PNHP

MedPAC to examine Medicare premium support

MedPAC to examine Medicare premium support

MedPAC Examines How Medicare Premium Support Might Work

By Kerry Young, CQ Roll Call
The Commonwealth Fund, November 7, 2016

Congress’s advisers on Medicare are studying what steps would be needed if lawmakers eventually were to shift the giant federal health entitlement program to a so-called premium support model designed to restrain spending. House Republicans have called for making such a change.

The Medicare Payment Advisory Commission (MedPAC) intends to offer lawmakers a review of these options in its June 2017 report, said Eric Rollins, an analyst with the panel. MedPAC will not make formal suggestions to Congress on this topic next year.

“We are not going to recommend for or against premium support,” said Paul Ginsburg, a MedPAC member and healthy policy researcher with the Brookings Institution and the University of Southern California.

Ginsburg said he expects Congress at some point to take a serious look at the concept of premium support, although it’s currently unlikely to do so at this time. MedPAC’s work this year will help prepare lawmakers for eventual discussions of this approach to managing Medicare, he said.

MedPAC intends to outline possible paths and pitfalls toward a more competitive system for administering health benefits for senior citizens and people with disabilities. Traditional fee-for-service Medicare might compete with insurer-run Advantage plans under this system, Rollins said in his briefing. People enrolled in Medicare could avoid higher premiums by seeking out plans with lower costs in this new model, MedPAC’s Rollins said.

House Republicans earlier this year called for a move toward premium support as part of their policy paper on health care. In the House GOP model, people on Medicare would be given a choice of insurer-run plans and traditional Medicare starting in 2024. In the paper, House Republicans note that the idea of premium support “is based on a long history of bipartisan reform plans, including the 1999 Breaux-Thomas Commission and the 2010 Domenici-Rivlin Report.”

The prospect of more out-of-pocket costs for beneficiaries likely will prove a hurdle for lawmakers who want to shift to premium support. Willis D. Gradison Jr., a MedPAC member who represented an Ohio district in the House from 1975 through 1993, raised this political consideration.

http://www.commonwealthfund.org…

***

October 2016 meeting presentation: Reforming quality measurement and implications for premium support

By Ledia Tabor and Carlos Zarabozo
MedPAC, October 7, 2016

Premium support in a local market area

* Each plan bids to provide benefits to average health beneficiary

* Medicare determines government contribution based on FFS and private plan bids

* If beneficiary selects plan with bid above government contribution they pay a premium; plan with lower bids give enrollees a cash rebate

http://www.medpac.gov…

***

Comment:

By Don McCanne, M.D.

MedPAC (Medicare Payment Advisory Commission) advises Congress on Medicare. As the October 7 MedPAC presentation demonstrates, they are currently preparing for Congress a review of premium support – a voucher model designed to restrain federal spending by shifting more costs to Medicare beneficiaries.

It is unlikely that today’s election will change the political climate to where immediate enactment of premium support would be likely, but since the 1999 Breaux-Thomas (Frist, Jindal) Commission there has been bipartisan support of this proposal, though predominantly from the Republicans. Both sides in Congress do want changes, and it is quite possible that premium support could be advanced through a conservative-neoliberal coalition effort involving tradeoffs, especially since it is likely that we will have a neoliberal president who could well sign such legislation.

So pay attention or we may end up with a privatized, defined contribution Medicare program which will compound problems of affordability and access for our Medicare beneficiaries, not to mention stifling our dreams of an improved Medicare for all.

California’s Prop. 61 Offers Opportunity to Take on Big Pharma

By RoseAnn DeMoro
Common Dreams, Nov. 2, 2016

While the world is watching the Presidential race Tuesday night, another election battle in California provides a window in the ability of voters to challenge corporate power – in this case one of the most abusive industries in the world, big pharma.

Proposition 61 in California pits the drug cartel and those shilling for it, against patients, nurses, and consumer advocates. At a time when the drug giants have buried proposals in Congress and state legislatures to block any restraints on its predatory pricing, Prop. 61 would actually begin the process of lowering prices.

The drug corporations are running scared. They’ve poured in over $120 million, the most ever spent on a California ballot measure (and likely the most ever in the U.S.) with a non-stop pounding of deceptive and misleading ads intended to bully voters the way they routinely intimidate lawmakers.

Some of the tactics are right out of the playbook the industry has used across the country. As veteran national healthcare writer Trudy Lieberman notes, “PhRMA has reaped big dividends from having patient advocacy organizations shill for it in the legislative and regulatory arenas.”

With Prop. 61, the drug companies rarely speak in their own name, hiding their opposition role behind others viewed to have more public credibility. The Intercept cites public filings that reveal “19 different civic organizations, from the Foreign Legion to a bilingual voter guide organization, taking drug industry funds and endorsing No on Prop 61.”

Among them are several LGBT Democratic clubs whose influence has helped neutralize some liberal to progressive potential supporters, and prominent veterans organizations, all of whom have received drug industry funding.

Additionally, big pharma has lined up most of the corporate news media with Trudy Lieberman caustically noting after reading many editorials and op eds, “I concluded they must have been written from drug industry talking points dropped off at the newspaper offices.”

Yet, in the face of the massive onslaught of ads, every time you turn on your TV, computer, or mobile device, Prop. 61 has held its own with voters, polls have shown, and has a real chance to win.

That’s what has the drug companies alarmed. Sen. Bernie Sanders, who has embraced Prop. 61 in videos, billboard ads, and campaign visit, says, “Californians on Nov. 8 have a chance to stand up to the pharmaceutical industry’s greed and spark a national movement to end this price-gouging.”

Nurses have crisscrossed the state in support of Prop. 61, noting that they see patients on a regular basis who put their health at grave risk by self-rationing medication because of the high out of pocket cost.

They tell stories like this one, from a Fresno RN Amy Arlund of a “young man in his late 40s living on a fixed income, working two jobs, who was diagnosed with high blood pressure. This one medication was going to cost him over $400 a month.

‘I’m young, still in my 40s,’ he thought, ‘I’ll just have to live with it a little longer.’

About three months after this diagnosis, because he could not afford to take his blood pressure medication, he had a massive stroke and is now permanently disabled.”

Or from Long Beach RN Margie Keenan, who described “patients provided a heart stent for serious coronary disease sent home with directions to take anti-platelet drugs for continuing therapy, are returning to the ER with serious chest pain. Or dying before they get there. Why? They can’t afford the high out-of-pocket cost for their medication.”

For those not keeping track, here’s what big pharma has become, an industry with enough wealth and power to make Pablo Escobar blush:

  • 164 – percent of price increase since 2008 for brand name drugs in the U.S.
  • $1.6 trillion – worldwide profits, 50 top drug companies since 1995.
  • $3.4 billion – federal lobbying, 1998 through 2016, more than any other industry, including the banking and fossil fuel industries.
  • 1,400 – pharma federal lobbyists, 2015.
  • $11 billion – compensation for pharma executives, 2011-2015, mostly based on pay for performance (high stock prices driven by inflated prices). Ten executives made an aggregate $327 million in 2015 alone.
  • $1.7 trillion –pharma mergers and acquisitions spending,  1992-2015, during which drug costs, fueled by monopolization, rose by over 300 percent.
  • 89 – percent of top 100 drug firms that spend more on marketing than on research and development (R&D), 27 percent spend 10 times as much. Much R&D is funded by taxpayers, performed at public universities.
  • 65 – percent of industry R&D for minor tweaks to existing drugs that do little to make them more effective, but allow the company to extend the monopoly patent protection for a high priced brand name drug over a generic alternative up to 20 more years.

(Note: Find more background on the pharmaceutical industry from CNA/NNU’s Institute for Health and Socio-Economic Policy here.)

Seen enough? Prop. 61 requires the state to pay no more for medications for people it covers than is paid for the same prescription drugs by the Department of Veterans Affairs, the one agency that has authority to use public power to negotiate bulk price discounts.

Prop. 61 won’t end drug price gouging, but it’s a big start. One industry publication called California “ground zero” in the battle against big pharma and warned drug company executives, that “adoption of VA pricing by the state of California would be a “pricing disaster” for the entire U.S. drug industry.

That would be welcome. Passing Prop. 61 would send an unmistakable message that you can confront the corporate grip over our politics, our economy and our health – and win.

RoseAnn DeMoro is executive director of National Nurses United.

http://www.commondreams.org…

High deductibles less effective than previous interpretations of RAND HIE

NBER Working Paper 22802
Intertemporal Substitution in Health Care Demand: Evidence from the RAND Health Insurance Experiment

By Haizhen Lin and Daniel W. Sacks
National Bureau of Economic Research, November 2016

Abstract

Nonlinear cost-sharing in health insurance encourages intertemporal substitution because patients can reduce their out-of-pocket costs by concentrating spending in years when they hit the deductible. We test for such intertemporal substitution using data from the RAND Health Insurance Experiment, where people were randomly assigned either to a free care plan or to a cost-sharing plan which had coinsurance up to a maximum dollar expenditure (MDE). Hitting the MDE — leading to an effective price of zero — has a bigger effect on monthly health care spending and utilization than does being in free care, because people who hit the MDE face high future and past prices. As a result, we estimate that sensitivity to short-lasting price changes is about twice as large as sensitivity to long-lasting changes. These findings help reconcile conflicting estimates of the price elasticity of demand for health care, and suggest that high deductible health plans may be less effective than hoped in controlling health care spending.

From the Introduction

Studying intertemporal substitution is important for at least two reasons. First, with the important exceptions of Einav et al. (2015) and Cabral (2016), most of the literature on health care demand and the effect of insurance on spending has neglected intertemporal substitution, and estimated in a wide range of price elasticities, from as small as -0.2 to as large as -1.5 (for example, Manning et al. (1987); Eichner (1998); Zweifel and Manning (2000); Cardon and Hendel (2001); Bajari et al. (2014); Dalton (2014) and Kowalski (2015, 2016))). Most papers assume that health care decisions are made statically on an annual basis, meaning that there is no scope for future prices to affect current demand. Estimated. However, if there is intertemporal substitution, then patients may respond very differently to a temporary price change than to a long-lasting one. Therefore, depending on the sources of price variation used for identification, one might draw dramatically different conclusions regarding price sensitivities. Accounting for intertemporal substitution makes it possible to separate elasticities with respect to permanent or temporary price changes, and may help reconcile the disparate elasticity estimates in the literature.

Second, intertemporal substitution affects the response to high deductible health plans, which are now common in the American health insurance landscape. Regulators, insurers, and policymakers tolerate the weak risk protection of high deductible health plans out of the hope that they will reduce health care spending. This view implicitly assumes that care foregone in one year because of the high deductible represents a permanent reduction in health care spending. But if patients are deferring needed care, then their spending may be higher in future years, either because deferrable problems become so severe that they must be addressed, regardless of the cost, or because once patients finally do hit the deductible, they stock up on care, retiming deferrable procedures to a year when their price is low. Thus a key question for the effectiveness of high deductible health plans is whether patients intertemporally substitute in their demand for health care. Evidence of intertemporal substitution would suggest that high-deductible health plans may not be as effective as hoped in controlling overall health care spending.

Reconciliation with original HIE findings

We have argued that intertemporal substitution is an important part of how patients respond to nonlinear cost-sharing, causing them to stock up on health care when it goes on “sale,” with especially large anticipatory responses. Neglecting these dynamics can lead to biased estimates of the long-run effect of cost-sharing on utilization. The original RAND investigators, however, argued that intertemporal substitution was not an important part of the response to cost-sharing, and found little evidence for anticipatory effects. Here we reconcile these different conclusions.

The key difference between our analysis and the original investigators is in the timing of when we look for intertemporal substitution and anticipatory responses. They focus on the period around hitting the MDE, before and after. We focus on the end of the coverage year. As Keeler and Rolph acknowledge, it is likely difficult to detect anticipatory effects or pent up demand by focusing on fine timing around hitting the MDE. Households may not know exactly when they hit the MDE (as has been pointed out by the original RAND investigators), and may not appreciate the link between their current and future spending (Einav et al., 2015; Dalton et al., 2015; Abaluck et al., 2015). On the other hand, by the end of the coverage year, most families who hit the MDE will have seen a bill which makes clear their financial position, and it is not hard to understand that in the future, prices will be higher. Indeed, providers may help make this clear. Thus the myopia or limited understanding of the insurance contracts may have made it difficult for the original investigators to identify intertemporal substitution; by looking at the end of the year, we avoid this difficulty.

From the Conclusion

Studying data from the RAND Health Insurance Experiment, we found striking patterns of health care spending over the insurance coverage year. In most months, spending is lower in cost-sharing plans than in the free care plan. But in the last 1-3 months of the coverage year, spending rises quickly in cost-sharing relative to free care, and by the end of the year spending in the two plans is roughly equal. On the other hand, spending in free care is roughly flat over the coverage year, but it is particularly high early in the first coverage year, and it spikes dramatically at the end of the experiment.

These patterns are inconsistent with the standard model of demand for health care, which assumes away intertemporal substitution. Instead they suggest that patients can retime their care, especially for medically deferrable procedures and dental care, to reduce their out-of-pocket expenses in the face of nonlinear cost-sharing rules. To quantify the importance of intertemporal substitution, we estimate how health care spending responds to lag and lead prices as well as current prices. The estimates suggest that short-run moral hazard — the response to a one time, unanticipated price change — is substantially larger than the long-run response.

These results have important implications for health care spending and insurance design. First, they help reconcile some of the disparate estimates of the price elasticity of health care demand, since they imply that health care spending is more responsive to temporary price changes — for example, hitting the deductible — than to permanent price changes, for example, from insurance plan changes. Second, they suggest that high deductible health plans may not be as effective as hoped in controlling health care spending. These plans can reduce health care spending as long as patients do not hit the deductible. But in years when patients do hit it — as they eventually will — the large short-run response means that spending will make up for lost time, as patients stock up on care.

http://www.nber.org…

***

Comment:

By Don McCanne, M.D.

At the risk of over-simplification, we can interpret this complex study to show us that previous conclusions from the RAND Health Insurance Experiment (RAND HIE) ignored the responsiveness of year-end health care spending once hitting the deductible, and that particular increase in spending suggests that “high deductible health plans may not be as effective as hoped in controlling health care spending.”

The primary purpose of high deductibles in insurance plans is to reduce health care spending by insurers, employers and government plans. The tradeoff is that they create financial hardships and impair health care access for patients. But isn’t health care reform supposed to be about the patients?

How much are deductibles really saving? For the 20 percent of people using 80 percent of health care, the savings are negligible since the deductible is met early on for those individuals and thus has no further impact. For the four-fifths of us who use only one-fifth of the nation’s health care, many of us have deductible coverage through Medicaid, Medigap or MA plans, or health savings accounts, and thus are not affected.

So who is negatively impacted by high deductibles? It is individuals who do not qualify for Medicaid nor for ACA subsidies and who often cannot fund a health savings account. This is our workforce and their families. As a percent of our national health expenditures, the amount saved is very small, and may be even smaller than believed based on this NBER study. This seems to be too heavy of a price to pay for such a relatively small savings.

So high deductibles don’t work very well and they harm patients. In contrast, single payer tools do control spending while helping patients. Do we really have to continue contemplating making the change that would finally fix our system? Why not action now?

Affordable Care Act hikes could spark Medicare for All

By Bill Knight
Morton (Ill.) Times-News, Oct. 31, 2016

Illinoisans who don’t have health insurance through their jobs or from individual policies they bought face premium hikes as sign-up starts this week for the Affordable Care Act, and those who fault President Obama for everything from Bears quarterback Jay Cutler to another danged week of Daylight Saving Time aren’t hesitating to blame Obama.

There’s plenty of blame to go around, but focusing exclusively on Obama is like denouncing an architect when the rent goes up. Building designers, engineers, contractors or carpenters aren’t landlords, and Obama didn’t decide to raise premiums.

Here, now, it’s the insurers, and their greedy move could be the Step Too Far that rekindles consideration of Medicare for All.

In Illinois, premiums would go up 44 percent for the lowest-priced “bronze” plans, and about 300,000 people not in employers’ plans, Medicare or Medicaid could be affected. Out of 10.5 million enrolled nationwide, about 1.6 million face higher prices.

Besides insurers’ premiums increasing, policyholders’ choices in insurance exchanges — central to the ACA — are decreasing. In states using HealthCare.gov, the number of plans is dropping from 47 to 30 because corporations such as Aetna, UnitedHealth Group and Humana are pulling out of some states, concerned that they otherwise won’t continue making millions in profits – essentially blaming policyholders who actually need the coverage. (If health insurers covered only young and healthy people and paid no medical expenses, they’d REALLY make profits.)

When Bill Clinton on Oct. 3 called it a “crazy system … with their premiums doubled and their coverage cut in half,” he was talking about private companies being in charge of public good.

However, insurers’ actions in the ACA – signed into law in 2010 but not fully implemented until 2014 — could spark demands for Medicare for All.

In the meantime, ACA officials recommend shopping around for less-expensive plans and using available subsidies, which increase along with premium prices. But Health and Human Services Sec. Sylvia Mathews Burwell also adds that lawmakers share responsibility, too, not only for insisting on keeping the insurance industry in its powerful position, but Congress’ “efforts to undermine the ACA,” like trying to kill the ACA more than 60 times, blocking funds to help protect insurers with high-cost customers, and refusing to expand Medicaid. Some 3 million people can’t get Medicaid help because the Supreme Court OK’d states’ right to decline expanding Medicaid.

“It’s not because of any policy in the Affordable Care Act that the rates are going up,” Obama said. “If state leaders purposefully try to make something not work, then it’s not going to run as smoothly.”

Further, constant criticism by right-wing radio, Fox News and their ilk contribute to the ACA’s low approval rating while its actual provisions (preventive care, coverage for those with pre-existing conditions, protections for young people, and cancer screenings) are popular.

U.S. Sen. Bernie Sanders said, “Health care cannot continue to be dependent upon the whims and market projections of large private insurance companies whose only goal is to make as much profit as possible. That is also why we need to pass a Medicare-for-All, single-payer system.”

The ACA is having success, too. Experts expect enrollment to rise to a monthly average of 11.4 million next year, health-care jobs are increasing, and hospitals’ finances improving, according to the new book “150 Years of Obamacare” by Daniel Dawes, who notes that a recent Gallup survey showed that the percentage of uninsured nonelderly adults is 11.5, a historical low, down from about 20 percent in 2012.

Plus, putting the country’s health-care spending into perspective, projections in 2009 called for health-care spending to increase 19.3 percent of Gross Domestic Product by now, but the ACA has helped hold that to 18.1 percent, according to economist Dean Baker.

Meanwhile, Medicare for All could build on strengths and fix weaknesses by encouraging cost control because service, not profit, would be the priority. As Margaret Flowers of the Physicians for a National Health Program explains, “Insurance companies cherry-pick the healthy. The only thing that will turn this system around is to expand traditional Medicare. Everyone is in it. All the health-care providers are in it. Everyone pays through a progressive tax. Then we can get the cost savings that we need to provide high-quality universal care.”

http://www.mortontimesnews.com…

Fix our system? Listen to Oxfam and Doctors Without Borders

The U.S. Is Standing in the Way of Cheaper Drugs for the Poor

By Jason Cone and Raymond C. Offenheiser
The New York Times, October 27, 2016

In the United States, companies have raised prices on many drugs over the past five years, mostly with little public notice or scandal. Pfizer alone raised the prices of more than 100 drugs in one year. Drug prices have seen double-digit inflation over the past three years, at a time of relatively low inflation in the rest of the economy. Recent research suggests that cancer patients may be delaying use of lifesaving drugs, while there are reports that prisoners are rationed access to hepatitis C treatments — all because of high prices.

But this problem is also international. In poorer countries across the world where our organizations work, millions of people are priced out of medicines that could save lives and relieve suffering. For example, a recent World Health Organization study found that in some 30 countries, hepatitis C medicines were unaffordable for much of the population.

Pharmaceutical companies simply charge whatever they want — or can. They have big budgets to counter image problems from bad press and congressional hearings. And while they claim that high prices are necessary to develop new drugs, it’s just not true. Public funding and subsidies pay for much of today’s pharmaceutical innovation.

Many world leaders recognize that high drug prices are a public-health crisis. Earlier this year, Ban Ki-moon, the secretary general of the United Nations, commissioned a panel of industry, government, academic and civil society experts, including Oxfam International’s executive director, to recommend ways to bring drug prices down to affordable levels and to improve research and development of new medicines in order to fulfill the human right to health.

The panel’s report, released last month, found that today’s system is failing. Pharmaceutical monopolies reap huge profits from high prices, while medicines are unaffordable for too many people. The report called for more transparency and competition in the drug industry and for preserving and implementing existing policies that help reduce prices.

Shamefully, the American government sought to obstruct and oppose the panel, even denying the premise that high drug prices undermine public health.

The Obama administration’s response to the report’s release called the panel’s work “deeply flawed” and accused it of recommending “divisive policies,” which it warned ominously “could have significant unintended negative consequences.” In other words, if we want new medicines and innovations, we must continue to support a system in which the pharmaceutical industry has unlimited power to set prices. Considering alternative pathways is apparently off limits.

These scare tactics not only contradict the United States’ stated global and domestic health priorities, they are also an offense to people unable to afford critical treatment. Worse yet, the American government actively exports this approach to other countries through trade agreements like the Trans-Pacific Partnership, which, if allowed to take effect, will lock in and extend global monopoly protections and high medicine prices for years to come.

Yet to really transform how drugs are developed, governments must lead the charge. There are hopeful signs this might happen. In September, world leaders agreed to address antibiotic resistance in part, by committing to develop new drugs through such new research and development models.

The United Nations panel recommendations, which the Obama administration has tried to attack and discredit, are precisely designed to open new paths to medical innovation that benefit us all. Access to existing and new medicines and treatments should not depend on how much money you have, where you were born or whom you know.

The United States government, especially the next president, must stop defending industry profits and work to reform how we pay for medical research to ensure that all patients’ needs are addressed. High prices of medicines are not inevitable; they are a choice the American government has made. Many lives and livelihoods hang in the balance until that choice changes.

Jason Cone is the executive director of Doctors Without Borders USA. Raymond C. Offenheiser is the president of Oxfam America.

http://www.nytimes.com…

***

Comment:

By Don McCanne, M.D.

Those of us who have tried so hard for so long to fix our dysfunctional health care system will understand this article. Reform efforts being celebrated today have enhanced the business successes of the medical-industrial complex and especially the insurance and pharmaceutical industries, while patients face more barriers to care through restricted networks, greater cost sharing and exorbitant pricing.

What is missing here? Jason Cone of Doctors Without Borders USA and Raymond Offenheiser of Oxfam America make it quite clear that it is our government that is failing the people while taking care of the industrial special interests.

Perhaps worse, we have a polarized nation with one side opposed to all things government in health care, and the other side celebrating the government’s gifts to the industry even though the welfare of patients is sacrificed in order to accomplish those ends.

In a democracy we are supposed to be able to fix these problems through our elections. But on my ballot for next Tuesday I don’t see any options that could realistically assure us support for the altruistic goals of Oxfam and Doctors Without Borders. It’s not like in two years of campaigning there wasn’t adequate opportunity to advance ideas that would truly make us stronger together as we make America great again. All we got instead was campaign slogans and further polarization on a scale with negative polarity at either end.

Sorry.

CDC: Reducing the rate of uninsured may have plateaued

Progress reducing uninsured rate threatens to stall

By Ricardo Alonso-Zaldivar
Associated Press, November 3, 2016

President Barack Obama’s legacy health care law has reduced the number of Americans going without health insurance to historically low levels, but continued progress threatens to stall this year, according to a new government report.

The study released Thursday by the Centers for Disease Control and Prevention suggests the law may be reaching a limit to its effectiveness in a nation politically divided over the government’s role in guaranteeing coverage.

The CDC said the number of uninsured people dipped by only 200,000 between 2015 and the first six months of this year, which it called “a nonsignificant difference.” The findings come from the National Health Interview Survey, which has queried more than 48,000 people so far this year.

Since the health care law’s big coverage expansion in 2014, millions have gained coverage each year. Now the pattern appears to be changing.

Experts say Obama’s overhaul deserves most of the credit for 20 million Americans gaining coverage since 2014. But progress has been less and less each year, and now it’s slowed to a crawl.

“It has got to be close to tapped out,” said Dan Witters, director of a major private survey that also follows insurance trends, the Gallup-Healthways Well-Being Index.

The new survey offers a hint that the nation’s historic coverage expansion may have actually gone into reverse during part of this year. An earlier CDC report covering just the first three months of this year found that the number of uninsured had been even lower, an estimated 27.3 million people — or a million fewer than the six-month figure in the latest report.

Another notable finding from Thursday’s report is that the share of Americans in high-deductible health insurance plans keeps increasing. That may help explain widespread anxiety about affordability at a time when overall health care spending is growing at a moderate pace.

The CDC survey defines high-deductible coverage as insurance that requires patients to pay at least the first $1,300 of annual medical expenses for an individual plan, or $2,600 for a family. In the first six months of this year, 38.8 percent of persons under age 65 were in high-deductible plans, an increase from 36.7 percent in all of 2015, the survey found.

Employers started shifting workers and their families to high-deductible plans before Obama took office, and now that’s becoming the norm. Many people are unhappy with the change, and some public-opinion experts say that helps explain the continued low ratings for Obama’s health overhaul, even if it was not the cause.

http://bigstory.ap.org…

***

Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–June 2016

By Emily P. Zammitti, M.P.H., Robin A. Cohen, Ph.D., and Michael E. Martinez, M.P.H., M.H.S.A.
National Center for Health Statistics, November 3, 2016

* In the first 6 months of 2016, 28.4 million (8.9%) persons of all ages were uninsured at the time of interview — 20.2 million fewer persons than in 2010, but only 0.2 million fewer persons than in 2015 (a nonsignificant difference).

* Among adults aged 18–64, the percentage with private coverage through the Health Insurance Marketplace or state-based exchanges has not changed significantly — from 4.8% (9.3 million) in the second quarter of 2015 to 4.8% (9.4 million) in the second quarter of 2016.

https://www.cdc.gov…

***

Comment:

By Don McCanne, M.D.

It looks like the reduction in the rate of uninsured as a result of the Affordable Care Act may have plateaued. This is not a surprise since it was understood that the design limitations of building on the existing fragmented financing system could never result in truly universal coverage.

A well designed single payer system would have accomplished the goal of universality. We could still reach that goal without increasing our total national health expenditures beyond the current level, not to mention that we would gain the multitude of other benefits of a single payer system.

The Cubs fans stuck with a perpetual loser for over a century, and they finally broke through last night. With the same determination, maybe we could finally achieve the political breakthrough that we need to enact a health care system that actually does include everyone. Next Tuesday could be a start.

Future physicians’ demands for national health insurance

By John Geyman, M.D.
The Huffington Post, Nov. 3, 2016

Medical students are becoming strong advocates all over the country for expanded and improved Medicare for All. Spurred on by their increasing awareness of the restricted access, unaffordability, and inequities keeping many Americans from necessary health care, they are organizing and making their voices heard about the urgency of real health care reform.

With the co-sponsorship of the American Medical Student Association (AMSA), the Latino Medical Student Association (LMSA), White Coats for Black Lives, and many regional and local groups, a good example of their activism was the Halloween Day event in Boston a few days ago, which they dubbed #TreatNotTrick. Donning their white coats, often with Halloween costumes, they staged a public demonstration and call-in asking Rep. Mike Capuano to co-sponsor the single-payer bill in the House, H.R. 676. Their message is that private health insurance is a trick, and that they just want to treat patients in a fair system of universal coverage of health care for all Americans.

The Boston event was part of the Second Annual Medicare-for-All National Day of Action put on by Students for a National Health Program (SNaHP), the student arm of Physicians for a National Health Program (PNHP). Similar events were held from California to Minnesota to Tennessee on no fewer than 33 medical campuses. In Ohio, medical students visited Sen. Sherrod Brown’s office urging him to sponsor a single-payer bill in the U.S. Senate. In Philadelphia, they rallied to memorialize the lives lost because of being uninsured or underinsured. Their message is clear — private health insurance is a trick that erects barriers to care.

Today’s medical students, altruistic as so many are, see a medical profession caught up in a medical-industrial complex controlled by large corporations ranging from the insurance industry to the pharmaceutical and medical device industries. The business model prevails — profits and revenue for corporate CEOs and their shareholders call the tune.

Medical students are seeing that almost two-thirds of physicians are now employed by big organizations, mostly expanding hospital systems. They see the decline of small group practice and the professional autonomy of earlier years diminished. They see an increasingly fragmented system with erosion of continuity of care amidst frequent changes of insurance coverage, narrowed and changing networks, and patients losing choice of physicians and hospitals. And they hear about earlier retirements and increasing burnout of physicians trying to keep up with the paperwork and bureaucracy of today’s multi-payer, largely for-profit system.

Medical students and their colleagues in other health professions are looking for a simplified system with universal access for all Americans to necessary care based on the principle that health care is a human right. That approach has been adopted for many years, in one way or another, by almost all advanced countries, while the U.S. remains by far the most expensive system with worse access and quality of care than most of these countries.

A sizable majority of Americans have favored national health insurance (NHI) for many years, usually including about three of five respondents to national surveys. A 2008 survey of more than 2,200 U.S. physicians in 13 specialties also favored NHI.

Activist positions for single-payer NHI have been taken in recent years by a growing number of members of professional organizations, including members of the American College of Physicians, the American Society of Clinical Oncology, the American Psychiatric Association, the American Women’s Medical Association, the American Public Health Association, the American Nurses Association, and National Nurses United.

Jean Ross, co-president of National Nurses United, recently had this to say about the rapidly increasing insurance premiums in 2017 under the Affordable Care Act: “The [just announced] premium increases are outrageous and just the most recent sign of a broken, dysfunctional health care system.”

Medical students and other young health professionals are right in calling single-payer national health insurance, or Medicare for All, an urgent need. They are the future of health care in this country. Those of us in older generations welcome their empathy and caring in leading toward health care reform.

National health insurance, as soon as it is enacted, will deliver a better system for both patients and health professionals — one based on a service ethic that will transition over 15 years to a not-for-profit system. It would have simplified administration allowing physicians and other health professionals more time for direct patient care, the essential purpose of the medical profession.

Dr. John Geyman is the author of “The Human Face of ObamaCare: Promises vs. Reality and What Comes Next” and “How Obamacare is Unsustainable: Why We Need a Single-Payer Solution For All Americans.” He is professor emeritus of family medicine at the University of Washington School of Medicine and past president of Physicians for a Naitonal Health Program. Visit www.johngeymanmd.org.

http://www.huffingtonpost.com…

Anthem Blue Cross forcing PPO patients into EPOs

Anthem is cutting out-of-network health coverage in a ‘bait and switch,’ lawsuit says

By Melody Petersen
Los Angeles Times, November 1, 2016

On the first day of Obamacare open enrollment, a consumer group sued Anthem Blue Cross for attempting to automatically renew policies that no longer cover out-of-network costs for hundreds of thousands of Californians.

A lawyer for Consumer Watchdog said Tuesday that Anthem was “railroading existing members into bare-bones plans” without properly disclosing the change to them in recent renewal letters.

On top of the loss of out-of-network coverage, many of the customers also face big premium hikes.

Consumer Watchdog’s lawsuit says Anthem engaged in a “bait-and-switch” scheme. The group’s attorneys said Anthem should have sent the customers a “discontinuation” notice to properly inform them that they were losing their out-of-network coverage. Instead the insurer sent notices saying the policies would automatically renew if the member takes no action by Dec. 15.

Darrel Ng, an Anthem spokesman, said his company had changed the plans’ design “to mitigate rate increases and keep monthly premiums affordable.”

“The benefit package being offered in 2017 was approved by the Department of Managed Health Care and Covered California and is consistent with federal guidance,” Ng said. “Affected members have been mailed written notice of this change so they can make an informed decision on their healthcare needs during the open enrollment period for the coming year.”

The change, effective Jan. 1, affects policyholders who had signed up for Anthem’s preferred provider organization, or PPO.

In most areas in the state, Anthem is changing its PPO into a so-called exclusive provider organization, or EPO — which means that it will no longer pay even a portion of bills from doctors or hospitals not in its network.

http://www.latimes.com…

***

Comment:

By Don McCanne, M.D.

Once again, using the legitimate excuse that they need to keep premiums affordable, insurers are shifting more costs to patients. In this instance, California’s Anthem Blue Cross is no longer going to pay anything for often unavoidable out-of-network health care. They will do this by switching their CaliforniaCare plans from PPOs (preferred provider organizations) to EPOs (exclusive provider organizations).

As an example, unsuspecting patients caught off guard may find that their specialists providing them with essential health care services are no longer covered by their plan.

This is yet one more example of the one-way march to save money for the insurers’ risk pools by further impairing coverage of essential medical services, for the sole reason of protecting the insurer’s business model.

This march began with the advent of the managed care revolution and accelerated since the enactment of the Affordable Care Act – not because of the Act itself but rather because of the failure to enact a model that would control health care costs while removing financial barriers that impair access to care.

The model that would work, of course, is a single payer national health program. The nation’s failure to enact such a program can only lead us further down the insurers’ primrose path – pleasing the insurers while compounding the disastrous consequences for patients. We surely will not actually allow them to lead us all the way to the everlasting bonfire, would we?

Complexity of annual enrollment decisions

7 Tips To Help Avoid Costly Health Plan Enrollment Headaches

By Michelle Andrews
Kaiser Health News, November 1, 2016

With the annual sign-up period for plans on the health law’s marketplaces starting Nov. 1, many consumers are worried about rising premiums, shrinking provider networks and the departure of major insurers such as UnitedHealthcare, Aetna and Humana from many exchanges.

The impact on coverage will vary, but the shifting landscape means that it’s more important than ever for consumers to carefully evaluate the plans that are available in their area and choose the best one for their needs. There are several elements to factor into that decision.

It’s crucial to log into the marketplace and review plan details. Comparing plan premiums and deductibles only scratches the surface of what you should evaluate before selecting a plan this fall. Policy details can make an important difference in coverage and costs, but it may take some digging to uncover them.

Avoid Premium Sticker Shock

Premium increases for 2017 will generally be higher than last year’s rate hikes, though with significant geographic variation. In the two-thirds of states where the federal government runs the marketplace, the average premium increase for the second lowest cost silver plans will be 25 percent next year, according to a recent report by the Department of Health and Human Services. Last year, the comparable premium increase was 7 percent. The average premium, before tax credits, for the lowest cost silver plan will be $433.

About 85 percent of marketplace customers have incomes of up to 400 percent of the federal poverty level (about $47,000 for one person) and qualify for federal tax credits to help pay their premiums. If you are one of these consumers, it may be necessary to switch plans to minimize your share of the premium because your tax credit is pegged to the second lowest-cost silver plan in your area, which often changes from year to year.

Next year, three quarters of people can find a cheaper plan at the same metal level if they come back to the marketplace to shop. Consumers who bought the lowest cost silver plan in 2016 can save an average $58 per month by switching to the cheapest silver plan next year, according to HHS.

People with subsidies “can insulate themselves from premium increases by selecting one of the lowest cost silver plans,” said Caroline Pearson, a senior vice president at the consulting firm Avalere Health.

If you’re currently buying an individual plan but not going through the marketplace, be sure to recheck your eligibility for subsidies. Federal officials estimated earlier this month that 2.5 million people who purchased coverage outside the exchanges have incomes that would qualify for financial assistance.

Look For Hidden Benefits

A close look at plan details may show that coverage is more generous than it appears. Even as deductibles continue to rise, many plans are offering coverage for certain services before the deductible is satisfied. So instead of having to pony up the entire cost of your visit to the doctor or your prescription drug until the deductible is paid off, you may just owe a copayment.

This year, for example, 66 percent of silver-level plans sold on healthcare.gov covered primary care doctor visits before the deductible. Half of plans covered generic drugs before the deductible. (In addition, the health law requires that many preventive care services, including tests and screenings, vaccinations and contraceptives, generally be covered without requiring people to pay anything out of pocket in all new marketplace plans.)

This practice can serve two purposes. Encouraging primary care may save insurers money down the road on more expensive treatment. And exempting some services from the deductible could help make plans more appealing to the relatively healthy people insurers want to attract and who might otherwise balk at policies with a typical deductible of around $3,000.

“Part of it is trying to give people some value even if they’re not high users of health care,” said Sarah Lueck, a senior policy analyst at the Center on Budget and Policy Priorities in Washington, D.C.

Sidestep Automatic Reenrollment

If your plan is continuing next year, you may be automatically renewed, but that may not be your best option. Do some comparison shopping on marketplace plans to see whether there are changes to plan benefits or provider networks that matter to you and how 2017 pricing will affect your subsidy.

If your plan is not going to be available next year and you don’t actively pick a new plan, you may find yourself automatically enrolled in a plan with similar costs and benefits. But that can mean changes in the list of approved drugs or losing access to your favorite hospitals and doctors, among other things.

Pay attention to timing. Enrollment ends Jan. 31, but to have coverage that starts Jan. 1, you must make a choice by Dec. 15.

Check Out New Standardized Plans

Next year, healthcare.gov will join several state-based marketplaces in offering standardized plans that are expected to help consumers make apples-to-apples comparisons between plans at the bronze, silver and gold levels and cut down on confusion caused by a sometimes bewildering array of options. In these “simple choice” plans, the deductibles and annual limits on out-of-pocket spending will be standardized, as will many of the consumer payments for medical services. For example, the standardized silver plan will have a deductible of $3,500 and the maximum amount you will owe out of pocket for the year will be $7,100.

In addition to standardized benefits, many of the plans cover a number of services before the deductible is satisfied, such as primary care and specialist visits, drugs, urgent care and outpatient mental health.

Many standardized plans also rely on copayments (fixed amounts that you pay for a service), rather than coinsurance (a percentage of the cost of the service), to a greater extent than people may see in regular marketplace plans, said Sabrina Corlette, research professor at Georgetown University’s Center on Health Insurance Reforms. Insurers aren’t required to offer standardized plans in most states, but the federal government is promising that the plans will be  prominently displayed on healthcare.gov.

Dig Into Prescription Drug Details

Drug coverage is a big concern for many people, but finding plan details can be tough. You can check out a plan’s list of covered drugs through healthcare.gov, but determining what your share of the cost will be can be more challenging. That’s because even though state marketplaces typically only show four cost-sharing tiers online, many plans have five, six or even more tiers. In 2016, 40 percent of silver marketplace plans had more than four cost-sharing tiers, according to Avalere data.

Also, insurers on the exchanges may require that your doctor or other health provider get prior authorization from the insurer before prescribing some drugs for you or demand that you try a less expensive drug before getting a more expensive one, a practice called step therapy, said Pearson.

“If you’re a consumer that has a lot of drug costs or takes specialty medications, actually consulting the plan documents is important, because you need more granularity than is available on the website,” said Pearson.

Check Provider Networks

You will be able to check which doctors and hospitals participate in the plans you’re considering on healthcare.gov. That’s increasingly important as networks continue to narrow and fewer plans offer any out-of-network coverage. An initiative by the federal government to communicate whether a plan’s network is basic, standard or broad in all states using the federal marketplace has been trimmed back to a four-state pilot in Tennessee, Maine, Ohio and Texas.

Use Caution When Shopping Off The Marketplace

If the marketplace plans don’t appeal and you don’t qualify for subsidies, you can shop for individual market coverage off the exchanges, although the number of such offerings has been declining, said Katherine Hempstead, who directs health insurance coverage research for the Robert Wood Johnson Foundation.

Off-exchange plans can’t be too wildly different from what’s available on the exchange, because they also have to cover the essential health benefits and offer plans in metal tiers that cover the same proportion of care as those on the marketplace, among other things. But in some markets, plans may offer different or broader provider networks outside the exchanges, said Corlette.

There’s a potential downside, however. If your income is too high to qualify for subsidies at the beginning of the year, you may qualify for them later if your income drops — for example, if you lose a major client. But that’s only an option if you’re already enrolled in a marketplace plan.

“If you’re enrolled outside the exchange and you have a change in income, you can’t qualify for a special enrollment period to sign up for a different plan,” Corlette said.

http://khn.org…

***

Comment:

By Don McCanne, M.D.

By glancing at the section titles (in bold) you can quickly identify seven categories that can result in enrollment headaches if care is not exercised in selecting your health plan. But the article is reproduced in its entirety because under each section there are a multitude of more specific considerations that increase the complexity of plan selection.

The purpose of this message is to demonstrate that, regardless of the source of your insurance, there are so many variables that must be considered each year that it is impossible to select a plan that will best serve your needs when the 80 percent of us who are healthy cannot know whether or not next year will be a year in which we join the 20 percent with very high health care costs.

One of the more important functions of insurance is to protect everyone against potential catastrophic losses in health care, and that is defeated when so many plan variables leave individuals more exposed to these losses, while protecting the insurers against these same losses. It is evermore difficult to justify the very high administrative costs of private plans when they are shifting their risk bearing function onto the backs of their own plan beneficiaries.

Besides, the variables, such as narrowing provider networks and whether or not the plan will even be offered next year, are continually changing, creating instability in insurance coverage. Think back 20 years and hardly anyone now has the same coverage they did then (except those over 85 who have been on Medicare).

The reason for these variables that are creating instability is not to benefit plan enrollees but rather to continually modify the insurance products to match the business model of the insurers. They are supposed to be serving us, not themselves.

We can fix this problem by removing the insurers from the equation. Medicare does need some attention, but it would be far better to fix Medicare and then provide it to everyone. That would eliminate these enrollment headaches. Everyone would be secure with the knowledge that a single payer Improved Medicare for All would eliminate the instability and uncertainties inflicted on us by the private insurance industry.

High-risk pools and the public option

Sounds Like A Good Idea? High-Risk Pools

By Julie Rovner and Francis Ying
Kaiser Health News, October 31, 2016

One way Republicans say the system could be fixed is by returning to something called a high-risk pool.

The idea is to let all the sick people buy their policies in a separate insurance pool, and then have insurance companies and states and the federal government all chip in to pay for their care and keep their premiums low.

Before the Affordable Care Act, 35 states had high-risk pools.

The federal government had one, too, as a transition to the health law. But none of them worked very well.

The biggest problem? Both premiums and other costs remained too high for many people with health conditions to afford. The federal program ran out of money almost a year before it was scheduled to end.

Sometimes the pools got so expensive for states that they had to impose waiting lists for coverage.

And often, to keep costs down, risk pools set up waiting periods before they started paying bills for the very illness that made people high risk.

Republicans say their new risk pools plan would be better than the old ones. Their plan says it would keep premiums low, and no wait lists would be allowed.

But it’s not clear that the $25 billion in federal funding they propose would be enough, or that states would step in to help fund the pools.

http://khn.org…

***

Comment:

By Don McCanne, M.D.

Republicans have repeatedly voted to repeal the Affordable Care Act, stating that health plans are too expensive, They suggest that we replace them with plans that cover only what is needed, leaving many benefits out, and that we reduce regulation by selling plans across state borders, relieving insurers of the requirement that they must sell plans to the sick as well as the healthy. Such plans would certainly have lower premiums, but they would work only for healthy individuals who have relatively few health care needs. What about those who would need much more care?

The Republicans do recognize the need. They suggest that we establish high-risk pools to cover these individuals. Plans in these pools would be very expensive – not affordable for most. They suggest that these plans be partially subsidized by the government, and they have proposed $25 billion in federal funding.

Since the sick would be concentrated in these high-risk pools, many of the 80 percent of us who are relatively healthy could then afford to buy the deregulated, stripped-down plans they propose. So the Republicans can sell their concept based on the fact that these plans would be much more affordable than those currently offered in the exchanges.

But the high-risk pool concept is not new. Many states have experimented with them before, and even ACA included high-risk pools during the transition. But these plans mostly failed for a very obvious reason. Concentrating very expensive patients into a single risk pool results in unaffordable premiums, and our legislators refused to provide the level of funds that would be required to make the programs work. They stripped down the plans, exposing patients to intolerable out-of-pocket costs, and they sharply restricted enrollment in the plans, creating long waiting lists of people in need.

If we created a separate high-risk pool for the 20 percent of us who have greater health care needs, how much money would we need? Well, since they would use about 80 percent of our health care dollars, it would require roughly $2,400 billion of the $3 trillion plus that we are already spending on health care. Obviously the $25 billion that the Republicans propose would not go very far, and people would have to look to other programs to finance their care.

However some of the high-risk patients are already in other programs. Some are covered by Medicare or Medicaid, though the Republicans would convert Medicare to a defined contribution program (premium support), shifting more of the costs to these patients with high needs, and they would change Medicaid into a block-grant program, reducing the federal component of the funding when Medicaid already has serious problems because of its chronic underfunding. Basically, Republicans want to reduce the role of government in financing health care. That can only make things worse for those with greater health care needs.

In a bit of irony, the Republicans are now in a position wherein they can stand on the sidelines and holler about protecting the public purse from the public option proposed by the Democrats, while smugly realizing that it is likely that the public option will turn out to be the high-risk pools that Republicans support.

Ida Hellander, Director of Policy and Programs for Physicians for a National Program, has this to say:

The Democratic Senators are calling on states to create ‘public options’ for their health exchanges because 20 percent of people won’t have a choice on insurer in 2017, and in 2018 it could be higher.

The exchanges open a week before the election, and they want to look like they have a solution.

Clinton herself has said repeatedly that the states can set up public options because of section 1332 of the ACA.

Alaska got down to one insurer that was going bankrupt so it had to kick in $51 million in state funds to keep it afloat. In MN all seven insurers were going to bail until the state agreed to let them limit enrollment. If the state doesn’t put together a public option soon, there will be people eligible for subsidies on the exchanges with no insurance plan to sign up for.

These state options won’t have any of Medicare’s advantages of course. They’ll have to follow all the rules already set for commercial insurers. They serve only one purpose.

The PO is not a ticket to single payer. It is a last ditch attempt to save the ACA. These state-based public options will only survive with giant state subsidies. In other words, we’ll be back to state-based high risk pools, which is what they will quickly turn into.

The intersection of policy and polarized politics makes for quite a scene. The Republicans fight for high-risk pools. The Democrats fight for the public option not realizing that it is really just high-risk pools in drag. The Democrats win by trading off more important public policies, but that is a win in name only. The Republicans get their high-risk pools, adding to their other obfuscated victories (Medicare Advantage privatization of Medicare, Medicaid managed care privatization, privatized Medicare drug benefits, and especially the conservative Heritage reform plan that became Obamacare). That should explain why the mixed aroma of cigars and brandy wafts over from the right side of the Congressional isle.

Need more proof that the liberals keep losing? We have nothing remotely resembling an equitable, efficient, universal single payer system, but the conservatives have almost everything they want.

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

Med students hold Halloween-themed rally concerning U.S. health care system

By Billy Bevevino
The Daily Free Press (Boston), Oct. 31, 2016

Speakers stood in front of hundreds of miniature tombstones Monday afternoon at Boston University’s Medical Campus, not to just celebrate Halloween, but to represent those who have died from a lack of access to proper health care.

In addition to the festive tombstones, songs such as “Monster Mash” and “Thriller,” blasted from speakers and Halloween inspired posters bearing slogans such as “Treat Not Trick,” the title of the demonstration organized by the BU chapter of Students for a National Health Program.

The crowd included approximately 20 BU medical students, doctors and Massachusetts State Sen. Jamie Eldridge, who all came together in support of a single payer health care system and health care justice in Massachusetts.

Pat Downs Berger, a retired doctor who works with Massachusetts Campaign for Single Payer Health Care, a program dedicated to establishing a single payer system, according to their website, urged the younger attendees to work to change the health care system during her speech at the demonstration.

“You are the people who really are going to make a change,” she said.

Janine Petito, a fourth-year student in the BU School of Medicine, and one of event’s organizers, said she is working to change the current health care system because she wants to be able to treat her patients based on medical need and not financial status.

Petito said she believes this can only be achieved through a single payer national health insurance that would provide Medicare for all.

“Twenty-nine million Americans are currently uninsured, and a similar number are underinsured,” Petito said.

Petito explained that in addition to having a poor national health care program, the United States also has a disproportionate amount of medical debt.

“The United States has the highest rates of medical debt out all the developed countries in the world [and the] highest infant mortality rate in comparison to equally wealthy countries in Europe and elsewhere,” Petito said. “At the end of the day, we are wealthy country and it shouldn’t be this way.”

Andrew Olsen, a second-year student in BUSM, who attended the event, said while the Affordable Care Act is a step in the right direction, America still has a long way to go to establish universal health care.

“[We have] recognized that health care is a human right and … taken action, [but] America has never developed a system that covers everybody,” Olsen said. “Many [are left] without insurance at all.”

Olsen said while the ACA has beneficial tax policies, it does not provide substantial health care to taxpayers.

“One of the biggest downsides of the ACA has been that it has created a new category of underinsurance that allows people to avoid tax penalties, but doesn’t provide that kind of care that keeps them healthy.”

Brad Zehr, a fourth-year student at BUSM, attended the event to show his support for a single payer health care system in the United States because he is unsatisfied with the current system, he said.

“If you spent a day looking at the research regarding our health system and compared that to other advanced, wealthy nations … ours is a complete disaster,” he said.

Zehr added that the current state of health care in the United States discourages him from pursuing a career in medicine.

“The fact that we still can’t find a way to insure everybody affordably and sustainably, the fact that we pay twice as much as a country per person and still can’t give everyone insurance, makes you realize that you don’t want to be a physician in a system that doesn’t make sense,” he said. “You want to be a physician in a system that you’re proud of and treats everyone in the country.”

Heather Sweeney, a first-year student at BUSM, who attended the event, said she supports the single payer system because universal health care should be considered a fundamental human right.

“The health care system as it is now is pretty broken, and it’s sad how many people do not have access to insurance,” Sweeney said. “Health insurance is a right, much like a police department or a fire department.”

The Daily Free Press is the independent student newspaper at Boston University.

http://dailyfreepress.com…

U of L med students urge ‘Medicare for all’

By Deborah Yetter
Courier-Journal (Louisville, Ky.), Oct. 31, 2016

Using Halloween to underscore their message that patients deserve to be treated for illness, not tricked by high costs of health care, a group of University Louisville medical students and physicians on Monday rallied for “Medicare for all”  as a solution for problems of the current health care system.

“Medicare works fine,” said Dr. Peter Esch, a gerontologist who treats patients on Medicare, the government-sponsored plan for older Americans. “It will work for everyone.”

Dr. Barbara Casper, chief of internal medicine at U of L, said a single source of coverage for her patients would end the complexities of dealing with multiple commercial insurance plans and help people who have no health insurance.

“I hope we can get it in the time I’m still practicing as a physician,” said Casper, who’s been a doctor for 30 years.

Monday’s event, held on the plaza in front of the U of L medical school, was part of such events nationwide organized by the group Students for a National Health Program. Several U of L medical students spoke, including Mallika Sabharwal, who dressed in a devil’s costume to illustrate what she said is the “devilishly high” cost of health care in America.

It comes as many Americans begin the annual rite of enrolling in employer-based health plans or choosing a private plan through marketplace exchanges created under the Affordable Care Act of 2010, also known as Obamacare.

Enrollment begins Nov. 1 for private plans and in Kentucky, that means thousands of people for the first time will be directed to Healthcare.gov, the federal health exchange, to shop for plans. Gov. Matt Bevin has dismantled kynect, the Kentucky health exchange created by his predecessor, Steve Beshear, saying the state’s site is too costly.

Speakers on Monday said the current system is too cumbersome, overly complicated and that adequate health coverage is still out of reach for many Americans.

Some of the medical students shared personal stories, including Lyn Summay, who said that while in college, she had no health coverage and on one occasion didn’t seek care for what turned out to be a case of strep throat because she couldn’t pay for treatment. As a result, she developed a debilitating case of rheumatic fever — a complication most often associated with people from developing nations with poor health care.

“I was in bed for weeks because I didn’t have health coverage,” she said. “I don’t believe anybody else should have to deal with something like that.”

Summay said she understands the notion of a single source of health care is controversial and often breaks down amid a partisan political divide among conservatives, who dislike the idea of expanding government’s role in health care, and liberals, who believe government should play a greater role.

“If it’s identified as conservative or liberal, people start butting heads and it gets more polarized,” she said. “I’m hopeful we can convince people this is a bipartisan thing.”

Justin Watkins, a U of L medical student who previously lived in Canada — which has a government-run system that covers all residents — said his biggest worry about health care in that country was making sure he had his medical ID card when he visited the doctor.

Watkins said that after moving to the United States to complete undergraduate studies for medical school, he went three years without health coverage because he couldn’t afford it.

“I didn’t understand why in America, the wealthiest and most advanced country in the world … there were so many people without insurance,” he said. “I’d just taken it for granted as a Canadian.”

Speakers urged support for U.S. House Resolution 676, a measure to expand Medicare health coverage to people of all ages in the U.S.

Dr. Garrett Adams, a Louisville physician who has long advocated for a single system of health coverage in the United States, said the expansion of health coverage under the federal Affordable Care Act — though it added coverage for some 20 million Americans — isn’t the solution. The 2010 law simply has too many flaws, he said.

It doesn’t address skyrocketing pharmaceutical prices, he said. The cost of premiums for people seeking to buy individual health insurance plans rose sharply this year, he said. And 19 states refused to accept Medicaid expansion for low-income residents, leaving such individuals in a coverage gap between Medicaid for the very poor and costly, commercial plans for those with higher incomes.

For those reasons, Adams said he thinks the U.S. eventually will move toward a unified system.

“I think it has to happen,” he said. “It will happen.”

Contact reporter Deborah Yetter at 502-582-4228 or at dyetter@courier-journal.com.

http://www.courier-journal.com…