single-payer system is the best way to control costs while providing universal access to high quality care; and we are committed to building an aggressive strategy to educate lobby and mobilize to achieve that goal; and

WHEREAS, many in Congress have called for the repeal and replacement of the ACA; and

WHEREAS, workers, their families, and their unions are waging an increasingly difficult struggle to win or keep good health benefits; and

WHEREAS, almost every union at every contract deadline must battle and sacrifice merely to sustain health insurance benefits; and

WHEREAS, the rising cost of health insurance premiums are blocking worker progress in wages, job growth, and other areas. All of our unions face a health care crisis; and

WHEREAS, economic necessities and moral conscience compel us to seek a better way; and

WHEREAS, Congressman John Conyers Jr. has introduced H.R. 676, the United States National Health Insurance Act. A.K.A. “Expanded and Improved Medicare for All;” and

WHEREAS, H.R. 676 will cover every person in the United States for all necessary medical care from birth to death; therefore be it

RESOLVED that UAW Local 551 endorses Congressman Conyers H.R. 676 Bill “Expanded and Improved Medicare for All”; and be it further

RESOLVED that UAW Local 551 will work with other unions and community groups to build support and action for H.R. 676 until we make what is morally right for our nation into what is also politically possible; and be it finally

RESOLVED that UAW Local 551 will take other actions to mobilize our members and the community at a grassroots level, to encourage other members of the House to sign on as co-sponsors of H.R. 676 and to encourage Senators to introduce a companion bill in the Senate.

Issued by:
All Unions Committee for Single Payer Health Care–HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636-1551
nursenpo@aol.com
unionsforsinglepayer.org
facebook.com/unionsforsinglepayer

H.R. 676 would institute a single-payer health care system by expanding a greatly improved Medicare to everyone residing in the U.S. Patients will choose their own physicians and hospitals. H.R. 676 would cover every person for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental (including oral surgery, periodontics, endodontics), mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care and correction, hearing services including hearing aids, chiropractic, durable medical equipment, palliative care, podiatric care, and long-term care. H.R. 676 ends deductibles and co-payments. H.R. 676 would save hundreds of billions annually by eliminating the high overhead and profits of the private health insurance industry.

H.R. 676 has been endorsed by 628 union organizations including 152 Central Labor Councils/Area Labor Federations and 44 state AFL-CIOs (KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO, MN, ME, AR, MD-DC, TX, IA, AZ, TN, OR, GA, OK, KS, CO, IN, AL, CA, AK, MI, MT, NE, NJ, NY, NV, MA, RI, NH, ID).

The list of union endorsers.

The sample endorsement resolution.

Achieving Universal Coverage Without Turning to a Single Payer

Lessons From 3 Other Countries

By Regina E. Herzlinger, DBA; Barak D. Richman, JD, PhD; Richard J. Boxer, MD
JAMA, February 27, 2017

The most popular parts of the Affordable Care Act (ACA) are the most expensive. Universal coverage is a top priority not only for Democrats but also for President Trump. Both Republicans and Democrats want to preserve many costly coverage features of the ACA, including those that prevent insurers from precluding people with preexisting conditions and those that eliminate lifetime or annual coverage limits. The challenge is how to preserve these features and make insurance affordable.

A primary obstacle to achieving affordable universal coverage is the high costs of those with diseases or costly traumatic events — approximately 20% of individuals accounting for approximately 80% of health care spending. So, a key question is how to pay for their care.

Some nations in the Organisation for Economic Co-operation and Development (OECD) rely on a governmental single-payer model to achieve universal coverage, but this approach is politically infeasible in the United States. As the United States relies on private-sector insurance, 3 other countries that use private-sector insurance to offer affordable universal coverage provide some potentially helpful lessons.

Paying for Costly Patients

Some advocate creating risk pools for enrollees with preexisting conditions. This strategy removes individuals with high health care costs from the broad pool of enrollees and uses government funds to subsidize their insurance premiums. In turn, the cost of insurance is substantially reduced for the rest of those who are insured. This strategy, however, requires substantial infusions of funds.

If high-risk pools are part of the solution to attaining universal coverage, federal funding is essential. But federal policy makers are unlikely to commit a sufficient amount of funds to make this approach successful.

Another strategy to pool costly patients would channel them into Medicare and rely on the federal government as the ultimate risk bearer. But Medicare premiums are artificially controlled by passing some present spending onto future generations. Trustees project Medicare’s 75-year total spending in excess of dedicated revenues at $27.9 trillion, and the Centers for Medicare & Medicaid Services Office of the Actuary projects this amount at $36.8 trillion. Adding costly individuals to Medicare would only exacerbate these intergenerational problems.

This leaves a third strategy: the individual mandate — or as the Supreme Court characterized it, an annual tax assessed against individuals who have not purchased qualified health insurance within the calendar year. Although vilified by some, the mandate is attractive for several reasons. It is relatively easy to implement, is effective in pooling risk, and reflects the values of individual responsibility. Coverage is primarily funded by the enrollees rather than by general taxation. For these reasons, some nations that are committed to a private health insurance sector have achieved universal coverage and effective risk pooling by mandating the purchase of insurance.

Examples of the Individual Mandate and Penalties

Switzerland, Singapore, and Germany have achieved universal coverage and made insurance affordable even for their citizens with highest health care costs by instituting an individual mandate. One major difference, however, is that unlike the ACA, the mandates instituted by these countries are reinforced with effective penalties for nonparticipation, thus ensuring that lower-cost enrollees — generally healthier individuals — balance out the costs of the others who require more medical resources.

* In Switzerland, citizens must purchase health insurance. If they do not, government authorities automatically enroll them, selecting the insurance provider on the individuals’ behalf. Moreover, insurers can implement debt enforcement proceedings against anyone failing to pay their premiums and collect a penalty in addition to back premiums. The Swiss government subsidizes premium payments for more than a quarter of the population, including retirees who purchase the same insurance as workers.

* Singapore institutes compulsory contributions from employers on behalf of their employees to create medical savings accounts. Employees maintain these accounts for health care expenses such as health and disability insurance premiums, hospitalization, surgery, rehabilitation, end-of-life care, and outpatient services. Those failing to pay their premiums are subject to garnished wages and other legal actions that can force payment of back premiums, penalties, and interest. Unemployed or low-income individuals are eligible for government subsidies that enable them to pay for the premiums.

* In Germany, insurance is funded by compulsory contributions to private insurers levied as 7.3% of income. Unemployed individuals have their contribution taken out of their unemployment benefits coupled with means-based sliding-scale subsidies, and uninsured self-employed persons who later attempt to purchase insurance face payment of back premiums for the period in which they were uninsured.

In sum, health insurance models in Switzerland, Singapore, and Germany suggest that an individual mandate, with adequate subsidies, can achieve affordable universal coverage. But the recipe for their success also includes firm penalties. Achieving universal coverage, like these 3 nations, requires a more forceful approach.

From the Conclusions

If the goal is universal health coverage that provides care even for patients with the highest health care costs without relying on public insurance programs, the financial burden must be spread across the whole population. This requires either massive government spending, whether through high-risk pools or Medicare, or requiring individuals to purchase insurance.

It is time to stabilize the premiums of the universal insurance market by neutralizing the political disagreements surrounding the ACA’s mandate and penalties. As these 3 countries demonstrate, maintaining the popular aspects of the ACA requires keeping its less popular part, and achieving the stated goal of universal coverage requires a serious commitment to individual responsibility.

http://jamanetwork.com…

***

A Conversation With Regina E. Herzlinger, PhD: A New Individual Market on the Horizon

Managed Care, July 2011

Quotes from the interview:

“I have always supported universal coverage for personal and economic reasons. There are 40 million people who are uninsured. Typically, in any pool, 20 percent are sick. That’s 8 million people. How are we going to cover these 8 million sick people? The only way we can pay for them is to raise taxes — which is not going to happen — or to have universal coverage. Universal coverage is in many ways much more acceptable than a tax in which the well subsidize the sick.”

Are we headed toward a single payer system?

“I wouldn’t say that. I think we are going to a Swiss system. Employers will drop their health insurance coverage, not solely for reasons of cost. Many employers find buying health insurance onerous, and they would rather it be a consumer purchase.”

Accountable care organizations — does this concept have any legs?

“It’s like the Affordable Care Act itself — great idea, poorly thought through. Fee-for-service payment is perverse because it penalizes integration. The problem is the scope of the ACO, which is not just one disease or one condition, but everything for everybody. It’s not feasible to excel in managing every kind of care. It’s too complicated.”

Will the consumer model make its way to Medicare?

“Consumer-driven health care started in the commercially-insured population. I would hope it would go to Medicaid so that the poor aren’t stuck in this terrible program. And eventually it will go to Medicare because we have to solve the Medicare problem.”

The Congressional Budget Office thinks that senior citizens will be worse off under a voucher system from Medicare, which is Rep. Ryan’s plan.

“What the CBO failed to think about is, if 50 million seniors go out in the insurance market, is that market going to remain the same, or is it going to become more competitive in ways the Swiss insurers are competitive, by reducing administrative costs? The CBO’s mistake was assuming that nothing would change. If 50 million seniors show up in the insurance market, they are going to force insurers to become more competitive.”

Providers talk about the difficulty of dealing with so many insurance companies. Is it going to get worse for them as more health plans enter a consumer-driven market?

“Well, either you are going to have a lot of insurers breathing down your neck, or it’s going to be single payer. Our last gasp is consumer-driven health care. Take your choice.”

https://www.managedcaremag.com…

***

Comment:

By Don McCanne, M.D.

The theme of this article is somewhat astonishing. The authors recommend that we modify the most unpopular element of the Affordable Care Act – the mandate to purchase private health insurance or face penalties – by increasing the severity of the penalties to a degree that they will drive people to purchase plans, thereby forcibly achieving near universal coverage. This, as the title of the JAMA article implies, is to avoid the inevitability of single payer, as if single payer were so terrible that it is worth it for us to make being uninsured an unconscionable act warranting severe punishment.

The intent of this approach to health care financing is to avoid “massive government spending” as they say might occur with high-risk government insurance pools or by enrolling high-risk patients in Medicare (or, of course, single payer). By instead requiring individuals to purchase insurance the costs would shift to the individuals. But considering our very high national health expenditures, who could afford to pay for plans that include all of the high-risk individuals in the insurance pools? Of course, only wealthier, higher-income individuals. That puts us back into the position of either providing government subsidies that are more generous than those currently offered under ACA, or opening the market to barebones plans that would make health care access unaffordable.

Harvard Business School Professor Regina Herzlinger has been a long-time advocate of consumer-directed health care. She believes that “the stated goal of universal coverage requires a serious commitment to individual responsibility” with the individual functioning as an informed consumer in the private health insurance marketplace. Her opposition to single payer is ideological, preferring markets over governments.

She has repeatedly threatened us with single payer if we don’t establish policies that promote consumer-driven health care. In spite of her disdain for single payer, she does recognize that “either you are going to have a lot of insurers breathing down your neck, or it’s going to be single payer. Our last gasp is consumer-driven health care. Take your choice.”

Some choice: Market-driven hell or single payer nirvana.