PNHP

Insurance decisions raise stress

Insurance decisions raise stress

By Carol Paris, M.D.
The Tennessean, Letters, Oct. 4, 2016

I’ve just received my letter from Blue Cross Blue Shield of Tennessee informing me that they have reached “the difficult yet necessary decision” to withdraw from the Nashville market.

In one more year I can finally get some piece of mind; I will turn 65 and qualify for Medicare. What about my daughter and her family and all the other Tennesseans affected by this decision?

Once again, needless time will be spent exploring diminishing options and undoubtedly deciding to accept more risk (and stress) in the form of higher deductibles and co-pays so that monthly premiums can be worked into the already strained family budget.

This stress has become an epidemic in this country and it has a name: PIISD (pronounced “pissed”), Private Insurance Induced Stress Disorder. If you avoid seeking medical care because of cost, if you can’t afford to take needed medication as prescribed because of cost and worst of all, if you avoid talking about this because you feel ashamed and alone, you meet the diagnostic criteria for PIISD.

Although the majority of the American population has gotten PIISD, we have not decided to demand the cure, an improved and expanded Medicare for all. What is it going to take?

Dr. Carol Paris resides in Nashville.

http://www.tennessean.com…

Harvard’s shameful stance on insurance for low-income employees

Harvard’s low-income workers deserve affordable health insurance

By Micah Johnson and Sanjay Kishore
STAT, September 30, 2016

There’s an outbreak of a hidden epidemic — unaffordable employer-based health insurance, especially for low-income workers — at Harvard, a place where it should never occur.

As medical students at Harvard, we were deeply troubled to learn that our university was proposing changes to dining workers’ health plans that would make essential health care unaffordable. After months of negotiation, the dining workers’ union voted to authorize a strike, which will launch on Wednesday if a deal is not reached. The campus has rallied around the workers, circulating a petition of support signed by 2,500 students, including us, in advance of federal mediation held earlier this week.

In the dining workers’ fight with Harvard, we see a microcosm of current challenges for health insurance across America.

The affordability of health insurance plans comes down to two factors: premiums and out-of-pocket costs. How affordable are employer plans? A team of Harvard medical students compared the plan Harvard proposed for the dining workers to what would be available on the Massachusetts health exchange.

For a family of three earning $30,000, the Harvard plan requires an employee to contribute a premium of $233 a month, while the health exchange has plans that require no premium at all. Harvard Medical School faculty and the World Health Organization have defined any health spending over 10 percent of annual income as a catastrophic expenditure. The Harvard plan comes perilously close to this with premiums alone. The cherry on top? Harvard’s plan also has higher co-pays than the exchange plans.

It is shocking that these low-income workers would be better off financially if they were not offered employer-sponsored insurance.

This may seem confusing. After all, exchange plans have been lambasted for their soaring costs. But the sobering truth is that the situation is worse among employer-provided plans. A recent Urban Institute study showed that total premiums were lower in exchange plans than in employer-provided plans in more than 80 percent of major US markets. In Boston, the premiums for exchange plans were 35 percent less expensive than employer plans. The gap would likely be even larger for lower-income employees, who would be eligible for more robust subsidies in the exchange plans.

Harvard’s proposal for its dining workers threatens to widen health disparities along lines of race and class. Many of the dining workers are immigrants, over half identify as people of color, and nearly half earn less than $35,000.

Innovation in health care is more likely to happen when big employers, rather than low-income workers, feel the burden of health care costs. Institutions like Harvard hold tremendous untapped power to implement novel programs and pressure health systems to make badly needed reforms.

Not every creative intervention will work. But only by moving beyond the status quo will we learn which new ideas have real benefits. Simply making poor families pay more for essential services like insulin prescriptions and hospital admissions is an unacceptable cop-out.

As physicians in training, we cannot stand by as the world’s richest university forces its most vulnerable employees to choose between dinner and a doctor’s visit. Harvard can do better, and this “better” can have a ripple effect on other unions, other universities, and other workplaces across the nation. Employers like Harvard must pursue real innovation, not simply balance their budgets on the backs of those least able to afford it — and least likely to survive it.

Micah Johnson and Sanjay Kishore are second-year students at Harvard Medical School.

https://www.statnews.com…

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Harvard students freak out as dining hall workers prepare to strike: ‘I don’t need to worry about where my food is coming from’

By Meg Wagner
New York Daily News, October 4, 2016

Harvard’s dining hall staffers are about to go on strike, much to the dismay of starving, stressed-out students.

“I understand it’s for legitimate purposes, but I’m worrying about midterms right now,” freshman Sofia Garcia told the Washington Post. “I don’t need to worry about where my food is coming from.”

It’s unclear if students — who pay a whopping $36 a day for unlimited dining hall access — will be refunded for any lost meals.

Union negotiator Michael Kramer said the 750 workers demand “the ability to earn at least $35,000 a year and a health insurance program that does not shift costs onto those who can least afford it.”

The university countered that the workers receive “some of the most generous hourly wages and benefits” for food service workers in the region and that it is proposing “modest” health care changes already accepted by thousands of other unionized university workers.

http://www.nydailynews.com…

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Comment:

By Don McCanne, M.D.

Creeping deterioration of employer-sponsored health insurance seems to lie in the background as concerns are directed to many other more obvious deficiencies in America’s dysfunctional health care financing system. But creeping deterioration is occurring and the seriousness of it is demonstrated by Harvard – an employer that should be carrying the banner towards comprehensive reform but instead is shamefully joining the trend toward shifting unaffordable health care costs onto its employees, seriously impacting affordability and access especially for its lowest wage employees.

It is gratifying to see that two of Harvard’s medical students, Micah Johnson and Sanjay Kishore, are joining in the effort to publicize the plight of low-income Harvard employees in their stalled negotiations over maintaining essential health benefits.

But Harvard defends itself by saying that the reductions are modest and commonplace, while Johnson and Kishore suggest that we need to experiment with creative intervention. And student Sofia Garcia simply doesn’t want to worry about where her food is coming from during the strike.

We have decades of creative intervention and that has only resulted in the highest costs and the most dysfunctional health care financing system of all industrialized nations.

This problem is much greater than being simply a negotiating point in a labor dispute. Harvard, their students, and everyone else needs to demand enactment of a health care financing system that will make health care affordable and accessible for all of us – a single payer national health program. Harvard’s dining hall staffers might still need to negotiate for decent wages, but at least they would have affordable and accessible health care permanently.

Ask Minnesota if the individual insurance market is stable

Individual health plan premiums to jump at least 50 percent in Minn.

By Christopher Snowbeck
StarTribune, September 30, 2016

Health insurers are hiking premiums and limiting enrollment in Minnesota’s individual market next year, with regulators saying the emergency measures were needed to avert a market collapse.

The moves are a clear sign that the market for some 250,000 people who buy coverage for themselves is dysfunctional and needs reform, said Commerce Commissioner Mike Rothman during a Friday news conference.

While rate increases of more than 50 percent aren’t fair to consumers, Rothman said, things could have been worse. He described a period this summer when all health insurers in the state seemed prepared to abandon that segment of the market.

The premium jumps and enrollment caps are confined to the individual market, where about 5 percent of state residents buy coverage. The market includes the MNsure exchange and has undergone significant changes with the federal Affordable Care Act.

Premiums will jump by an average of 50 percent to 67 percent, depending on the insurer. Regulators also are taking the unusual step of letting most health plans limit the number of enrollees they’ll cover.

The caps will pressure consumers to shop early during the coming open enrollment period, since some plan options could disappear once insurers hit their limits. And regulators say the policies being sold for next year will feature tighter controls on the doctors and hospitals that enrollees can use.

The premium hikes and enrollment caps amount to a “finger in the dike” that’s meant to buy time while the state figures out what to do, said Jim Schowalter, chief executive of the Minnesota Council of Health Plans, a trade group for insurers.

“What I think no one really appreciated until today was the trouble that the insurance market is in,” Schowalter said. “This announcement is another sign that how people are getting their own insurance isn’t working.”

“These rising insurance rates are unsustainable and unfair,” Rothman said. “Middle-class Minnesotans, in particular, are being crushed by the heavy burden of shouldering these costs.”

http://www.startribune.com…

***

Comment:

By Don McCanne, M.D.

We keep hearing that ACA is working as intended, that all we need to do is enroll more younger, healthier individuals in the plans and all will be well. Ask the people in Minnesota how it is going. And they certainly are not the only state with problems.

Our politicians on the one hand tell us that all we need is a couple of patches, and on the other hand tell us that we should dump the system and let the markets work. Well, the system is not amenable to patches – we need comprehensive reform of the financing infrastructure – and the market cannot possibly work when prices far exceed the discretionary income of most of those who need health care.

The current patches in Minnesota include large premium hikes, and allowing the insurers to put limits on the total number of enrollees. Those patches might help the insurers, but for patients they make insurance less affordable and less accessible. Wasn’t reform supposed to take care of patients?

Regular readers know what would work – a well designed single payer national health program. Everyone would be covered by a system that would be affordable for each one of us. Minnesota should be leading the way on this.

Let’s aim to be happier with ColoradoCare

By Chris Schwab
The Coloradoan, Letters, Oct. 3, 2016

I guess I’m supposed to laugh when I see the cutie-pie anti-Amendment 69 ad that has been popping up on TV — but the only reaction I seem to be having is my blood pressure rising. The big-money, fact-distorting ad tries to scare us with the specter of state bureaucrats running health care — but leaves out the fact that health care is now run by for-profit corporate bureaucrats who fundamentally make their money by not providing health care — a huge, huge incentive to provide as little money as possible for care and keep as much as they can for themselves.

Before taking the heavily biased advice of some superficial ad on TV, you might want to try a few things first: Google “best medical systems in the world.” I believe you will find a vast majority of systems more in line with what Amendment 69 is proposing 1 than with the system we have now that siphons off money for sky-high administration costs. While you are at it, you might try googling “happiest countries”; see any correlation? Finally, get the advice of boots-on-the-ground medical professionals such as those at Physicians for a National Health Program, my son the doctor, and my daughter the pharmacist — all who are sickened by seeing health care money not going for actual care.

I would love to see the pro-Amendment 69 people counter with their own ad — maybe something with vampires? Vote yes on Amendment 69! Hey, even Donald Trump has been quoted as being in favor of the concept. 2

Chris Schwab lives in Fort Collins.

http://www.coloradoan.com…

Endnotes

1. PNHP has published a brief evaluation of the ColoradoCare ballot initiative, Amendment 69, here.

2. During the Aug. 6, 2015 Republican primary debate, Donald Trump claimed that single payer “works in Canada.” This is true. During the Oct. 9, 2016 general election debate, Donald Trump claimed that Canadian Medicare was “catastrophic in certain ways.” This is false. For more information on myths related to Canadian health care, click here.

The Affordable Care Act presents challenges for college students

By Aldebra Schroll, M.D.
KevinMD Blog, Oct. 1, 2016

The school year is back in session, and our student health center is busy.  As a college health doctor, I have been able to watch the rollout of the Affordable Care Act (ACA) among this population. Since its passage, more of our students are now insured, but many unique challenges still persist for this population.

Young adults have historically demonstrated high rates of un-insurance. An estimated 30 percent of those 19 to 25 years old were uninsured prior to passage of the ACA. They may have been working in jobs that did not offer coverage. Often, they had been excluded from health care when they aged out of their parents’ plan, or they were denied access due to pre-existing conditions.

Referred to as the “young invincibles,” young adults are considered an important part of the insurance marketplace. This population is generally healthy, not requiring a great deal of medical care, thus providing a balance by subsidizing the older, usually sicker population. The concern is that without the young adults buying health plans, the insurance exchanges will be burdened with the cost of an older, sicker population producing what has been called a “death spiral” where in the cost of insurance rises beyond what people can afford.

Since passage of the ACA, young adults have benefited with an expansion of health insurance coverage allowing them to stay on their parents’ plan until the age of 26. An estimated three million young adults have gained coverage through their parents’ health insurance plans. However, that assumes the parents have a health plan. I frequently find our students have been uninsured and had no regular access to health care in the years prior to arriving at college.

For those who are covered under a family plan, there is a cost in terms of privacy. College students are young adults; many of whom prefer to have their medical needs managed without parental knowledge or oversight. Those who remain on their parents’ healthcare plan into young adulthood often express concerns about their privacy. This is particularly apparent when addressing issues of sexual health, psychiatric care or treatment for alcohol or drug abuse. Although their medical chart remains private; if they use their insurance for a referral, testing or treatment, the explanation of benefits (EOB) will go to the primary insurance holder, usually a parent. At an age when medical providers are trying to encourage this population to take on the responsibility for their health; this is a persistent challenge.

Furthermore, I have found the policy to rescind insurance coverage at the age of 26 to be arbitrary. Many of our graduate and even undergraduate students are still enrolled at this age. Suddenly they find themselves uninsured, which can lead to major interruptions in their health care management, particularly for those who have an emergency, need hospitalization or specialty care.

Another concern for this population is cost sharing and issues of underinsurance. Cost sharing for silver plans is about $3,000 and over $5,000 for the bronze level plans. When considering the increasing costs of higher education, the added expense of health care can stretch the budget of a student, creating another stressor.

Expansion of Medicaid has also aided young adults; particularly in those states that agreed to accept the Medicaid expansion. Unfortunately, twenty states have chosen to “opt out” of the Medicaid expansion. This has led millions of citizens to find themselves in the “coverage gap.” They do not qualify for tax credits to purchase a plan; while at the same time, they are ineligible for coverage through Medicaid. This is a common dilemma for students who are working while attending college.

For our students who are eligible for Medi-Cal, the California State Medicaid program they often wait several weeks to get enrolled and then find there are no local providers taking new patients. For those who are enrolled in managed care Medi-Cal in their county of origin but attending school in another county, sometimes hundreds of miles away, they find themselves out of network, limiting their access to care. This issue also arises when students enroll in a private plan, then relocate to attend college far from home.

Meeting the needs for students with mental illness is a growing concern for campuses across the country. Greater numbers of students arrive on campus, having previously been treated for mental health issues. Finding appropriate specialists that are in network and taking new clients is a constant struggle for a semi-rural campus such as ours.

Many of our students remain uninsured for a variety of reasons. They may not understand or see the need to get coverage. Some find “shopping” for options on the state website to be daunting. They are also confused thinking that having access to our student health services is the same as insurance.

Despite the implementation of the ACA, our current health care delivery system is convoluted, creating a maze of challenges to those seeking care. It is inefficient and enormously costly, rife with bureaucratic waste. A single-payer national health system would provide comprehensive health care through a system that covers all medically necessary care, with simple enrollment and allowing the free choice of doctor. Such a plan, often referred to as “Medicare for all” would save an estimated $400 billion a year by eliminating the costly administrative expenses associated with the private insurance industry. Anticipated benefits include the elimination of the insurance networks that bind people to a particular geographic area. Further benefits are anticipated through job growth; as employers would no longer carry the burden of providing health care insurance.

The Affordable Care Act was a laudable attempt at guaranteeing health care access to all. However it has fallen far short. Millions remain uninsured; those who obtained coverage must deal with high co-pays, deductibles, and limited networks. The college-age population has many unique challenges as they transition to adulthood and take on the responsibility for managing their health care needs. This population could benefit greatly in a single-payer health care model offering affordable, comprehensive coverage, with geographic flexibility while ensuring their privacy.

Aldebra Schroll is a family physician.

http://www.kevinmd.com…

How would a Medicare buy-in and a public option be designed?

Designing a Medicare Buy-In and a Public Plan Marketplace Option

By Linda J. Blumberg and John Holahan
Urban Institute, September 2016

Medicare is an attractive basis for developing an insurance alternative (either a direct buy-in or a public option based in some way on Medicare rates) because the program generally has lower provider payment rates and lower administrative costs than private insurers. However, Medicare’s structure and cost-sharing requirements are different from private insurers’ as well. A Medicare-related proposal could provide more plan choice for those eligible, which would have a significant effect where few or even only one insurer offers coverage in the nongroup insurance market. Depending upon how the proposal is structured, it could reduce costs for younger adults in the private insurance market as older adults leave the risk pool. However, designing such programs raises myriad issues, each with specific implications for costs and benefits to different age groups.

Medicare Buy-In for 55- to 64-Year-Olds

We assume that a Medicare buy-in option would offer enrollees the same covered benefits and cost-sharing structures offered to current Medicare beneficiaries. Even so, a buy-in directly into the existing Medicare options would lead to questions necessitating policy decisions:

*  Would potential enrollees have the choice of traditional Medicare, Medicare Advantage, or both?
 
*  Would eligibles be able to choose between a Medicare option and Marketplace-qualified health plans for which they are currently eligible, or would Medicare be their only option outside of employer-sponsored insurance?

*  Would enrollees be allowed to make separate purchase decisions for Medicare Parts A, B, and D, or would they have to purchase all if they purchase any? How will consumers respond to offers of coverage that, unlike private insurance options, have no out-of-pocket maximum? Would Medigap or some other supplemental plans be available to the 55- to 64-year-olds?

*  How would the unsubsidized cost of coverage be determined? For example, what premium would be charged to individuals with high incomes? Would 55- to 64-year-olds be charged the same premiums as those age 65 and older, even though the premiums would not reflect the cost of coverage for those enrolled? Or would actuaries set premiums based on the benefits provided and cost-sharing requirements for each component? Would the high income surcharges in the current Medicare program apply to the buy-in population?

*  Assuming that 55- to 64-year-old enrollees would not pay the same premiums as current-law Medicare enrollees, would premiums reflect the health care costs of only the 55- to 64-year- olds enrolling? Or would premiums be set to reflect enrollees’ health care costs being shared by others? For example, their costs could be shared with other nongroup market enrollees or perhaps with current-law Medicare enrollees, but that would require the development of a mechanism for achieving it.

*  Would the 55- to 64-year-olds buying in to Medicare be eligible for financial assistance similar to that for Medicare beneficiaries today (e.g., 75 percent of Medicare Part B costs for all but the high-income beneficiaries? Would they be eligible for ACA-like financial assistance, advanced premium tax credits and cost-sharing reductions? Or would no financial assistance be offered at all? If subsidies are provided, how would they be structured? Would actuarial differences between Medicare and Marketplace silver coverage be taken into account, affecting both advanced premium tax credits and cost-sharing reductions?

*  Would 55 to 64 year olds with access to an affordable employer insurance plan be permitted to enroll in a Medicare buy-in option?

A Public Option for All Age Groups

A public option is a qualified health plan that would be sold through the ACA’s government-created Marketplaces (either federal or state). The public option would bear health insurance risk like other insurers, complying with the ACA’s insurance reforms (e.g., modified community rating, guaranteed issue, and essential health benefits) and offering coverage in the same actuarial value tiers.

A public option avoids complexities associated with a Medicare buy-in for 55- to 64-year-olds. Because the option would be structured and operated in much the same way as any other Marketplace-qualified health plan, it would not have different actuarial values, cost-sharing structures, or premium structures than other Marketplace options. The appropriateness of applying a Marketplace subsidy structure to a Medicare product would not be an issue, and risk-sharing questions across different age groups would not arise. Yet several design decisions would remain:

*  How would provider payment rates be set? Would they be set consistent with Medicare rates, set consistent with Medicare rates plus some percentage, or based on some other fee schedule? Many states have self-insured plans for their employees; this is another potential platform for creating a public option offered in a state Marketplace.

*  If rates are set at the Medicare level (or at some other level that falls below those paid by private insurers), what leverage would the plan have to ensure sufficient provider participation? How does a state’s leverage compare with that of the federal government in this respect?

*  Should public options be set up in all geographic areas or only those with high premiums, high premium growth, or otherwise weak insurer or provider competition? If the latter, who will judge appropriate locales, and by what metric will an area’s appropriateness be assessed?

From the Summary

Regardless of the approach taken, providers are likely to resist new insurance options that may move more patients into plans paying lower rates. While this is to be expected, it highlights the perpetual quandary of health care cost containment. Health care spending and its growth cannot be reduced without either paying less, on average, per unit of service rendered or reducing the quantity of services provided. No matter the strategy for containing costs, achieving that goal will take money out of the pockets of providers. To protect providers financially means abdicating cost-containment efforts of any type.

http://www.urban.org…

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Comment:

By Don McCanne, M.D.

There is considerable enthusiasm for expanding on the advances of the Affordable Care Act by adding a Medicare buy-in for those 55 to 64, and by adding a public option – an insurance program run by the government competing with private health plans. What is lacking in this discussion is a precise description of either proposal considering that there are a multitude of policy options that must be decided on in order to construct these programs.

In this Urban Institute paper, Linda Blumberg and John Holahan discuss some of the design options, and there are many more. Each option has its own advantages and disadvantages, so it is inevitable that the eventual design would forge a compromise between benefits and deficiencies. Building these two programs on top of our highly fragmented financing infrastructure inevitably perpetuates inefficiencies.

Each program would require an act of Congress. We need only to look at the insurance industry influence in the legislative process that developed the designs for the private insurance exchanges under ACA, for the Part D Medicare drug program, for the private Medicare Advantage plans, for the privatization  of the Medicaid programs, for the previous public option proposals that never got off the ground, and for the co-op model that is failing in the marketplaces, and it will be obvious that the Medicare buy-in and public option will be designed to maximize the leverage of the private insurance industry at a cost to potential enrollees and taxpayers. The insurers will introduce features that are designed to make public programs noncompetitive or even cause them to fail.

When you hear people advocate for a Medicare buy-in or for the public option – and those people are everywhere – demand that they show you their model that was distilled from the multitude of policy options. (Be sure to read the Blumberg and Holahan paper so that you understand at least some of the issues.) Without such a model, the design will default to the private insurers.

Once advocates present their definitive model then analyze it to see how well it meets our reform goals. Will it ensure that everyone is covered? (No) Will it slow the increase in health care costs? (No) Will it ensure that everyone has free choice of health care professionals and institutions? (No) Will it remove financial barriers to care? (No) Will it fill in all of the gaps in coverage of our traditional Medicare program? (No)

Efforts to enact a single payer national health program are rejected because the program supposedly is not politically feasible. Does anyone really believe that a Medicare buy-in and a public option would be politically feasible in a Congress dominated by conservatives and neoliberals? It’s not the goal of a single payer model that needs to be changed; it’s the politics. That takes work. A lot of it.

A Productive Life of Caring

Quentin D. Young Festschrift

By John Geyman, M.D.
Northwestern Magazine, Summer 2016

Quentin Young ’48 MD was an eloquent and persistent voice and advocate for social justice in U.S. health care from the time he entered medicine more than 70 years ago until his last breath recently at age 92. He lived at least five lives in one, always in defense of health care as a human right. He was a consistent moral compass for the medical profession, always ready to defend medicine against the incursion of those who commercialize and exploit the system for their gain over the care of patients. He excelled all along the way as a clinician, teacher, administrator, and as a fierce advocate for health care reform in the public interest.

In this Festschrift we will look at the body of his work over his long and productive career, drawing partly from his 2013 book, Everybody In, Nobody Out: Memoirs of a Rebel Without a Pause, 1 and some of his other writings along the way. Because of his prodigious efforts over the years, it is only possible to touch on some of the highlights.

Early Years

Quentin was born in Chicago in 1923, the first-born of a Jewish couple who had moved there shortly before. His dad had graduated from Fordham University in pharmacology, wanted to go to medical school but could not afford it. His mother wanted to name her son after Quentin Roosevelt, the World I flyer killed over France in 1917, and was able to get permission to name him that instead of after a deceased relative. The family lived in a modest house just half a mile west from the University of Chicago.

As a youngster, Quentin read a lot, and was bumped up two grades at his elementary school. He had many friends, and was an active member of the Jack and Jill Players, a well-known children’s acting troupe that performed onstage and on the radio. That led in later years to a long association with the Chicago public radio station WBEZ, where he would host a show and appear frequently on others.

Entering high school at 16 in 1936, in the middle of the Great Depression, Quentin became fully aware of rampant unemployment and labor-management struggles as well as Hitler’s rise in Germany, Mussolini’s invasion of Ethiopia, and the Spanish civil war. He gave credit to his parents, as New Deal Democrats, for his social and political conscience, and soon became active in the American Student Union at Hyde Park High, an anti-Nazi, progressive group. He went on to the University of Chicago in 1940, attracted by the curriculum instituted by President Hutchins, the “Chicago Plan,” requiring all students to take two-year courses in the humanities, the natural sciences, the social sciences, and reading, writing and criticism.

Sometime during his first or second year in college, Quentin decided that he wanted to be a doctor, for these reasons:

Because medicine was the profession most in keeping with my system of beliefs. It was a livelihood that offered the opportunity to do good (not that every doctor takes up that offer). Yes, it was a relatively tough academic ride, but if you could make it to the end and get your license, you could earn a comfortable living. And, if you chose, you could go to work every day and be a decent, caring, supportive person practicing your profession. 2

Army experience

At the time of the Pearl Harbor attack on December 7, 1941, Quentin was 17, was anti-isolationist and wanting to join the military and fight, especially against Hitler. He was too young to enlist, and was pre-med. Two years later, at 19, though he could likely have secured a student deferment, he enlisted in the Army. His first choice was the infantry, but he was too nearsighted.  His second choice was the artillery, but he was assigned to the medical department, hoping to be trained as a medic on the front lines.  But the Army instead put him into the just established Army Specialized Training Program (ASTP). He was sent to Cornell University in Ithaca, New York, to complete pre-med studies, then back near home to medical school at Northwestern University, starting in 1944 and graduating in 1948, when he was a civilian again and married with two children.

Graduate medical education at Cook County Hospital 1948-53

There was no question about where he would take his graduate training. Cook County Hospital, with 3,400 beds, was with Los Angeles County and Bellevue in New York, among the largest and best teaching hospitals in the country. He had taken medical student rotations there during medical school, and liked the emphasis on service and seeing everything that happens in medicine. He wanted to become a general internist, and spent the next three years there after his two-year internship, plus a year in West Virginia in 1951, completing his residency training in 1953.

True to his nature throughout his medical school and residency years, Quentin spent time agitating for better conditions for both his colleagues and patients. He became active in the Association of Interns and Medical Students (AIMS), lobbying for the end to racial and gender discrimination in  medical schools, better policies to address unwanted pregnancies, other health issues, and national health insurance. AIMS ran counter to the AMA and more conservative deans of medical schools, with its sequel in 1952 becoming the less progressive American Medical Students Association (AMSA), as it is known to this day. In 1951, Quentin founded the Committee to End Discrimination in Chicago’s Medical Institutions (CEDCMI).

Quentin was inspired by Cook County Hospital, which he described as “like a loving mother with arms outstretched to embrace all who sought her care. Without barrier and with no exclusionary questions asked, County stood poised to help all comers and usually the care was very good.” And this is what he learned at County:

I am convinced that until we, as a nation, have a system of universal health care, including everyone—everybody in, nobody out—until we provide that, we as a society just provide care through a system like County. [In his 2013 book, he said]: Sadly, all these years later, this is still the case. 3

Practice years

Quentin hoped to set up practice in a neighborhood near the steel mills on Chicago’s far South Side and serve blue collar workers, but that plan was thwarted by potential landlords who wouldn’t rent him office space, fearing that the powers that be would not want a physician on the premises treating union men and women. So instead, he joined another physician in Hyde Park, where he already had many friends. He welcomed the socioeconomic and racial diversity of Hyde Park. He enjoyed being a generalist primary care physician in a way that he had seen modeled at Cook County. As he said, “My joy and comfort mostly lay in seeing all kinds of people with all kinds of illnesses.” 4

Civil Rights Activist

Taking time from his own practice, Quentin’s political activism increased even more when he met and marched with Dr. Martin Luther King, who had settled in Chicago’s ghetto on the West Side in 1966 in order to fight for open housing and an end to segregation in the public school system. They had first met in Mississippi during the Freedom Summer of 1964. Quentin had been an early organizer of a new group in Chicago, the Medical Committee for Human Rights (MCHR), that provided medical services that summer, during the march from Selma to Montgomery the next year, and at other later events to forward the cause of civil rights. MCHR, with its membership of physicians, dentists, nurses, and social workers, had responded to a call from organizers of the Mississippi Summer Project to join these marches, both to bear witness and provide services as needed. Quentin was just one or two people away from Dr. King on these marches, and was the first to treat him when he was hit in the head by a rock and sustained a large scalp laceration. Many of the marchers were jailed, often with wounds. MCHR physicians were generally well treated by the police, who let them accompany those arrested into jail cells to determine the extent of their injuries, if any. MCHR would loudly proclaim any who were uninjured, which helped to reduce possible jailhouse violence. 5 Quentin later served as national chairman for MCHR from 1967 to 1968 and from 1971 to 1973.

Chief of Medicine at the County 1972-1981

All was going well in his practice and political activist work until 1972, when Quentin was recruited to his old home, the County, to help fix desperate problems the hospital was having. The newly elected Republican Governor Richard Ogilvie, with the support of the state legislature, was planning to downsize the hospital to 500 beds, more as a community hospital with full-time staff, and with “links to neighborhood health centers.” That would eliminate County’s mission as a long-time teaching hospital, and where would all its patients go for care? This plan prompted a firestorm of protest from attending physicians, department chairs, and house staff as the politics became intense. The chairman of the Department of Medicine at County, Quentin’s medical school classmate, Dr. Rolf Gunnar resigned. That department alone had 450 beds, 70 interns, more than 200 residents, fellows in many other specialties, and many attending physicians.

Quentin agreed to take on this challenge, to save County as he had known it. Before accepting, he demanded that the hospital establish health care clinics in the neighborhoods, with resources for comprehensive care. His immediate challenge was to ward off mass resignations of house staff, which brought a strike in 1975. Under dire circumstances, he needed to settle the strike and continue to recruit the most competent house staff, attending physicians and departmental chairs to maintain the County’s teaching excellence. Despite having the strong support of senior physicians and the house staff as he dealt with these problems, he was fired twice (temporarily) by the commission and administrator that had been established by the Governor. Persisting through his ten years as Chief of Medicine at County, Quentin outlived the commission that had fired him, succeeded in averting any further strikes by the house staff, saved his Department as a leading teaching service, started a new program in occupational medicine, and established four vital community health centers in surrounding neighborhoods.

Despite these successes, County was still in big trouble. It was an old facility and in financial crisis, largely due to its serving a large working poor population without Medicaid (the cutoff then was $4,600 annual income for a family of four). In view of this crisis and seeing an inadequate political response to it, Quentin offered his resignation after ten years, citing underfunding, the threat of privatization, denial of unionization benefits to the County’s workforce, problems with the Jail Health Service, and mismanagement by the Hyatt Hospital Management Association. As he said at the time:

I have decided to resign because of a series of developments [above mentioned] have convinced me that unless there is new support and remedy of these situations, it would not be possible for this wonderful and historic institution to continue its mission, offering health care to the hundreds of thousands of sick poor in this area who depend on it. 6

Health and Medicine Research Policy Group

Based on his experience and beliefs, it was only natural that Quentin, soon after leaving County, established the Health and Medicine Research Policy Group (HMRPG), an “action think tank” with the goal to positively influence the health system in Chicago and Illinois. As he said at the time: “it would be independent of any institution, we would oppose the exploiters of the health system—specifically corporations—and the board would be a working board, not a membership one.” This group set about to “RESEARCH the major medical, political, and social determinants of illness…EDUCATE the public about the hazards inherent in the existing health care system…Analyze HEALTH POLICY decisions to identify and expose the corporate beneficiaries of the existing system. [Such work would serve as] “the foundation to advocate changes in the system…Quentin served as the chairman of the HMRPG board continuously since 1981 as it grew by 2013 to a board of thirty active members with an annual budget of more than $1 million and a staff of a dozen people. This is what he said after this 32-year experience with HMRPG:

We have accomplished what we have by joining with others who share our vision. Policy change is hard and can only be done by building coalitions, conducting solid research, and articulating a clear vision to the media, policy makers and the public. I never expected this group to accomplish so much and to be a leader in so many spheres. But it has, and I am proud that I have been the leader of such a robust action-think tank for these 32 years. 7

Here are two examples of Quentin’s prescient concerns in 1975 and 1984 about the threat of the growing for-profit private enterprise in U.S. health care, all of which has come to pass:

Since the sale of health services for profit is counterproductive, the major elements in the therapeutic system should be dealt with as public utilities with standards established nationally but control vested locally. Included in such a system would be production and distribution of drugs, hospitals, and nursing homes, physician and other professional services, laboratory services, and financing arrangements. 8

[Once for-profit providers have the stage], their monopoly behavior so odious to this nation could easily be the most serious new distortion of our vast health resources. The for-profit moves to add vertical consolidation (combining hospitals, psychiatric units, health maintenance organizations, home health care and even hospices) to the massive horizontal consolidation of the big chains are harbingers of a for-profit dominance in our system of health care from birth to grave. 9

Chicago Public Radio

Acting on his leadership role in education of the public, Quentin put on still another hat from 1983 to 2005 as Talk Show Host of WBEZ Radio’s “Speaking of Health and Medicine.” In these regular one-hour shows, as the program’s medical contributor, he would speak to issues of the day, interview policy makers, and take listeners’ phone calls on subjects ranging from immunizations to the segregated health system in Chicago. 10

American Public Health Association (APHA)

Quentin’s leadership extended way beyond Chicago and Illinois. He served as president of the American Public Health Association in 1988. Founded in 1872, this Washington, D.C. based organization has a membership of more than 25,000 health care workers with a mission to “protect all Americans and their communities from preventable, serious health threats and strive to assure that community-based health promotion and disease prevention activities and preventive health services are universally accessible in the United States.” 11

Physicians for a National Health Program (PNHP)

As an early member of PNHP, formed by co-founders Drs. David Himmelstein and Steffie Woolhandler in 1988, Quentin rose to its presidency from 1991 to 1993 before serving as its National Coordinator for the next twenty-plus years. PNHP has endorsed single-payer national health insurance from its beginnings as an improved Medicare for All program. The 2010 Affordable Care Act has fallen far short of the nation’s needs. As Quentin said in 2013:

Conventional wisdom suggests we should wait and see how the Obama administration’s health law plays out. But we’ve seen how comparable reforms have fared on the state level: they’ve invariably failed, chiefly because they can’t control costs. Meanwhile, more millions suffer and tens of thousands die each year from lack of adequate coverage. Tragically, this picture will not be significantly improved by the new health law. But it’s never too late to do the right thing. 12

Quentin Young’s Legacy

After this long and productive career, we might wonder when and how his passion for leadership toward fairness and reform started. He answered this in his 2013 book:

I think that whatever organizational leadership I’ve demonstrated has its roots in my childhood. Recall, I was double promoted in grade school—a very bad thing. Getting out of grade school at age 12 and high school at age 16, I had to rely on something other than physical prowess and athletic skill to make my way in my peer group…When I went to University of Chicago, I was 16…If you were willing to give it the time, you could have a leadership role. That happened successfully as time went on…And there’s this: I always loved a battle. Still do. I’ve never tired of the good fight. 13

Over his entire career, Quentin naturally rose to leadership positions in most every effort he tackled. Table 1 lists just some of his top leadership positions over the years. He received widespread recognition and awards, including the Ethical Humanist Society’s Humanist of the Year award in 1976, the Doctor of Humane Letters at Columbia College in 1972 and at the University of Illinois in 1997, and Alumnus of the Year at Northwestern University in 2010.

Table 1

This is what Margie Schaps, Executive Director of HMPRG over many years, had to say after Quentin’s passing:

Quentin’s extraordinary intellect, his moral compass, combined with his total recall of history always led us to a clear path as we tried to solve the challenges in front of us. He taught me that the lessons of history should never be forgotten—that fighting for social justice, racial justice, for health justice is not new. We must learn from struggles that came before us, learn from the failures, and build upon the successes. Quentin taught me to always stand in solidarity with the struggles of working men and women, that no rally was too small to attend, that any opportunity to get our message across was worth taking, that every individual injustice is an injustice to all of us. In his words, you could get a lot accomplished if you didn’t have to take the credit and if you linked arms with others in struggle. 14

Drs. Mardge Cohen and Gordy Schiff trained with Quentin in the 1970s, then worked with him for many years afterwards at Cook County Hospital. Here’s how they describe his mentorship:

He always found time for us and everyone else, which is a model for us and we strive to be mentors for others. We would call him when we needed input into key professional, personal and political decisions. He listened, got it immediately and helped tremendously. From his witty and prescient metaphors to his lessons in talking truth to power and information sharing to his commitment to a doctor-patient partnership, Quentin taught/showed us what it really meant to listen, empower and partner with patients to make them better and to make a better world. 15

Here’s how Quentin ends his own 2013 book, words that are timeless as we face the future:

From my adolescent years to the present, I’ve never wavered in my belief in humanity’s ability—and our collective responsibility—to bring about a more just and equitable social order. I’ve always believed in humanity’s potential to create a more caring society…It’s been a lifelong, driving force to promote equality and the common good. I’ve spent a lifetime trying to help others—in my daily rounds, in my clinic, as a hospital administrator, at demonstrations, in my work with health advocacy groups—and it all adds up to a deeply rewarding career. Few people have such good fortune…I retain a terrible reputation for excessive optimism. The glories of humankind’s ingenuity and inventiveness have not yet been exhausted. The future can be bright, but only if we work to make it so. 16

Some of Quentin Young’s Leadership Positions

1955-1957, President, Southside Branch, Chicago Medical Society

1972-1981, Chairman, Department of Medicine, Cook County Hospital

1981-2016, Chairman of the Board, Health and Medicine Policy Research Group

1983-1984, President designate, Chicago Board of Health

1987-2016, Clinical Professor of Preventive Medicine, University of Illinois Medical Center

1989-1991, Chairman, Human Rights and Medical Practice Subcommittee, American College of Physicians

1991-1993, President, Physicians for a National Health Program

1993-2014, National Coordinator, Physicians for a National Health Program

1997-1998, President, American Public Health Association

References

1. Young, QD. Everybody In, Nobody Out: Memoirs of a Rebel Without a Pause. Friday Harbor, WA. Copernicus Healthcare, 2013, pp. 3-12.
2. Ibid # 1, p. 13.
3. Ibid # 1, p. 36.
4. Ibid # 1, 45, 124.
5. Ibid # 1, 55-65.
6. Ibid # 1, 179.
7. Ibid # 1, 182, 196.
8. Young, QD. Structural reforms in health-care delivery. Ann Intern Med 135: 909, 1975.
9. Young, QD. Impact of for-profit enterprise on health care. Journal of Public Health Policy 5 (4): 452, 1984.
10. Ibid # 1, 233-234.
11. Ibid # 1, 231.
12. Ibid # 1, 72.
13. Ibid # 1, 75.
14. Schaps, M. Remembering the extraordinary intellect and moral compass of Quentin Young. Health and Medicine Policy Research Group, March 10, 2016.
15. Ibid # 1, 178.
16. Ibid # 1, 239, 242.

John Geyman, M.D. is professor emeritus of family medicine at the University of Washington School of Medicine in Seattle, where he served as chairman of the Department of Family Medicine from 1976 to 1990.

http://www.northwestern.edu…

Gerald Kominski discusses the politicians’ proposals and the future of U.S. health care

“The Presidential Candidates: Their Health Plans”

By Dr. Gerald Kominski
Director, UCLA Center for Health Policy Research
Professor, UCLA Fielding School of Public Health
The UCLA Center for Health Policy Research
Health Policy Seminar Series, September 27, 2016

Excerpt at 0:52:24 of the video:

Question: Will the U.S. move to universal health care in the next ten years or so?

Gerald Kominski: Wow! I’ve spent my entire career talking about the history of the effort to get universal health care in the United States. And, again, I’m looking at Mark Peterson whose written about this extensively as well and knows the history. Our history is that we have been trying to do this now for 120 years in the United States. We’ve made progress, but the progress is glacial. Having said that, we never stop fighting for that. First of all, that’s why we’re in Public Health. It’s why this center – The Center for Health Policy Research – does what it does, and it’s why thousands of people across the country, across the state…millions of people are working towards this goal. But the next ten years are very difficult…we are so divided politically right now, it is very, very difficult to imagine the scenarios that lead us to true universal access through, say, a single payer system in the next ten years. But I’m an optimist, and I believe that there are people in this room who will one day see a single payer system in this country. Now I may not be around, but some of you will be. And we’re getting there. It just takes a long time.

Video, with PowerPoint:
http://healthpolicy.ucla.edu…

***

Comment:

By Don McCanne, M.D.

In this seminar Gerald Kominski discusses the health care proposals of presidential candidates Democrat Hillary Clinton and Republican Donald Trump plus those of Libertarian Gary Johnson and Green Party candidate Jill Stein.

Health policy wonks and others certainly understand the complexity of the proposals of the two leading candidates and even that of Libertarian Gary Johnson, as described by Professor Kominski. But he was able to describe Jill Stein’s proposal in full in one brief, elegant sentence. Here is his full description of her plan (at 0:41:12 of the video):

“Jill Stein, the Green Party candidate, is for a Medicare for All plan, basically a single payer plan with no copayments, no deductibles, basically free health care for all Americans.”

That’s it!

Wow!

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

Why Health Insurance Industry Consolidation Is Bad For Your Health

By Wendell Potter
The Huffington Post, Sept. 29, 2016

You undoubtedly have heard that some of the country’s biggest health insurers have decided to leave several Obamacare markets, which means that tens of thousands of us will be affected next year.

You probably haven’t heard — at least not lately — that some of the biggest health insurers are moving full steam ahead to merge with each other, which means that tens of millions of us — yes, millions — will be affected next year. And not in a good way. If the consolidation happens as planned, many of us will find ourselves in health plans with much worse patient satisfaction and customer complaint scores.

Here’s some context: Executives of UnitedHealthcare, Aetna and Humana made headlines this summer when they announced plans to quit selling policies on several Obamacare exchanges at the end of the year because they haven’t yet figured out how to turn a profit on that business. That means people enrolled in those companies’ Obamacare plans will have to pick a different insurer for 2017.

If That’s Not Bad Enough

That’s a big inconvenience for those folks, of course. But far more of us, including several million who are enrolled in employer-sponsored plans, will be more than inconvenienced if state and federal regulators approve the Anthem-Cigna and Aetna-Humana mergers.

Employers, consumer groups, the American Medical Association and many other organizations have told regulators they think those mega mergers are not in the public’s best interest. The U.S. Justice Department and several state officials agree. They filed a lawsuit in July to stop both of them. Nevertheless, the mergers are far from dead.

That should worry us. A lot. That’s because the acquiring companies, Anthem and Aetna — but Anthem especially — have higher customer complaint ratios and lower patient satisfaction scores than other companies, as recent reports by the state of California’s Office of the Patient Advocate (OPA) show. And if the Anthem-Cigna merger goes through, Anthem, with the worst scores overall, would become the nation’s biggest health insurer.

“Your Call Is Not Important To Us”

Take a look at OPA’s Annual Health Care Complaint Data Report, which provides a wealth of information about the complaints California regulators received in 2014, the most recent year for which data were available for analysis.

Anthem scored the worst by far of any of the other health plans operating in the state. Data provided to OPA by the Department of Managed Health Care, which has jurisdiction over most of the state’s HMOs, showed, for example, that Anthem had 12.28 complaints per 10,000 enrollees. Compare that with Kaiser Permanente, the nonprofit company that rivals Anthem in terms of enrollment in California. Kaiser had just 4.50 complaints per 10,000. In other words, Anthem had nearly three times as many complaints as Kaiser.

Anthem also led the pack in the ratio of complaints received by the California Department of Insurance. That department said Anthem had a whopping 47.64 complaints per 10,000. Cigna, the company Anthem is trying to buy, had just 2.69 complaints per 10,000.

And it’s not just in California that Anthem has generated an inordinate number of complaints about how it treats its customers. It appears to be nationwide. In fact, the Department of Justice cited Anthem’s less than stellar reputation in its lawsuit to block its takeover of Cigna. This is from a September 20 story in the Hartford Courant about the status of the proposed $54 billion deal:

The federal government claims that many large employers dislike Anthem and that doctors fear the company because its large customer base gives it leverage in negotiations.

The Department of Justice complaint says that although Cigna can’t get as low prices from hospital systems and doctors in some markets as Anthem does, “Cigna competes vigorously with Anthem for large groups by offering exceptional customer service, innovative wellness programs that lower its members’ utilization of health care, and provider-collaboration programs with hospitals and doctors. By contrast, many large-group employers believe that Anthem provides poor customer service and is far less innovative. Soon after the merger was announced, two prospective customers complained to Cigna: “We hate Anthem and you guys are about to become them.”

When it comes to how patients rate their experience with their HMOs, another report by the California Office of the Patient Advocate shows that the big for-profits involved in the proposed mergers also get much lower scores than their nonprofit competitors. Nonprofit Kaiser Permanente’s HMOs were the only ones rated “excellent.”

Earlier this month, a Harvard Law watchdog group filed complaints with the U.S. Department of Health and Human Services against seven big insurers — including Anthem, Cigna and Humana—alleging that they all were in violation of anti-discrimination laws pertaining to the coverage of HIV/AIDS treatments. The allegations involved refusing to cover vital medications that HIV/AIDS patients need and requiring high-cost sharing for other medications used to treat HIV/AIDS.

“When an insurer requires chronically ill patients to pay a disproportionate share of the cost of medication, it violates federal law,” said Robert Greenwald, clinical professor of law at Harvard Law School.

The American Medical Association has become one of the most vocal opponents of the mega-mergers, particularly the Anthem-Cigna deal. On September 21, the AMA released a report showing that Anthem’s “market power” would be significantly increased in several states and numerous metropolitan areas — especially in California — if the deal is approved.

Despite all of this, the mergers could still happen. A U.S. District Court has set a November 21 trial date for the lawsuit the Department of Justice has filed to stop the Anthem-Cigna merger. The Aetna-Humana trial is scheduled to start on December 5. Both trials likely will go on for several weeks. If the Department of Justice loses, millions of Americans will soon find themselves enrolled in health plans administered by companies with some of the industry’s worst quality and customer satisfaction scores. That’s something not only to worry about but also to try keep from happening. The last thing we need is for Anthem and Aetna to be more in control of our lives.

This has also been published by HEAL California.

http://www.huffingtonpost.com…

Wellmark Blue Cross and Blue Shield placing greater squeeze on patients

Wellmark announces individual ACA market changes in Iowa and South Dakota

Wellmark, September 28, 2016

Wellmark Blue Cross and Blue Shield announced today it will make changes in the individual Affordable Care Act (ACA) market in Iowa and South Dakota.

For the past two years, Wellmark members with individual ACA plans have endured double-digit increases. In addition, Wellmark has lost approximately $99 million over the same time period in the individual market in Iowa and South Dakota.

“Wellmark’s mission is to create affordable health insurance for people to access quality health care. And, for the majority of the past 75 years, we’ve been able to achieve that,” said Wellmark Chairman and CEO John Forsyth. “However, it’s apparent that continuing to offer plans with broad networks, combined with the rich benefits of the ACA, is not consistent with managing continually rising costs. While we could seek additional premium increases to mitigate rising costs, this is not sustainable for our members’ pocketbook.”

Iowa changes

In Iowa, Wellmark will narrow its product choices to offer plans that are lower priced and encourage health care delivery by Iowa providers. Specifically, Wellmark will no longer offer gold tier plans nor will the company promote individual under 65 plans that use its Preferred Provider Organization (PPO) network in Iowa.

Wellmark will also continue its plans to introduce a new, simplified HMO plan called Blue Simplicity℠. This plan is like no other on the market today and is designed to help consumers understand the true value of care through simple copay plans – providing members with transparency and predictability of cost as they seek and use medical services.

South Dakota changes

In South Dakota, Wellmark will no longer offer individual Affordable Care Act (ACA) plans effective Jan. 1, 2017.

“Although the ACA has done many positive things, it has also had its challenges and those challenges vary by state,” said Forsyth. “Fortunately, in 2017, the ACA gives states the ability to begin addressing those challenges with the goal of stabilizing the individual under 65 health insurance market. We look forward to working with Iowa and South Dakota policymakers on those solutions in the near future.”

https://www.wellmark.com…

***

Comment:

By Don McCanne, M.D.

The largest health insurer in Iowa, Wellmark Blue Cross and Blue Shield, is discontinuing their more comprehensive gold tier plans and is discontinuing the promotion of its PPO plans with wider provider networks. They are also introducing a new HMO plan “designed to help consumers understand the true value of care through simple copay plans” (i.e., making them better shoppers by having to bear more of the costs). These changes are compounding the two problems plaguing insurance purchasers today: requiring higher out-of-pocket spending for health care, and narrowing the selection of health care providers covered by the plans.

This is a one-way path designed to keep insurance premiums as competitive as possible. As Chairman and CEO Forsyth states, “continuing to offer plans with broad networks, combined with the rich benefits of the ACA, is not consistent with managing continually rising costs.” Insurers are not going to cover more out-of-pocket costs by increasing the actuarial value of their plans (percent of costs they will pay), and they are not going to expand their networks when they can negotiate lower prices by promising provider exclusivity.

Look, as long as we leave these people in charge, we can anticipate that they will engage in strategies that will protect and improve their own market advantage. If we had our own public program, our stewards who work for us would be engaging in strategies that would ensure our access to the health care that we need. There really is a difference. If only for selfish reasons, we should prefer the latter. The fact that it helps everyone else is a bonus.

America needs to adopt VA’s prevention-based approach to health care to improve outcomes

By W.T. “Bill” McKibben
The Buffalo News, Sept. 25, 2016

The Veterans Affairs health care system is America’s favorite political football. We love our vets and are quick to pick up on any failure to care for them or treat them well. We were all stunned by reports of vets dying while waiting to see a doctor. A closer look reveals that they were waiting to be accepted into the VA health care system and be assigned to a primary care doctor. The image of sick and dying vets already within the VA system waiting for care is simply false.

Worse, this myth has been unfairly projected onto the doctors and all those delivering care to the vets in the system. The truth is vets in the system never wait when they need to see a doctor. The VA’s prevention-based approach is very different from the greed-driven, treatment-based system most Americans are stuck with.

A doctor’s appointment for those in the VA system, whether it’s with a vet’s primary physician or a specialist, is never for anything urgent, it’s for a regular checkup, follow-up, specialist consult or a routine medical test.

When vets need immediate care, they don’t call for an appointment. Instead, they just head to one of the system’s 1,700 medical centers and clinics. Not just for emergencies, that’s where vets go for a cold, the flu, or anytime they need to see a doctor. The VA’s facilities are set up to act as immediate care centers as well as standard emergency rooms.

Altogether the VA operates America’s largest integrated health care system, serving nearly 9 million vets annually. It has hundreds of clinics plus 152 medical centers that have full hospital facilities, as well as emergency room/immediate care centers.

The major difference in the care that vets receive – and the source of its superiority – is the VA’s focus. The VA utilizes the system prevalent in every developed nation in the world except America: the prevention-based system as opposed to the treatment-based system most Americans have. Our nation spends twice as much as any other nation in the world on health care. And yet our outcomes rank down among the Third World countries.

When a provider’s only revenue source is to treat or medicate, that’s what he does; and sadly too often greed takes over. Overtreatment and overmedication trigger thousands of deaths and health issues in America every year, but not at the VA. Just like providers all over the world, those at the VA – some of the most skilled medical practitioners in America – are paid to prevent health care issues, not just to treat them.

The VA’s prevention-based approach delivers much better outcomes. Better than Medicare, even though the VA has a more vulnerable patient base. The VA is treating a bunch of beat-up old folks and some horrifically beat-up younger vets. By comparison, Medicare patients, in general, are much healthier than our vets. Yet even with that disadvantage, the VA gets better outcomes than Medicare, and it does it for less – nearly 40 percent less per patient.

It’s clear that we need to follow the rest of the developed nations on this planet and make some dramatic changes. We need to adopt a single-payer, prevention-based system. Big Pharma hates this idea, for-profit hospitals hate this idea and, sadly, even some health care providers hate this idea.

We spend twice as much as any other nation on health care with more than half the cost coming out of taxpayer funds. That would lead one to believe that with a more cost-efficient single-payer system, we might find that we have been paying for a better system all along and throwing away half of what we currently spend. It’s time we got our money’s worth.

W.T. “Bill” McKibben is a Buffalo-based author. He was a Medicare Part B and health care insurer consultant for more than a quarter century.

http://www.buffalonews.com/opinion/viewpoints/america-needs-to-adopt-vas-prevention-based-approach-to-health-care-to-improve-outcomes-20160925

Universal health care would solve crisis of uninsured

By Richard Weiskopf, M.D., Kaye Jaeger, R.N., and Joel Potash, M.D.
Syracuse.com, Sept. 28, 2016

A commentary published Sept. 14 (“How many are insured because of Obamacare? Good question”) points out the challenge of assessing the Affordable Care Act’s impact on closing the insurance gap. Focusing strictly on health “insurance” coverage obscures the crisis in healthcare access across the country that millions continue to live without access to needed health care. In New York, since the passage of the Affordable Care Act, there are still 1.5 million individuals without health insurance and countless more who are underinsured — that is they have insurance but can’t access healthcare they need due to high co-pays, deductibles, and rising drug costs.

In a system dominated by private health insurance corporations, those with high incomes can afford adequate health care, while the poor and many middle class cannot. The consequences are tragic. According to a Harvard study, 45,000 Americans die each year for lack of health insurance. Medical bills contribute to more that 60 percent of all bankruptcies, and most people who file for medical debt related bankruptcy had insurance when they got sick.

What is it like to be uninsured or underinsured? Imagine having asthma or chronic pulmonary disease (COPD) and not being able to afford the medication your doctor prescribes. Beyond daily shortness of breath and chronic cough, untreated respiratory diseases make people more susceptible to pneumonia.

Sudden pauses in medication use are not uncommon and can have serious consequences. For example, a patient who pauses use of hypertension medicine faces an increased likelihood of stroke and heart attack. As healthcare providers, it’s heartbreaking to know that a patient won’t be able to relieve his or her suffering due to financial barriers.

We need to shift our public conversation from discussing issues of insurance to the task of guaranteeing universal access to medically necessary care from cradle to grave.

Under our present system of multiple health insurers, a large amount of the money that private insurance companies collect in premiums is spent on administrative costs and CEO compensation rather than care. The national Medicare program which covers the elderly is much more efficient, allowing a greater portion of the money to be spent directly for health care. Administrative costs in the private insurance infrastructure consume 31 percent of U.S. health spending while Medicare maintains an annual administrative cost of 2 to 3 percent.

An economic analysis conducted in 2015 by economist Gerald Friedman found that implementing a universal public healthcare system, like the one proposed by the New York Health Act, would reduce New York’s health care spending by 25 percent, more than $70 billion, by 2016. The savings would come from reducing burdensome billing expenses, administrative waste, the monopolistic pricing of drugs and medical devices, and fraud. According to Friedman’s analysis, 98 percent of New Yorkers would pay less for health care. But most important, New York Health would provide universal access to healthcare to all New Yorkers.

All of us need health care, regardless of age, income or employment status. The New York State Assembly has passed such a plan with huge majority support. We urge Sen. Dave Valesky to be a champion for universal health care by sponsoring the New York Health Act in the next session and passing it through the Senate.

Dr. Richard Weiskopf is a member of Physicians for a National Health Program (PNHP). Kaye Jaeger is a registered nurse. Dr. Joel Potash is a palliative care physician. All live in Syracuse.

http://www.syracuse.com…