PNHP

AFGE Endorses HR 676, National Single-Payer Bill

AFGE Endorses HR 676, National Single-Payer Bill

News release
Single Payer News, Feb. 16, 2016
 
The National Executive Council of the American Federation of Government Employees (AFGE) has unanimously endorsed HR 676, national single payer legislation sponsored by Congressman John Conyers of Michigan. The resolution was submitted by AFGE National Vice President Arnold R. Scott of District 6.
 
With 1,100 local unions, AFGE is the largest federal employee union and has 670,000 members across the country.
 
The text of the AFGE resolution is below:

Union Resolution in Support of HR 676, National Single Payer Legislation, Expanded and Improved Medicare for All

Submitted by:  NVP Scott
 
Whereas, America’s health care system is in deep trouble.  In spite of efforts to regulate the insurance industry for-profit health insurance companies are finding ways to skirt the law.  The Affordable Care Act, passed in 2010, made it possible for some of the uninsured to find coverage, but did not resolve the problem that health insurance companies are pricing care beyond our means, and
 
Whereas, unions have battled to achieve the highest standards of health care for members and their families, and those gains have lifted up health benefits for all workers, even those who have no union.  All of these achievements are now under constant attack as costs rise and employers seek to shift those costs to workers.  Union multiemployer health plans are struggling under the unfair advantages allowed to non-union companies.  Rising copays and deductibles make it more difficult for those who have insurance to get the care they need.  The excise tax of 2018 will make things worse, and
 
Whereas, employers seek to drop health benefits for early retirees, for spouses, for part-timers.  Some corporations use bankruptcy laws to shirk their contractual health care obligations.  The rising cost of health insurance is blocking progress in wages and other areas, and
 
Whereas, insurance companies rather than patients are deciding what doctors we can see and what hospitals we can use.  Drug company profits soar as, so far, congress has not used the power of bulk purchasing to bring down the prices.  The US spends double per capita what other industrialized nations spend, yet ranks far below in life expectancy and infant mortality, and
 
Whereas, we deserve better.  It doesn’t have to be this way.  Firefighters don’t ask us to pay before they save our families from burning houses.  They just proceed to do the right thing.  Health care is just as important as fire protection.  Lives are at stake and all of us should have the best care that this wealthy nation has the ability to provide.  Our tax dollars subsidize the research, the medical schools, and the hospitals.  Unions led the way in other industrialized countries to assure universal coverage with good care through a form of single payer, and Congressman John Conyers Jr. (D-MI) has introduced HR 676, Expanded and Improved Medicare for All.  HR 676 will establish a single payer health care system by expanding a greatly improved Medicare to cover everyone.  It will restore our right to choose our physicians and free us from insurance company interference in medical decisions.  It will free our health care from corporate control, and
 
Whereas, HR 676 will cover everyone for all necessary medical care including dental, prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care, chiropractic, eyeglasses, hearing aids, other medical devices and long term care.  HR 676 will end deductibles and copayments, and
 
Whereas, HR 676 will save hundreds of billions annually by eliminating the high overhead and profits of the private health insurance industry and by using our purchasing power to rein in the drug companies.  The transition to national health insurance would apply the savings from administration and profits to expanded and improved coverage for all, and
 
Whereas, standing up for all working people and leading the effort to win healthcare for all we will affirm labor’s rightful role as a leader in the fight for social justice.  Bold action by our unions can rally the nation to pass HR 676.
 
Therefore be it resolved, that AFGE wholeheartedly endorses Congressman Conyers’ bill HR 676, “Expanded and Improved Medicare for ALL,” a single payer health care program.
 
Be it further resolved, that AFGE will work with other unions and community groups to build a groundswell of popular support and action for single payer universal health care and HR 676 until we make what is morally right for our nation into what is politically possible.
 
And that AFGE will send a copy of this resolution to Congressman Conyers, to all members of the US House and Senate, to the AFL-CIO Executive Council, and to the news media.
 
And further, that AFGE will take other actions to mobilize our members and our community at the grassroots to encourage other members of the House to sign on as co-sponsors of HR 676 and to encourage Senators to introduce a companion bill in the Senate.
 
Passed unanimously by the National Executive Council of the American Federation of Government Employees, November 2015.
 
#30#

HR 676 would institute a single payer health care system by expanding a greatly improved Medicare to everyone residing in the U.S. Patients will choose their own physicians and hospitals.

HR 676 would cover every person for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental (including oral surgery, periodontics, endodontics), mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care and correction, hearing services including hearing aids, chiropractic, durable medical equipment, palliative care, podiatric care, and long term care.

HR 676 ends deductibles and co-payments. HR 676 would save hundreds of billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs. In the current Congress, HR 676 has 60 co-sponsors in addition to Congressman Conyers.

HR 676 has been endorsed by 623 union organizations including 151 Central Labor Councils/Area Labor Federations and 44 state AFL-CIO’s (KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO, MN, ME, AR, MD-DC, TX, IA, AZ, TN, OR, GA, OK, KS, CO, IN, AL, CA, AK, MI, MT, NE, NJ, NY, NV, MA, RI, NH, ID.
 
For a list of union endorsers, or a sample endorsement resolution, contact:
 
Kay Tillow
All Unions Committee for Single Payer Health Care–HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551
 
Email: nursenpo@aol.com
http://unionsforsinglepayer.org
https://www.facebook.com/unionsforsinglepayer

The $3 trillion elephant in the presidential campaign

By Ed Weisbart, M.D.
St. Louis Post-Dispatch, Feb. 16, 2016

Remember the heated discussions about health care in the Republican debates? No, you don’t, because they were arguing about things like fantasy football. In fact, all we heard about health care was, “Repeal Obamacare!”

We get it, being a member of The Repeal Obamacare Club is a prerequisite for running for president on the GOP ticket, as is having no plan with which to replace it.

Jeb Bush promotes tax credits for individuals to purchase “affordable” and “portable” plans. We hope Bush thinks “affordable” means less than 10 percent of annual income, but given that he wants to retain the same insurance industry whose bureaucracy now consumes 30 percent of every health care dollar, it’s unlikely.

Ben Carson supports health savings accounts, a great idea for healthy and wealthy individuals, but a terrible idea for everyone else who would be more deeply trapped in increasingly expensive plans. It’s a particularly bad idea for women, whose annual cost of care typically is $1,000 more than it is for men.

Ted Cruz crows, “Repeal every blasted word of Obamacare.” With what? All the problems Obamacare addressed? Crisis treatment in ERs instead of prudent prevention? Denials for pre-existing conditions? Denials for people with the audacity to get sick and actually use their insurance? Annual and lifetime caps?

Marco Rubio, like Jeb, would give you a refundable tax credit to purchase insurance. How does that control costs? And how is that so different from the premium subsidies provided by Obamacare, which Rubio opposes?

Donald Trump promises: “I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.” So far, Trump offers no details. He either doesn’t have them or doesn’t want us to know them. But when he does, they’ll be “fabulous!”

And what about the Democrats? Hillary Clinton would retain the Affordable Care Act and lower out-of-pocket and prescription costs, but she hasn’t said how. The Affordable Care Act has saved countless lives, but it is essentially an insurance-reform/subsidy program, not the comprehensive solution our nation needs to remedy our chronic bloating of health care costs.

Bernie Sanders supports HR 676, the Expanded and Improved Medicare for All Act, co-sponsored by Rep. William Lacy Clay and 63 other U.S. representatives. It’s a comprehensive plan with robust details. It provides full coverage without premiums, like people enjoy in all other advanced countries, at roughly half of what we spend per person in the United States today.

Any candidate who isn’t forthcoming with these details is ignoring our current dire reality. Our health care system has a literal death grip on this nation. It is the new “giant sucking sound” of money being vacuumed from our entire economy and into health care’s deep, private-profit pockets.

More than another cycle of modest reform, we need to base our solution upon our nation’s most successful health care system, Medicare. We need to divorce our health insurance from our employers, releasing businesses from that burden and giving job mobility back to employees. We need to implement universal access to health care, paid for by progressive taxes, delivered by the world’s best doctors and hospitals. We need to replace our woefully wasteful private insurance system with the efficiency of Medicare.

By eliminating sales, marketing, underwriting and other non-productive administrative functions required of private insurers, Medicare’s overhead is 2 percent; private insurance’s is 18 percent.

We have some of the best health care in the world, but far too many Americans can’t afford to use it, and everyone pays way too much for it. Medicare offers 50 years of proof that our government can administer health care as well or better than anywhere else in the world. Let’s make it available to each and every American, and demand that anyone running for high office explain how they could do better. They won’t because they can’t.

Dr. Ed Weisbart is chairman of Physicians for a National Health Program — Missouri chapter.

http://www.stltoday.com/news/opinion/the-trillion-elephant-in-the-presidential-campaign/article_ae4ef099-5c48-52c2-902d-7c1714f91730.html

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

Medicare for all is what U.S. needs

By Jack Bernard
The Citizen (Fayetteville, Ga.), Feb. 16, 2016

I enjoyed reading Dr. Scherz’s (opinion column, 1-10-16), which was well written. As a retired senior level healthcare exec and former GOP elected official, I understand his frustration with the downside of Obamacare (the ACA). I hear much the same from my two sons, who are practicing physicians.

But, I am not in agreement with Scherz’s suggested solution, i.e., going back to the time before we had primary care insurance and having individuals fend for themselves, negotiating direct agreements with each of their doctors. The paperwork, research, skill and time required on both sides would be immense.

And, there it is a certainty that the consumer would pay more due to paucity of easily obtainable comparative data and lack of any leverage when dealing with providers. In other words, Medicare can get better rates than an individual because many providers cannot afford to lose the government’s business, accounting for over half of all U.S. healthcare expenditures.

Along the lines of the Scherz approach, a conservative friend mentioned to me the other day that he agreed with Gov. Mike Huckabee on healthcare. The problem with Americans is that we do not know the cost of healthcare services, so we want everything.

True, there are problems with our insurance system, some of which were identified by Dr. Scherz. Health insurance certainly does insulate the patient from costs. That is what all insurance is supposed to do; should we eliminate all types of insurance? Plus, we are already less insulated than other nations (see study cited below).

One alternative is to have no health insurance for anyone, an impractical suggestion advocated by the then-head of the Georgia Medical Association in response to one of my earlier Atlanta Journal-Constitution editorials. Dr. Scherz seems to suggest something similar for primary physician care, although he does not mention the hospital side where much of the cost, and possibly waste, resides.

Another alternative often suggested by conservatives is to have deductibles so high (one physician I know suggested $10,000) that most patients pay just about everything out of pocket. Does anyone other than the 1 percent really think that is an optimum solution? Unfortunately, due to inaction by Congress, the private insurance system seems headed that way now.

Huckabee, Scherz and others are subtly building on the healthcare establishment’s historical position: “We have the best health care in the world.” The real problem is patients and their reliance on insurance to insulate them from costs. So why change anything on the financing end through government programs like Obamacare (the Affordable Care Act, ACA)?

But, how do other nations view our system? The Journal of the Royal Society of Medicine (the UK’s AMA) did a comparative study in 2011 of 19 countries and found: “In cost-effective terms, i.e., economic input versus clinical output, the USA healthcare system was one of the least cost-effective in reducing mortality rates.”

Our own National Institute of Health (NIH) issued a study (1-9-13) which detailed many problems with our lifestyle, but it also criticized our access problems, stating that 50 million residents had no health insurance. Regarding access, all nations studied did better than the U.S., except Turkey, Chile and Mexico. (Note: Despite its problems, the ACA has made a significant dent in this figure via Medicaid expansion and the healthcare exchanges.)

Specifically, NIH criticized the private-public-provider-payer morass that constitutes American health care delivery and financing, stating that U.S. patients do not receive the care that they need and sometimes receive care that they do not need. It further indicated that “Americans do not experience optimal quality when they do receive health care” due to the “fragmented” nature of our system, creating “inefficiencies and coordination” problems that other nations do not have.

The report also referred to a Commonwealth Fund study which found that Americans were more uncertain than others that their treatments would be adequate if they were seriously ill.

And, NIH found that Americans already had higher deductibles, copayments and out of pocket expenses versus other nations, with 40 percent of those under 65 with insurance reporting access problems due to cost.

As opposed to what many on the right say, the study found that our citizens were more likely than other countries to experience delays when seeing a physician for serious ailments. The study also reported that other studies have shown hospital readmission rates to be higher here, an indicator of lower quality care.

All told, it is a damning indictment of how we get health services in the United States … the result of our excessively expensive but deeply flawed system.

What can we do about the situation? First, stop buying false arguments about the only problem being the patient. We have identifiable access, cost and quality issues.

The website of Physicians for a National Health Program (PNHP) outlines another solution, used by many of the nations who are clearly ahead of us: true national health insurance covering everyone.

With Medicare as the sole payer, not only can costs be controlled and universal access guaranteed, but we can institute national quality measures as well.

Will this grand plan happen tomorrow? No, it will take time. But, if we push our legislators to logically look at facts and science, versus the histrionics of TV entertainers and politician skeptics, that day will come.

Jack Bernard resides in Peachtree City, Ga. His former chairman of a county commission (Jasper County) and chair of the Republican Party there. He is also a a retired healthcare executive and the former director of Health Planning for the state of Georgia. His website is http://universalhealthreform.wordpress.com/.
 
http://thecitizen.com/letters-editor/medicare-all-what-us-needs

Why haven’t the exchanges done more for us?

Cancer Patients Snagged in Health Law’s Tangled Paperwork

By Ricardo Alonso-Zaldivar
Associated Press, February 15, 2016

Hundreds of thousands of people lose subsidies under the health law, or even their policies, when they get tangled in a web of paperwork problems involving income, citizenship and taxes. Some are dealing with serious illnesses like cancer. Advocates fear the problems, if left unresolved, could undermine the nation’s historic gains in health insurance.

The government says about 470,000 people had coverage terminated through Sept. 30 last year because of unresolved documentation issues involving citizenship and immigration. During the same time, more than 1 million households had their financial assistance “adjusted” because of income discrepancies. Advocates say “adjusted” usually means the subsidies get eliminated.

“When people get that bill for a full-price plan, they panic and they cancel the insurance,” said Elizabeth Colvin of Foundation Communities, an Austin nonprofit that serves low-income people. Some worry the problem could undermine the law’s insurance markets, now in their third year.

“These problems can grow, and they can contribute to undermining consumer faith in the system, and that could lead to attrition,” said Rachel Klein of Families USA, an advocacy group that supports the health law.

Pressured by a Republican-led Congress hostile to Obama’s overhaul, the administration is highly sensitive to criticism that some people may be getting benefits they’re not legally entitled to. But Health and Human Services Secretary Sylvia M. Burwell recently acknowledged the paperwork tangle is more likely to trap the innocent than fraudsters.

http://hosted.ap.org/dynamic/stories/U/US_HEALTH_OVERHAUL_PAPERWORK_TRAP

***

Costs, changes led Obamacare enrollment to fall short of earlier estimates

By Jayne O’Donnell
USA TODAY, February 16, 2016

The number of people who signed up for health insurance for 2016 on the state and federal exchanges was up to 40% lower than earlier government and private estimates, which some say is evidence that the plans are too expensive and that people would rather pay a penalty than buy them.

In 2010, the non-partisan Rand Corporation estimated 27 million people would have exchange policies this year and the Congressional Budget Office at that time was estimating 21 million for 2016. CBO even said last June that 20 million people would have plans purchased on the exchanges this year. Just 12.7 million signed up for plans, however, by the end of open enrollment Jan. 31 and about 1 million people are expected to drop their plans — or be dropped when they don’t pay their premiums.

http://www.usatoday.com/story/news/nation/2016/02/15/costs-changes-led-obamacare-enrollment-fall-far-short-estimates/80061050/

Participation in the ACA exchanges is coming in at a much lower level than were the original predictions. Furthermore, significant numbers drop out each year, and many find that they receive significantly less financial assistance than they expected at enrollment.

Since the exchanges are not working as hoped, perhaps we need incremental innovations that would improve their functioning – you know, those incremental improvements some politicians and policy wonks keep telling us is all that we need to make ACA a universal, affordable system.

But what incremental change would expand coverage to absolutely everyone? What incremental change would make the plans affordable for everyone? What incremental change would ensure that access to care is affordable when facing very high deductibles? What incremental change would ensure that everyone would remain covered by their plans throughout the year, especially when there are so many different reasons that individuals lose their plans?

As mentioned many times before, the flawed health care financing infrastructure is not amenable to simple incremental patches. Keeping the same infrastructure will only perpetuate the severe deficiencies of our dysfunctional financing model. Many will remain uninsured. Many will not be able to afford health care, even if insured. And, worst of all, many will suffer and die.

Maybe we should start tallying the financial hardship, suffering and death in increments so that we can gradually feed that information to the incrementalists who insist this is a small price to pay for keeping intact the model that protects so well our private insurance industry. Maybe then they will understand the evil of defaulting to incrementalism.

Single payer would fix it.

Concierge medicine at Mass General

Founded for the Poor, Mass General Looks to the Wealthy

By John Hanc
The New York Times, February 12, 2016

Can a hospital founded more than 200 years ago to treat the poor also adopt a form of medicine some criticize as health care for the rich?

The answer may come in August, when Massachusetts General Hospital, the third-oldest general hospital in the nation, plans to open a concierge medicine practice.

Based in Boston, the hospital, whose $800 million annual research budget is among the nation’s biggest, is affiliated with Harvard Medical School and is perennially ranked No. 1 in many categories of U.S. News & World Report’s listings of the country’s best hospitals.

Despite its reputation, Mass General — as it is known — was established in 1811 to care for the city’s poor and indigent. Patients in concierge medicine are likely to be anything but that.

The idea of wealthy people paying doctors a retainer for exclusive service is not new. With concierge medicine, which was introduced in the 1990s, patients pay physicians a monthly or annual retainer and expect more personalized care and greater access. “A concierge patient who signs up for a practice is not only looking for quality care, they are looking for unfettered access to their provider,” said Dr. Michael R. Jaff, the medical director of Mass General’s Center for Specialized Services and a professor at Harvard Medical School.

There are pros and cons to concierge medicine — or direct primary care, a similar model — which, according to the industry trade magazine Concierge Medicine Today, is embraced by about 6,000 doctors across the country.

“The upside is that it gives more time for patient-physician interaction, and the data shows that generally the more time a patient has with a physician, the better the outcome,” said Dr. Wanda D. Filer, president of the American Academy of Family Physicians. “The downside is that it can be very exclusive and difficult for middle- and low-income patients to afford. So there’s a concern that you’ll have a two-tier system.”

In recent years, concierge medicine and similar types of programs have spread from private practices to hospitals. Mass General’s embrace of it may prove influential.

To critics of concierge medicine, Mass General’s foray into the field is no cause for celebration. “It’s worrisome, unless you’re rich,” said Pauline Rosenau, professor of public health at the University of Texas Health Science Center in Houston. As for the hospital’s historical mission, she added, “I’d say it’s in jeopardy.”

The proximity to the main hospital will give concierge patients easy access to Mass General’s specialists (something not typically offered in private concierge services). “We’ve made the institutional commitment that these patients will get the best of the best at a phone call,” Dr. Jaff said. “So if I call and say I need a general surgeon, they’ll have a world-class general surgeon that day.”

As for benefits of the concierge practice for the rest of the hospital’s patients (Mass General has about 1.5 million outpatient visits a year), Dr. Jaff admitted they were a little less tangible, though still critical. “With dwindling reimbursement,” he said, “there needs to be other sources of revenue to help us support our mission to the community at large.”

What some call “health care for the rich,” the hospital says it believes, can be one such source.

http://www.nytimes.com/2016/02/14/your-money/founded-for-the-poor-mass-general-looks-to-the-wealthy.html?ref=health

***

Comment:

By Don McCanne, M.D.

Say it isn’t true. Mass General? Concierge hospital? Two-tier medicine? Selling the front of the queue to the wealthy?

Is the payment of a bribe to gain better health care access access ethical just because Mass General has given its stamp of approval? They say the money will help support their mission to the community at large, but how does pushing the entire queue back by giving the wealthy a ticket to butt in in front of everyone else help those with low or moderate incomes?

It gives a new meaning to triage. As we organize the delivery of care based on need and urgency, we now have a new paramount guideline, “Let the money in first!”

Under a more egalitarian single payer system, at least the bribes would not be so flagrant.

Concierge medicine at Mass General

Founded for the Poor, Mass General Looks to the Wealthy

By John Hanc
The New York Times, February 12, 2016

Can a hospital founded more than 200 years ago to treat the poor also adopt a form of medicine some criticize as health care for the rich?

The answer may come in August, when Massachusetts General Hospital, the third-oldest general hospital in the nation, plans to open a concierge medicine practice.

Based in Boston, the hospital, whose $800 million annual research budget is among the nation’s biggest, is affiliated with Harvard Medical School and is perennially ranked No. 1 in many categories of U.S. News & World Report’s listings of the country’s best hospitals.

Despite its reputation, Mass General — as it is known — was established in 1811 to care for the city’s poor and indigent. Patients in concierge medicine are likely to be anything but that.

The idea of wealthy people paying doctors a retainer for exclusive service is not new. With concierge medicine, which was introduced in the 1990s, patients pay physicians a monthly or annual retainer and expect more personalized care and greater access. “A concierge patient who signs up for a practice is not only looking for quality care, they are looking for unfettered access to their provider,” said Dr. Michael R. Jaff, the medical director of Mass General’s Center for Specialized Services and a professor at Harvard Medical School.

There are pros and cons to concierge medicine — or direct primary care, a similar model — which, according to the industry trade magazine Concierge Medicine Today, is embraced by about 6,000 doctors across the country.

“The upside is that it gives more time for patient-physician interaction, and the data shows that generally the more time a patient has with a physician, the better the outcome,” said Dr. Wanda D. Filer, president of the American Academy of Family Physicians. “The downside is that it can be very exclusive and difficult for middle- and low-income patients to afford. So there’s a concern that you’ll have a two-tier system.”

In recent years, concierge medicine and similar types of programs have spread from private practices to hospitals. Mass General’s embrace of it may prove influential.

To critics of concierge medicine, Mass General’s foray into the field is no cause for celebration. “It’s worrisome, unless you’re rich,” said Pauline Rosenau, professor of public health at the University of Texas Health Science Center in Houston. As for the hospital’s historical mission, she added, “I’d say it’s in jeopardy.”

The proximity to the main hospital will give concierge patients easy access to Mass General’s specialists (something not typically offered in private concierge services). “We’ve made the institutional commitment that these patients will get the best of the best at a phone call,” Dr. Jaff said. “So if I call and say I need a general surgeon, they’ll have a world-class general surgeon that day.”

As for benefits of the concierge practice for the rest of the hospital’s patients (Mass General has about 1.5 million outpatient visits a year), Dr. Jaff admitted they were a little less tangible, though still critical. “With dwindling reimbursement,” he said, “there needs to be other sources of revenue to help us support our mission to the community at large.”

What some call “health care for the rich,” the hospital says it believes, can be one such source.

http://www.nytimes.com/2016/02/14/your-money/founded-for-the-poor-mass-general-looks-to-the-wealthy.html?ref=health

Say it isn’t true. Mass General? Concierge hospital? Two-tier medicine? Selling the front of the queue to the wealthy?

Is the payment of a bribe to gain better health care access access ethical just because Mass General has given its stamp of approval? They say the money will help support their mission to the community at large, but how does pushing the entire queue back by giving the wealthy a ticket to butt in in front of everyone else help those with low or moderate incomes?

It gives a new meaning to triage. As we organize the delivery of care based on need and urgency, we now have a new paramount guideline, “Let the money in first!”

Under a more egalitarian single payer system, at least the bribes would not be so flagrant.

The flip-flop behind the flawed attacks on Sanders’s single-payer plan

By David U. Himmelstein and Steffie Woolhandler
The Washington Post, Letters, Feb. 12, 2016

The Jan. 29 editorial “The real problem with Mr. Sanders” alleged that Sen. Bernie Sanders’s (I-Vt.) health-care plan “rests on unbelievable assumptions about how much he could slash health-care costs.” That dismissive claim was based on a deeply flawed analysis by Kenneth Thorpe, an Emory University professor and former Clinton administration official who, like Democratic presidential candidate Hillary Clinton, has done a recent flip-flop on the facts about single-payer.

So what has changed? In 2003, Thorpe calculated that single-payer would achieve huge administrative savings — more than 10 percent of total health spending, equivalent to $350 billion this year alone. Now he has cut that estimate by more than half, even though the costs of bureaucracy in the United States have continually climbed, while they’ve remained low in single-payer nations.

Thorpe previously predicted that single-payer would cause a modest uptick in the utilization of care. Now — despite the fact that fewer are uninsured — he has decided there would be a huge increase.

Finally, Thorpe says nothing about savings on drug prices, despite the fact that every nation with a national health-insurance program gets discounts of about 50 percent.

The old Kenneth Thorpe — like the old Hillary Clinton — acknowledged the facts about single-payer. The new one ignores them. The editorial board should know better.

David U. Himmelstein and Steffie Woolhandler are professors of health policy and management at the City University of New York School of Public Health and lecturers in medicine at Harvard Medical School. They reside in New York.

https://www.washingtonpost.com/opinions/the-flip-flop-behind-the-flawed-attacks-on-sanderss-single-payer-plan/2016/02/12/32e82bd0-c9d8-11e5-b9ab-26591104bb19_story.html

PNHP note: Physicians for a National Health Program (PNHP) is a nonpartisan educational organization. It neither supports nor opposes any candidates for public office. For a more detailed critique of Kenneth Thorpe’s flawed analysis, see this article by Drs. David Himmelstein and Steffie Woolhandler in The Huffington Post.

In Fact, Argue Experts, Sanders’ Medicare-for-All Numbers ‘Do Add Up’

“It’s indisputable that single-payer systems in other countries cover everyone for virtually everything, and at much lower cost than our health care system,” PNHP co-founder says

By Nadia Prupis
Common Dreams, Feb. 12, 2016

During Thursday night’s Democratic presidential debate, Hillary Clinton criticized Bernie Sanders’ proposal for a “Medicare for All” healthcare program, stating, “the numbers just don’t add up.”

“A respected health economist said that these plans would cost a trillion dollars more a year,” Clinton said, likely referring to a recent analysis by Emory University professor Kenneth Thorpe, who helped craft a single-payer healthcare system in Sanders’ home state of Vermont, which said Sanders’ proposal was off by an extra $1.1 trillion annually.

“So if you’re having Medicare for all, single-payer, you need to level with people about what they will have at the end of the process you are proposing,” Clinton said. “And based on every analysis that I can find by people who are sympathetic to the goal, the numbers don’t add up, and many people will actually be worse off than they are right now.”

But according to other healthcare experts, both Clinton and Thorpe are working with false calculations.

Dr. Steffie Woolhandler, a professor in public health at City University of New York at Hunter College and co-founder of the advocacy group Physicians for a National Health Program, said Friday that the “numbers on single-payer do, in fact, add up.”

“It’s indisputable that single-payer systems in other countries cover everyone for virtually everything, and at much lower cost than our health care system,” Woolhandler said. “Experience in countries with single-payer systems, such as Canada, Scotland, and Taiwan, proves that we can have more, better and cheaper care.”

For example, “if the U.S. moved to a single-payer system as efficient as Canada’s, we’d save $430 billion on useless paperwork and insurance companies’ outrageous profits, more than enough to cover the 31 million Americans who remain uninsured, and to eliminate co-payments and deductibles for everyone,” she said.

In January, Woolhandler and her colleague Dr. David Himmelstein authored a response to Thorpe’s analysis that found it to be based on “several incorrect, and occasionally outlandish, assumptions,” including “administrative savings of only 4.7 percent of expenditures” and “huge increases in the utilization of care, increases far beyond those that were seen when national health insurance was implemented in Canada, and much larger than is possible given the supply of doctors and hospital beds.”

“Moreover, it is at odds with analyses of the costs of single-payer programs that he produced in the past, which projected large savings from such reform,” the professors wrote.

Woolhandler said Friday, “A single-payer system could save even more money by bargaining with drug companies for discounts on drugs. Other countries get discounts of about 50 percent, and as the biggest customer we could have the bargaining power to get similar savings…Finally, single-payer systems have been better at controlling costs over the long-haul.”

“Our medical arms race—with hospitals competing to offer expensive high tech care, even when they don’t do enough to be good at it—has driven up costs and compromised the quality of care. In contrast, single-payer nations have used thoughtful health planning, to invest in expensive high tech care where it’s needed, not just where it’s redundant but profitable,” she said.

During Thursday’s debate, Sanders rejected the argument that his plan was “unachievable.”

“Every major country on earth, whether it’s the UK, whether it’s France, whether it’s Canada, has managed to provide healthcare to all people as a right and they are spending significantly less per capita on healthcare than we are,” he said. “So I do not accept the belief that the United States of America can’t do that.”

“Please do not tell me that in this country, if—and here’s the if—we have the courage to take on the drug companies, and have the courage to take on the insurance companies, and the medical equipment suppliers, if we do that, yes, we can guarantee health care to all people in a much more cost effective way,” he said.

The charge that the numbers for a sweeping healthcare reform plan “don’t add up” is one that Clinton herself has been hit with in the past, regarding the Health Security Act—dubbed ‘Hillarycare’—introduced in 1993 under President Bill Clinton’s administration.

This work is licensed under a Creative Commons Attribution-Share Alike 3.0 License
 
http://www.commondreams.org/news/2016/02/12/fact-argue-experts-sanders-medicare-all-numbers-do-add

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

Single-payer would cut costs, improve care

By John Benziger, M.D.
Kennebec (Maine) Journal, Letters, Feb. 11, 2016

Just as the tobacco and fossil-fuel industries sponsored “experts” to perpetuate the idea that their industries were harmless, the for-profit American heath care industry is now engaging in misinformation claiming Bernie Sander’s single-payer system would “break the bank.”

The truth is that an “Improved Medicare For All” single-payer system would cut costs drastically and provide coverage for everybody. Virtually every other developed country has an affordable universal system that proves the point.

At issue is that single-payer threatens the multimillion-dollar paychecks of insurance companies and their CEOs, and the outrageous profits of drug and medical device companies and medical entrepreneurs. Under single-payer, private health insurance companies are gone and the system can negotiate for lower drug and medical device costs.

People are waking up to see that corporate greed is hurting Americans. We have a broken for-profit health care system. Quality is mediocre, and more than 25 million Americans are still uninsured. Medicare, Medicaid and hospitals are under threat of new cuts. Meanwhile the nation’s for-profit health industry nets billions in profits, and CEOs take home tens of millions in pay.

A single-payer “Improved Medicare For All” would cut costs dramatically by streamlining health care paperwork and making health care affordable. Savings would be enough to provide coverage for everyone, without ANY additional spending! The concept is popular with the American people and enjoys the support of most doctors.

Consult Physicians for a National Health Program (pnhp.org) and learn how you can help bring about a real universal health care system. Add your voice to the growing chorus, and tell our leaders to stand up for the health of the American people rather than the wealth of our richest firms.

Dr. John Benziger resides in South China, Maine.

https://www.centralmaine.com/2016/02/11/single-payer-would-cut-costs-improve-care/

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

Choose a high ranked hospital and lose your choice of plans

Most Regionally Ranked Hospitals Stay In-Network with Marketplace Plans, But Participation Declines

By Katherine Hempstead, PhD, MA
Robert Wood Johnson Foundation,  February 6, 2016

Looking at network participation by state, nearly all highly ranked regional hospitals were in-network with at least one marketplace plan in both 2015 and 2016.

Key Findings

*  Network participation decreases significantly, however, as more than half of hospitals reduce the number of networks in which they participate between 2015 and 2016.

*  The percent of hospitals in-network with only one marketplace plan increased from 7 percent in 2015 to 20 percent in 2016.

*  Network participation declined more in metro areas.

*  Customers loyal to a particular hospital can in most cases still find a marketplace plan that includes it, but choices are narrowed in 2016 relative to 2015; plans with these hospitals may be more expensive.

Conclusion

Many consumers returning to the marketplace in 2016 may find that their choices have changed in ways that limit their access to certain providers. Yet it is still the case that almost all of these highly rated hospitals are in-network with at least one marketplace plan.

http://www.rwjf.org/en/library/research/2016/02/most-regionally-ranked-hospitals-stay-in-network-with-marketplac.html

Brief (15 pages, mostly tables):
http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2016/rwjf426368

***

Comment:

By Don McCanne, M.D.

A well-functioning health care system should be designed such that patients who would specifically benefit from the services of a highly ranked regional hospital should be assured of access to that hospital. Instead, we have a health care system that ignores the primacy of the patient, and, in this instance, places the highest priority on the business relationship between the hospital and the insurer. As a result, far too many insured patients do not have coverage for highly ranked regional hospitals.

In many communities, only one insurer includes the highly ranked hospital. Thus the patient must make a choice between buying that plan, which is usually more expensive, or buying a competing plan which otherwise may be more suitable because of the many other variables between plans. This is getting worse since participation of highly ranked hospitals in multiple plan networks is declining.

A far better system would provide the patient with a choice of primary care services wherein guidance can be provided to ensure access to the most appropriate facilities and specialized services in the community. To inject into the consideration private insurer restrictions on what services and facilities can be used is the epitome of poor health planning. Yet this is the system that many politicians and policy wonks insist that we must protect, limiting changes to incremental tweaks.

What incremental change would fix this? Should we require all insurers to cover all health care professionals and all facilities? If so, then how would an insurer have any power to negotiate lower rates with a provider that must be included? Instead of negotiating individually with providers should we set standard rates, as Medicare does? If so, then why would we continue to use a wasteful, fragmented market of private plans and public programs when one public entity could administer the system much more efficiently?

These are not examples of incremental steps that preserve our multi-payer system. This is one step that replaces our dysfunctional financing system with a single payer national health program. Our financing system is beyond repair, and incremental additions won’t change that. It’s the fundamentally flawed financing infrastructure that needs to be replaced.

Choose a high ranked hospital and lose your choice of plans

Most Regionally Ranked Hospitals Stay In-Network with Marketplace Plans, But Participation Declines

By Katherine Hempstead, PhD, MA
Robert Wood Johnson Foundation,  February 6, 2016

Looking at network participation by state, nearly all highly ranked regional hospitals were in-network with at least one marketplace plan in both 2015 and 2016.

Key Findings

*  Network participation decreases significantly, however, as more than half of hospitals reduce the number of networks in which they participate between 2015 and 2016.

*  The percent of hospitals in-network with only one marketplace plan increased from 7 percent in 2015 to 20 percent in 2016.

*  Network participation declined more in metro areas.

*  Customers loyal to a particular hospital can in most cases still find a marketplace plan that includes it, but choices are narrowed in 2016 relative to 2015; plans with these hospitals may be more expensive.

Conclusion

Many consumers returning to the marketplace in 2016 may find that their choices have changed in ways that limit their access to certain providers. Yet it is still the case that almost all of these highly rated hospitals are in-network with at least one marketplace plan.

http://www.rwjf.org/en/library/research/2016/02/most-regionally-ranked-hospitals-stay-in-network-with-marketplac.html

Brief (15 pages, mostly tables):
http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2016/rwjf426368

A well-functioning health care system should be designed such that patients who would specifically benefit from the services of a highly ranked regional hospital should be assured of access to that hospital. Instead, we have a health care system that ignores the primacy of the patient, and, in this instance, places the highest priority on the business relationship between the hospital and the insurer. As a result, far too many insured patients do not have coverage for highly ranked regional hospitals.

In many communities, only one insurer includes the highly ranked hospital. Thus the patient must make a choice between buying that plan, which is usually more expensive, or buying a competing plan which otherwise may be more suitable because of the many other variables between plans. This is getting worse since participation of highly ranked hospitals in multiple plan networks is declining.

A far better system would provide the patient with a choice of primary care services wherein guidance can be provided to ensure access to the most appropriate facilities and specialized services in the community. To inject into the consideration private insurer restrictions on what services and facilities can be used is the epitome of poor health planning. Yet this is the system that many politicians and policy wonks insist that we must protect, limiting changes to incremental tweaks.

What incremental change would fix this? Should we require all insurers to cover all health care professionals and all facilities? If so, then how would an insurer have any power to negotiate lower rates with a provider that must be included? Instead of negotiating individually with providers should we set standard rates, as Medicare does? If so, then why would we continue to use a wasteful, fragmented market of private plans and public programs when one public entity could administer the system much more efficiently?

These are not examples of incremental steps that preserve our multi-payer system. This is one step that replaces our dysfunctional financing system with a single payer national health program. Our financing system is beyond repair, and incremental additions won’t change that. It’s the fundamentally flawed financing infrastructure that needs to be replaced.

What incremental changes would ensure coverage for seasonal farm workers?

Farm Contractors Balk At Obamacare Requirements

By April Dembosky
Kaiser Health News, February 11, 2016

Obamacare is putting the agricultural industry in a tizzy.

Many contractors who provide farm labor and must now offer workers health insurance are complaining loudly about the cost in their already low-margin business.

Some are also concerned that the forms they must file with the federal government under the Affordable Care Act will bring immigration problems to the fore. About half of the farm labor workforce in the U.S. is undocumented.

Last year, employers with 100 or more full-time employees had to offer health insurance to their workers or pay a stiff penalty. This year, employers with 50 to 99 full-time employees must comply.

“There’s definitely going to be some repercussions to it,” said Jesse Sandoval, a farm labor contractor based in Stockton, California.

Sandoval has about 100 workers on his payroll. When farmers need a crew to pick cherries, pumpkins or asparagus, they call him to send the workers. He has to offer them insurance this year, and he’s smarting over the price tag. At $300 a month per employee, he’s looking at a $30,000 monthly bill.

Sandoval said he can’t absorb the hit. “The numbers aren’t there,” he said. “My margin is 10 percent, and I have to increase expenses 10 percent? Well, that doesn’t work.”

So, like a lot of contractors, he’s passing the bill on to the farmers, who in turn are passing the bill on to the farm workers. Under the Affordable Care Act, employees can be asked to contribute 9.5 percent of their income toward health premiums.

But for farm workers who pick oranges or peaches for $10 an hour, that’s still too much. Agostin Garcia of Fresno, California, said the two contractors he works for near Fresno offered him insurance directly. But when he saw the price tag, he turned them both down.

“For me, I’m the only one in my house who works,” he said. “There’s five of us in the family. It just wouldn’t work. Either I pay for health insurance, or I pay the rent and utilities.”

Garcia said only a fraction of his co-workers have signed up for coverage. He said when farm labor contractors hand out packets explaining the coverage, the page where workers reject it is right on top.

“I think they do it intentionally,” Garcia said. “They comply with the laws by saying, ‘I offered.’ But they know that nobody’s going to accept it, they know that nobody’s going to pay those amounts.”

The cost isn’t the only thing about Obamacare stressing people out in the ag industry. Some are worried about immigration problems. Employers have to file new health care forms with the IRS for all their workers, whether or not they accept the insurance.

Farm labor contractors say they’re stuck in a Catch-22. Technically, immigrants who are in the U.S. illegally aren’t eligible for Obamacare benefits. But employers can’t admit that any of their employees may be working illegally, so they have to offer the insurance or face stiff fines from the IRS, maybe even a discrimination claim.

http://khn.org/news/farm-contractors-balk-at-obamacare-requirements-2/

***

Comment:

By Don McCanne, M.D.

Seasonal agricultural workers do not fit into a neat slot in the dysfunctional, fragmented financing system that President Obama and Congress have selected for us.

Following is a paragraph from my Quote of the Day of June 1, 2010 on this topic:

“Just briefly touching on some of the policies inherent in PPACA: employers with over 50 full-time equivalent employees will have to purchase coverage for their seasonal employees or pay a $2000 penalty per employee, even though that may be a staggering bill because of a temporary ten-fold increase in the number of employees; since most seasonal employees are uninsured, moving in and out of coverage during the harvest season results in instability of coverage; many seasonal workers are undocumented and thus ineligible for purchase of plans in the exchanges, defeating the purpose of the individual mandate; seasonal workers might be able to obtain care through community health centers, though that depends on having clinics accessible and may mean that important specialized services may not be provided, and the mere existence of such clinics may not fulfill the mandate requirements anyway; though the workers and their families might be eligible for Medicaid on an income basis, that may conflict with the employer mandate; etc.”

At that time, I wrote, “What would fix this would be a single payer national health program with automatic enrollment for everyone, financed separately though equitable tax policies.”

Yet our politicians rejected single payer, and instead insisted on improving the Affordable Care Act incrementally. Now that the topic of single payer has become one of the leading issues in the presidential campaign, there has been a surge of politicians, policy wonks, and columnists who are telling us that only incremental reform can work. They say we have to build on the current system.

So what incremental steps have been taken on improving coverage of seasonal agricultural workers since I wrote the above critique over five years ago? None. Now give some thought to incremental changes that we might introduce now that would ensure seasonal agricultural workers affordable access to health care throughout the year. (Pause.) Still thinking? We’ll give it some more time. Okay. Ready to describe the incremental changes to ACA that would ensure year-round affordable coverage for these workers? Thought not.

Regular readers understand that incremental reforms cannot do much more than tweak the current system. The reason is that the health financing infrastructure perpetuated by ACA is so highly flawed that it cannot be repaired. It proves the lie that “we have to build on the system we have.” We need a new, effective infrastructure.

The next time that someone says that single payer is too hard politically, demand that she tell you the precise incremental changes that will ensure health insurance coverage for the seasonal workers who help put food on our tables. As she stammers, or maybe repeats a non-responsive 15 second canned sound bite, emphatically point out that single payer would do it.


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