PNHP

Medicare expansion versus same worn-out platitudes

Medicare expansion versus same worn-out platitudes

By Jack Bernard
Ledger-Enquirer (Columbus, Ga.), July 16, 2016

My party, the GOP, is once again running for election this year on the old slogan of “repeal and replace Obamacare.” I agree that the Affordable Care Act (ACA, Obamacare) has major issues, but the key question remains: What should be its replacement? We differ drastically on the answer.

The GOP, led by Speaker Ryan in his recent policy pronouncement, is once again simply rehashing the worn-out notions that they have stated in the past: expanding of HSAs (Health Savings Accounts); lessening provider liability; selling insurance across state lines; and changing Medicaid from an entitlement to a block grant.

There are major problems with every one of these simplistic, piecemeal, marketplace “solutions” — too many to detail in this limited space.

My answer is comprehensive, effective and efficient: Medicare for All. Here is my rationale.

Studies have shown that there were about 50 million U.S. residents without insurance prior to Obamacare. Under the ACA, 12.4 million signed up through the exchanges and now have insurance, as well as millions more under Medicaid expansion provisions. As opposed to what my avowedly religious Republican brethren preach, from a moral standpoint the ACA is clearly better than what we had previously.

Unfortunately, the ACA has problems. The Medicaid expansion provision was made voluntary by a politicized Supreme Court. Expansion does a lot to help very low-income, mostly working people who cannot afford insurance premiums and are ineligible for supplements … but only in the states accepting federal dollars (90 percent federal funding long term). So the percentage of uninsured remains much higher in many “red” states. Plus, tens of millions are still without insurance and will be for the foreseeable future under the ACA.

Further, because the ACA is built on the defective private insurance model, it will never be very effective or efficient. And with no ACA public option, insurance companies will take advantage of consumers, price gouging, especially where there are few options.

Long-term, Obamacare does little to contain costs, the “affordable” portion of the Affordable Care Act. Again, this is because private insurers are at the core of the program.

As opposed to some in my party, I do not believe that we can just repeal the ACA and go back to what we had before. It is also unrealistic to propose simply doing away with Medicare and Medicaid in their current form, as Ryan and other GOP leaders propose. Advocating for this policy will just ensure that the GOP becomes a regional party, permanently losing national elections.

Let me be very clear. As a proven fiscal conservative, I generally do not like high taxes, especially when public money is going to the wrong places and programs. In my two terms as a Jasper County commissioner, I was the driving force in my county to lower the rate of increase in property taxes from 10 percent a year to just 1 percent annually for the years I was in office. That was one of the lowest rates of increase in the state.

So why do I want to see more government involvement in our health insurance system via Medicare expansion to everyone?

Because — based on their experience — taxpayers (especially senior citizens like me) love their Medicare and, as opposed to some government programs, Medicare works very well.

And it is efficient, reducing marketing and overhead costs. Medicare has overhead expenses of only 3 percent compared to up to 20 percent for private insurance companies.

Single payer (Medicare for All) simplifies billing on the physician side as well. One recent study showed that a typical U.S. orthopedic surgeon spent over $80,000 a year just on billing due to our complex array of private insurance companies and plans. A similar surgeon in Canada spent one-fourth of that amount. The same would be true for our hospitals which have extensive, and extremely costly, billing operations.

Before Obama ran for the presidency, he was in favor of single payer. He has since indicated that he changed his position because we have to work with the system that is currently in place. That is D.C. code for he could not handle the politics — the influential insurance/pharma/provider lobby. Not surprising, since he came into office with very limited experience on the national level, naively expected some GOP support (which never happened) and saw any insurance expansion as a political win.

Obama, by nature a cautious moderate, made a major mistake in abandoning his principles so quickly. He should have reversed course after the ACA was passed and established a Presidential Commission to determine the exact benefits and costs of converting our current non-system to single-payer, Medicare for All.

Studies by the respected Physicians for a National Health Program (PNHP) have shown that this conversion is financially feasible. More can be found on their website: www.pnhp.org.

Only through executive action will we get verification of this premise via an impartial study. I hope that Trump or Clinton will have the political courage to move on this item once elected.

Jack Bernard is a retired senior healthcare executive and served as the first director of health planning for the state of Georgia. He is a former chair of the Jasper County Commission and of the Jasper County Republican Party.

http://www.ledger-enquirer.com/opinion/article89906507.html#storylink=cpy

Dr. Patricia Salber: Economically, a Single-Payer System Makes Sense

By the editors
AJMC.com, AJMC TV, July 16, 2016

The United States is closer than it has ever been to considering a single-payer health system. Patricia Salber, MD, MBA, of “The Doctor Weighs In,” discusses how a single-payer system economically makes sense.

Transcript (slightly modified):

The idea of a single-payer health system in the US has been discussed more in the past year. Do you think the US is ready for a single-payer health system?

I think we’re more ready than we’ve ever been. Whether that means we’re ready and it will actually happen this year or next year or 10 years from now, I don’t know the answer to that question, because a lot of it has to do with politics. I think depending on the results of this upcoming election we may see us going back to the old battle of preserving the Affordable Care Act as opposed to repealing it as opposed to moving on.

I do think it’s interesting that Colorado has an initiative on the ballot to have a statewide single payer. And although people I’ve talked to say it’s unlikely to pass, I think it’s very interesting to see something in a state as big as Colorado being put forward at this time.

Is single payer an actual possibility in the US or would the country not be amenable to such a health system?

Well, you know what Churchill said: we’ll do everything wrong until we finally do it the right way. Even myself, I’ve not been a big single-payer advocate, but I feel like we’ve tried so many different things and the rest of the developed world has variations on a single-payer model, whether they’re private delivery systems underneath the single payer. What they’ve done is simplified the process by having the management of the claims payment — you know, that payer part — managed by a single entity.

And it makes sense. Economically, it makes sense. There’s a new video that’s out that was produced by an employer called “Fix It” — I think the subtitle is “healthcare at the tipping point” — where they take you through how much money we’re paying to continue to have the inefficient, complex, confusing, multi-payer system that we have now.

Sometimes I think we forget to say [when asking] “Is this thing we want to do going forward good or bad?” well we forget to say “What is it that we have right now?” Right now it isn’t working for a lot of people.

http://www.ajmc.com/interviews/dr-patricia-salber-economically-a-single-payer-system-makes-sense#sthash.cV1c8M3y.dpuf

Republican and Democratic platforms on health care

2016 Republican Platform

Restoring Patient Control and Preserving Quality in Healthcare

Any honest agenda for improving healthcare must start with repeal of the dishonestly named Affordable Care Act of 2010: Obamacare. It weighs like the dead hand of the past upon American medicine. It imposed a Euro-style bureaucracy to manage its unworkable, budget-busting, conflicting provisions. It has driven up prices for all consumers. Their insurance premiums have dramatically increased while their deductibles have risen about eight times faster than wages in the last ten years.

Preserving Medicare and Medicaid

More than 100 million Americans depend on Medicare or Medicaid for their healthcare; with our population aging, that number will increase. To preserve Medicare and Medicaid, the financing of these important programs must be brought under control before they consume most of the federal budget, including national defense. We intend to save Medicare by modernizing it, empowering its participants, and putting it on a secure financial footing. We will preserve the promise of Medicaid as well by making that program, designed for 1965 medicine, a vehicle for good health in an entirely new era.

Medicare’s long-term debt is in the trillions, and it is funded by a workforce that is shrinking relative to the size of future beneficiaries. When a vital program is so clearly headed for a train wreck, it’s time to put it on a more secure track. That is why we propose these reforms: Impose no changes for persons 55 or older. Give others the option of traditional Medicare or transition to a premium-support model designed to strengthen patient choice, promote cost-saving competition among providers, and better guard against the fraud and abuse that now diverts billions of dollars every year away from patient care. Guarantee to every enrollee an income-adjusted contribution toward a plan of their choice, with catastrophic protection. Without disadvantaging present retirees or those nearing retirement, set a more realistic age for eligibility in light of today’s longer life span.

Medicaid presents related, but somewhat different challenges. As the dominant force in the health market with regard to long-term care, births, and persons with mental illness, it is the next frontier of welfare reform. It is simply too big and too flawed to be administered from Washington. Most of the vaunted expansion of health insurance coverage under Obamacare actually has been an unprecedented expansion of the Medicaid rolls in many states. We applaud the Republican governors and state legislators who have undertaken the hard work of modernizing Medicaid. We will give them a free hand to do so by block-granting the program without strings. Their initiatives — whether premium supports for purchasing insurance, refundable tax credits, alternatives to hospitalization for chronic patients, disease prevention activities, and other innovations — are the best strategy for preserving Medicaid for those who need it the most.

https://prod-static-ngop-pbl.s3.amazonaws.com/media/documents/DRAFT_12_FINAL%5b1%5d-ben_1468872234.pdf?mid=76323&rid=16464502

***

2008 Democratic Party Platform

Covering All Americans and Providing Real Choices of Affordable Health Insurance Options

Families and individuals should have the option of keeping the coverage they have or choosing from a wide array of health insurance plans, including many private health insurance options and a public plan. Coverage should be made affordable for all Americans with subsidies provided through tax credits and other means.

http://www.presidency.ucsb.edu/ws/?pid=78283

***

2016 Democratic Party Platform (DRAFT)

Universal Health Care

We believe as Democrats that health care is a right, not a privilege, and our health care system should put people before profits. Thanks to the hard work of President Obama and Democrats in Congress we took a critically important step towards the goal of universal health care by passing the Affordable Care Act (ACA), which has offered coverage to 20 million more Americans and ensured millions more will never be denied coverage on account of a pre-existing condition.

We will keep costs down by making premiums more affordable, reducing out-of-pocket expenses, and capping prescription drug costs. Democrats will also work to end surprise billing and other practices associated with out-of-control medical debt that lead to unconscionable economic strain on American households. We will offer relief so Americans do not face high costs, and we will fight back against insurers trying to impose excessive premium increases.

https://demconvention.com/wp-content/uploads/2016/07/2016-DEMOCRATIC-PARTY-PLATFORM-DRAFT-7.1.16.pdf

***

Comment:

By Don McCanne, M.D.

Political party platforms are typically loaded with rhetoric designed to fire up the political base, and, as such, are often not taken seriously. But piercing through the rhetoric there are often concepts of substance, good or bad. Take health care.

The Democratic platform of 2008 promised us a market of private health plans with government subsidies. That, in essence, is what we got as a major feature of the Affordable care Act. The Democrats rejected single payer and instead delivered on their comparatively feeble platform promises.

For the preliminary draft of their 2016 platform, the Democrats again voted to reject single payer and substituted it with a “health care is a right” statement void of any meaningful policy. They support instead mere tweaks to the Affordable Car Act.

Reading past the Republican’s rhetoric, they are now promising in their platform changes to two of our most important government health programs. They would convert Medicare to a premium support program, shifting costs away from the federal government and onto the backs of Medicare beneficiaries. They would also establish block grants to the states for the Medicaid program, shifting costs from the federal government and onto the states, many of which which would likely respond with a reduction in essential health care benefits for the needy.

One party wants to coast along with a grossly deficient system, leaving millions uninsured and underinsured, and the other would begin to dismantle what protection the government does provide. Wish they would dump the rhetoric and start working on real policy that would ensure adequate, affordable health care for everyone.

Of course, several readers would remind us that the Green Party supports single payer reform. Yes… Hmm…

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

Republican and Democratic platforms on health care

2016 Republican Platform

Restoring Patient Control and Preserving Quality in Healthcare

Any honest agenda for improving healthcare must start with repeal of the dishonestly named Affordable Care Act of 2010: Obamacare. It weighs like the dead hand of the past upon American medicine. It imposed a Euro-style bureaucracy to manage its unworkable, budget-busting, conflicting provisions. It has driven up prices for all consumers. Their insurance premiums have dramatically increased while their deductibles have risen about eight times faster than wages in the last ten years.

Preserving Medicare and Medicaid

More than 100 million Americans depend on Medicare or Medicaid for their healthcare; with our population aging, that number will increase. To preserve Medicare and Medicaid, the financing of these important programs must be brought under control before they consume most of the federal budget, including national defense. We intend to save Medicare by modernizing it, empowering its participants, and putting it on a secure financial footing. We will preserve the promise of Medicaid as well by making that program, designed for 1965 medicine, a vehicle for good health in an entirely new era.

Medicare’s long-term debt is in the trillions, and it is funded by a workforce that is shrinking relative to the size of future beneficiaries. When a vital program is so clearly headed for a train wreck, it’s time to put it on a more secure track. That is why we propose these reforms: Impose no changes for persons 55 or older. Give others the option of traditional Medicare or transition to a premium-support model designed to strengthen patient choice, promote cost-saving competition among providers, and better guard against the fraud and abuse that now diverts billions of dollars every year away from patient care. Guarantee to every enrollee an income-adjusted contribution toward a plan of their choice, with catastrophic protection. Without disadvantaging present retirees or those nearing retirement, set a more realistic age for eligibility in light of today’s longer life span.

Medicaid presents related, but somewhat different challenges. As the dominant force in the health market with regard to long-term care, births, and persons with mental illness, it is the next frontier of welfare reform. It is simply too big and too flawed to be administered from Washington. Most of the vaunted expansion of health insurance coverage under Obamacare actually has been an unprecedented expansion of the Medicaid rolls in many states. We applaud the Republican governors and state legislators who have undertaken the hard work of modernizing Medicaid. We will give them a free hand to do so by block-granting the program without strings. Their initiatives — whether premium supports for purchasing insurance, refundable tax credits, alternatives to hospitalization for chronic patients, disease prevention activities, and other innovations — are the best strategy for preserving Medicaid for those who need it the most.

https://prod-static-ngop-pbl.s3.amazonaws.com/media/documents/DRAFT_12_FINAL%5b1%5d-ben_1468872234.pdf?mid=76323&rid=16464502

***

2008 Democratic Party Platform

Covering All Americans and Providing Real Choices of Affordable Health Insurance Options

Families and individuals should have the option of keeping the coverage they have or choosing from a wide array of health insurance plans, including many private health insurance options and a public plan. Coverage should be made affordable for all Americans with subsidies provided through tax credits and other means.

http://www.presidency.ucsb.edu/ws/?pid=78283

***

2016 Democratic Party Platform (DRAFT)

Universal Health Care

We believe as Democrats that health care is a right, not a privilege, and our health care system should put people before profits. Thanks to the hard work of President Obama and Democrats in Congress we took a critically important step towards the goal of universal health care by passing the Affordable Care Act (ACA), which has offered coverage to 20 million more Americans and ensured millions more will never be denied coverage on account of a pre-existing condition.

We will keep costs down by making premiums more affordable, reducing out-of-pocket expenses, and capping prescription drug costs. Democrats will also work to end surprise billing and other practices associated with out-of-control medical debt that lead to unconscionable economic strain on American households. We will offer relief so Americans do not face high costs, and we will fight back against insurers trying to impose excessive premium increases.

https://demconvention.com/wp-content/uploads/2016/07/2016-DEMOCRATIC-PARTY-PLATFORM-DRAFT-7.1.16.pdf

Political party platforms are typically loaded with rhetoric designed to fire up the political base, and, as such, are often not taken seriously. But piercing through the rhetoric there are often concepts of substance, good or bad. Take health care.

The Democratic platform of 2008 promised us a market of private health plans with government subsidies. That, in essence, is what we got as a major feature of the Affordable care Act. The Democrats rejected single payer and instead delivered on their comparatively feeble platform promises.

For the preliminary draft of their 2016 platform, the Democrats again voted to reject single payer and substituted it with a “health care is a right” statement void of any meaningful policy. They support instead mere tweaks to the Affordable Car Act.

Reading past the Republican’s rhetoric, they are now promising in their platform changes to two of our most important government health programs. They would convert Medicare to a premium support program, shifting costs away from the federal government and onto the backs of Medicare beneficiaries. They would also establish block grants to the states for the Medicaid program, shifting costs from the federal government and onto the states, many of which which would likely respond with a reduction in essential health care benefits for the needy.

One party wants to coast along with a grossly deficient system, leaving millions uninsured and underinsured, and the other would begin to dismantle what protection the government does provide. Wish they would dump the rhetoric and start working on real policy that would ensure adequate, affordable health care for everyone.

Of course, several readers would remind us that the Green Party supports single payer reform. Yes… Hmm…

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

NHS privatization – lessons for the U.S.

NHS – on life support

By Alex Scott-Samuel
Politics of Health Group POHG Blog, July 17, 2016

I want to give a broad political overview of what’s happening in the NHS in England and of the background to the current situation.

As you’ll know, the English NHS is in a bad way, with practically every part of the country in financial deficit. Many hospitals and many services are being closed down, cut back or rationed. At the same time, many long term contracts for the provision of NHS services are being awarded to private sector companies – though often people are unaware of this because the likes of Virgin, Carillion and SpecSavers are allowed to operate under the NHS logo.

By definition, these arrangements are wasteful, because private companies have a duty to make profits and to give those profits to their shareholders. That means that public money is haemorrhaging out of the NHS – whereas when a public provider of NHS services makes a surplus it is reinvested in the NHS.

There is also a substantial legacy of (mainly Labour initiated) private finance initiative (PFI) funded hospitals, whose exorbitant loan interest payments have to be made before NHS funds can be spent on routine services. And it’s no coincidence that people’s inboxes are filling up with adverts for health insurance, with their invitations to jump the NHS queues. Everything I’ve described forms part of what in my view is an intentional strategy by the Conservative government to create financial, managerial, professional and public chaos throughout the NHS, so that private provision of NHS services, alternative private health services, health insurance, and NHS co-payments and ultimately charges will be seen as inevitable.

This ‘cultural revolution’ takes many different and apparently unrelated forms whose destructive nature is denied by the government – which continues to assert that it has the public interest at heart and that it is factors like the ongoing impact of the credit crash, the increasing costs of drugs and medical equipment, the ageing population and our unhealthy lifestyles which are the true problems facing the NHS. The building blocks for privatisation to which I have referred currently include: the aforementioned awarding of NHS contracts to private bidders – often asset strippers who provide poor quality services, fragment and undermine the cohesive public ethos of the NHS; the creation by the Treasury of NHS deficits and of regulations which forbid them; enforced rationing of services to extend waiting lists and encourage patients to seek private alternatives; manufactured confrontations with doctors and other members of the NHS workforce; the imposition of ‘new models of care’ which undermine NHS hospitals and create community based healthcare structures ripe for privatisation; personal health budgets, designed to link with health insurance. There are many more and I can provide documented evidence for all of them. It is a national scandal.

What is to be done? Until we have a government committed to tackling and reversing this appalling onslaught on our beloved NHS, we must continue to expose what is happening, to challenge it and to campaign loudly and widely in order to increase public awareness and action.

http://www.pohg.org.uk/blog/nhs-on-life-support/

***

Comment:

By Don McCanne, M.D

The phased privatization of England’s National Health Service is taking a toll in undermining “the cohesive public ethos of the NHS.” This brief description by Dr. Alex Scott-Samuel will give you a hint of the disaster that is taking place. Their political leaders apparently have learned nothing from the dysfunction that characterizes our system in the U.S., nor are we learning anything from them.

At a time that we need to be converting our fragmented public and private insurance system into a single public program, we are going in the opposite direction. Our public Medicare program is being privatized through similar cognitive processes as are taking place in England.

Just as the Conservative and Labor parties have conspired in these changes, here in the U.S. the Republicans and Democrats, the latter now dominated by the neoliberals, are damaging the traditional Medicare program through neglect while pushing on with fiscal and regulatory policies that have expanded enrollment in the private Medicare Advantage plans. When you read the paragraph above on the “cultural revolution” you cannot help but note the similar ethic of the two nations driving this insane march to rent-seekers nirvana at a cost of compromising patient care.

We can learn something from this, can’t we?

NHS privatization – lessons for the U.S.

NHS – on life support

By Alex Scott-Samuel
Politics of Health Group POHG Blog, July 17, 2016

I want to give a broad political overview of what’s happening in the NHS in England and of the background to the current situation.

As you’ll know, the English NHS is in a bad way, with practically every part of the country in financial deficit. Many hospitals and many services are being closed down, cut back or rationed. At the same time, many long term contracts for the provision of NHS services are being awarded to private sector companies – though often people are unaware of this because the likes of Virgin, Carillion and SpecSavers are allowed to operate under the NHS logo.

By definition, these arrangements are wasteful, because private companies have a duty to make profits and to give those profits to their shareholders. That means that public money is haemorrhaging out of the NHS – whereas when a public provider of NHS services makes a surplus it is reinvested in the NHS.

There is also a substantial legacy of (mainly Labour initiated) private finance initiative (PFI) funded hospitals, whose exorbitant loan interest payments have to be made before NHS funds can be spent on routine services. And it’s no coincidence that people’s inboxes are filling up with adverts for health insurance, with their invitations to jump the NHS queues. Everything I’ve described forms part of what in my view is an intentional strategy by the Conservative government to create financial, managerial, professional and public chaos throughout the NHS, so that private provision of NHS services, alternative private health services, health insurance, and NHS co-payments and ultimately charges will be seen as inevitable.

This ‘cultural revolution’ takes many different and apparently unrelated forms whose destructive nature is denied by the government – which continues to assert that it has the public interest at heart and that it is factors like the ongoing impact of the credit crash, the increasing costs of drugs and medical equipment, the ageing population and our unhealthy lifestyles which are the true problems facing the NHS. The building blocks for privatisation to which I have referred currently include: the aforementioned awarding of NHS contracts to private bidders – often asset strippers who provide poor quality services, fragment and undermine the cohesive public ethos of the NHS; the creation by the Treasury of NHS deficits and of regulations which forbid them; enforced rationing of services to extend waiting lists and encourage patients to seek private alternatives; manufactured confrontations with doctors and other members of the NHS workforce; the imposition of ‘new models of care’ which undermine NHS hospitals and create community based healthcare structures ripe for privatisation; personal health budgets, designed to link with health insurance. There are many more and I can provide documented evidence for all of them. It is a national scandal.

What is to be done? Until we have a government committed to tackling and reversing this appalling onslaught on our beloved NHS, we must continue to expose what is happening, to challenge it and to campaign loudly and widely in order to increase public awareness and action.

http://www.pohg.org.uk/blog/nhs-on-life-support/

The phased privatization of England’s National Health Service is taking a toll in undermining “the cohesive public ethos of the NHS.” This brief description by Dr. Alex Scott-Samuel will give you a hint of the disaster that is taking place. Their political leaders apparently have learned nothing from the dysfunction that characterizes our system in the U.S., nor are we learning anything from them.

At a time that we need to be converting our fragmented public and private insurance system into a single public program, we are going in the opposite direction. Our public Medicare program is being privatized through similar cognitive processes as are taking place in England.

Just as the Conservative and Labor parties have conspired in these changes, here in the U.S. the Republicans and Democrats, the latter now dominated by the neoliberals, are damaging the traditional Medicare program through neglect while pushing on with fiscal and regulatory policies that have expanded enrollment in the private Medicare Advantage plans. When you read the paragraph above on the “cultural revolution” you cannot help but note the similar ethic of the two nations driving this insane march to rent-seekers nirvana at a cost of compromising patient care.

We can learn something from this, can’t we?

National Health Service – on life support

By Alex Scott-Samuel
POGH blog (U.K.), July 17, 2016

I want to give a broad political overview of what’s happening in the NHS in England and of the background to the current situation.

As you’ll know, the English NHS is in a bad way, with practically every part of the country in financial deficit. Many hospitals and many services are being closed down, cut back or rationed. At the same time, many long term contracts for the provision of NHS services are being awarded to private sector companies – though often people are unaware of this because the likes of Virgin, Carillion and SpecSavers are allowed to operate under the NHS logo.

By definition, these arrangements are wasteful, because private companies have a duty to make profits and to give those profits to their shareholders. That means that public money is haemorrhaging out of the NHS – whereas when a public provider of NHS services makes a surplus it is reinvested in the NHS.

There is also a substantial legacy of (mainly Labour initiated) private finance initiative (PFI) funded hospitals, whose exorbitant loan interest payments have to be made before NHS funds can be spent on routine services. And it’s no coincidence that people’s inboxes are filling up with adverts for health insurance, with their invitations to jump the NHS queues. Everything I’ve described forms part of what in my view is an intentional strategy by the Conservative government to create financial, managerial, professional and public chaos throughout the NHS, so that private provision of NHS services, alternative private health services, health insurance, and NHS co-payments and ultimately charges will be seen as inevitable.

This ‘cultural revolution’ takes many different and apparently unrelated forms whose destructive nature is denied by the government – which continues to assert that it has the public interest at heart and that it is factors like the ongoing impact of the credit crash, the increasing costs of drugs and medical equipment, the ageing population and our unhealthy lifestyles which are the true problems facing the NHS. The building blocks for privatisation to which I have referred currently include: the aforementioned awarding of NHS contracts to private bidders – often asset strippers who provide poor quality services, fragment and undermine the cohesive public ethos of the NHS; the creation by the Treasury of NHS deficits and of regulations which forbid them; enforced rationing of services to extend waiting lists and encourage patients to seek private alternatives; manufactured confrontations with doctors and other members of the NHS workforce; the imposition of ‘new models of care’ which undermine NHS hospitals and create community based healthcare structures ripe for privatisation; personal health budgets, designed to link with health insurance. There are many more and I can provide documented evidence for all of them. It is a national scandal.

I’m not usually a conspiracy theorist; the reasons I feel confident in making these claims are because my and other people’s researches over the last decade have revealed a series of papers and reports going back to the 1970s, in which the eventual privatisation of the NHS is laid out. Their sources include the Conservative Research Department, the Central Policy Review Staff, the Adam Smith Institute and the Centre for Policy Studies.

A few names occur recurrently – most notably Oliver Letwin, who helped plan many of Thatcher’s privatisations of public goods and services and who until July this year was a senior minister in the government. It was Letwin, not just Secretary of State Andrew Lansley, who had a major role in ensuring that the Health and Social Care Act 2012 passed into law. The monumental 350 page H&SCA – drafted by corporate lawyers – constitutes the complete enabling legislation for full privatisation of the English NHS.

What is to be done? Until we have a government committed to tackling and reversing this appalling onslaught on our beloved NHS, we must continue to expose what is happening, to challenge it and to campaign loudly and widely in order to increase public awareness and action. And even the opposition can draft legislation and campaign around it: the NHS Bill, first tabled in the previous parliament as a cross-party bill by Green MP Caroline Lucas, with support from Jeremy Corbyn and John McDonnell, was reintroduced as a Ten Minute Rule bill by Labour’s Margaret Greenwood on July 13 2016; it will have its second reading on November 4. Drafted by Professor Allyson Pollock and barrister Peter Roderick, it would reintroduce the Secretary of State’s duty – abolished by the 2012 H&SCA – to provide a universal, nationalised NHS in England. We must do everything in our power to support these aims.

Websites:
www.KeepOurNHSPublic.com
www.HealthCampaignsTogether.com

Further reading:
Jacky Davis and Raymond Tallis, eds. NHS SOS. How the NHS was betrayed – and how we can save it. Oneworld, 2013.
Jacky Davis, John Lister and David Wrigley. NHS For Sale. Myths, lies and deception. Merlin Press, 2015.
Youssef El- Gingihy. How to Dismantle the NHS in 10 Easy Steps. Zero Books, 2015.

Dr. Alex Scott-Samuel MB, ChB, MCommH, FFPH, is senior lecturer (clinical) in public health at the University of Liverpool.

http://www.pohg.org.uk/blog/nhs-on-life-support/

Physicians are not familiar with the MACRA reforms, nor the ensuing pain

Holy MACRA! Half of docs have never heard of Medicare payment reform

By Dave Barkholz
Modern Healthcare, July 14, 2016

Half of non-pediatric physicians have never heard of the Medicare Access and CHIP Reauthorization Act of 2015—a new CMS payment plan that will put 4% or more of their Medicare reimbursement at risk beginning in 2019, according to a new survey by Deloitte & Touche.

With CMS preparing final rules this autumn, just 21% of self-employed or small-group physicians and 9% of physicians employed by hospitals or larger groups were even somewhat familiar with the pending reimbursement changes, the survey showed.

Physicians with a high share of Medicare payments were just as clueless about MACRA as those with lesser exposures, Deloitte found.

MACRA has two payment tracks. Clinicians in advanced alternative payment models can earn bonuses annually of 5%.

The majority of physicians, though, will participate in the Merit-based Incentive Payment System. On that track, physicians can earn plus or minus 4% of reimbursement in 2019, 5% in 2020, 7% in 2021 and 9% in 2022.

Medicare’s own MACRA projections show the vast majority of physicians in groups of less than 10 suffering penalties.

That includes 87% of solo practitioners who can expect their reimbursement to fall and 70% of physicians in groups of two to nine, Medicare data show.

http://www.modernhealthcare.com/article/20160714/BLOG/160719930/blog-holy-macra-half-of-docs-have-never-heard-of-medicare-payment

Deloitte release:

http://www.prnewswire.com/news-releases/deloitte-survey-finds-low-physician-awareness-and-many-needed-changes-by-physicians-for-medicares-macra-program-300297982.html

Quote of the Day: MACRA and the ethics of physician burnout (4/22/16):

https://pnhp.org/news/2016/april/macra-and-the-ethics-of-physician-burnout

(WARNING: Reading the Table of Contents of the following document has been known to cause acute bouts of depression)

Federal Register: Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models:

https://www.federalregister.gov/articles/2016/05/09/2016-10032/medicare-program-merit-based-incentive-payment-system-mips-and-alternative-payment-model-apm

Physicians celebrated the passage of MACRA because it brought the end to the despised SGR method of making adjustments to Medicare payment rates. The legislation was not simply a repeal of SGR, but it was repeal and replace legislation. Most physicians are not “even somewhat familiar with the pending reimbursement changes.”

Physicians complain about Medicare’s low payment rates, but are they in for a surprise. Most solo and small group physicians will have rate cuts of up to 9 percent under MACRA.

Those interested in more information may want to read the Federal Register entry on MACRA’s MIPS and APM (link above), or maybe not, since it could take you the better part of a week. Just reading the very long Table of Contents may be enough.

In a fairly recent Quote of the Day we described how MACRA will likely compound the current epidemic of physician burnout (link above). It’s depressing.

We can do something about it. We can enact and implement a well designed single payer national health program. For those who think that the current system is better, it is probably time to make an appointment with your mental health professional.

Physicians are not familiar with the MACRA reforms, nor the ensuing pain

Holy MACRA! Half of docs have never heard of Medicare payment reform

By Dave Barkholz
Modern Healthcare, July 14, 2016

Half of non-pediatric physicians have never heard of the Medicare Access and CHIP Reauthorization Act of 2015—a new CMS payment plan that will put 4% or more of their Medicare reimbursement at risk beginning in 2019, according to a new survey by Deloitte & Touche.

With CMS preparing final rules this autumn, just 21% of self-employed or small-group physicians and 9% of physicians employed by hospitals or larger groups were even somewhat familiar with the pending reimbursement changes, the survey showed.

Physicians with a high share of Medicare payments were just as clueless about MACRA as those with lesser exposures, Deloitte found.

MACRA has two payment tracks. Clinicians in advanced alternative payment models can earn bonuses annually of 5%.

The majority of physicians, though, will participate in the Merit-based Incentive Payment System. On that track, physicians can earn plus or minus 4% of reimbursement in 2019, 5% in 2020, 7% in 2021 and 9% in 2022.

Medicare’s own MACRA projections show the vast majority of physicians in groups of less than 10 suffering penalties.

That includes 87% of solo practitioners who can expect their reimbursement to fall and 70% of physicians in groups of two to nine, Medicare data show.

http://www.modernhealthcare.com/article/20160714/BLOG/160719930/blog-holy-macra-half-of-docs-have-never-heard-of-medicare-payment

Deloitte release:

http://www.prnewswire.com/news-releases/deloitte-survey-finds-low-physician-awareness-and-many-needed-changes-by-physicians-for-medicares-macra-program-300297982.html

Quote of the Day: MACRA and the ethics of physician burnout (4/22/16):

https://www.pnhp.org/news/2016/april/macra-and-the-ethics-of-physician-burnout

(WARNING: Reading the Table of Contents of the following document has been known to cause acute bouts of depression)

Federal Register: Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models:

https://www.federalregister.gov/articles/2016/05/09/2016-10032/medicare-program-merit-based-incentive-payment-system-mips-and-alternative-payment-model-apm

***

Comment:

By Don McCanne, M.D.

Physicians celebrated the passage of MACRA because it brought the end to the despised SGR method of making adjustments to Medicare payment rates. The legislation was not simply a repeal of SGR, but it was repeal and replace legislation. Most physicians are not “even somewhat familiar with the pending reimbursement changes.”

Physicians complain about Medicare’s low payment rates, but are they in for a surprise. Most solo and small group physicians will have rate cuts of up to 9 percent under MACRA.

Those interested in more information may want to read the Federal Register entry on MACRA’s MIPS and APM (link above), or maybe not, since it could take you the better part of a week. Just reading the very long Table of Contents may be enough.

In a fairly recent Quote of the Day we described how MACRA will likely compound the current epidemic of physician burnout (link above). It’s depressing.

We can do something about it. We can enact and implement a well designed single payer national health program. For those who think that the current system is better, it is probably time to make an appointment with your mental health professional.

Employer-based health care is failing workers

By Kay Tillow
Daily Kos, July 14, 2016

Health care in the United States is the most costly in the world. The per capita the U.S. spends on health care is double the average of other industrialized countries, yet other nations have better outcomes in life expectancy, infant mortality, and most measures. In the U.S., we pay more but get less. About 40 percent of people in the U.S. forgo needed care because of cost.

The powerful, dynamic unions of the CIO established the highest standards for health care in the country lifting up the rest of the nation as they set the floor. Several decades later, after the rest of the industrialized world moved to universal health care systems, the collective bargaining power of U.S. unions is no longer sufficient to advance and protect health care benefits. Profiteers have rigged the system. For-profit insurers and pharmaceuticals are holding our health care, our collective bargaining, and our democracy hostage.

Reining in that control now requires far more than collective bargaining. It requires a dynamic movement that rallies the rank and file of the labor movement, links with communities and the public, takes on the corporate controllers of health care, and pushes relentlessly until it passes national single-payer health care, HR 676.

The evidence of the crying need to act is all around us. “Today, we said enough is enough, and went on strike for a restoration of health benefits and fair wages and working conditions,” said Fabia Sespedes, a housekeeper who has worked for nine years at the Trump Taj Mahal in Atlantic City. Nearly a thousand workers at the Taj Mahal casino walked out at dawn as the July 4 holiday weekend began. They are cooks, housekeepers, servers and other casino workers, members of Local 54 UNITE-HERE. They have been without health care and retirement benefits since those were taken away in October of 2014. Current owner of the Taj, billionaire Carl Icahn, is refusing to restore those benefits and threatening to shut down the casino.

Half of the workers rely on subsidized health insurance and a third have no health benefits at all. Icahn extracted $350 million from the property using bankruptcy proceedings to strip Taj workers of health care and pensions. “Now we’re going to take it to the streets,” said Mayra Gonzalez, a pantry chef at the Taj for 26 years.

In June over 4,000 coal miners from seven states rallied in Lexington, Kentucky, to demand passage of Senate Bill 1714 to shore up health and pension funds. Without that action, 22,000 retired miners and their families face the dropping of their health care benefits before the end of the year. “We’re not asking for welfare — we’ve earned these benefits,” said Michael Partin, a retired miner from Bell County who worked underground for 30 years. In the compelling fiery rhetoric that is his custom, UMWA President Cecil Roberts called on the miners to go home, recruit five people each, and prepare to march on Washington, D.C. A rally has been set at the U.S. Capitol Building for September 8, 2016.

In June 5,000 Minnesota Nurses Association members who work for the Allina Hospitals struck for 7 days as Allina sought to shift $10 million in health care costs onto nurses and their families. Monica Proulx, a surgery nurse for more than 20 years, said that Allina has refused to negotiate over issues such as patient care and reducing workplace violence unless the union capitulates on the health insurance issue. The nurses are back at work but the struggle continues.

In May more than 350 workers at Honeywell Aerospace were locked out in South Bend, Indiana, and in Green Island, New York. Members of UAW Local 9 in South Bend who make airplane brakes and wheels say they voted the contract down by 270 to 30 because it would drastically increase what they pay for health insurance. Local President Adam Stevenson says those who were working nights were ushered out of the plant by security guards and the day shift was barred from entering. Stevenson said one of the sticking points in the negotiations is that Honeywell wants to be able to change the structure of union members’ health care benefits, including what people pay for premiums and deductibles, during the term of the contract. The union has planned a rally for July 18.

At the Green Island location more than 500 supporters came out to rally with UAW Local 1508 where workers at the picket line say the average out-of-pocket expenses for a family under the plan included in the company’s offer will rise by as much as $7,000 a year.

Tim Vogt, a 29-year Honeywell employee and president of UAW Local 1508, said, “We cannot accept a contract that destroys our ability to provide for our families’ health and well-being.” The lock out continues.

Last Christmas thousands of Honeywell retirees received a letter from their former employer announcing that at the end of 2016 they would no longer have health insurance. In Fostoria, Ohio, where over 1,000 of those retirees live, UAW Local 533 President David Angles said, “It is dishonorable that this corporation would do this to people that gave 30 or more years of their lives to this company helping them make billions of dollars in profit and then turn around and take this benefit away during a time in their life that they need it the most.”

“We are the only industrialized nation in the world that does not have a national health care system and it’s time. Stand up and do something, if not for yourself, your children and grandchildren, because they will need your help,” concluded Angles.

President Angles is right. “Stand up and do something.”

Begin by getting your union or organization to endorse HR 676, national single-payer health care. A sample resolution is here.

Organize your city, county, or state to endorse HR 676. Use as a model one of the resolutions that have already been passed. They are here.

UnitedHealth Group CEO Stephen J. Hemsley took home over $66 million in compensation in 2014, while the health care crisis continued for millions of workers.

As retired USW steelworker Steve Skvara asked in Chicago when he stood up at a 2007 AFL-CIO Presidential Candidates Debate: “Every day of my life, I sit at the kitchen table across from the woman who devoted 36 years of her life to my family and I can’t afford her health care. What’s wrong with America and what will you do to change it?”

Kay Tillow is a leader of Kentuckians for Single Payer Health Care and the All Unions Committee for Single Payer Health Care–HR 676. She can be reached at nursenpo@aol.com.

http://www.dailykos.com/stories/2016/7/14/1548153/-Employer-based-health-care-is-failing-workers-Time-to-Stand-Up-and-Do-Something?_=2016-07-14T05:24:30.858-07:00

Hospital CEO says health care system broken, favors Medicare for all

By Ameet Sachdev
Chicago Tribune, July 15, 2016

U.S. Sen. Bernie Sanders’ call for a single-payer “Medicare for all” health system during his presidential campaign didn’t have a lot fans , even among fellow Democrats [PNHP note: not true]. But Bill Kottmann, president and CEO of Edward Hospital in Naperville, is sympathetic to the idea.

Kottmann said the current mix of private insurance and government insurance programs is “mind-boggling” for hospitals to figure out, let alone consumers. Moving to a health system fully funded by the government would be compassionate because it would be there for everyone, but Kottmann said he would allow people “of means” the option to receive concierge services.

“I think it’s tragic that we have families who go bankrupt because they can’t afford to pay medical bills,” Kottmann said. “That needs to be fixed, and Obamacare, I’m sorry, didn’t come close.”

Kottmann’s approval of a single-payer system would offend many in the health care industry, particularly private insurers, but he is not afraid of making bold statements. He is perhaps best known in the local industry for secretly wearing a listening device for the FBI for eight months in 2003 after he and his boss Pam Davis raised extortion complaints in their bid to build a hospital in Plainfield. Davis also was an FBI informant.

Kottmann, 61, would rather forget that stressful time and focus on the future, one he admits is a little scary. Chicago-area hospitals face numerous challenges, including lower admissions, new competitors and insurance company mergers.

“Let’s face it: The health care system is broken in my mind, from the payment system and everything else,” said Kottmann, who joined Edward in 1991 as a human resources executive and became CEO July 1. “We need a complete redo. But we have to deal with it the way it is and make the best of it.”

The full article, including an interview with Kottmann, is available at the following link:

http://www.chicagotribune.com/business/ct-edward-hospital-bill-kottmann-exec-qa-0717-biz-20160715-story.html

Projected national health expenditures

National Health Expenditure Projections, 2015–25: Economy, Prices, And Aging Expected To Shape Spending And Enrollment

By Sean P. Keehan, John A. Poisal, Gigi A. Cuckler, Andrea M. Sisko, Sheila D. Smith, Andrew J. Madison, Devin A. Stone, Christian J. Wolfe and Joseph M. Lizonitz (all from CMS Office of the Actuary)
Health Affairs, July 13, 2016 (Online before print)

Abstract

Health spending growth in the United States for 2015–25 is projected to average 5.8 percent — 1.3 percentage points faster than growth in the gross domestic product — and to represent 20.1 percent of the total economy by 2025. As the initial impacts associated with the Affordable Care Act’s coverage expansions fade, growth in health spending is expected to be influenced by changes in economic growth, faster growth in medical prices, and population aging. Projected national health spending growth, though faster than observed in the recent history, is slower than in the two decades before the recent Great Recession, in part because of trends such as increasing cost sharing in private health insurance plans and various Medicare payment update provisions. In addition, the share of total health expenditures paid for by federal, state, and local governments is projected to increase to 47 percent by 2025.

National Health Expenditures (NHE) 2016

NHE  $3.3507 trillion
NHE as percent of GDP  18.1%
Government proportion of NHE  46%
NHE per capita  $10,345.5

Conclusion

The health sector is in the midst of a unique period, in which various forces are exerting differential pressures on health spending growth. Economywide and medical-specific price growth have been very low, helping restrain inflation’s impact on health spending, and the Medicare program is experimenting with various alternative payment approaches. Meanwhile, many Americans are gaining access to health coverage for the first time, aging into Medicare, or finding that a greater share of their health expenses needs to be paid out of pocket. And the Medicaid program is evolving: Its population mix is increasingly likely to be covered through private plans.

For the period 2015–25, growth in health spending is projected to average 5.8 percent, influenced in part by an expectation of higher economywide and medical prices. By 2025, as economic, legislative, and demographic influences play out, the health spending share of the economy is projected to reach 20.1 percent, up from 17.5 percent in 2014, and governments are anticipated to sponsor 47 percent of health spending, up from 45 percent in 2014. The percentage of the US population that is uninsured is expected to be 8 percent in 2025, down from about 11 percent in 2014.

http://content.healthaffairs.org/content/early/2016/07/12/hlthaff.2016.0459.abstract

CMS National Health Expenditure Projections 2015-2025:
https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/Proj2015.pdf

***

Comment:

By Don McCanne, M.D.

The Great Recession has contributed to slowing of the growth in health care spending in recent years, but the future changes are predicted to be more closely related to various demographic related coverage changes plus certain payment trends including the increase in cost sharing in private insurance plans. Also the increase in the government contribution to our national health expenditures deserves special mention.

Regarding increases in patient cost sharing, it is no secret that this has been a blunt instrument to control spending, resulting in a decline in use of beneficial health care services. As has been stated repeatedly, we need more patient-friendly methods of slowing the increase in spending such as fairer publicly-administered pricing through a single payer national health program.

The government contribution to our national health expenditures has increased to 46 percent, but that does not include two large components of taxpayer-funded government spending on health care: 1) The government contribution to employee health insurance on the federal, state and local levels, and 2) the massive tax expenditures for employer-sponsored health plans (i.e., the health insurance component of the employee benefit package is not subject to income taxes, reducing revenue for the government which must be made up by other taxpayers).

The irony is that we already pay in taxes devoted to health care alone more than almost every other nation pays in public and private health care spending combined. Without increasing our current level of spending we could pay for a comprehensive, government-financed, single payer national health program. Yet we continue to support our dysfunctional financing system that wastes so much on administrative excesses while perpetuating injustices by misallocating distribution of our health care resources.

We can and must do better.