PNHP

What single-payer healthcare would mean to doctors

What single-payer healthcare would mean to doctors

By Liz Seegert
Medical Economics, May 25, 2016

Health insurance is again in the political spotlight as Democratic presidential candidate Bernie Sanders promotes his version of single-payer that he calls “Medicare for all.” He says it will improve care, reduce administrative burdens and allow physicians to focus just on practicing medicine. Dissenters say it’s a pipe dream that will only lead to rationed care, lower reimbursement rates and long waiting lists.

Single payer is held up by supporters as the ideal egalitarian healthcare model. If other nations can provide expansive medical care for their citizens, they ask, why can’t the U.S.? Opponents disparage the idea as anti-choice; they predict the implosion of the healthcare system and demise of physician autonomy.

Could single payer be the boon to medical practice its supporters insist? Or would we end up with a system that limits care and ignores best practices in favor of the bottom line? Who’s right?

The short answer is, both sides are.

Continue reading…

http://medicaleconomics.modernmedicine.com/medical-economics/news/what-single-payer-healthcare-would-mean-doctors

Single payer essential to controlling health-care costs

By David Woods
The Philadelphia Inquirer, May 16, 2016

One hears these days mutterings by disaffected Americans that if Donald Trump becomes president, they will pack their bags and leave for Canada. One assumes, of course, that no wall will be built along the border to thwart their exit.

I made the reverse trip. Having emigrated from Britain to Canada, where I became the editor in chief of the Canadian Medical Association Journal, I opted to come to the United States in 1988 for personal reasons.

But I was also taken with American rugged individualism and a health-care system focused on market forces and competition. I wrote articles for the Economist Intelligence Unit and other periodicals on the wonders of the American system. In print, I debated longtime advocates of single-payer national health insurance, extolling the virtues of the health-care market that others abhorred.

Gradually, though, I too began to have doubts about market-driven health care. Over the 25 years that I’ve lived on the U.S. side of the border, I’ve come to the view that the American health-care system – which still leaves 11 percent of the population uninsured, despite the Affordable Care Act – is inferior to the health systems in Canada and the United Kingdom.

One of the ACA’s architects, Dr. Ezekiel Emanuel, describes the U.S. health system as a “terribly complex, blatantly unjust, outrageously expensive, grossly inefficient, error-prone system.” Unfortunately, that’s still true, six years after the ACA’s passage.

The reform didn’t address the fundamental problem in U.S. health care: It’s more about profit than patients.

Controlling health-care costs is essential to the long-term financial health of the United States. A single-payer system would make truly universal coverage affordable, costing no more than we already spend on health care. Of the $3.1 trillion the United States will spend on health care this year, 63 percent is taxpayer-financed, funding Medicare, Medicaid, and Veterans Affairs, along with private coverage for government employees and tax subsidies for employers.

Because of its fragmented, profit-driven system, the United States spends 18.1 percent of gross domestic product on health care, compared with about 8 percent in Britain and 11 percent in Canada. Much of U.S. health spending is simply wasted. For example, 25.3 percent of hospital expenditures go to administrative costs, compared with 12.4 percent in Canada, where there is a single payer in each province and hospitals are mainly funded on a global or lump-sum basis.

Canadians also save money by training a higher percentage of primary-care doctors relative to specialists, negotiating drug prices with pharmaceutical companies, and prohibiting drug companies from advertising directly to consumers. These measures would save Americans billions annually. Americans spend $1,010 per capita on pharmaceuticals; Swedes spend less than half that, according to the Organization for Economic Cooperation and Development. The reason? Sweden doesn’t pay the list price.

Lobbying and influence-peddling by the pharmaceutical and insurance industries keeps the United States from adopting a single-payer health system. Several presidential candidates this season seemed completely under their hypnotic sway. The private insurance industry brazenly tells me, now a U.S. voter, which doctors I can see, charges me astronomical premiums, not to mention co-pays and deductibles, and then wants me to believe that having publicly funded health care that would allow me to go to any doctor in the United States without a $5,000 deductible would be “socialism.”

And don’t believe the widely held U.S. notion that Canadians suffer long waits for care. That’s a canard. We are not going to cut U.S. health spending to Canadian levels. With our much higher level of spending, waits would not be an issue, even with the population aging. Japan and many countries in Europe already have higher percentages of elderly citizens than the graying of the baby boomers is projected to produce.

In his book “In Search of the Perfect Health System,” British economist Mark Britnell notes that the British love their single-payer National Health Service because of its fairness; it’s available to everyone. He even quotes a former U.K. finance minister who said that the NHS is the closest thing the English have to a religion. Their single-payer system keeps quality indexes up and costs down for the population at large. This enables the British to invest additional funds in education and economic stimulation, areas that also contribute to health and well-being.

The United States should take a lesson from the example of nations with single-payer systems. They offer a measure of hope and optimism that high-quality health care can be the right of all Americans, if they demand it.

David Woods is a former editor in chief of the Canadian Medical Association Journal. hmi3000@comcast.net

http://www.philly.com/philly/health/20160516_Commentary__Single-payer_essential_to_controlling_health-care_costs.html

Why American doctors are calling for Canadian-style medicare

At a time doctors to the south are looking to Canada for answers, we are at risk of losing the health advantage we have

By Karen Palmer
Toronto Star, May 15, 2016

In a dramatic show of physician support for deep health care reform in the U.S., more than 2,200 physician leaders have signed a “Physician’s Proposal” calling for sweeping change.

The proposal, published May 5 2016 in the American Journal of Public Health, calls for the creation of a publicly financed, single-payer, national health program to cover all Americans for all medically necessary care.

If that sounds familiar, it should. These American doctors are calling for Canadian-style medicare. They want a decisive break from the expensive and inefficient private insurance industry at the heart of the U.S. health care system.

How ironic that at the same time U.S. physicians are calling for a single-payer health system like ours, Canada is in the midst of a legal battle threatening to pave the way for a multi-payer system resembling what has failed Americans.

What’s at stake? A trial about to begin in British Columbia threatens to make the Canada Health Act unenforceable.

The Canada Health Act is federal legislation that guides our health care system. It strongly discourages private payment for medically necessary hospital and physician services covered under our publicly funded medicare plans. This includes out-of-pocket payments in the form of extra billing or other user charges. Legislation in most provinces further prohibits private insurance that duplicates what is already covered under provincial plans.

If patients are billed for medically necessary hospital and physician care, the federal government is mandated to withhold an equivalent amount from federal cash transfers to provinces or territories violating the Act.

At least that’s what supposed to happen.

Unfortunately, the last decade saw a proliferation of extra billing in several provinces, and few instances of government clawing back fiscal transfers. Perhaps, things will change. Health Minister Jane Philpott recently said the government will “absolutely uphold the Canada Health Act.”

In B.C.’s upcoming trial, the plaintiffs — including two for-profit investor-owned facilities, Cambie Surgery Centre and the Specialist Referral Clinic — are attempting to have the court strike down limits on private payment. They support the creation of a constitutionally protected right for physicians to bill patients, either out-of-pocket or through private insurance, for medically necessary care, while also billing the public plan.

In other words, the plaintiffs want to undo our elegantly simple single payer system for hospital and physician care, creating instead a multi-payer system like the U.S. If their constitutional challenge is successful, the door will swing wide open in BC — and across Canada — for insurers to sell what will amount to “private queue jumping insurance” for those who can afford it, potentially harming the rest of us who can’t.

The outcome of this trial could be that those who can pay for care would jump the queue, drawing doctors and other resources out of the public system. Those who can’t pay would likely wait longer. Rather than a solution for wait times, private payment in the Canadian context would make them worse.

Global evidence shows that private insurance does not reduce public system wait times. The Achilles heel of health care in several European countries, such as Sweden, has been long waiting times for diagnosis and treatment in several areas, despite some private insurance. After Australia introduced private insurance to save the government money, those with private insurance have faster access to elective surgery than those without. Divisions in equitable access to care is one of the biggest challenges now facing countries that have adopted multi-payer systems.

Multi-payer systems are administratively complex and expensive, explaining why the U.S. health insurance industry spends about 18 per cent of its health care dollars on billing and insurance-related administration for its many private plans, compared to just 2 per cent in Canada for our streamlined single payer insurance plans. Hospital administrative costs are lowest in Canada and Scotland — both single payer systems — and highest in the U.S., the Netherlands, and the U.K. — all multi-payer systems.

For all of its warts in how we deliver health care in Canada, the way in which we pay for care — a single public payer in each province or territory — avoids the high administrative costs of multi-payer systems.

Abundant evidence shows private insurance is at the root of what ails the U.S. system. Dr. Marcia Angell, co-author of the Physicians’ Proposal, Harvard Medical School faculty and former editor-in-chief of the New England Journal of Medicine, sums it up: “We can no longer afford to waste the vast resources we do on the administrative costs, executive salaries, and profiteering of the private insurance system.”

A Canadian-style single payer financing system would save the U.S. about $500 billion annually.

Meanwhile, in Canada, abandoning our single payer health care system for a U.S.-style multi-payer system would be the worst possible outcome for Canadians. Let’s hope the evidence convinces the judge. The trial begins in September.

Karen Palmer is an advisor with EvidenceNetwork.ca, a health policy analyst, and adjunct professor in the Faculty of Health Sciences at Simon Fraser University.

https://www.thestar.com/opinion/commentary/2016/05/15/why-american-doctors-are-calling-for-canadian-style-medicare.html

sdrawkcab reform

Sorry, We Don’t Take Obamacare

By Elisabeth Rosenthal
The New York Times, May 14, 2016

Amy Moses and her circle of self-employed small-business owners were supporters of President Obama and the Affordable Care Act. They bought policies on the newly created New York State exchange. But when they called doctors and hospitals in Manhattan to schedule appointments, they were dismayed to be turned away again and again with a common refrain: “We don’t take Obamacare,” the umbrella epithet for the hundreds of plans offered through the president’s signature health legislation.

“Anyone who is on these plans knows it’s a two-tiered system,” said Ms. Moses, describing the emotional sting of those words to a successful entrepreneur.

The goal of the Affordable Care Act, which took effect in 2013, was to provide insurance to tens of millions of uninsured or under-insured Americans, through online state and federal marketplaces offering an array of policies. By many measures, the law has been a success: The number of uninsured Americans has dropped by about half, with 20 million more people gaining coverage.

Yet even as many beneficiaries acknowledge that they might not have insurance today without the law, there remains a strong undercurrent of discontent. Though their insurance cards look the same as everyone else’s — with names like Liberty and Freedom from insurers like Anthem or United Health — the plans are often very different from those provided to most Americans by their employers. Many say they feel as if they have become second-class patients.

Some early studies of the impact of the Affordable Care Act plans are proving patients’ grumbling justified: Compared with the insurance that companies offer their employees, plans provide less coverage away from patients’ home states, require higher patient outlays for medicines and include a more limited number of doctors and hospitals, referred to as a narrow network policy. And while employers tend to offer their workers at least one plan that allows them coverage to visit doctors not in their network, patients buying insurance through A.C.A. exchanges in some states do not have that option, even if they’re willing to pay higher premiums.

The research thus far suggests that the differences between plans offered through the A.C.A. and those offered by employers may be quite significant. A study in the policy journal Health Affairs found that out-of-pocket prescription costs were twice as high in a typical silver plan — the most popular choice — as they were in the average employer offering. In research conducted with the Robert Wood Johnson Foundation, Dr. Polsky found that 41 percent of silver plans offered a “narrow or very narrow” selection of doctors, meaning at best 25 percent of physicians in an area were included. The consulting firm Avalere Health found that exchange plans had 42 percent fewer cancer and cardiac specialists, compared with employer-provided coverage.

When designing the new plans, for-profit insurers naturally tended to exclude high-cost, high-end hospitals with whom they had little clout to negotiate discounts. That means, for example, that as of late last year none of the plans available in New York had Memorial Sloan Kettering Cancer Center in their network — an absence that would be unacceptable to many New York-based employers buying policies for their employees.

And when Simon F. Haeder of the University of Wisconsin and his colleagues studied the plans sold on the California exchange, they found that they included 34 percent fewer hospitals than those sold on the open market and tended to exclude the priciest medical centers, like Cedars Sinai, a highly regarded hospital that runs the largest heart-transplant program in the country.

http://www.nytimes.com/2016/05/15/sunday-review/sorry-we-dont-take-obamacare.html

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Special Enrollment Periods for the Health Insurance Marketplace

CMS.gov, May 6, 2016

Special Enrollment Periods

While SEPs provide a critical pathway to coverage for qualified individuals who experience qualifying events and need to enroll in or change qualified health plans (QHPs) outside of the annual open enrollment period, it’s equally important to avoid SEPs being misused or abused.  As it announced today, HHS is tightening the rules for certain special enrollment periods and making clear that SEPs are only available in six defined and limited types of circumstances.

An Interim Final Rule with Comment (IFC) published in the Federal Register provides that individuals requesting a “permanent move” SEP must have minimum essential coverage for one or more days in the 60 days preceding the permanent move, unless they were living outside of the United States or in a United State territory prior to the permanent move. This ensures that individuals are not moving for the sole purpose of obtaining health coverage outside of the open enrollment period.

https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-05-06.html

When explaining that health care reform seems to be moving backwards, does it improve communication to discuss reform that is sdrawkcab (ananym of backwards)?

NYT’s Elisabeth Rosenthal has provided us with another great article that describes how some of the supposedly forward advances in reform are really backwards. The ACA exchange plans are undoing some of the financial protection that health insurance should afford us, while impairing access through narrower provider networks. If we said that this reform is sdrawkcab, would that help us understand it better?

As small business owner Amy Moses stated, “Anyone who is on these plans knows it’s a two-tiered system.” Does it not seem absurd that the policies inherent in ACA would place a business owner in the lower tier of a two-tiered system? Isn’t that sdrawkcab? Yes and no. Actually what is sdrawkcab is that we would even have tiers in our health care system when it would be much more efficient, more equitable, and more effective to have a single high level system for everyone – an improved Medicare for all.

A specific example of the wrong direction in which too much of our policy is headed is provided by the new CMS rule that describes yet another technical reason to prohibit individuals from obtaining coverage through special enrollment periods. Although health reform supposedly was designed to expand access to insurance plans, this rule is sdrawkcab in that it prohibits access for certain uninsured individuals. True, the rule was designed to protect insurers from individuals who might have an acute need for coverage outside of the open enrollment period, but the entire system should have been designed to automatically enroll everyone instead of ignoring individual needs while providing insurers with their optimal business model.

No more sdrawkcab reform. Everybody in, nobody out!

The elephant in the room: health care’s inaccessibility

By Paul Redstone, M.D.
Clinical Psychiatry News, May 14, 2016

As I read the array of articles in medical newspapers and on websites, I am intrigued by various reports about medications, such as the article, “Antidepressants tied to lower dementia mortality.” This and other articles about new therapeutic approaches involving medications are useful and interesting. However, what is lacking in this coverage of health care are articles about the “elephant in the room.” That elephant is the sadly deficient state of health care availability for vast numbers of the population who might, in fact, benefit from these treatments. This problem obviously is not unique to psychiatry; I am sure this could be said for all branches of medicine.

I have been working for many years in the Medicaid/Medicare inner city sector of society and am continually appalled by the lack of support available to the people I serve. I am not talking about the problem of availability and access to doctors – which is another important issue. I am talking about people who “drop out” of treatment for 6 months or more because, as they have said: “I had trouble with my insurance changing!” or “They sent me a letter, and I didn’t know what it was for and discovered by not replying I lost my coverage,” and on and on.

Then there are those who confess that they didn’t fill the prescription “last month” or for several months because they could not afford the copay. Yes, that $3-$7 required copay added to other health medications plus food and shelter needs simply did not exist! And on and on go the stories. I am not talking about Ronald Reagan’s imaginary welfare queens or drug users who are diverting money elsewhere. These are people who might or might not even be on welfare. Contrary to myth, many people on Medicaid actually work but are still unable to earn enough money for food and rent, much less prescription copays.

In addition to this glaring deficiency in medicine as a whole, has anyone noticed the deafening silence regarding dental care? If we think about what we are trying to treat, how does giving an antidepressant serve the person with chronic dental problems, or the person who is reluctant to smile because of being self-conscious about not having dentures? How does the antidepressant help that patient? The field of psychiatry constantly includes discussions about addressing problems in the context of the whole individual. Does that not include the mouth? I am amazed that there is not more public discussion by psychiatrists and other physicians about this unconscionable state of affairs. We keep discovering new drugs and treatments, but so what if it is only for a select few?

Our publications and organizations like the American Psychiatric Association and the American Medical Association need to be producing blazing headlines about this terrible state of affairs. As physicians, we are in the business of helping people by treating and hopefully alleviating suffering. It shouldn’t be our problem to figure out how our patients can pay for this treatment. But if they can’t pay for it, what good is our training, intention, or business?

If our patients cannot reliably afford the treatments we prescribe, it seems our only choice as physicians is to become politically vocal: So when will we all unite to insist on accessible health care (including dental) for all? The article published within the past few days in the American Journal of Public Health from 2,000 doctors supporting a single-payer health care system is a wonderful start. I am sure that more than 2,000 doctors would agree. However, it is only a start! And if you object to the sound of “single payer,” that is fine as long as we create a situation in which there is a health care system that effectively provides truly comprehensive access for all.

Dr. Redstone is a psychiatrist who practices in Springfield, Mass.

PNHP note: This opinion piece was originally published under the title “The elephant in the room: Health care for the working poor.”

http://www.clinicalpsychiatrynews.com/views/single-view/the-elephant-in-the-room-health-care-for-the-working-poor/bbbf597e0f4398c5fe92bccc19265283.html

Doctors’ single-payer prescription for health care reform

By Steffie Woolhandler & David U. Himmelstein
The Hill, Congress Blog, May 12, 2016

Many months before Bernie Sanders entered the presidential race, we (along with Dr. Adam Gaffney, an energetic younger colleague, and Dr. Marcia Angell, the former editor of the New England Journal of Medicine) convened a nonpartisan group of 39 leading physicians to envision health care reforms that would fix the glaring problems that remain despite the Affordable Care Act (ACA).

After the Supreme Court removed the final roadblock to the law in 2015, President Obama declared that at last “in America, health care is not a privilege for a few, but a right for all.” Yet doctors on the ground knew that wasn’t entirely true. We continue to see patients who dangerously delay their care because of cost concerns or insurance obstacles.

At least 27 million Americans remain uninsured, and for tens of millions with insurance, sky-high copayments and deductibles (which average $5,300 in the bronze plans sold on the ACA exchanges) mean they’d be bankrupted by a serious illness. Many more people have narrow network coverage that won’t pay for care at top cancer centers or academic hospitals.

Meanwhile, giant insurers and hospital conglomerates with a single-minded focus on their bottom line increasingly dominate health care. And doctors and nurses contend with insurers’ growing demands for mind-numbing electronic documentation. These trends predated the ACA, but the law accelerated them. The ACA has also fueled medical merger-mania and the health system’s administrative complexity and cost.

The alternative we and our colleagues developed (which has now been endorsed by 2,227 other physician colleagues) appears in the current issue of the American Journal of Public Health. It calls for radical change: a single-payer national health program, essentially an expanded and improved version of Medicare for all, much along the lines that Bernie Sanders has advocated.

The single-payer plan we propose would cover everyone for all medically necessary care – including dental care, prescription drugs and long-term care – without copayments or deductibles. In contrast to private insurers’ narrow networks that restrict patients’ choice of doctors and hospitals, the single payer would cover care from any doctor or hospital.

Our nation can readily afford such expanded and improved coverage if we replace the current wasteful patchwork of insurers with a streamlined single-payer system. At present, private insurers’ take 12.3 percent of total premiums for their overhead; only 88 cents of every premium dollar ever reaches a doctor, hospital or pharmacy. And insurers inflict massive paperwork on doctors and hospitals, which spend about one-quarter of their revenues on billing and administration.

In contrast, insurance overhead is only 1.8 percent in Canada’s single-payer system, about the same overhead as in our Medicare program. And Canadian hospitals have administrative costs less than half those of their U.S. counterparts. That’s because Canadian hospitals are paid annual global budgets, like U.S. fire departments, instead of billing separately for each Band-Aid and aspirin tablet. Billing is also simple and inexpensive for Canadian physicians.

Overall, a single payer would save about $500 billion annually by trimming administrative spending to Canadian levels. Moreover, as in other nations, the single payer could use its purchasing power to lower drug prices, saving tens of billions more each year. These savings could fully cover the new costs of the coverage expansions we propose, a conclusion in keeping with past estimates by the Government Accountability Office, the Congressional Budget Office, and private consulting groups (including one that’s owned by an insurance company).

Contrary claims, including those contained in a report published by the Urban Institute this week, are fraught with flawed assumptions and grossly underestimate the savings a single-payer system would assure.

We and our colleagues recognize that, despite widespread public support for Medicare for all, passage of our proposal is unlikely absent sweeping changes in the makeup of Congress. But the same can be said about any salutary health reform; Congress has resisted even modest tweaks to the ACA.

Yet as physicians we feel obliged to offer our best advice. Our health care crisis can be solved. We have the resources needed to provide excellent care for all Americans; an abundance of hospitals and sophisticated equipment; superbly trained doctors and nurses; prodigious research output; and generous health care funding. Yet only thoroughgoing single-payer reform can realize the healing potential that is currently thwarted by our dysfunctional health care financing system.

The authors are internists who teach at the City University of New York at Hunter College and Harvard Medical School. They co-founded Physicians for a National Health Program, a nonpartisan organization that advocates single-payer reform.

http://thehill.com/blogs/congress-blog/healthcare/279508-doctors-single-payer-prescription-for-health-care-reform

PNHP note: This article, with many hyperlinks included, was also published at The Huffington Post on May 18.

Republicans planning further privatization of Medicare

GOP closing in on ObamaCare alternative, lawmakers say

By Peter Sullivan and Sarah Ferris
The Hill, May 12, 2016

House Republicans huddled behind closed doors on Thursday to discuss their plan to replace ObamaCare, which they said is on track to be released in June.

The proposal will include a version of Speaker Paul Ryan’s (R-Wis.) long-standing proposal to make Medicare more market-based, giving seniors a kind of voucher to use for private insurance, according to two Republican lawmakers who attended the meeting.

“It’s turning out to be more encompassing than what we expected,” Rep. John Fleming (R-La.) said after the meeting. “Now we’re actually adding in Medicare and the premium support, the things that Paul Ryan’s been talking about for years.”

Ryan was an “active participant” during Thursday’s meeting, said Rep. John Kline (R-Minn.).

“We want to help provide the policy issues, where if [Trump’s] elected, we can go forward,” Ryan said, according to Energy and Commerce Committee Chairman Fred Upton (R-Mich.).

http://www.thehill.com/policy/healthcare/279755-gop-closes-in-on-obamacare-alternative

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House GOP Mulling Medicare Age Changes and Taxation on Premiums

By Mary Ellen McIntire and Caitlin Owens
Morning Consult, May 12, 2016

The details of House Republicans’ plan to replace Obamacare are beginning to emerge. Members seemed pleased with what they heard after a closed-door caucus meeting Thursday afternoon at which the leaders of the effort presented their ideas.

Many of the ideas presented at the meeting are consistent with conservative proposals previously floated by House Speaker Paul Ryan (R-Wis.).

Earlier on Thursday, Ryan met with Donald Trump, the presumptive GOP presidential nominee. Ryan loosely tied the afternoon policy meeting to his earlier meeting with Trump, according to Upton.

Medicare changes discussed at the meeting included enhancing Medicare Advantage, the private alternative to traditional fee-for-service Medicare, and raising the Medicare eligibility age.

https://morningconsult.com/2016/05/house-gop-mulling-medicare-age-changes-taxation-premiums/

***

Blog: Trump adviser now says Medicare and Medicaid changes are on the table

By Harris Meyer
Modern Healthcare, May 12, 2016

On Wednesday, Sam Clovis, Trump’s chief policy adviser, signaled to a Washington group that strongly favors a major overhaul of Medicare, Medicaid and Social Security that Trump is open to their agenda. “After the (Trump) administration has been in place, then we will start to take a look at all of the programs, including entitlement programs like Social Security and Medicare,” Clovis said, according to the Wall Street Journal.

http://www.modernhealthcare.com/article/20160512/blog/160519947

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Comment:

By Don McCanne, M.D.

For those of you who were dubious about the claim in yesterday’s Quote of the Day comment that Medicare is well on its way toward privatization, today’s report should provide additional fodder for your consideration.

The House Republicans will soon release a white paper describing the policies they recommend for replacing the Affordable Care Act. A few details have been released following their closed-door caucus meeting yesterday – a meeting attended by House Speaker Paul Ryan. Ryan’s presence is important because, when he agreed to accept the Speakership, it was on the condition that he would have a leading role in shaping the conservative Republican agenda.

We now know that they do intend to introduce premium support to the Medicare program – a voucher-like system that would enable Medicare beneficiaries to purchase private health insurance plans perhaps comparable to the current Medicare Advantage plans.

Furthermore, in spite of exposure of the nefarious plot to overpay the private Medicare Advantage plans in order to entice beneficiaries into the private plans, the Republicans intend to further enhance the Medicare Advantage plans to attract even more Medicare beneficiaries – making the private plans the preferred choice because of the extra benefits they can offer. Once a critical mass is enrolled in the private plans, they can start to disassemble the then deficient, neglected, antiquated traditional Medicare program.

The fact that they intend to increase the age for Medicare eligibility indicates that they are not really interested in the welfare of the Medicare population. The purpose of premium support is to reduce the government contribution so that more of the costs are shifted to the beneficiaries through higher premiums, through greater deductibles and other cost sharing, and through reduced benefits and reduced access through narrower provider networks.

Can they actually accomplish this? Although far more people vote for Democrats than Republicans in the House elections, the Congressional district borders are controlled predominantly by Republican state governments. This gerrymandering of the districts will ensure that Republicans will maintain control of the House even with a minority of votes. Ryan’s agenda will prevail in the House deliberations.

If Republicans maintain control of the Senate and if a Republican is elected as President, Senate Majority Leader Mitch McConnell surely will be tempted to use the “nuclear option” – changing the rules so that the Democratic minority would be less able to block legislation, such as the Medicare privatization proposals.

Donald Trump’s popularity in the Republican primaries and caucuses was certainly not predicted. It is very possible that the voters may choose him for President, perceiving him as an outsider who will get things done as opposed to an establishment insider whose popularity has been declining.

Although Trump has said that he would protect Medicare, Sam Clovis, his chief policy advisor, said yesterday, “we will start to take a look at all of the programs, including entitlement programs like Social Security and Medicare.” Also Trump is holding meetings with Paul Ryan wherein Ryan’s clear intent is to unify the party by convincing Trump to support Ryan’s agenda. After his meeting with Trump yesterday, Ryan promoted premium support to his caucus.

If will be difficult to campaign for Medicare for All if Medicare becomes a despised program in which private insurers take away our health care choices and force us into debt. The threat is very real.

Yesterday’s Quote of the Day on overpayments to Medicare Advantage

https://www.pnhp.org/news/2016/may/cms-not-fulfilling-obligation-to-recover-medicare-advantage-overpayments

PNHP is a single issue organization, promoting education and research for the single payer model of health care reform. We do not support nor oppose any political parties or candidates. (Today’s message should be perceived as a plea to all politicians, not just Republicans, to protect and support Medicare.)

Republicans planning further privatization of Medicare

GOP closing in on ObamaCare alternative, lawmakers say

By Peter Sullivan and Sarah Ferris
The Hill, May 12, 2016

House Republicans huddled behind closed doors on Thursday to discuss their plan to replace ObamaCare, which they said is on track to be released in June.

The proposal will include a version of Speaker Paul Ryan’s (R-Wis.) long-standing proposal to make Medicare more market-based, giving seniors a kind of voucher to use for private insurance, according to two Republican lawmakers who attended the meeting.

“It’s turning out to be more encompassing than what we expected,” Rep. John Fleming (R-La.) said after the meeting. “Now we’re actually adding in Medicare and the premium support, the things that Paul Ryan’s been talking about for years.”

Ryan was an “active participant” during Thursday’s meeting, said Rep. John Kline (R-Minn.).

“We want to help provide the policy issues, where if [Trump’s] elected, we can go forward,” Ryan said, according to Energy and Commerce Committee Chairman Fred Upton (R-Mich.).

http://www.thehill.com/policy/healthcare/279755-gop-closes-in-on-obamacare-alternative

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House GOP Mulling Medicare Age Changes and Taxation on Premiums

By Mary Ellen McIntire and Caitlin Owens
Morning Consult, May 12, 2016

The details of House Republicans’ plan to replace Obamacare are beginning to emerge. Members seemed pleased with what they heard after a closed-door caucus meeting Thursday afternoon at which the leaders of the effort presented their ideas.

Many of the ideas presented at the meeting are consistent with conservative proposals previously floated by House Speaker Paul Ryan (R-Wis.).

Earlier on Thursday, Ryan met with Donald Trump, the presumptive GOP presidential nominee. Ryan loosely tied the afternoon policy meeting to his earlier meeting with Trump, according to Upton.

Medicare changes discussed at the meeting included enhancing Medicare Advantage, the private alternative to traditional fee-for-service Medicare, and raising the Medicare eligibility age.

https://morningconsult.com/2016/05/house-gop-mulling-medicare-age-changes-taxation-premiums/

***

Blog: Trump adviser now says Medicare and Medicaid changes are on the table

By Harris Meyer
Modern Healthcare, May 12, 2016

On Wednesday, Sam Clovis, Trump’s chief policy adviser, signaled to a Washington group that strongly favors a major overhaul of Medicare, Medicaid and Social Security that Trump is open to their agenda. “After the (Trump) administration has been in place, then we will start to take a look at all of the programs, including entitlement programs like Social Security and Medicare,” Clovis said, according to the Wall Street Journal.

http://www.modernhealthcare.com/article/20160512/blog/160519947

For those of you who were dubious about the claim in yesterday’s Quote of the Day comment that Medicare is well on its way toward privatization, today’s report should provide additional fodder for your consideration.

The House Republicans will soon release a white paper describing the policies they recommend for replacing the Affordable Care Act. A few details have been released following their closed-door caucus meeting yesterday – a meeting attended by House Speaker Paul Ryan. Ryan’s presence is important because, when he agreed to accept the Speakership, it was on the condition that he would have a leading role in shaping the conservative Republican agenda.

We now know that they do intend to introduce premium support to the Medicare program – a voucher-like system that would enable Medicare beneficiaries to purchase private health insurance plans perhaps comparable to the current Medicare Advantage plans.

Furthermore, in spite of exposure of the nefarious plot to overpay the private Medicare Advantage plans in order to entice beneficiaries into the private plans, the Republicans intend to further enhance the Medicare Advantage plans to attract even more Medicare beneficiaries – making the private plans the preferred choice because of the extra benefits they can offer. Once a critical mass is enrolled in the private plans, they can start to disassemble the then deficient, neglected, antiquated traditional Medicare program.

The fact that they intend to increase the age for Medicare eligibility indicates that they are not really interested in the welfare of the Medicare population. The purpose of premium support is to reduce the government contribution so that more of the costs are shifted to the beneficiaries through higher premiums, through greater deductibles and other cost sharing, and through reduced benefits and reduced access through narrower provider networks.

Can they actually accomplish this? Although far more people vote for Democrats than Republicans in the House elections, the Congressional district borders are controlled predominantly by Republican state governments. This gerrymandering of the districts will ensure that Republicans will maintain control of the House even with a minority of votes. Ryan’s agenda will prevail in the House deliberations.

If Republicans maintain control of the Senate and if a Republican is elected as President, Senate Majority Leader Mitch McConnell surely will be tempted to use the “nuclear option” – changing the rules so that the Democratic minority would be less able to block legislation, such as the Medicare privatization proposals.

Donald Trump’s popularity in the Republican primaries and caucuses was certainly not predicted. It is very possible that the voters may choose him for President, perceiving him as an outsider who will get things done as opposed to an establishment insider whose popularity has been declining.

Although Trump has said that he would protect Medicare, Sam Clovis, his chief policy advisor, said yesterday, “we will start to take a look at all of the programs, including entitlement programs like Social Security and Medicare.” Also Trump is holding meetings with Paul Ryan wherein Ryan’s clear intent is to unify the party by convincing Trump to support Ryan’s agenda. After his meeting with Trump yesterday, Ryan promoted premium support to his caucus.

If will be difficult to campaign for Medicare for All if Medicare becomes a despised program in which private insurers take away our health care choices and force us into debt. The threat is very real.

Yesterday’s Quote of the Day on overpayments to Medicare Advantage

https://pnhp.org/news/2016/may/cms-not-fulfilling-obligation-to-recover-medicare-advantage-overpayments

PNHP is a single issue organization, promoting education and research for the single payer model of health care reform. We do not support nor oppose any political parties or candidates. (Today’s message should be perceived as a plea to all politicians, not just Republicans, to protect and support Medicare.)

Editorial: A single payer system

By The Editorial Board
Indiana Daily Student (Bloomington, Ind.), May 11, 2016

We have all heard criticism of the Affordable Care Act or Obama Care ad nauseam. Most of the criticism comes from people who oppose the Affordable Care Act because they feel the law is too close to universal health care.

May 5, a group of 2,000 doctors released a proposal in the American Journal of Public Health that calls for a single payer health care system in the United States and criticizes the Affordable Care Act for not going far enough.

This group of doctors has put together a solid, well thought out plan for switching the current health care system over to a single payer system similar to Canada. The Editorial Board understands a single payer system would be difficult in the U.S., but believes it’s still a necessary right for all U.S. citizens.

According to the proposal, the single payer health care program would be called the National Health Program and would promise all citizens health care coverage without premiums, co-pays or deductibles.

The National Health Program would get the majority of its funding through existing government allocations, which already covers two-thirds of health care. The rest of the funding will come from taxpayer increases in replacement of insurance premiums, co-pays and 
deductibles.

The doctors said a single payer system will cut down on administrative costs, which will not require the government to spend more money on health care than it already does. Many of the doctors believe a single payer system will improve upon the problems of the Affordable Care Act, which are cost prohibitive co-payments and deductibles that prevent many citizens from getting the care they need.

Even though this plan is well thought out and seems like a solution to many of the financial issues involved with the U.S. health care system, the Editorial Board recognizes the fear such a system will lead to long wait times and increased taxes.

The argument of whether or not the single payer system should be introduced into the U.S. is not a new or different argument. Vermont had a single payer system until the governor deactivated it after learning that the costs were higher than the state could afford.

Colorado citizens will vote in November to decide whether or not the state will move to a single payer system. The tax increases for employers under the single payer system will be 7 percent, 3 percent for employees and 10 percent for the self-employed. Even if the single payer system is implanted on a state-by-state basis, the physicians who proposed the National Health Program claim this reform will only work when introduced at the national level.

However, with a health care system that allows low income households to have more access to affordable care, the health care system can focus on preventative care with those who have historically not had regular checkups, which would save the system from the more costly procedures. A study published in Health Affairs showed that spending more on preventative medicine would result in medical savings of $573 per person, per year.

And while in Canada, the single payer system has resulted in longer wait times, a report from the Commonwealth Fund found other single payer systems, like the one in the UK, costs less than the U.S. system and results in more same-day appointments and access to after hours care than the U.S.

The debate on whether or not a single payer health system will work in this country could rage on forever. Either we keep expensive health care that leaves millions uninsured or we implement a single payer system that guarantees every citizen free health care that might lead to wait times for doctor’s offices. The choice is ours.

http://www.idsnews.com/article/2016/05/editorial-a-single-payer-system

CMS not fulfilling obligation to recover Medicare Advantage overpayments

Auditors: feds failed to rein in billions in over-billing by Medicare Advantage

By Fred Schulte
The Center for Public Integrity, May 9, 2016

Private Medicare Advantage plans treating the elderly have over-billed the government by billions of dollars, but rarely been forced to repay the money or face other consequences for their actions, according to a new Congressional audit.

In a sharply critical report made public Monday, the Government Accountability Office called for “fundamental improvements” to curb overbilling by the health plans, which are paid more than $160 billion annually.

GAO took aim at Medicare’s primary tactic for recouping overcharges, a secretive, and lengthy, audit process called Risk Adjustment Data Validation, or RADV. Unlike many other anti-fraud programs, RADV has cost the government way more than it has returned to the treasury.

The GAO said that the Centers for Medicare and Medicaid Services, an arm of the Department of Health and Human Services, has spent about $117 million on these audits, but so far has recouped just $14 million.

The GAO launched its audit in October 2014 in the wake of the Center for Public Integrity’s “Medicare Advantage Money Grab” series.

The Center’s investigation traced the overpayments to abuse of a billing formula called a risk score, which pays higher rates for sicker patients and less for people in good health. Since 2004, however, the risk score formula has largely operated as an honor system, despite criticism that many health plans have overstated how sick some patients are to boost their revenues. That practice is known in medical circles as “upcoding.”

Medicare officials have quietly conducted these audits since 2008. But they have never imposed stiff financial penalties even as evidence built up that billing errors were deeply rooted and wasting tax dollars at an alarming clip.

GAO in its report noted that CMS has failed to target health plans with “known improper payment risk,” thus allowing the worst performers to escape the net.

GAO reviewers said that CMS is stepping up the RADV audits, but added that much more needs to be done. GAO noted that officials expect the upcoming audits to recover $370 million, but that’s just three percent of the total estimated annual overpayment.

https://www.publicintegrity.org/2016/05/09/19660/auditors-feds-failed-rein-billions-over-billing-medicare-advantage

***

Report to the Chairman, Committee on Ways and Means, House of Representatives

Medicare Advantage: Fundamental Improvements Needed in CMS’s Effort to Recover Substantial Amounts of Improper Payments

Government Accountability Office, April 2016

Conclusions

Limitations in CMS’s processes for selecting contracts for audit, in the timeliness of CMS’s audit and appeal processes, and in the agency’s plans for using MA RACs to assist in identifying improper payments hinder the accomplishment of its contract-level RADV audit goals: to conduct annual contract-level audits and recover improper payments. These limitations are also inconsistent with federal internal control standards and established project management principles. Our analyses of these processes and plans suggest that CMS will likely recover a small portion of the billions of dollars in MA improper payments that occur every year. Shortcomings in CMS’s MA contract selection methodology may result in audits that are not focused on the contracts most likely to be disproportionately responsible for improper payments. Furthermore, CMS’s RADV time frames are so long that they may hamper the agency’s efforts to conduct audits annually, collect extrapolated payments efficiently, and use audit results to inform future RADV contract selection. By CMS’s own estimates, conducting annual contract-level audits would potentially allow CMS to recover hundreds of millions of dollars more in improper payments each year. Agency officials have expressed concerns about the intensive agency resources required to conduct contract-level RADV audits. To address the resource requirements of conducting contract-level audits, CMS intends to leverage the MA RACs for this purpose; however, the agency has not outlined how it plans to incorporate RACs into the contract-level RADV audits and is in the early stages of soliciting industry comment regarding how to do so.

http://www.gao.gov/assets/680/676441.pdf

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Medicare Advantage 2016 Spotlight: Enrollment Market Update

By Gretchen Jacobson, Giselle Casillas, Anthony Damico, Tricia Neuman and Marsha Gold
Kaiser Family Foundation, May 11, 2016

The number and share of Medicare beneficiaries enrolled in Medicare Advantage has steadily climbed over the past decade, and this trend in enrollment growth is continuing in 2016. The growth in enrollment has occurred despite reductions in payments to plans enacted by the Affordable Care Act of 2010 (ACA).

Almost one in three people on Medicare (31% or 17.6 million beneficiaries) is enrolled in a Medicare Advantage plan in 2016.

http://kff.org/medicare/issue-brief/medicare-advantage-2016-spotlight-enrollment-market-update/

***

Comment:

By Don McCanne, M.D.

Today’s message provides yet one more example of CMS’s complicity in the privatization of Medicare. What does that mean and why does it matter?

Medicare Advantage (MA) plans are private health insurance plans that Medicare enrollees can select in place of the traditional Medicare program. The purpose was ideologically driven – to get the government out of Medicare.

Congress originally established the private plan option through the Medicare + Choice program. They believed the promise of the private insurers that they could provide higher quality care at a lower cost. That failed and insurers withdrew simply because it costs considerably more to finance health care through private insurers than through our public Medicare program. Congress went back to the drawing boards and established the Medicare Advantage program in which the private insurers were paid about fourteen percent more than the public program was paying for comparable patients.

Thus the private MA plans were able to attract patients by offering them supplemental benefits and lower out-of-pocket cost sharing. They also successfully marketed to a healthier, lower cost population – being paid more while spending less. To counter this “favorable selection,” risk adjustment was introduced in which the insurers would be paid more if they enrolled sicker patients. The insurers quickly learned how to upcode to qualify for payments greater than the health status of their enrollees warranted.

When Congress created the Affordable Care Act it was recognized that the overpayments needed to be pared back, especially since the insurers were rewarding themselves with favorable selection and upcoding. Thus ACA required that the overpayments be reduced gradually, and that process has now been completed.

But what happened? Each year CMS has found offsets to the required payment reductions – offsets that were generous enough to actually result in increased payments in each year that reductions should have occurred.

And what about the upcoding that was used to qualify for unearned risk adjustments? The Government Accountability Office (GAO) has shown that CMS has failed to recapture the overpayments even though the problem was well recognized and theoretically a process was in place to do so. After pressure from the GAO and from the investigative reporting of The Center for Public Integrity, CMS is going to step up its efforts at recovery. However, these renewed efforts are expected to recover only about three percent of the overpayments. The insurers get to keep their illicit overpayments, with the complicity of CMS.

Kaiser (KFF) has just released a report showing that the nefarious plot to transfer patients to the private MA plans is working. Enrollment has steadily climbed over the past decade. If Congress and CMS can keep up this subterfuge then very soon Congress can begin to reduce funding for the traditional Medicare program which will cause more providers to drop out. That will then create a public demand for the overpaid private MA plans. Congress can then enact their premium support (voucher) program for private Medicare Advantage plans, and then follow through by emasculating the traditional program (“drown it in a bathtub”).

Once everyone is in a privatized Medicare voucher program, Congress can ratchet down the value of the voucher. This will complete their goal of bringing us consumer-directed health care – placing patients in charge of controlling health care costs through price sensitivity necessitated by high deductibles and other cost sharing, whether or not they have health savings accounts. This, of course, will lead to financial hardship and forgone health care.

If you think that our government would never do this to us, keep in mind that the process is well underway. Today Speaker Paul “Premium Support” Ryan met with likely presidential-nominee Donald Trump to set the agenda for our nation’s future.

Ky docs call for single national health plan

By Deborah Yetter
The (Louisville) Courier-Journal, May 11, 2016

Arguing that health care in America costs too much and too many people go without it, a group of local physicians, medical students and others on Tuesday called for a single system of health coverage in this country.

Standing before the University of Louisville medical school, speakers said it’s time to move beyond the Affordable Care Act, which expanded coverage to many Americans, and extend it to everyone through a single, public-funded system such as Medicare.

“The Affordable Care Act has helped,” said Dr. Barbara Casper, a U of L professor of medicine and chief of internal medicine. “But we still have a significant number of people falling through the cracks.”

Tuesday’s event held by Kentuckians for Single Payer Healthcare follows the recent call in the American Journal of Public Health for a single, national health care system similar to that of most industrialized countries. It was signed by more than 2,200 doctors nationwide.

Several physicians and medical students called on more Kentuckians to join the movement, saying they see too often the adverse impact on patients who lack coverage or can’t afford the costs of their health plans, such as high deductibles and copays.

Mallika Sabharwal, a U of L medical student and president of Students for a National Health Program, said she experienced firsthand the effects of lack of coverage after her family emigrated to the United States from India when she was younger. The family didn’t always have health coverage and that meant sometimes going without needed medical care, she said.

Brandi Jones, a U of L medical student and past president of the group, said she supports universal coverage because as a future physician dedicated to healing people and saving lives, she can’t “condone a system that allows people to die.”

Speakers at Tuesday’s event acknowledged it will be a tough political battle to sell a national health plan, possibly by expanding the current Medicare system to all Americans.

“We need a Congress with a very stronger spine,” said Dr. Edgar Lopez, a plastic and reconstructive surgeon.

The current model in the United States is simply unsustainable, said Dr. Morris Weiss, a cardiologist who said America spends far more of its gross domestic product on health care than European nations such as France, Germany and Italy – with far less to show for it.

When it comes to health outcomes, “we’re one of the bottom countries of all the industrialized nations,” he said.

Dr. Syed Quadri, a physician who runs a free health clinic in Elizabethtown, said the nation must address the growing problem of working people who can’t afford health care.

At the Community Health Clinic he opened in 2002, Quadri said he sees many working people who make too much for Medicaid – the government plan for the poor – but can’t afford private plans that often come with high costs.

Such individuals often come to the free clinic “very reluctantly,” he said. “They don’t want a handout.”

Seeing those patients and others without health coverage prompted him to join the movement for a national health plan, Quadri said.

“This is the only way to bring health care to everyone in the country,” he said.

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

http://www.courier-journal.com/story/news/politics/2016/05/10/ky-docs-call-single-national-health-plan/84150928/

Why some doctors want the government to handle all health insurance

By Baylee Pulliam
Louisville Business First, May 10, 2016

There are a lot of ways to get health insurance — but not everyone does.

Right now, there are multiple payers, including private companies and the federal government. But a new proposal from the Physicians for a National Health Program advocacy group suggests there should be only one.

Proponents in Louisville rallied Tuesday near the University of Louisville School of Medicine to discuss the proposal, which calls for all health insurance to be administered by the federal government — the “single-payer” — as Medicare is now.

So far, the proposal so far has signatures from more than 2,200 physicians and 149 students across the country.

Under the proposal, everyone would get a National Health Program (NHP) card, which they could use to get care at any doctor’s office or hospital, with no bills or co-pays for covered services. (Democratic presidential candidate Bernie Sanders also has supported a similar payer plan.)

PNHP also says a single-payer system would reduce overhead for health care providers, who now have to employ additional staff and spend more time filling out paper work and tracking down insurance information from multiple sources.

Because the providers would spend less to provide care, they could charge less, which would make it more affordable for the federal government to provide coverage, according to PNHP.

PNHP says that if the U.S. had the same level of per-capita health care spending as Canada, which uses a similar system, it would free up about $500 billion per year toward the cost of providing that care.

But, of course, if the government is the single payer, there’s the question of what happens to private insurers such as Louisville’s Humana Inc. (NYSE: HUM).

That’s still not clear, but Dr. Barbara Casper, professor at the U of L School of Medicine and a supporter of the PNHP proposal, said there are a few possibilities. One is that they go away entirely, and their employees could be retrained for new jobs or go to work for the government.

Another possibility is that they continue to exist, but offer optional, additional coverage for those who choose to buy it.

The idea behind the plan is to give everyone access to the same basic health care coverage, Casper said.

Casper, who has practiced medicine for 34 years, said more people have coverage since the Affordable Care Act was passed. “But I’ve still admitted three patients today who had no insurance.”

A national health plan also would lessen the burden on employers, some of which are opting to pay the $2,000 penalty for not providing coverage to their workforces because that costs less.

“Businesses don’t provide car insurance,” said Dr. Syed Quadri, a private practice internist from Elizabethtown and supporter of PNHP. “Why should they provide health insurance? When businesses are free from this task, they can focus on business.”

Baylee Pulliam covers these beats: health care, health insurance, media/marketing and technology.

http://www.bizjournals.com/louisville/news/2016/05/10/why-some-doctors-think-the-government-should.html