PNHP

We can do better with single-payer

We can do better with single-payer

By Harvey Fernbach, M.D., M.P.H.
Yale Medicine, Spring 2017 

Cathy Shufro’s review of EMBRACE, by Gilead Lancaster, M.D. [Yale Medicine, Winter 2017], encouraged me to read it. Although well-intended, the author made two significant errors in his approach to universal health coverage. He strongly believes that for-profit insurers still have a role, even after years of bad experience by patients, hospitals, and physicians. For-profit insurers are known for cherry-picking customers, steering patients away from specialists, and denying and rationing care for profit. Second, he favorably compares his approach to the Canadian single-payer program and leaves out H.R. 676, Expanded and Improved Medicare for All Act, which has 79 co-sponsors in the U.S. Congress. With input from Physicians for a National Health Program (PNHP.org), H.R. 676 offers comprehensive care for all, is not linked to employment, and would establish a universal single-payer health care system. This means medical, surgical, mental health, dental, prescriptions, hospitals, and long-term care, with no out-of-pocket costs. Numerous studies have demonstrated that this could be done with the same amount currently spent on health care. In 2013, United Health axed their contract with the 1,200-physician Yale Medicine practice, causing harm to many. We can do better with single-payer simplicity.

Excess emergency department charges for uninsured and out-of-network care

Variation in Emergency Department vs Internal Medicine Excess Charges in the United States

By Tim Xu, MD, MPP; Angela Park; Ge Bai, PhD, CPA; et al
JAMA Internal Medicine, May 30, 2017

From the Introduction

Patients presenting to different emergency departments (ED) can face widely varying charges for similar care. Hospitals use chargemasters (list of services and their charges) to compile each patient’s bill, but the actual payment depends on the patient’s insurance type and network status. In-network patients and their insurers usually pay discounted amounts, whereas uninsured and out-of-network patients may be liable for the full hospital charges. In 2012, the 50 hospitals in the United States with the highest markups charged patients at least 9.2 times what the Medicare program would pay for care.

In this study, we used physician payment data from the Centers for Medicare & Medicaid Services to study the variation in markups on ED professional services and in relation to markups in internal medicine. We also examined the association between the level of markup and the characteristics of the hospitals and their patient populations.

From the Results

Nationwide, services provided by emergency medicine physicians to Medicare Part B fee-for-service beneficiaries totaled $4 billion in charges and $898 million in Medicare-allowable amounts, representing an overall markup ratio of 4.4 (340% excess charges). By contrast, the overall markup ratio for all services provided by internal medicine physicians was 2.1 (110% excess charges). Markup ratios for common ED services varied widely by procedure code and hospital.

By hospital, the aggregated markup ratio for all ED services ranged from 1.0 to 12.6; the aggregated markup ratio for all internal medicine services ranged from 1.0 to 14.1. Greater ED markup ratios by hospital were associated with for-profit status, greater uninsured population, African American and Hispanic patient populations, and location in the southeastern United States. These associations between markups and hospital characteristics were not present for internal medicine services.

From the Discussion

In this national study of hospital pricing practices in 2013, we found wide variation in excess charges for ED services relative to what Medicare would have paid. Moreover, ED services were generally priced higher than those in the internal medicine department for the same services within a given hospital. Emergency departments with the greatest markups were more likely to be for-profit and serve larger uninsured populations. These findings reinforce the recent interest among states in protecting patients from excess medical charges.

In addition to uninsured patients, insured but out-of-network patients can become subject to chargemaster prices. In the course of negotiations between insurers and physicians over payment rates, patients of physicians who remain out of network may receive a balance bill for the difference between the chargemaster price and the amount paid by the insurer. Out-of-network care can also result from hospitals outsourcing ED and other physician services to private contractors who are not part of the hospital’s insurer network.

Conclusions

Using national Medicare payment data, our study demonstrates the wide variation in the prices EDs charge patients for medical services, which can vary between 1.0 and 12.6 times the Medicare-allowable amount by hospital. Moreover, we found that hospitals typically charge patients more for similar services when performed by an ED physician compared with an internal medicine physician. In this context, the ongoing trends of uninsurance, hospital consolidation, and narrowing insurance networks since implementation of the Affordable Care Act are poised to increase the potential for patient financial harm in the years to come. Now, more than ever, protecting uninsured and out-of-network patients from highly variable hospital pricing should be a policy priority.

http://jamanetwork.com…

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Comment:

By Don McCanne, M.D.

We have long recognized the injustices of emergency department patients being charged higher rates if they are uninsured or if the physicians providing the care are not in the networks of the patients’ insurance plans. This study adds to our understanding by quantifying the extra costs faced by the patients. These charges typically are 4 times  Medicare-allowable rates for the emergency physician and as much as 12 times for the hospital.

These unjust excessive charges would not exist in a well designed single payer system – an improved Medicare for all. Patients would benefit by the elimination of cost sharing, and the professionals and institutions would be paid based on legitimate costs and fair margins. Everyone would benefit except insurers and providers who currently gouge.

California’s single payer bill would reduce costs for most businesses and households

Economic Analysis of the Healthy California Single-Payer Health Care Proposal (SB-562)

By Robert Pollin, James Heintz, Peter Arno, and Jeannette Wicks-Lim
Political Economy Research Institute (PERI), University of Massachusetts – Amherst, May 2017

The State of California is considering a bill to create a statewide single-payer health care system. This study provides an economic analysis of the proposed measure, The Healthy California Act (SB-562). The study includes four major sections: 1) Cost Estimate of Universal Health Care Coverage in California; 2) Cost Saving Potential under Healthy California; 3) Financing Healthy California; and 4) Impact on Individual California Families and Businesses.

The primary goal of Healthy California is to provide high-quality health care to all California residents, including those who are presently either uninsured or underinsured. The study finds that the providing full universal coverage would increase overall system costs by about 10 percent, but that the single payer system could produce savings of about 18 percent. The study thus finds that the proposed single-payer system could provide decent health care for all California residents while still reducing net overall costs by about 8 percent relative to the existing system.

We propose two new taxes to generate the revenue required to offset the loss of private insurance spending: a gross receipts tax of 2.3 percent and a sales tax of 2.3 percent, along with exemptions and tax credits for small business owners and low-income families to promote tax-burden equity.

Within this proposed tax framework, Healthy California can achieve both lower costs and greater equity in the provision of health care in California for both families and businesses of all sizes. Thus, net health care spending for middle-income families will fall by between 2.6 – 9.1 percent of income.

Small firms that have been providing private health care coverage for their workers will experience a 22 percent decline in their health-care costs as a share of payroll. The small firms that have not provided coverage will still make zero payments for health care under Healthy California through their gross receipts tax exemption. Medium-sized firms will see their health care costs fall by between 6.8 and 13.4 percent as a share of payroll relative to the existing system. Firms with up to 500 employees will experience a 5.7 percent fall, and the largest firms, with over 500 employees, will experience a 0.6 percent fall as a share of payroll relative to the existing system.

In sum, the establishment of the Healthy California single-payer system will generate financial benefits for both families and businesses throughout the California economy. For families at most income levels and for businesses of most sizes, these financial benefits will be substantial. These benefits are in addition to those that the residents of California will achieve through having universal access to decent health care.

http://www.healthycaliforniaact.org…

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Comment:

By Don McCanne, M.D.

This meticulous economic study of the the Healthy California single-payer health care proposal (SB-562) reveals that it would provide health care for all Californians while reducing net costs for almost all households and businesses. This study is much more credible than the staff committee report released last week, primarily because of the detail in this study and the application of well established health policy science to the analysis.

A multitude of articles based on the cursory staff study have been published stating that total costs and a hypothetical high payroll tax would be outrageous and totally unaffordable. This study lays those claims to rest and should be used to refute the rhetoric of the opponents of single payer reform in California.

In fact, California cannot afford to pass up this opportunity to bring health care to everyone while finally controlling our spending on it.

If you wish to see how a single payer system really could provide health care for everyone while reducing costs for businesses and households alike, you should download the full analysis and study it (link above).

Dr. Mark Ryan underscores the importance of single payer health care in Rhode Island

Interview by Dan Yorke
State of Mind, May 31, 2017

Dr. Ryan, chairman of the Rhode Island chapter of PNHP, and Rep. Aaron Regunberg (D-Distrcit 14), discuss proposed single-payer legislation at the state level. Dr. Ryan presented several slides to make the case for fundamental reform (full slide sets available here). His portion of the panel discussion begins at the 10:40 mark.

original link:
http://foxprovidence.com…

Blumenauer: US Could Have Single Payer Care Within A Decade

Portland-based Democratic Congressman spoke Tuesday to a supportive crowd about the role Oregon could play in changing the national healthcare debate.

By Courtney Sherwood
The Lund Report, May 31, 2017

U.S. Congressman Earl Blumenauer touted single-payer healthcare as a solution to the nation’s tangled and expensive system of care on Tuesday, in a speech before a politically supportive audience at First Unitarian Church of Portland.

Speaking to packed pews, the Democrat was joined on stage by author and single-payer activist T.R. Reid, state Senator Michael Dembrow, D-Portland, state Rep. Alissa Keny-Guyer, D-Portland, and activist physicians Samuel Metz and Paul Gorman.

Blumenauer described the Affordable Care Act as a slightly left of center compromise bill that must be protected or improved during the current era of Republican dominance in Congress. But he also argued that now is the time to discuss a more left-leaning alternative, even if it may take years to enact actual change.

“Because of the near-meltdown of the economy, the fierce turmoil of the Tea Party, the chaos of the past 10 months, I think we’re in a position today to put together a solution,” Blumenauer said.

“I think transformational change is possible far quicker than people recognize,” the congressman continued. “There’s something happening around the country. Twenty years from now there will be a single payer system of some variation. I think it could be 10 years. Things may happen sooner, depending on what we all do.”

As to that question of what to do, Blumenauer turned the microphone over to Reid, who reiterated arguments put forth in his best-selling book, “The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care.”

Through his work, Reid looked at roughly 35 developed democracies to see how each approached healthcare, the author said.

“All the other countries like us, all the other developed democracies on the planet, have decided to provide healthcare for everybody,” Reid said. “There’s only one industrialized democracy that does not provide healthcare for everybody, and that’s the world’s richest country, the United States of America. To me this is a national disgrace.”

Reid noted that there’s no universal approach to universal coverage. Some countries offer single-payer care, others like Japan and Germany host multiple insurance plans that collectively cover everyone. Some provide totally free care with never a bill to pay, others require co-pays or other investments in the system.

Regardless of specifics, these countries consistently spend less per capita on medical treatment, and get better results at the same time.

“There are different routes to that destination, but they all agree on what we ought to do,” said Reid, who lamented his home state of Colorado’s failed effort to enact its own statewide system of coverage.

That initiative effort failed when voters balked at the $25 billion pricetag, and as insurance industry opponents outspent supporters by $8 million-to-$800,000, Reid said.

But Oregon could be more successful at winning that ballot box battle, he argued.

“Here in Oregon, you’ve got a bunch of trouble makers, rabble rousers, apple cart upsetters, doctors, patients, members of Congress” – not to mention, state legislators, he noted.

Among those legislators are Democrats Sen. Dembrow and Rep. Alissa Keny-Guyer, who each argued in favor of radical action within the state.

Keny-Guyer noted that already this legislative session, small reforms are advancing through the process – including a bill that would limit out-of-pocket pharmaceutical costs to insured patients, and would force drug makers to offer rebates to insurance companies if they charge significantly more in Oregon than in other major countries around the world.

And Dembrow spoke of growing support among Democrats in the state for a single-payer bill – unlikely to pass this legislative session, especially without any Republican backing, but a possibility for a future ballot referendum.

“California is making support for single payer a marker for Democrats down there,” and that leadership could help Oregon activists gain momentum, he said.

“What we have to think about doing, as we are preparing for our election here in Oregon, to put single payer on the ballot – which right now is looking like the year 2020 – is how can we partner with Washington so they get it on their ballot in 2020? How do we partner with Colorado so they get it on their ballot in 2020?” Dembrow asked.

He argued that coordinating efforts across multiple states would help activists resist the flow of big business lobbying funds. “All those insurance dollars are going to get spread out. Because otherwise they are going to pick us off state by state. And let me say, if California can do it, it’s going to make it so much easier for the rest of us. As many of us know, you put California together with Oregon and Washington, you’ve got the world’s sixth largest economy.”

https://www.thelundreport.org…

Provide improved Medicare for all

By Emilio V. Perez-Jorge, M.D.
The (Columbia, SC) State, May 31, 2017

I encounter patients daily who are worried about the future of health care. One of the greatest threats to the health of our nation and our state is the revised American Health Care Act, currently being considered by the U.S. Senate.

The bill would take money out of Medicaid, and cancel subsidies that help working families buy private coverage through the Affordable Care Act’s health-insurance exchanges.

The Affordable Care Act, also known as Obamacare, has helped citizens afford health-care coverage, but it has some flaws as well. That is why we should move forward to a single-payer “improved Medicare for all” plan.

Ask your state legislators to introduce the Palmetto Comprehensive Health Care Act, which Rep. David Mack and Sen. Brad Hutto proposed in 2015. At the federal level, ask your U.S. representatives to support the “Expanded and Improved Medicare for All Act” (H.R. 676), and ask Sens. Lindsey Graham and Tim Scott to oppose the revised American Health Care Act.

Dr. Emilio V. Perez-Jorge resides in Lexington.

http://www.thestate.com…

U.S. patients would benefit from single-payer plan

By Andrew Quint, M.D.
Columbia (MO) Daily Tribune, May 30, 2017

I would like to respond to Luke Davis’ recent commentary in the Tribune. Having worked as a primary care physician at Family Health Center, a federally qualified community health center, serving medically underserved patients in Columbia since 1997, I have experienced firsthand the inequality, inefficiency and warped incentives of our healthcare system.

Davis writes that treatment in a single-payer system “tends to be lower in overall quality.” For example, he cited a recent study of the Canadian health care system that found the average wait time for medically necessary treatment after seeing a specialist was 9.8 weeks. Davis’s citation of this study leaves out a critically important caveat: It was a survey of wait times for elective treatment — by definition not medically urgent care. While a longer wait time for this type of treatment is frustrating, it does not mean the Canadian system produces meaningfully lower quality care. Moreover, my uninsured patients often don’t ever get to see a specialist. One patient had a kidney stone that wouldn’t pass; he experienced pain and blood in his urine for three months. Only when he got insurance through the Affordable Care Act could I get him in to see a specialist to have the stone removed. Uninsured patients are not counted in these statistics on wait times because they often don’t even get referred to specialists.

Davis says that in the United States, “government programs and regulations also guarantee that a certain baseline level of care is provided to all residents.” This is not true unless one believes that access to an emergency room constitutes a “baseline level of care”. If you are bleeding or having a heart attack, you can go to an emergency room and be treated even if you don’t have health insurance. But emergency rooms do not provide preventative care or treat chronic diseases such as diabetes and do not provide the vast bulk of medical care that people need to avoid ending up in an emergency room with a heart attack or stroke.

The infant mortality rate in the United States is 6 per 1,000 live births; in Canada it is 4.8. Life expectancy in the United States at birth in 2012 was 81.2 years for females, 76.4 for males. In Canada it was 83.6 for females and 79.4 for males. We have higher rates of premature death for all leading causes of death than comparable countries on average. Our rates of all-cause mortality, premature death, death amenable to healthcare, and disease burden are not improving as quickly as in other comparable countries during the past 10 years. We have better short-term outcomes after treatment for certain conditions, such as 30-day mortality post-heart attack and ischemic stroke. Five-year survival rates for specific cancers (like breast and colon cancer) are higher here. But we lag behind comparable countries in prevention and other measures of quality. We have relatively higher hospital admission rates for many preventable conditions, including congestive heart failure, asthma and diabetes complications. And we have higher rates of medical errors than comparable countries.

Our per capita spending on health care is double that of other developed countries. In 2016 the United States spent $9,024 per capita on health care; Canada spent $4,506. Despite our high cost, with a few exceptions, our outcomes are generally worse than in those countries. We excel at high technology high cost care. We do not perform nearly as well on lower cost preventative care. The economic incentives in our system favor high cost medications and procedures rather than low cost educational interventions and prevention.

A colleague of mine attended a lecture on research to develop a drug to promote the growth of new blood vessels around arterial blockages. Instead of heart surgery, a patient could take this drug to grow a bypass. When it was pointed out to the speaker that exercise promotes the growth of new blood vessels around blockages, he replied “Yes, but we don’t get paid for that.”

Single-payer systems in other countries are cheaper, provide better access to care, and allow those countries to improve the financial incentives that make their health care systems more rational, with more focus on prevention of diseases and their complications.

Andrew Quint is medical director at the Family Health Center in Columbia.

http://www.columbiatribune.com…

CMS Administrator Verma is further privatizing enrollment in insurance exchanges

Consumer Advocates Wary Of New Marketplace Rules For Brokers

By Michelle Andrews
Kaiser Health News, May 30, 2017

Signing up for coverage on the health insurance marketplace should be easier for some people this fall because new federal rules will allow brokers and insurers to handle the entire enrollment process online, from soup to nuts. Some consumer advocates are concerned, though, that customers going this route won’t get the comprehensive, impartial plan information they need to make the best decision due to the financial self-interest of insurers and brokers.

“Facilitating the participation of brokers and getting web brokers involved is a good thing for the market,” said Timothy Jost, emeritus professor at Washington and Lee University School of Law in Virginia and an expert on health reform. But there are risks for consumers. “If you’re enrolling with a web broker, you could see ‘best deals’ that often aren’t the best deal for you but are the best deal for the people who are marketing them.”

The staff at online health insurance broker eHealth is thrilled with the change.

“It’s a big deal,” said Nate Purpura, vice president of consumer affairs at eHealth. “Many people, including our CEO, have been to Washington, D.C., multiple times to explain the benefits of being able to help in this way.”

Its website, which works with 180 insurance carriers nationwide, offers about 75 percent of the plans that are available on healthcare.gov, Purpura said.

That’s a problem, say some policy analysts. Federal rules require web brokers to display basic information about all the plans that are available on the federal marketplace, whether or not they actually sell them. It includes the name of the plan and insurer that offers it, the type of plan — HMO, PPO, EPO — and metal level (bronze, silver, gold or platinum). Web brokers must also publish a disclaimer that says the website information about all the available marketplace plans might not be complete and provide a link to healthcare.gov.

But the information web brokers present about plans they sell and get a commission for may be much more comprehensive than the information provided about plans they don’t handle.

But some analysts remain concerned that details about how consumers’ privacy and security will be protected under the new system are still too vague.

“This is really sensitive information, people’s tax information, which needs to be highly protected,” said Jost. “There are a lot of concerns with confidentiality and privacy. I have some concerns about fraud.”

http://khn.org…

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The Centers for Medicare and Medicaid Services (CMS) announces streamlined direct enrollment process for consumers seeking Exchange coverage

CMS.gov, May 17, 2017

“This is another important step to help create stability in the health insurance market,” said CMS Administrator Seema Verma. “It is common sense to make it as simple and easy as possible for consumers to shop for and access health coverage. It is time to get the federal government out of the way and give patients the best tools to make their own healthcare decisions.”

https://www.cms.gov…

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Comment:

By Don McCanne, M.D.

CMS Administrator Seema Verma is expanding the role of private insurance brokers, such as eHealth, in enrolling individuals in plans offered by the government ACA health insurance exchanges. Not only do the private brokers promote only selected plans on the exchanges, they obviously are motivated to push the plans for which they receive a generous commission, whether or not the plans selected are in the best interests of the enrollees. This does not serve the applicants well.

In her CMS release, Verma states, “It is time to get the federal government out of the way.” Her pro-privatization, anti-government ideology is so intense that she says that it is “common sense” to add additional, wasteful private administrative services with these outside brokers, paying them fees with our tax money, and yet depriving enrollees of the full informational services that our current government-operated exchanges are providing.

Worse services, piling on of administrative excesses, and diverting public money to private vendors are a terrible price to pay simply to please the anti-government bureaucrats that are filling the positions of public trust in this administration.

In a recent Quote of the Day, it was recommended that her boss, HHS Secretary Tom Price, be replaced based on the potential havoc created by his adhering to his nutty anti-government ideology. She should be replaced for the same reason as well – ASAP.

This comment is the opinion of the author and is not an official view of Physicians for a National Health Program.

N.Y. Assembly passes universal health care bill

By Dan Goldberg
Capital New York, May 27, 2015

The state Assembly on Wednesday voted for a single-payer health bill, the first time in more than two decades the chamber has taken up the measure.

The vote was 89-47, an overwhelming but largely symbolic step toward universal health insurance. The bill now heads to the Republican-controlled Senate where it is not expected to pass.

Assemblyman Richard Gottfried, chair of the health committee, gave an impassioned speech on the floor in support of the New York Health Act, arguing that it was long past time for New Yorkers to rid themselves of the intrusive insurance companies whose goal is to deny claims rather than provide care.

“You do not have to be an Einstein to understand New York Health is the right choice for New York,” Gottfried said.

Gottfried, a Democrat from Manhattan, spent the legislative session barnstorming the state, trying to gain support for his bill, which would be funded through a progressive income tax and payroll assessments. There would be a net savings of $45 billion in health spending by 2019, Gottfried said, based on an analysis from Dr. Gerald Friedman, a professor at the University of Massachusetts at Amherst, though that figure was attacked by Republicans.

The bill, Gottfried said, would lower costs by getting rid of insurance companies. It would lower administrative costs and allow doctors to focus their time on treating patients instead of fighting for reimbursements.

“What will bring down health care costs is taking out of the equation the more than 20 percent we now spend on administrators whose job it is to fight with insurance companies,” he said.

The plan’s benefits, Gottfried said, would be more generous than any plan on the current market, and there would be no co-pays or deductibles. The bill would also require a care coordinator for every member, though that coordinator is not empowered to choose the type of care a patient receives.

For some Republicans, it was all too good to be true.

“This bill promises remarkable things for New York State residents,” said Assemblyman Andy Goodell, a Republican from Chautauqua. “It says providers, ‘you’ll be paid a lot more money,’ and it says to the employees ‘you’ll contribute a lot less money,’ and it says to the patients ‘you’ll have much broader access,’ and to the employers ‘you’ll pay $45 billion less.’ My background is in math and economics and I haven’t been able to figure out how this all works. … There is no free lunch, there is no free health care.”

Leslie Moran, spokeswoman for the New York Health Plan Association, which represents insurers, said the bill “represents an unrealistic, utopian view of a universal health care system where everyone would be covered, everything would be covered and the system would magically pay for it all.”

One problem, pointed out by Republicans, is that the offering, while generous, is the opposite of what public health officials are pushing, including those in the Cuomo administration, who have professed that insurance systems, and high deductibles and co-pays help ensure people use the health system judiciously instead of opting for more, often unnecessary, care.

“There is a role for insurance companies,” state health commissioner Dr. Howard Zucker said Wednesday before the debate.

The last time a universal health care bill was on the Assembly floor was 1992. It passed but the debate was sidelined because of federal efforts to reform health care, which ultimately failed under the Clinton administration.

The passing of the Affordable Care Act, which subsidizes private insurance for people below a certain income level, was a valid effort, Gottfried said, but ultimately served to highlight why the system needs to be entirely scrapped.

“I think the A.C.A. has made it clear to people … there are profound problems in our health care system that cannot be addressed by incremental change in that system,” Gottfried said.

Wiping out an industry — even the insurance industry — was not seen as popular by many Republicans who worried about the loss of jobs and what might happen should this plan fail.

Goodell asked why the state should go down this road when when Medicaid — a government run insurance program for lower-income residents — is expensive, burdensome and not well liked.

“Why would we want to expand that type of approach,” he asked.

Gottfried responded that his bill would improve Medicaid by putting everyone into one pot. He would, he said, eliminate the two-tiered system. There’d be no greater risk of fraud under this law than in the current Medicaid program.

Republicans also pointed out how much was left to be done. The income tax rates have yet to be decided, but would likely cost the highest earners more than they currently pay for health insurance, while subsidizing lower income residents.

The analysis provided by Gottfried estimates no income tax on the first $25,000, an income tax of 9 percent on income between $25,0001 and $50,000, graduating to 16 percent tax for income over $200,000.

The legislation is also not specific on how to deal with residents of New York State who retire to another state.

That would have to be resolved at a later date, Gottfried said.

“Though we have numerous pages on this legislation, we have numerous holes also,” said Al Graf, a Republican from Holbrook. “There is no way I can go back to my constituents and tell them you may have coverage in the future. … This is an exercise in insanity.”

Moran said there is no certainty that providers would accept government set reimbursement, though Gottfried said almost all would receive more for their services than they are currently being paid.

The bill also “completely disregards the economic contribution of health plans — both to the state and to local communities,” Moran said.

Joseph Borelli, a Republican from Staten Island, cited Vermont, which tried and failed to enact a single-payer health system.

Vermont’s collapse has been a cautionary tale for even the most enthusiastic supporters of government sponsored health insurance, but Gottfried was having none of it.

“New York … bears no resemblance to Vermont,” Gottfried said. “The bill bears very little resemblance to Vermont. Their financing system is different. The two have absolutely nothing to do with one another, nothing! Why don’t you ask me whether New York will flood Just like Texas flooded if we enact this plan. The weather in Texas has as much to do with this as Vermont does.”

Read the bill here: http://bit.ly/1JVUg1I

http://www.capitalnewyork.com/article/albany/2015/05/8568890/assembly-pa…

N.Y. Assembly votes for universal health coverage

By Michael Virtanen, Associated Press
Democrat & Chronicle (Rochester, N.Y.), May 27, 2015

ALBANY – The New York Assembly voted 89-47 on Wednesday for legislation to establish publicly funded universal health coverage in a so-called single payer system.

All New Yorkers could enroll. Backers said it would extend coverage to the uninsured and reduce rising costs by taking insurance companies and their costs out of the mix.

With no patient premiums, deductibles or co-payments for hospital and doctor visits, testing, drugs or other care, New York Health would pay providers through collectively negotiated rates. It would be funded through a progressive payroll tax paid 80 percent by employers and 20 percent by employees.

Also, waivers would be sought so federal funds now received for New Yorkers in Medicare, Medicaid and Child Health Plus would apply.

“Employers are shifting more and more health care costs to workers or are dropping it entirely,” said Assemblyman Richard Gottfried, chief sponsor. “The only ones who benefit are the insurance companies.”

The Manhattan Democrat estimated universal care would save New Yorkers more than $45 billion annually, cutting the statewide total cost for health care to about $255 billion in 2019.

Assembly Republicans doubted Gottfried’s estimate and questioned what would happen to everyone now employed by insurance companies.

“All I can say right now I think this is the last think New York state needs as far as an additional cost,” said Assemblywoman Jane Corwin, an Erie County Republican. She said they’re still trying to grapple now with the cost of the federal Affordable Care Act. That extended health care coverage to about 1 million New Yorkers, more than half in Medicaid and the others in private insurance with possible tax subsidies to offset costs.

An identical bill hasn’t advanced in the state Senate and isn’t expected to before the legislative session ends in June. Senate Health Committee Chairman Kemp Hannon said Wednesday that Gottfried’s bill faces two major hurdles, resistance from senior citizens to giving up Medicare for a new state program and obtaining federal waivers to apply Medicaid and Medicare funding to support it.

http://www.democratandchronicle.com/story/news/local/2015/05/27/assembly…

I’m a Kansas City doctor in Australia. Trump is right about Australian health care

By Marie Shieh
The Kansas City Star, May 27, 2017

President Donald Trump, I heartily agree with you when you told Australian Prime Minister Malcolm Turnbull, “You have better health care than we do.”

You see, I have been both a patient and a doctor in the U.S. and Australia. After working and studying as a family physician in the U.S. for almost 20 years, I landed my dream job working in Australia in 2015. I love working within this excellent health care system where doctors and patients are supported by a program called Medicare. It is similar to American Medicare but covers every Australian of every age for most health care costs.

Patients pay a small out-of-pocket fee, based on income, for things like medications ($7-$30), doctor visits ($0-$30) or X-rays ($0-$40). As their primary care physician, I can decide to charge a copay (children and seniors are always free) or stick with the basic Medicare reimbursement. For example, I might not charge patients I feel might not return for a follow-up visit. The choice is mine. Unlike working in the U.S., I never worry about bringing people back to the office to be sure they are getting the best care.

My Australian patients are not afraid to come see me and get tests done. They can visit physical therapists, dietitians, exercise physiologists, diabetes educators, chiropractors, podiatrists and osteopaths. I do not worry about patients not being able to afford an electrocardiogram, blood tests, radiology tests or medications like I did in the U.S. I can send my Australian patients to the hospital and emergency room, and unlike in the U.S., they are not afraid to go for fear of medical bankruptcy. The hospitals here are of excellent quality.

My Australian patients get care when they need it, not when they can afford it. By contrast, my American patients would routinely avoid care and treatments for fear of cost, leading to complications and extended sickness.

Australian Medicare provides high-quality, compassionate care to the elderly and disabled, which allows my patients to live with dignity at home, not in nursing homes. Take two of my patients, an elderly couple: The husband is 90 years old and the wife 81 years old, with mild dementia. They receive regular home visits from nurses who conduct assessments and dispense medication. They might get a cleaner every two weeks if they cannot get down to scrub floors or bathtubs. And speaking of bathtubs, they get handrails installed for a substantial discount, to keep them safe from falls. These common-sense measures keep patients healthy and cut down dramatically on hospital costs.

My Australian patients with advanced or terminal illness get home visits from me if they are too weak to come to the office. They receive palliative care in their homes, on par with the best treatments I have seen in U.S. hospice care.

Compare this to my experience as a patient in the U.S. I had my first baby in 1992 while in medical school. Even though I carried insurance and enjoyed a normal, unmedicated delivery, we got hit with a bill that was five times our monthly rent. Instead of enjoying our first weeks home with our new son, we spent that time haggling with the insurance company and being threatened by a collection agency. On top of that, our son wasn’t covered for the care he received right after being born, and we received a bill for the newborn check, none of which was covered by our insurance. This would never happen in Australia.

President Trump, you were right. We do have better health care here in Australia. Don’t you think Americans deserve the same?

Marie Shieh, M.D., is an American physician who now works in Australia. She was born in Salt Lake City and raised in Kansas City.

original op-ed:
http://www.kansascity.com…

follow-up interview with Dr. Shieh:
http://www.kansascity.com…

Robert Borosage on paving the way to Medicare for All

Will the Republican Health-Care Debacle Pave the Way for ‘Medicare far All’?

By Robert L. Borosage
The Nation, May 25, 2017

This week, the Congressional Budget Office confirmed what was already apparent: The revised House Republican health-care bill will still deprive millions of Americans — 23 million in the CBO estimate — of health insurance. Senate Republicans are devising their plan in secret, because it too will likely deprive millions of health coverage. In contrast with Republican horrors, Obamacare has grown in popularity, but premiums are rising as insurance companies consolidate monopolies in various states and Trump works to sabotage it. Surely, now is the time for progressives to wage a fierce campaign for Medicare for All.

Americans are more than ready. The popularity of expanding Medicare is surprising, given how little support it has received from the political class.

Will Republican efforts to repeal and replace Obamacare pave the way to Medicare for All? Only if progressives force the debate. Americans are looking for sensible reform. Medicare for All is the right answer. Now is the time for progressives to educate and enlist to take on the entrenched interests that stand in the way.

https://www.thenation.com…

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Comment:

By Don McCanne, M.D.

With the backlash against the Republicans for their ongoing failure to deliver effective health care reform, and with the failure of ACA to provide affordable health care for everyone, the pathway to Medicare for All may now have been paved.

Robert Borosage suggests that it is time for progressives to push the process – force the debate, educate, and enlist. But that should not be limited to progressives in the Democratic party. We should work with Republican progressives, independent progressives, Democratic Socialist progressives, and even, albeit rare, libertarian progressives. By forcing the debate, educating, and enlisting, even conservatives and others who do not usually assign to themselves the “progressive” label, should be ready for a serious consideration of single payer.

Assured health care, at a price we could all afford, who could be against that? Neither ACA nor AHCA would bring us that. Members of Congress will be home on a break this next week. Let them hear from you, though you may not want to announce yourself using the “progressive’ label.

Health Care Financing: It’s a tape worm

By Ewell Scott, M.D., F.A.C.P.
The Morehead (Ky.) News, May 26, 2017

When Warren Buffett talks, everybody who is anybody sits right up and listens.

Mr. Buffett, living in Oklahoma in a modest ranch house situated in a middle class neighborhood, demands the attention of Wall Street Tycoons and Hedge Fund Managers as he has the uncanny ability of predicting the future in economic terms. He picks out the winners. His reputation for honesty, plain speaking and accuracy are legendary.

Well, just last week he described our current health care financing system a “tape worm.” WOW. I do not want to have a tape worm. Since childhood the image of a silent grisly creature eating away, living in my gut, was scary.

But I am afraid the shoe fits, as our private health insurance based system is literally wasting huge amounts of money.

We in the USA spend twice as much as any other civilized country but get less. Our military, the best and largest, consumes 5 percent of our gross domestic product while total health care spending is responsible for 18 percent. We needlessly spend ours on an inefficient, fragmented, confusing system.

Mr. Buffett’s co-executive at Berkshire Hathaway, Charlie Munger has recently called for adopting a single payer health care system with progressive financing to get rid of this unwanted situation. Medicare for All, new and improved, would do it.

Let’s tell our politicians we want a truly universal, affordable and comprehensive health care financing system.

http://www.themoreheadnews.com…