PNHP

Middlemen take rebates, driving up drug prices

Middlemen take rebates, driving up drug prices

Secret Rebates: Why Patients Pay $600 for Drugs That Cost $300

By Robert Langreth
Bloomberg, October 5, 2016

Behind the scenes, drugmakers gave insurers and benefit managers more than $100 billion a year in rebates and other discounts to reduce the skyrocketing cost of drugs.

No one balks when insurers get rebate checks after they actually paid for a drug. But, increasingly, Americans are forced to pay for medication out of their own pockets — at least for part of the year.

That’s because more are enrolling in insurance plans with deductibles as high as $4,000 for a family. In such cases, insurers receive the rebates even though they haven’t paid a dime.

Eight pharmaceutical companies contacted by Bloomberg, including Novo Nordisk A/S, which makes NovoLog; Merck & Co., Pfizer Inc. and EpiPen maker Mylan NV, said their contracts with benefit managers and insurers generally require rebates be paid to them on all prescriptions, even when the patients pay the full cost because of high deductibles.

On a $600 prescription, “if the patient has a high-deductible plan, then the insurer could pocket the $300 rebate and not share it with the patient,” says Adam Fein, president of Pembroke Consulting, which advises drugmakers on sales and distribution.

But why not break up the rebate checks and send the cash back to the patients who paid for the drugs? Representatives of corporate health plans say it would be impractical to do so because they get the money months after employees bought the drugs.

Says Laurel Pickering, chief executive of the Northeast Business Group on Health, a coalition of large employers: “It would be very difficult to figure out how to administer that.”

http://www.bloomberg.com…

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Comment:

By Don McCanne, M.D.

Drug rebates go to insurers. How does this work? Well, let’s go through this step by step.

1. The patient buys a health insurance plan with a high deductible – a plan that provides drug benefits.

2. The patient is prescribed a $600 medication before having met the deductible.

3. The patient purchases the drug at the pharmacy for the retail price of $600.

4. The insurance company (or pharmacy benefit manager) has previously made a confidential deal with the drug manufacturer that a 50% rebate will be paid to the insurer in exchange for including that drug in the formulary of drugs that are approved for coverage under the plan.

5. The 50% rebate – $300 – is paid to the insurer who keeps it.

6. None of the $600 is refunded to the patient.

7. The pharmaceutical firms jack up the retail prices of their drugs to pay for the rebates and to increase profits.

8. Net result:

  • The insurance provided no benefit to the patient.
  • The insurer paid out nothing.
  • The patient paid $600 for a drug that had a negotiated price of $300.
  • The insurer pocketed $300 which rightfully belonged to the patient.
  • We all pay more for drugs because of these secret deals.

The insurers may argue that they should be rewarded for negotiating the drug discount for the patient. But scooping up the entire discount and running away with it?

Will somebody please explain why our policymakers continue to demand that we maintain the middleman role for the private insurers in our health care financing system? It’s a great deal for the insurer, but wasn’t reform supposed to be about the patient?

Research cited by Trump on numbers of Canadian medical tourists criticized

By Kelly Grant
The Globe and Mail, Oct. 12, 2016

The number of Canadians who traveled abroad for non-emergency medical treatment dropped slightly last year, according to a new report from a think tank whose past research Donald Trump’s campaign cited to support his debate-night claim that when Canadians need “a big operation,” they often head for the United States to avoid long waits at home.

The Fraser Institute’s latest report, released Wednesday, found that an estimated 45,619 Canadians left the country for elective medical care in 2015, down about 13 per cent from 52,513 in 2014.

That works out to about 1 per cent of all Canadian patients receiving non-emergency care outside of Canada’s borders last year, a minor decrease from an estimate of 1.1 per cent the year before.

The right-leaning institute’s new estimates come on the heels of Mr. Trump name-dropping Canadian health care in Sunday night’s presidential debate, and not in a positive way.

The Republican nominee was in the midst of trashing the Affordable Care Act – better known as Obamacare – when he accused his Democratic rival Hillary Clinton of wanting a single-payer health system, which he said, “would be a disaster, somewhat similar to Canada.” (Ms. Clinton is promising to improve Obamacare, not implement a single-payer model.)

“And if you haven’t noticed the Canadians, when they need a big operation, when something happens, they come into the United States in many cases because their system is so slow,” Mr. Trump said. “It’s catastrophic in certain ways.”

The Washington Post reported that the Trump campaign later backed up that assertion by pointing to the Fraser Institute’s estimates on Canadians travelling abroad for medical care in 2014, the most recent year for which figures were available at the time.

The Trump campaign did not respond to a request for comment.

Even before they became a footnote to an American presidential debate, the Fraser Institute’s estimates on wait times and on Canadians seeking medical care abroad have been hotly disputed, with critics calling the institute’s methods flawed and its conclusions suspect.

“They don’t actually measure how many patients leave,” said Karen Palmer, a health-policy analyst and adjunct professor at Simon Fraser University in British Columbia. “They [ask doctors to] guess.”

Jeremy Snyder, an SFU professor who contributes to the school’s medical-tourism research group, said he was concerned that the Fraser Institute report presents a “very speculative narrative,” – namely that long lines at Canadian hospitals and doctors’ offices are to blame for patients going abroad for care, even though the think tank did not ask that question directly.

The Fraser Institute draws its estimates from an annual survey of medical specialists about wait times. The survey includes one question about medical tourism: “Approximately what percentage of your patients received non-emergency medical treatment in the past 12 months outside Canada?”

About 20 per cent of the 11,292 specialists the the Fraser Institute contacted responded to the most recent survey.

Bacchus Barua, a senior economist at the Fraser Institute’s Centre for Health Policy Studies, acknowledged the limitations of the survey, but said the findings are still useful given how few data exist on Canadians travelling abroad for elective medical care.

“Let’s say it’s lower than this estimate,” he said. “Does that really change what the issue at hand is? And that’s that there are Canadians travelling abroad to receive treatment that they cannot find here.”

One 2002 paper, published in the journal Health Affairs and circulated widely online after Sunday’s presidential debate, found that when it comes to Canadians heading to the U.S. for medical care, the numbers, “are so small as to be barely detectible relative to the use of care by Canadians at home.”

http://www.theglobeandmail.com…

PNHP note: Physicians for a National Health Program is a nonpartisan educational organization. It neither supports nor opposes any candidate for public office.

Gerald Kominski describes the real-world public option

What Would A Public Insurance Option Look Like In California?

By Pauline Bartolone
California Healthline, October 11, 2016

The “public option,” which stoked fierce debate in the run-up to the Affordable Care Act, is making a comeback — at least among Democratic politicians.

The proposal to create a government-funded health plan, one that might look like Medicare or Medicaid but would be open to everyone, is being reconsidered at both the federal and state levels.

Amid news that two major insurers were pulling out of Affordable Care Act exchanges, 33 U.S. Senators recently renewed the call for a public option. The idea was first floated, then rejected, during the drafting of the federal health reform law, which took effect in 2010.

Democratic presidential candidate Hillary Clinton includes a public option in her campaign platform, and President Barack Obama urged Congress to revisit the idea in a JAMA article published in August.

Dave Jones, the elected regulator of California’s private insurance industry, endorsed the idea of a state-specific public option in an interview last month with California Healthline, though he did not specify how it might work.

California may be uniquely poised for a public plan — but the state may not need one, according to Gerald Kominski, Director of the UCLA Center for Health Policy Research.

“It would look just like an insurance plan,” except that the state would pay for medical care, potentially set up the network of doctors and hospitals, and make rules about paying providers, Kominski said. Private industry could be involved in these or other aspects of running the health plan, much as they do in Medicare Advantage and managed care Medi-Cal.

Creating a public option in California may not be necessary at present, since the state currently has sufficient competition in the private insurance market, Kominski said. But he said policymakers could choose to implement a public option now as a backstop against a potential future scenario in which private insurers scaled back their California plan offerings.

California Healthline interviewed Kominski to better understand how a public option could work in California and on a national level. The interview was edited for length and clarity.

Q: When we talk about a public option, do we mean a health plan for which the government takes the risk, sets the coverage rules and pays out the claims — and enrollees pay premiums just as they would to an insurance company?

That is what the public option would be. But that still leaves out the answer to a lot of questions about how actually that would occur. How would a government agency essentially become the insurer? So we have two examples. We have the Medicare program and we have the Medicaid program.

Medicare establishes the rules. It contracts with insurance companies to pay the bills. And that’s the way that Medicare has operated for over 50 years.

Now we have Medicare Advantage plans, where the contracting is not to pay bills but is basically contracting with insurers to bundle the services. And rather than pay the doctors and hospitals, the government pays the insurer and puts the insurer at risk.

Q: Insurers have opposed this idea in the past, and they’re opposing it again now that it’s being raised by members of Congress.

Private insurers could participate as administrators or providers on behalf of the state. But here’s one concern that I have with that model: California has four large insurance companies in the exchange that account for about 90 percent of the market.

Let’s say the state of California wanted to create a public option and hire an insurance company to administer that product for it. What would be the reason or the incentive for any of those companies to agree to be the plan administrator for the public option when the public option would be competing with the product that they’re already offering? They would be competing with themselves.

Q: Some provider groups may be opposed to a public option because they say that government programs like Medi-Cal pay very little and they believe a public option plan would also pay little. Is this necessarily the case that a government program would pay low rates?

It’s not necessarily the case, but it is in fact what we observe in the Medicare and the Medicaid/Medi-Cal programs.

Q: Do you think a publicly subsidized or operated program would run the risk of having narrower provider networks because of lower payments to providers?

I don’t want to pre-judge that. If the anecdotal evidence that I’ve been told over the last couple years is indicative of what’s going on statewide, then Covered California plans are already paying somewhere around Medicare rates.

Q: Do you think a public plan would help bring down costs in the health care system by negotiating for lower payments to hospitals and doctors?

I think that is possible in other areas of the country, where there are markets with one or two health insurance plans in the exchange. I think California has one of the most competitive ACA marketplaces. And so would the public option in California dramatically reduce premiums? I think the answer is no. It would have little or no effect.

For some people, the advantage is that we think that the public option’s going to be around because the state’s not going to back out of its commitment, whereas private insurers come and go in the marketplace.

Q: Do you think we need a public option in California for any other reason?

In my opinion, a public option isn’t necessary in California, but it might nevertheless be worth exploring as a longer-term mechanism for guaranteeing access and an alternative to relying solely on the private insurance market.

Q: Is there something about California’s health care system that uniquely primes the state for a public option?

I think so. One of the things that’s unique about California is the high percentage of managed care enrollment. The public option in California would probably include or be based on a managed care model and Californians are pretty receptive to that model.

Q: So if the public option could include private insurance, why are the insurers so opposed?

Well, the simple answer is they don’t want more competition. And again it goes back to, why was this battle so intense during the development and enactment of the ACA back in 2009 and 2010? The insurance industry said we cannot compete with a plan, a government plan, that pays doctors and hospitals using Medicare fees or fee schedules.

You remember the fundamental rule of business is you don’t want more competition. You want the market to yourself.

Q: Do you think it would be more effective or easier to implement a public option at a state or national level?

Well that’s where you can’t ignore the political environment. And so the short answer is in the current political environment, doing something at the national level is extremely difficult. Even though there might be arguments to develop a public option at the national level, it’s very challenging in the current political environment to get the agreement.

Q: Is there something that’s more efficient about a national public option?

Potentially. It’s economies of scale. You know, the larger your potential market nationally, the lower the potential costs per person. You just get administrative savings and efficiency. But it’s not easy to create a national program. One issue that’s challenging is how to put together a national network of doctors and hospitals that would participate. That’s a lot of work.

Q: Do you think the idea of a public option is more viable now than it was when it was debated before and ultimately stripped from the Affordable Care Act?

Well, I think that what makes it more attractive right now is the fact that we’ve got two large insurance companies that are pulling out of the exchange marketplaces. And because of that…the idea of a public option to provide stability and protection for people in the exchanges has resurfaced. And I think with good reason.

http://californiahealthline.org…

***

Comment:

By Don McCanne, M.D.

Many public option supporters have this concept that the government would create a public insurance plan that would successfully compete with private insurance plans, eventually displacing them and becoming a single payer national health program. Is this realistic?

Gerald Kominski describes for us precisely what a public option really would look like. Clearly it would be nothing more than one more player in our inefficient, fragmented multi-payer system, only adding further to the administrative excesses that have created a tremendous financial burden for our health care system.

For those who usually skip the source in these messages and only read the comment, you should make an exception this time. It is important to understand that the public option would be crafted to resemble private plans with provider networks. It would not be a free standing public program, like Medicare, if for no other reason than the fact that you could not get the majority of physicians and hospitals to agree to participate unless you promised higher payment rates which then would make the premiums even less affordable. Further, the private insurance industry would be there to ensure that the design of the government insurance product would place it at a competitive disadvantage, just as they did with the co-ops.

Besides, competition is a feature of private markets. A public program is a model based on service. A public insurance model designed for competition in private markets, as Gerald Kominski has described, would be very different than a public model designed to remove financial barriers to care, such as a single payer national health program.

Really. Try to imagine a public option designed to become a single payer. It would have its own separate risk pool, funded with premiums instead of progressive taxes, subject to adverse selection, with pressure to reduce provider payment rates to keep the premiums affordable, with consequent difficulties in ensuring access to an adequate numbers of providers, and greatly burdened with administrative complexity. When you try to design such a system, you keep tweaking it until you end up with the model Gerald Kominski has described – just another private-style plan, public in name only.

It is no wonder that Professor Kominski said to his UCLA health policy students (in a recent Quote of the Day), “I believe that there are people in this room who will one day see a single payer system in this country.”

Letter: Healthcare solution

By Dr. Arthur J. Sutherland III
The Commercial Appeal, Oct. 9, 2016

The CA editorial on Sunday, Oct. 2 needs correcting (“Obamacare needs tweaks, not scrapping”). The editorial was a response to the Blue Cross Blue Shield decision not to sell insurance on the federal ACA exchanges next year in three of Tennessee’s largest cities.

For starters, the ACA was never intended to cover everyone in the U.S. It was just another patch in our dysfunctional and costly healthcare markets which are run for profit by the insurance and pharmaceutical industries. In addition, the data shows that the ACA has not controlled cost, but has added to the problem of affordability for the public.

Why do you think BC/BS canceled coverage in Knoxville, Nashville, and Memphis? It was to avoid the larger concentrations of poor people who live in metropolitan areas who have the most need for adequate healthcare. BC/BS is trying to “cherry pick” customers who are relatively healthy or young, and who would not have the volume of claims for medications or care that a less healthy poorer population experiences.

Senators Alexander and Corker want to continue to use the free market myth to tweak the system, but the insurance and pharmaceutical industries have failed us. Americans know this, and want change that will create equity in healthcare delivery.

What is my plan? Twenty thousand physicians, nurses, and other healthcare providers support Improved & Expanded Medicare for All.

http://www.commercialappeal.com…

How great is California’s Obamacare success?

So you think Obamacare is a disaster? Here’s how California is proving you wrong

By Noam N. Levey
Los Angeles Times, October 7, 2016

Even as turmoil in insurance markets nationwide fuels renewed election-year attacks on the Affordable Care Act, California is emerging as a clear illustration of what the law can achieve.

The state has recorded some of the nation’s most dramatic gains in health coverage since 2013 while building a competitive insurance marketplace that offers consumers enhanced protections from high medical bills.

California and its Obamacare marketplace, Covered California, still face challenges, including rising costs. Like consumers elsewhere, some Californians, particularly those who make too much money to qualify for government subsidies, are seeing substantial premium increases and narrowing networks.

But while health coverage has faltered in other states where politicians worked to undermine the law, California highlights what can be accomplished if government officials and industry leaders work together to expand insurance, control costs and protect consumers.

More than three-quarters of newly insured Californians said their health needs are now being met, a recent survey by the nonprofit Kaiser Family Foundation found.

At the same time, Californians who gained coverage reported fewer worries about paying for not just healthcare, but also housing, transportation, even food.

Much of the insurance expansion in California has been fueled by the state’s decision to take advantage of federal funding in the health law to expand Medicaid eligibility to poor, childless adults, a population traditionally excluded from most states’ safety nets.

But Covered California has also played a critical role, with about 1.3 million direct customers and nearly 1 million more who get health plans that must meet Covered California standards even though consumers don’t use the marketplace to purchase them.

In 2017, Covered California rates are increasing an average of 13.2%, driven in part by rising medical costs and the end of a federal program that helped hold down rates.

Premiums for several insurers, including Blue Shield of California and Anthem Inc., are increasing even more dramatically.

Preventing large rate hikes in the future will require adjustments to the marketplaces in California and elsewhere, many experts say.

http://www.latimes.com…

***

Comment:

By Don McCanne, M.D.

California’s aggressive implementation of the Affordable Care Act has made it one of the more successful states in expanding the numbers of individuals with insurance coverage while reducing, for the previously uninsured, the financial burden of health care. As the title of this article indicates, California has proved that Obamacare is not a disaster. But what if California had had a better designed health care financing system with which to work? Say, a single payer system.

* The 3.8 million California residents who remain uninsured would be covered.

* Patients would not be faced with unaffordable deductibles.

* Exchange enrollees would not be facing an average of 13.2% increase in premiums.

* Patients would not be locked into narrow networks, limiting their choice of providers.

* Patients’ health would not be negatively impacted by constant churning of health plans and programs.

* The need to shop premium prices, which increases churning, would go away.

* Patient dollars would no longer be wasted on our profound administrative excesses.

* Employers would be relieved of the burden of administering employee health benefit  programs.

* Since lifetime, comprehensive, public coverage would be initiated at birth automatically, health insurance plans and their exchanges would go away.

California is to be commended for accomplishing what they have within the limitations of our multi-payer system as modified by the Affordable Care Act. But is this the best we could have done?

California bears responsibility for not leading the nation in demanding enactment of a single payer national health program – an improved Medicare for all. All that work for a comparatively small gain, when we could have had a much simpler, more equitable, more effective, more efficient and more affordable health care financing system.

The disaster is that we didn’t move forward with single payer. In this case, disaster relief is only a matter of political will.

Under a multi-payer system, churning is inevitable and bad for your health

Insurance Churning Rates For Low-Income Adults Under Health Reform: Lower Than Expected But Still Harmful For Many

By Benjamin D. Sommers, Rebecca Gourevitch, Bethany Maylone, Robert J. Blendon and Arnold M. Epstein
Health Affairs, October 2016

Abstract

Changes in insurance coverage over time, or “churning,” may have adverse consequences, but there has been little evidence on churning since implementation of the major coverage expansions in the Affordable Care Act (ACA) in 2014. We explored the frequency and implications of churning through surveying 3,011 low-income adults in Kentucky, which used a traditional expansion of Medicaid; Arkansas, which chose a “private option” expansion that enrolled beneficiaries in private Marketplace plans; and Texas, which opted not to expand. We also compared 2015 churning rates in these states to survey data from 2013, before the coverage expansions. Nearly 25 percent of respondents in 2015 changed coverage during the previous twelve months—a rate lower than some previous predictions. We did not find significantly different churning rates in the three states over time. Common causes of churning were job-related changes and loss of eligibility for Medicaid or Marketplace subsidies. Churning was associated with disruptions in physician care and medication adherence, increased emergency department use, and worsening self-reported quality of care and health status. Even churning without gaps in coverage had negative effects. Churning remains a challenge for many Americans, and policies are needed to reduce its frequency and mitigate its negative impacts.

http://content.healthaffairs.org…

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Comment:

By Don McCanne, M.D.

Churning – moving in and out of health plans, whether or not there are gaps in coverage – is clearly bad for the patient’s health.

In this study, the rate of churning did not differ between states with different approaches to implementing the Affordable Care Act. In a multi-payer system, churning automatically occurs due to factors such as changes in employment, changes in income and program eligibility, changes in residency, changes in plan availability, and changes because of administrative disruptions.

Regardless of the reason, churning resulted in “disruptions in physician care and medication adherence, increased emergency department use, and worsening self-reported quality of care and health status.” Negative effects occurred even without gaps in coverage.

Need it be said? A single payer national health program would totally eliminate churning and thus would improve the health of Americans caught up in the churning trap. If this were the only reason for enacting a single payer system, it would certainly be worth doing.

Sen. John Marty’s “Healing Health Care”

The Case for a Commonsense Universal Health System

By John Marty
MNHealthPlan.org, October 2016

During my 30 years in the Minnesota Senate, I have seen firsthand the failure of our political system to seriously address health policy. In the United States, we squander outstanding health care resources — providers, clinics and hospitals, medical research and technology — on a broken system that makes it difficult and expensive for many people to get the care they need.

Why would any society make it difficult for its people to access health care?

I wrote this book because I am tired of waiting while our political process spends billions of dollars but merely tinkers at the edges of our health care problems.

* First we take a few steps back and look at the mess we have. By doing so, we identify the problems, develop principles for a healthy health care system, and map out a logical plan based on those principles.

* Then we work through our civic process and political system, make the case for our proposal, and then work to implement that plan.

This proposed Minnesota Health Plan and the principles that underlie it are nothing more than what any caring society would desire in order to ensure good health care for all of its people.

A Call to Action

If twenty-first century progressives had been leading the nineteenth century abolition movement, we would still have slavery, but we would have limited slavery to a 40-hour work week, and we would be congratulating each other on the progress we had made.

Epilogue: It’s Time for the Minnesota Health Plan

Our current system, even with MNsure and the Affordable Care Act, still leaves many people without health coverage. Equally troubling, many Minnesotans who have health coverage still cannot afford the care they need.

Health insurance coverage fails to guarantee that people have access to health care, because insurance frequently excludes coverage for needed care such as dental, chemical dependency treatment, mental health, or long- term care.

Health insurance also requires significant out-of-pocket expenses, and it buries people and businesses with a thicket of confusing medical insurance applications and paperwork.

Despite our excellent medical providers and medical technology, Minnesota’s system is so dysfunctional that many families cannot access it even when they have insurance.

It’s time to stand up to the strong, well-financed opposition from the insurance industry and the pharmaceutical lobby.

We must replace health insurance for some with health care for all.

When European nations, Canada, and Japan are able to deliver comprehensive health care to all of their people, with better health outcomes, for roughly half the cost per person that we are currently spending, it is not an insurmountable challenge.

The Minnesota Health Plan would be an efficient health care system based on, and governed by, principles that ensure that all people receive high quality health care.

Minnesota has some of the best medical education, training, research, and technology in the world. It’s time we adopt a health care system to match.

“Healing Health Care” by John Marty can be downloaded for free at the following link:
http://mnhealthplan.org

Numerous excerpts from “Healing Health Care”:
http://mnhealthplan.org…

Senate, State of Minnesota: S.F. No. 2060 – Minnesota Health Plan:
http://tinyurl.com/MHP-2016-bill

***

Comment:

By Don McCanne, M.D.

“Healing Health Care” by Sen. John Marty is not only a description of a health care reform proposal for Minnesota, more importantly it is a discussion of policies that all of us desperately need to improve the functioning of our health care financing and health care delivery systems. It is a basic primer that all concerned about health care reform could use.

“Healing Health Care” can be downloaded for free at the link above. It is an easy read of less than 150 pages. For those who do not have the time, it would be well worth reading the excerpts at the second link above. They will provide some of the essence of the message in his book.

Minnesota Health Plan

New book outlines transition from the MNsure mess to a single-payer system

By the editors
The Timberjay (Tower, Minn.), Oct. 5, 2016

A new book by Minnesota state Sen. John Marty offers something that few politicians have ever provided to the public before — a straightforward plan to transition to a single-payer health care system in the state.

If there’s one thing, above all else, that passage of the Affordable Care Act has demonstrated, it is that any health care reform that maintains the existing private health insurance system is doomed to fail. While the ACA provided a brief respite in the spiraling cost of health care, premiums are now making up for lost time. Health officials here in Minnesota are already warning consumers that they are in for sticker shock when new MNsure rates are announced in a few weeks. Most plans are expected to see increases approaching 35-50 percent.

Despite skyrocketing premiums, Minnesotans are increasingly getting less in terms of coverage. To keep premium increases to a minimum, Minnesotans are opting for high deductible plans that require families to pay thousands of dollars before real insurance coverage kicks in. Even then, they still have co-pays and other charges. And many of the plans provide no dental coverage and only limited coverage for mental health care.

The problems inherent in the ACA are no justification for going back to the bad old days, when insurance companies could simply refuse to insure those in poor health, or when they were allowed to pocket huge profits by simply denying care even to those they had agreed to insure. In those days, we had 50 million uninsured Americans and our health care costs were spiraling out of control.

That leaves the obvious question. Where do we go from here?

Sen. Marty, in his new book, released at no charge in digital format this week, lays out a road map for the implementation of what he calls the Minnesota Health Plan, a comprehensive, single-payer health insurance proposal that he argues will provide significantly enhanced medical access for all Minnesotans, without spending any more than the $50 billion that Minnesotans and their employers currently pay for health care premiums and medical services every year.

The single-payer system would direct far more money towards actual care, however, since it would save the 15 cents on every health care dollar that goes to administering what is without a doubt the most inefficient health insurance system on the planet. That 15 percent amounts to seven billion dollars a year that Minnesotans and their employers spend on bureaucracy, whether it is administrative staff at hospitals, insurance companies, or in the government.

Complexity breeds inefficiency, as those who have struggled with the MNsure process are well aware. Yet it doesn’t have to be that way. As Sen. Marty notes, the cost of signing up seniors for Medicare is just a tiny fraction of the cost of getting Minnesotans signed up for coverage through MNsure. It’s not that government is inherently inefficient. Indeed, the Medicare system is far more efficient than any private insurance company. It’s that when government systems are set up to benefit special interests— like the insurance industry in the case of the ACA—that common sense and efficiency regularly disappear out the window.

The transition to a statewide single-payer system may well be possible, since the ACA does allow for waivers, which would essentially allow states to utilize federal health care dollars to develop alternatives to the current system, as long as they meet certain standards, which the Minnesota Health Plan, as envisioned by Sen. Marty, certainly would. In addition to federal funding, the cost of care under the Minnesota Health Plan would be paid for primarily by a payroll tax and individual premiums, similar to the way that Medicare is funded today.

Those who say a single-payer system isn’t viable are deploying mere rhetoric in place of reality. Many other developed countries manage to provide a successful single-payer system for their citizens, and so do we. Medicare, after all, is a single-payer health care system, and it’s one of the two most popular programs (the other being Social Security) run by the government.

Would the Minnesota Health Plan face political opposition? Without a doubt. Many politicians maintain their office by defending powerful special interests, and few are more powerful than the insurance lobby.

But one thing is certain. You don’t win if you don’t try. We ended up with the Affordable Care Act, with all its flaws, because the Obama administration opted to avoid a battle with the insurance industry, not because the administration could argue that theirs’ was a better plan.

Perhaps it took the misfire of the Affordable Care Act to open the door to something better. If so, Sen. Marty’s new book is pointing a way forward. It’s definitely worth a read.

http://timberjay.com…

Why You Should Vote Yes for Amendment 69, the ColoradoCare Health Plan

By Michael Roberts
Westword (Denver), Oct. 5, 2016

Of the nine amendments and propositions that will be on Colorado’s ballot next month, Amendment 69 is the most sweeping. Also known as ColoradoCare, the proposal would create a Colorado-specific health-care program with a goal of covering every citizen in the state with health insurance. It’s not quite a single-payer plan, since it wouldn’t supersede federal programs such as TRICARE, which focuses on veterans. As such, Owen Perkins, director of communications for the ColoradoCare Yes campaign, calls it “Medicare for all.”

Below is a transcript of our conversation with Perkins.

Westword: What are the reasons that folks should vote for Amendment 69?

Owen Perkins: Different people have different priorities about what they think is best about ColoradoCare. For me, it’s about getting us to the threshold where we can make sure everybody’s covered, everybody’s got access to health care. The Affordable Care Act did a good job of getting us closer. We went from over 800,000 uninsured to under 400,000. But that’s still kind of disgraceful to have nearly 400,000 people uninsured and uncovered in Colorado. So the ability to get everybody covered and everybody into the system is essential, I think, for a prosperous society like the United States and for Colorado. And to fall short of that is unacceptable.

The fact that we can do it while maintaining the benefits and saving billions of dollars a year is a tremendous bonus. And I think for a lot of people, the cost savings is the number-one reason. Ultimately, a lot of people look at their pocketbook, and for an individual or family in Colorado, they’ll be saving anywhere from thousands to tens of thousands of dollars. The overwhelming majority of Coloradans will be saving under ColoradoCare. That’s a big point for a lot of people — a good reason to pass ColoradoCare.

One things we’ve discovered, somewhat to our surprise, is that the frustration with the current system is nearly universal. I don’t think I’ve heard anyone try to make the case for the current system — the corporate-insurance, industry-based model. Everyone knows that it doesn’t work and that there are all kinds of problems with it. I think the only debate is about whether this is the right solution or not. A lot of us get tired of people who profess to want to make change but resist making the change when [they] actually have a viable solution in front of [them]. And I think that’s where we are now. I’m hoping Coloradans will take that opportunity to act on it.

How will ColoradoCare be instituted? What kind of Colorado-specific structure will be put in place?

It is a structure that will be entirely Colorado-specific, and it’s a big structure. It ends up involving thousands or tens of thousands of jobs that will be created. ColoradoCare becomes a payment system, basically. The exchange (Connect for Health Colorado, the health-insurance marketplace created under AFA) would go away, and you’d anticipate that a lot of people who’ve grown skilled at working for the exchange, if interested, would be well qualified to work for ColoradoCare.

The amendment creates a board of trustees, and then the board begins hiring the staff and putting an entire system into place: CEO, CFO, a staff, health-service information people. But it’s all on the coverage end of things as opposed to the provider end of things. ColoradoCare doesn’t encompass the providers; they don’t work for ColoradoCare. They stay in their private practices or work for hospitals or groups.

The process will take a couple of years. If it passes in November, the anticipation is that it will go into effect in January 2019. You get that time to build up, and there are a few things that are important that happen during that time. It could pass with 90 percent of the vote — I don’t anticipate that, but it could pass with an overwhelming majority — and end up not going into effect if it doesn’t get waivers from the federal government.

One of the things that happens in 2017 is, that’s the earliest anyone can apply for a waiver from the Affordable Care Act. The Affordable Care Act, I think very intelligently, created a mechanism that allows states to opt out of the act if they can create their own system. That encourages their innovation in finding a more efficient and cost-effective way to deliver and cover health care in states.

So we would be among the first states, if not the first state, to apply for a waiver from the Affordable Care Act, and that standard is very challenging. We need to show we can cover as many people or more as the Affordable Care Act at the same price or lower, with the same benefits or better. That’s, I think, an appropriately challenging standard, and to me, it’s encouraging that we’d have to meet that standard. It would have to be approved by the federal government — by the Health and Human Services Department — in order to move forward. That’s why I say we could get 90 percent of the vote, but if we’re not approved for the waivers by virtue of meeting those standards, we don’t move forward at all.

I never used to mention this, since I think it’s sort of a ridiculous situation — the idea that the federal government would grant the waivers but not give us the full funding. It seems ridiculous. They are encouraging states to be innovative and pursue the waivers through the Affordable Care Act, and it would seem bizarre to encourage states and approve the waiver and then not give the funding to make it work. But if that happens, which the Colorado Health Institute is supposing it would — and which I think that’s an irresponsible supposition — and we didn’t get full federal funding, it would not move forward. It has to get that approval and that funding from the federal government to be implemented. It requires about $13 billion of federal funding that Colorado currently gets; it requires that we get that funding in order to move forward. (Click to read the Colorado Health Initiative analysis of ColoradoCare.)

Would people be mandated to use ColoradoCare? Or could they still use private health care, or health care through their business or employer?

They won’t be mandated to use it, but they’ll still be covered. Every Colorado resident will be covered by ColoradoCare, but they can still choose to use private insurance instead, in much the same way that everyone in Colorado has access to public-school education but many choose to go to a private school and pay twice — pay the taxes for the public school and the tuition for a private school.

Everybody will be covered by ColoradoCare. For most people, that will mean they’ll be contributing a portion of their salary or their income. If people are making below the poverty level or if they’re seniors and have exemptions, they might not be paying anything and still be getting ColoradoCare. And if they’re unemployed, they’ll be getting ColoradoCare. But they don’t have to use it, and it doesn’t dictate that the private-insurance industry goes away. The private-insurance industry can stay as long as it wants. I would imagine initially that those who oppose ColoradoCare, many of them may keep paying for private insurance. But I would think that over time, they’ll realize, “I’m paying twice and my neighbor is getting great coverage from ColoradoCare — the same kind of coverage I’m getting. So I think I’ll stop paying twice for it.” And eventually, you might have the private-insurance industry essentially closing up shop in Colorado. But it doesn’t mandate that.

How do you guarantee that ColoradoCare provides service that is equal or better to the current system?

A lot of the coverage that establishes that minimum of meeting the current system — to ensure that it meets that standard — is in the language of the amendment. Some of it is about getting the Medicaid waiver, which is additional to getting the Affordable Care Act waiver, and that’s actually significantly more money than the Affordable Care Act — because ColoradoCare will essentially take over Medicaid here. ColoradoCare would be required to sustain any benefits that Medicaid offers. So anybody who’s eligible for Medicaid benefits would get those benefits under ColoradoCare.

It’s basically written into the language of the constitution. And within the constitution, you essentially want it to be a blueprint for ColoradoCare. I don’t think anyone wants the constitution micromanaging health care. So you want to find this balance of what needs to be covered, but not putting, for example, the cost of that coverage into the constitution when you know that changes over time — or the reimbursement rates, or things like that.

You get as much as is appropriate into the constitution. And I think it’s appropriate to have it in the constitution. That’s where we go to protect our rights. And I’m one of those who feel that health care should be a right, and is a right. Certainly we as a society, and me as a member of the society, I feel we have a responsibility to cover all of our residents, and if our society is taking that responsibility, I think concurrent to that, I believe everybody has a right to care. But micromanaging that in the constitution would be a little overkill.

Your opponents have three major objections to ColoradoCare. Among other things, they see it as risky putting all of this information into the state’s constitution, because that makes it difficult to change. But at the same time, they talk about the lack of specificity in the amendment, which they see as only an outline or a framework for a system — one that leaves too many questions unanswered. Could this have been done in the legislature, through statute? Or does putting it in the constitution make it more of a permanent pledge to the people of Colorado that their health care will be covered?

The latter. You do want that significant pledge. And I think we all know too well how fickle the legislature can be and how it can change as majorities change and how special interests can affect the legislature and result in something unwieldy.

That’s essentially what happened in Vermont. Vermont started with this ideal notion of getting a single-payer, universal plan to cover all their residents and then left it to the legislature to come up with how to do that. And the result, with so many legislators feeling the obligation to represent various special interests with aspects of the legislation, it became unwieldy. The costs escalated because of all the changes they tried to add, and the governor vetoed it. So you had the state accept something and then the legislature screwed it up. (Click for more information about Green Mountain Care, the failed Vermont single-payer plan.)

Those options — for the legislature to mess it up or the governor to veto it — are not an option when the people of Colorado put it into the constitution. It’s a question for them. We strongly believe this right should be defended and put into the constitution.

Obviously, this is making a change to the constitution. But I give the people of Colorado tremendous credit for making good decisions, for the most part, about what goes into the constitution. And if they make the challenging decision to accept this and put it in, I think they’ll be well situated to make changes in the future, if need be.

For example, the board can’t change the payroll-deduction rate without a vote of the people of Colorado. There are those who think they’ll never vote for an increase. But I think if they vote for this in the first place, they’re showing the ability to take on a challenging idea. The ballot language is very challenging for us, and if they can accept that, they can accept the idea of making changes in the future, if need be.

Our constitution, both nationally and in Colorado, has always been a living document. Vitally important things exist as amendments. The Bill of Rights, for example. And it’s essential that things get in when they need to get in.

Sometimes, there’s a baffling dichotomy on the opposite side of objecting to the idea that this is any way connected to government, by putting it into the constitution and collecting taxes, but at the same time also objecting to what they see as there not being enough government involvement or government oversight. But when the voters are educated about the issue — when they take the time to learn about it — they’ve shown the ability to make really wise, responsible choices. I’m comfortable with them doing it again in this case. But it is a challenge to get them educated about it, letting them know about it.

Your opponents say the measure calls for $25 billion in new taxes, and to provide some context, they note that the entire state budget is around $27 billion. They also say the new taxes would result in Colorado having the highest income-tax rate of any state in the country. Is that accurate, or an exaggeration?

It’s kind of a half-truth. The full truth is that it is $25 billion. That’s what’s called for in the language on the ballot. But the part they’re leaving out is that the $25 billion replaces the $30 billion we currently pay for health care in Colorado. That’s vitally important to understand.

I mentioned Vermont and the way they started with the ideal. Where Colorado started was with the practical, with the real. We looked at what we currently spend on health care, which is $30 billion. Families, firms, businesses, individuals currently pay that much on health care in premiums, deductibles, co-pays. We said, “Okay, $30 billion is what we spend. How do we create a better system with that budget?” And in part, when you go to a real universal health care system and get everybody into the pool, you end up saving money. We were able to find the more efficient model — take away the corporate-insurance-industry for-profit model and replace it with a Medicare-for-all model, which is based on Medicare, and takes the 20 percent administrative cost that’s associated with the corporate-insurance industry model and cuts that down to the 4 percent administrative cost Medicare uses. That eliminates 16 percent of the budget right there. It’s not where all the savings come from, but the overall savings are about $4.5 billion a year.

To talk about a $25 billion tax increase, that’s what the language of the ballot asks for — so there’s certainly truth in that. But to leave out the fact that we’re replacing the $30 billion we currently spend on health care is grossly negligent.

Our total cost of health care and income tax would be significantly less with ColoradoCare in place than it is now. That’s what we really need to look at. We’re eliminating insurance premiums, deductibles, co-pays for primary and preventive care and lowering them for other care and setting up the ability to waive them for financial-hardship co-pays. So you’re eliminating a lot of costs and replacing it with another cost that ends up being $4.5 billion less.

Your opponents also talk about a 10 percent payroll tax, which they describe as an important piece of the financing mechanism. A tax on all payroll incomes, two-thirds to be paid by the employer, one-third to be paid by the employee. But there’s also an additional 10 percent tax on non-payroll items, which would include things like savings, investments and capital gains. Is that accurate? And if so, why does that make sense in the context of the overall plan?

Yes, for most people, it’s a 3.33 percent payroll deduction, with the employer kicking in 6.67 percent. And for most people — and we’re talking about over 80 percent of Coloradans — that’s less than they’re paying now. The average Coloradan is paying closer to 12 percent — considerably higher than 3.33 percent. And the average employer is kicking in around 13.5 percent for employee health care. So both of those costs that people are currently enduring are replaced at what, for most people, is a lower cost of 3.33 percent. And that’s where the $25 billion comes from.

That’s part of the simplification process of eliminating a system that is bogged down in bureaucracy, because there are all the insurers and all the different plans each insurer has, which can add up to hundreds of options, and which create this unbelievable bureaucracy in medicine. And the number of bureaucrats in health care has skyrocketed since 1970, as opposed to the number of providers, which has stayed fairly consistent, growing at a smaller, more natural pace. But this explosion of bureaucratic entanglement in health care has created a kind of cottage industry for bureaucrats in health care. You eliminate that and go to a Medicare model where it’s all going to one place and they’re reimbursing without that profit motive — and when you eliminate the profit motive, you eliminate the incentive for denying coverage that so much of the insurance industry is consumed with right now. You get, essentially, an independent, nonprofit cooperative that’s owned by the people of Colorado and doesn’t profit from it — that exists to make a good environment for patients and providers. Their goal ends up costing less when you take out that profit motive that corporations are focused on.

We’re seeing millions of dollars going to the Coloradans for Coloradans campaign, and the vast majority of their funding comes from corporations — and most of that’s related to the health-care industry. Big Medicine, Big Pharma — and a huge percentage of that is coming from out of state. (Figures from September 19 show that $3,935,950 of $4,003,067 contributed to opposition group Coloradans for Coloradans came from corporations and business entities. The top four, whose contributions exceed $2 million, are from Ohio, California, Connecticut and Tennessee, respectively.) And that’s natural, because that’s their profits we’re talking about, and which they’re trying to defend. But those profits come at the expense of patient care in Colorado. So this is a real commonsense attempt to put patients over profits in the same way that Medicare does it. And Medicare has, for a long time, been considered the most popular and efficient government program out there. To use that as a tried-and-tested model makes immense good sense….

A lot of national organizations have been encouraging their supporters to support ColoradoCare, including Bernie Sanders and Our Revolution (a political organization created in late August). I think that’s a huge chunk of donations to ColoradoCare. It’s something we’ve anticipated coming for a long time. Bernie endorsed at the end of August. We anticipated he would as soon as he was through with his race. And he put it as a priority for the political-action group that he started. It’s one of I think seven ballot issues they’ve targeted around the country — things that fulfilled his vision and were in sync with his platform…. It’s one of the two or three biggest platform planks that has a chance to be enacted, and it’s here in Colorado.

Bernie Sanders knows and has said that if Colorado passes it, it will have an effect beyond Colorado. The reason the insurance industry is pouring millions of dollars into defeating it is not because of the money it will lose in Colorado, but because of the fear that other states will begin following that trend, just as they did with women’s suffrage, with child-labor laws, with minimum wage, with marriage equality, with interracial marriage, with recreational marijuana, and on and on. These things start at the state level and then reach a tipping point nationally as they become accepted.

The same thing happened in Canada with universal health care. It started in one province there — Saskatchewan — and then everyone saw how well it worked there. But rather than everyone moving to Saskatchewan, as the opposition claims will happen in Colorado if ColoradoCare passes, they moved that great idea from Saskatchewan to their own provinces and adopted it, and very soon had national universal health care. That’s what a lot of people expect will happen if Colorado passes it. And I think that’s what the insurance industry fears — getting a national, single-payer system. (Click to read more about the history of health care in Canada.)

To clarify, we’re not single-payer. Because Medicare still runs, and so does TRICARE for veterans, that keeps this from being purely a single-payer plan. But it’s similar. It’s understandable that people get it confused. But basically, it’s a Medicare-for-all program that does for Colorado what Medicare does for seniors. If you live here, you’re covered.

Are you pitching ColoradoCare not only as something that’s good for Colorado, but also as something that could go national? Or is it more important from your perspective that voters here look at how it will benefit them?

I think it’s more important for voters to look at how it benefits them in this state. So we probably don’t pitch the national aspect. But they’re one and the same. What’s good for Colorado is good for the nation. It makes the same economic sense; it’s the same moral-responsibility argument. It doesn’t really need to be separated. A lot of detractors say, “I’d like to see it on the national level, but I don’t want Colorado to start it on the state level.” But that’s how it’s going to happen. It’s going to start on the state level, and all the arguments for doing it nationally pretty much apply to starting it on the state level. It’s good for Colorado in terms of fulfilling our moral imperative as a society and saving us billions of dollars as a state and thousands or tens of thousands for individuals and families. It’s good any way you look at it.

As you’ve noted, your opponents are very well financed. Has it been a challenge to get your message out in the face of their resources? Or are you finding that word of mouth is working? And are you optimistic about the outcome?

It is a challenge. I think we’re all optimistic in that we know from polling that when people know about ColoradoCare, they like it and would vote to support it. The challenge is making sure they know about it. We have done a pretty good job all the way through in keeping up. It’s been a phenomenal grassroots effort. Our budget has been minuscule compared to the opposition…but the bottom line is, we need to make sure people know about it and understand it.

I think as we’ve gotten into the home stretch and those millions of dollars from the opposition have come into play with on-air ads, on TV for the most part, it’s been more challenging to keep up with. But the recent influx of donations will allow us to get on the air. We haven’t been on the air yet, but we’ve had something like 485 past and future presentations and speaking engagements and debates all over Colorado. I think about 125 of those have been debates. Reaching out, speaking to groups anywhere from a dozen to 500, has been effective. We’ve certainly been on the ground, knocking on doors and making phone calls. Every kind of grassroots tactic we can use to get the word out we’ve used, including a real aggressive volunteer effort to write letters to the editor and also to earn a lot of media attention. That’s helped us keep pace with the opposition, which has ten times the funding we have.

These last weeks, TV ads play such a big part — and it’s always tricky to figure out how they’re going to play. I think we’ve seen a lot of elections where TV advertising backfires. And certainly, I’ve heard from a lot of people who say the more they see of these ads, the less they trust them.

So, yes, it’s a challenge. But we know that when people know about it, they like it. And that gives us the drive to keep going, keeping doing everything we can to make sure Coloradans know the facts about it.

http://www.westword.com…

PNHP has published a brief evaluation of the ColoradoCare ballot initiative, here.

Canadian Medicare on trial

Could this be the beginning of the end for the Canadian single-payer system?

By Danielle Martin
DEMOCRACY, October 3, 2016

There’s an old joke that Canadians like to tell: What’s a Canadian? A gunless American with health care.

It’s only funny because we half-believe it’s true; despite the many things we have in common with our friends south of the 49th parallel, Canada’s single-tier, publicly funded health care system has long been a point of differentiation—and pride—for most Canadians. A 2012 poll found that our health care system—known in Canada as “Medicare”—was almost universally loved, with 94% of those surveyed calling it an important source of collective pride. The notion that access to health care should be based only on need is a deeply ingrained Canadian value.

But we can’t take our Medicare system for granted.

The challenges to Canadian Medicare have always been ideological and political. But, as of this month, they are also legal.

In the western province of British Columbia, a trial underway in that province’s Supreme Court is challenging the very foundations of Medicare: providing care based solely on need, and not on ability to pay.

Cambie Surgeries Corporation and the Specialist Referral Clinic, represented by Dr. Brian Day, an orthopedic surgeon in Vancouver, are suing the government of B.C., trying to knock down the laws that protect our single-payer system. If successful, some Canadians will be able to pay out-of-pocket or through private insurance for hospital and physician services—and doctors will be able to charge them whatever the market will bear.

The essence of the claim is that, because wait times for some elective surgeries in that province are longer than we would like them to be, doctors should have a constitutionally protected right to provide them more quickly and at a higher price. This would be done by charging some patients privately, either out-of-pocket or through private insurance. They allege that existing limits on charging patients privately infringe on patients’ rights to life, liberty, and security of the person under Section 7 of the Canadian Charter of Rights and Freedoms.

It is also worth noting recent efforts at tackling the main driver of this constitutional challenge: wait times for non-urgent surgery. These have come from within the public system, and include wait time targets, centralized intake for people with a common problem, and inter-professional health-care teams so that surgeons’ time does not create a bottleneck. Such initiatives show tremendous promise for reducing waits deemed unreasonable, but governments need to implement them, and health-care organizations and doctors need to help accelerate this kind of reform.

It may be that the Cambie plaintiffs will be unsuccessful in their quest to dismantle the essence of Medicare, but clearly the stakes for ordinary Canadians are very high. Like all developed countries, Canada struggles to control growth in health-care costs, meet the needs of an aging population, and provide timely care of the highest standard. Whether we continue to work to do so for all Canadians, or only some, will, in part, be determined by the outcome of the Cambie case.

Danielle Martin is a family physician in Toronto and Vice President, Medical Affairs and Health System Solutions at Women’s College Hospital.

http://democracyjournal.org…

***

Comment:

By Don McCanne, M.D.

The single payer model in Canada is closest to the ideal model of public financing/private health care delivery supported by Physicians for a National Health Program (PNHP). That model is now under legal challenge in Canada. If the Cambie lawsuit succeeds, the very concept of providing health care based on need rather than ability to pay will have suffered such a blow in the international community that we may never achieve that goal in the United States.

The trial will last an estimated six months and then will surely be appealed to the Supreme Court of Canada. Now, more than ever, Canadians need our moral support. And, oh yes, we need theirs.

Bill Clinton Is Right, For-Profit Healthcare Is the ‘Craziest Thing in the World’

Beneath the misleading headlines and corporate spin, former president gave a robust argument in favor of single-payer system

By Lauren McCauley
Common Dreams, October 4, 2016

Bill Clinton gave a robust argument in favor of a single-payer healthcare system on Monday night—but you wouldn’t know it if you read the news, or paid any attention to Republican nominee Donald Trump.

Speaking at Hillary Clinton campaign rally in Flint, Michigan, the former president discussed the importance of expanding access to Medicare and Medicaid while lambasting the for-profit insurance model that overcharges people and reaps enormous profit.

“The insurance model doesn’t work here,” he said, “it’s not like life insurance, or casualty insurance. It doesn’t work.”

“The current system works fine,” Clinton continued, referring to President Barack Obama’s Affordable Care Act (ACA), “if you’re eligible for Medicaid, if you’re a lower-income working person; if you’re already on Medicare, or if you get enough subsidies on a modest income that you can afford your health care. But the people that are getting killed in this deal are small business people and individuals who make just a little too much to get any of these subsidies.”

“Why?” he asked, “because they are not organized, they don’t have bargaining power with insurance companies and they are getting whacked.” As Clinton explained, insurance companies assessing risk for a small pool of people “overcharge, just to make sure, and make a whopping profit off the people least able to pay.”

“So you’ve got this crazy system where all of a sudden 25 million more people have health care and then the people who are out there busting it, sometimes 60 hours a week, wind up with their premiums doubled and their coverage cut in half. It’s the craziest thing in the world,” he continued.

Adding his voice to the growing call for a public option to be added to ACA, he said that the “simplest thing” is to let those individuals not eligible for subsidies buy into Medicaid and Medicare—a plan which is supported by Democratic nominee Hillary Clinton and her former challenger Sen. Bernie Sanders, as well as Obama.

After corporate media spun the remarks with the “grossly inaccurate” headline, “Bill Clinton calls Obamacare ‘the craziest thing in the world,'” Trump’s campaign predictably seized on the moment, issuing a statement that read: “even Democrats like Bill Clinton are coming to realize just what bad public policy ObamaCare really is.”

But as Clinton himself pointed out, allowing the market to take over has left the United States with the most expensive health insurance system, with the least number of people covered. According to the most recently available U.S. Census Data, 29 million people went uninsured in 2015, including 3.7 million children, and despite ACA, deductibles and other out-of-pocket costs continued to rise.

As proponents have argued, the “simplest thing,” in fact, would be to forgo the public option and enact a government-run, single-payer healthcare system, under which all citizens are covered.

Dr. Ida Hellander, director of policy and programs with Physicians for a National Health Program (PNHP), said that “when people talk about the public option, they are acknowledging that it’s the public part of the program that’s working.”

Clinton, she told Common Dreams, “seems to understand that but he’s not going all the way there,” likely because Secretary Clinton has also stopped short of calling for a single-payer model. However, she points out that this is not the first time the former president has voiced support for a universal system.

Agreeing with Clinton’s statement that “the insurance model doesn’t work here,” Hellander added: “The profit-driven, market-based healthcare model based on private insurance doesn’t work, and it will never work.”

http://www.commondreams.org…

Extend Medicare to everybody

By Jack Bernard  
The Citizen (Fayetteville, Ga.), Oct. 4, 2016

Megan McArdle, a well-known national writer for Bloomberg View, has put forth herself as an impartial expert on our healthcare system. However, I have found this piece (9-7-16, Citizen and 8-31-16, Bloomberg View) and other McArdle columns lacking in balance and solutions, not that what she says is necessarily wrong about the current situation.

For example, what she does not say is that the most recent data show that the ACA, Obamacare, has drastically reduced the number of uninsured. According to the National Center for Health Statistics, in the first quarter of 2016 there were “21.3 million fewer persons than in 2010” who were uninsured. That is quite an accomplishment, even though it still leaves 12% of our adult population uninsured, a bit less than 30 million people.

On the other hand, most of what she says about the ACA is true. It is a highly political “Rube Goldberg” rigged mess. Problems such as adverse selection, driving up costs for insurers who will then be forced to leave the market or raise rates, were entirely predictable. Years ago, my letters that were published in the Washington Post and USA Today indicated that virtually all of this would occur.

However, her analysis is incomplete. Although she briefly alludes to certain ACA provisions as halfhearted watered down versions of what works in Europe, she does not say is that the basic coverage and cost problems in the USA are due to our fragmented private insurance system.

It was and is this same system, via corporate lobbyists, that throws money at politicians so that nothing (including access, quality or cost) gets in the way of the corporate profit motive. It was corporate money and clout that pushed the ACA through Congress. Remember who funded the ads.

As she says, it’s the “political calculation,” and it is both parties who are guilty … aided and abetted by the relatively recent naive (read the decision to see how SCOTUS believes money has little effect on our politics) and disastrous Supreme Court decision known as Citizens United. How a supposedly conservative court can encourage the buying of our politicians is just beyond me.

But, my biggest problem with McArdle is that she appears to have no suggestions to clean up the malfunctioning system long term. A recent McArdle single payer (Medicare expansion) piece in Bloomberg purposefully misunderstands and excuses away the basic problem, our irrational healthcare financing and delivery system. In fact, the aim of that entire article seems to be to blindly accept the mess that we currently have because, in her words, “the politics is impossible” and there is a problem with “constitutionality,” whatever that means to her.

Further, she makes the incorrect assumption that single payer advocates believe that Medicare expansion will “magically transport us to the land of cheap health care.” I have been involved with single payer for many years and I know of no advocate who has said it will be easy. In fact, that very difficulty is the reason that both Obama and Trump have said that they could not support single payer, although both have made positive statements about it.

Let’s start with what McArdle gets right in her Bloomberg column. The U.S. spends a lot more per capita than any other country on healthcare, per her chart in that piece, and a lot of public dollars on a variety of government healthcare programs. And, our system does not deliver better results, an inconvenient fact which she ignores but that many healthcare experts know to be true.

We spend much more of our GDP on healthcare than other developed nations. When I became Director of Health Planning for the state of Georgia in the mid-1970s, we spent about 8 percent of GDP. We are now at about 18 percent … and still growing. What this means to the taxpayer is that we cannot make investments in other long-term priority areas, like education or alternate energy models, that are vital for the future of the nation.

With our current fragmented system, key players (providers, insurers, big pharmaceuticals) hold all the winning cards. That can only be changed if there is one payer, Medicare, with enough clout to force change. McArdle ignores this fact and others, incorrectly stating that private insurers (20 percent admin/marketing overhead) are just as efficient as Medicare (3 percent).

McArdle’s unstated conclusion in that piece and this current one as well is to just acknowledge that change is too hard to accomplish. So, let’s just complain and do little.

That position is a cop out and one that hurts this nation economically … and morally. What we need are leaders willing to look at the facts, fight the entrenched special interests and pass Medicare for All.

Jack Bernard resides in Peachtree City, Ga.

http://thecitizen.com…