PNHP

Insurance is a strange model for health care

Insurance is a strange model for health care

It's meant for life's uncertainties, but illness is actually a pretty sure thing.

By EDWARD P. EHLINGER, M.D.
Minneapolis Star Tribune, Oct. 5, 2010

For once I agree with Jason Lewis — sort of. Using an insurance model to cover preexisting health conditions doesn’t make any sense, as he says (“Government health care is on the way,” Oct. 1).

But I would take his notion a step further. Using an insurance model for basic and essential health care also doesn’t make any sense.

Insurance is a great mechanism that people can use to offset their risk of losing some material thing of great value like their house, boat, car or jewelry. It can also be used to protect a valuable personal occupational asset like a voice for an opera singer, a hand for a surgeon or a knee for a football player. And it can be useful in providing protection from a singular catastrophic event like a malpractice suit or the premature loss of life.

But for something that is predictable, ongoing, needed by everyone, or necessary for the welfare of our community, an insurance model makes absolutely no sense. That’s why we don’t use an insurance model to provide police or fire services or to provide an education to our children. For these we use the tax model. Basic essential health care should also be in this category.

We know that almost everyone will eventually need some health care and much of it will be ongoing. For a defined population, the health care needs are predictable, and we know that the health of individuals affects the overall welfare of our community. In addition, most believe that people should get treated for illnesses, diseases and injuries that might befall them and expect that everyone should have access to preventive services like prenatal care and immunizations that make our communities a healthier and better place.

Our insurance-based model doesn’t match our societal needs and expectations in many respects. It denies coverage to those who need care the most. Since health and income are related, it charges more for the people who can least afford it. It encourages a link with employment that has numerous negative side effects. By its reimbursement mechanism, our insurance-based health care system has also fostered maldistribution of resources between primary and specialty care.

The proof of the folly of using an insurance-based model for health care is that, while we have the most expensive health care system in the world, approximately one-third of Americans are uninsured or inadequately insured. The consequences of this are that health status indicators for the United States are far from the best.

Lewis suggests that “most (perhaps not all) existing conditions can find coverage already — for a price.” That is true, but a free-market approach puts care out of reach for many of those who need it the most. Historically, it was the failure of the free-market approach that prompted us to go to an employer-linked health insurance-based model in the first place.

When health care costs, access to care and health status concerns became a major issue in the 1940s, the United States had a chance to implement a more rational tax-based health care financing system. However, the country did not have the political will to implement such a system and opted for the insurance-based model we have today. In the 1960s, the failure of that system for the elderly prompted the passage of Medicare, which has dramatically improved both the physical and economic health of senior citizens.

Lewis also rails against an entitlement mentality. As members of a civilized society, there are lots of things we should feel entitled to — police and fire protection, clean air and water, a functional electrical grid, basic education, safe borders, stable currency, etc. It’s logical to me and to most Americans that access to basic and essential health services should also be one of those entitlements.

With the continued problems of our insurance-based model of health care financing, perhaps it’s time to implement an improved Medicare-for-all approach. Then preexisting conditions would not be only redundant, they would be irrelevant.

Edward P. Ehlinger is a Minneapolis physician.

http://www.startribune.com/opinion/commentary/104380093.html?elr=KArks7PYDiaK7DUdcOy_nc:DKUiD3aPc:_Yyc:aUU

Touring doctors make case for single-payer system

By Landon Hall
The Orange County Register, Oct. 2, 2010

IRVINE, Calif. – Bill Honigman, an emergency-room doctor at Kaiser Permanente in Anaheim and Irvine, says the only way to make real progress on a health care overhaul is to get rid of private insurance companies altogether.

“Ultimately,” he says, “we’re going to have to muscle them out of the system.”

Just like that? It’s one reason Honigman and his colleagues, who call themselves the “Mad as Hell Doctors,” face an uphill struggle in their fight to get the United States, starting with California, to adopt a single-payer system that covers everyone, at government expense.

Honigman shared the stage Saturday night with three other doctors – two from Corvallis, Ore., and another from the Bay Area – who have been touring California for the past week and a half addressing crowds both big and small about the inefficiencies of the current system. They don’t think much of the Obama administration-backed bill that became law six months ago, saying it was written by and for insurance companies.

They see California as a battleground because a bill that would establish a single-payer system (SB840) has twice passed both houses of the Legislature, only to be vetoed by Gov. Schwarzenegger. Dr. Marc Sapir, a primary-care physician in Hayward, said the failure of a similar measure (SB810) to advance robbed the public of the opportunity to learn about single-payer.

Honigman said the vetoes showed that the governor is on the side of big business and not the people.

“But we will bring it to the next session,” he said, noting that Sen. Mark Leno, D-San Francisco, plans to reintroduce SB810.

More than 100 people, mostly older, sat in the pews of the politically active Irvine United Congregational Church to listen to the “mad” doctors — Honigman, Sapir, Paul Hochfeld and Mike Huntington of Corvallis, and church member Howard Emery of Yorba Linda – give a nearly two-hour presentation. It’s a complicated subject, they acknowledged.

“Our goal is to give you the intellectual tools and the courage and the commitment and the insight to talk to your friends and your neighbors, and your Fox News-watching uncle, sitting around the Thanksgiving dinner table,” Hochfield said.

Steve Bell, 61, of Laguna Niguel, brought his stepdaughter Lindsey Buss, 25, and her boyfriend to the town hall-style meeting to learn more about single payer.

“We didn’t get health reform, we got insurance reform,” Bell said. “Once the reform implodes, which I’m sure it will, then maybe we’ll get another look at single payer.”

Another person in the audience taking careful notes was Christina Avalos, a Democrat who is running against Rep. Ed Royce in the 40th District.

“We’re not informed enough, and that’s what events like this are about,” Avalos said. “I plan to disseminate this information at the federal level so we can make it a national priority.”

Huntington said that even if Attorney General Jerry Brown is elected as governor, there’s no guarantee he’d sign single payer into law if it were to pass the Legislature again.

“He has never committed that to anyone,” Huntington said. “So regardless of who gets elected, we feel that this has to be a movement that involves lots of groups. If he’s going to be brave enough to sign a single-payer bill, he has to feel that there’s lots of support behind him.”

Contact the writer: lhall@ocregister.com or 714-196-2221

http://www.ocregister.com/news/payer-269330-single-honigman.html

HHS rushes into reform… with expedited waivers!

Statement on the application of medical loss ratio standards to certain health plans under the Affordable Care Act

U.S. Department of Health & Human Services
September 30, 2010

Jay Angoff, director of the Office of Consumer Information and Insurance Oversight, within the U.S. Department of Health and Human Services (HHS) released the following statement today, regarding the application of medical loss ratio standards to certain health plans under the Affordable Care Act:

“As many employers and insurers consider health insurance options for 2011, one question that has been raised is the applicability of provisions of the Affordable Care Act to health plans and coverage with special circumstances. HHS remains committed to implementing the law in a way that minimizes disruption to coverage that is available today while also ensuring that consumers receive the benefits the Act provides.

“For example, pursuant to the Affordable Care Act and our regulations, HHS recently announced an expedited process for plans to apply for a waiver from the requirement in the Affordable Care Act establishing minimum annual limits where such limits would result in decreased access or increased premiums. HHS has approved dozens of these waiver requests, most often filed by so-called “mini-med” plans, and in doing so, has ensured the continuation of health coverage for workers and their families. Complete waiver applications were generally processed in 48 hours.

“More recently, the issue of the applicability of the medical loss ratio requirements to plans such as mini-med plans has come up. HHS has not yet issued regulations implementing the medical loss ratio requirements because the Affordable Care Act tasks the National Association of Insurance Commissioners (NAIC) with first making recommendations to the Secretary.

“Although the NAIC is close to completing its work, we understand that some employers must soon make decisions regarding coverage options for 2011. As such, we fully intend to exercise her discretion under the new law to address the special circumstances of mini-med plans in the medical loss ratio calculations.  According to the Affordable Care Act, medical loss ratio “methodologies shall be designed to take into account the special circumstance of smaller plans, different types of plans, and newer plans.”  We recognize that mini-med plans are often characterized by a relatively high expense structure relative to the lower premiums charged for these types of policies. We intend to address these and other special circumstances in forthcoming regulations.”

http://www.hhs.gov/news/press/2010pres/09/20100930c.html

Comment: 

By Don McCanne, MD

So the Patient Protection and Affordable Care Act (ACA) didn’t extend health care coverage to everyone and didn’t enact significant cost containment measures, but at least it did establish regulations that would end insurance abuses such as low annual dollar caps on coverage and administrative excesses that waste dollars that should be going to health care. Or did it?

Next year plans are required to provide a minimum of $750,000 in coverage, phasing to unlimited coverage in 2014. Also group plans are required to pay out at least 85 percent of premium revenues for health benefits (medical loss ratio). These regulatory changes are essential if health plans are going to benefit the insured, even though that would require plan redesign by employers such as McDonald’s and Jack in the Box that currently offer limited-benefit plans (mini-med plans) to their employees.

These plans offer as little as $2,000 a year in benefits. This could be perceived as a practical joke, but it certainly isn’t funny. This isn’t under-insurance; it’s virtually no insurance at all. Also, with so few benefits paid out, these plans cannot possibly meet the required medical loss ratios. Though ACA will not insure everyone and will not control costs, the new regulatory rules were supposed to bring an end to these abusive un-insurance programs.

Under ACA the Department of Health and Human Services (HHS) was given an expanded role in regulatory oversight, so what is their response to these plans? They have established an expedited process for these plans to be granted waivers exempting them from the new requirements!

What will happen in 2014? What changes will take place in the interim that will cause HHS to terminate the waiver program and require removal of dollar caps on coverage along with compliance with medical loss ratios? If the employers need the waivers now, they’ll certainly need them in 2014 when premiums are much higher because of the new regulatory requirements.

Is HHS really that sympathetic to employers while being so uncaring about the needs of their employees? I mean waivers… not just waivers… but expedited waivers! Just what was reform supposed to have accomplished?

As with so many of these daily messages, this would not even be a topic if Congress had enacted a single payer national health program – an improved Medicare for all.

HHS rushes into reform… with expedited waivers!

Statement on the application of medical loss ratio standards to certain health plans under the Affordable Care Act

U.S. Department of Health & Human Services
September 30, 2010

Jay Angoff, director of the Office of Consumer Information and Insurance Oversight, within the U.S. Department of Health and Human Services (HHS) released the following statement today, regarding the application of medical loss ratio standards to certain health plans under the Affordable Care Act:

“As many employers and insurers consider health insurance options for 2011, one question that has been raised is the applicability of provisions of the Affordable Care Act to health plans and coverage with special circumstances. HHS remains committed to implementing the law in a way that minimizes disruption to coverage that is available today while also ensuring that consumers receive the benefits the Act provides.

“For example, pursuant to the Affordable Care Act and our regulations, HHS recently announced an expedited process for plans to apply for a waiver from the requirement in the Affordable Care Act establishing minimum annual limits where such limits would result in decreased access or increased premiums. HHS has approved dozens of these waiver requests, most often filed by so-called “mini-med” plans, and in doing so, has ensured the continuation of health coverage for workers and their families. Complete waiver applications were generally processed in 48 hours.

“More recently, the issue of the applicability of the medical loss ratio requirements to plans such as mini-med plans has come up. HHS has not yet issued regulations implementing the medical loss ratio requirements because the Affordable Care Act tasks the National Association of Insurance Commissioners (NAIC) with first making recommendations to the Secretary.

“Although the NAIC is close to completing its work, we understand that some employers must soon make decisions regarding coverage options for 2011. As such, we fully intend to exercise her discretion under the new law to address the special circumstances of mini-med plans in the medical loss ratio calculations.  According to the Affordable Care Act, medical loss ratio “methodologies shall be designed to take into account the special circumstance of smaller plans, different types of plans, and newer plans.”  We recognize that mini-med plans are often characterized by a relatively high expense structure relative to the lower premiums charged for these types of policies. We intend to address these and other special circumstances in forthcoming regulations.”

http://www.hhs.gov/news/press/2010pres/09/20100930c.html

So the Patient Protection and Affordable Care Act (ACA) didn’t extend health care coverage to everyone and didn’t enact significant cost containment measures, but at least it did establish regulations that would end insurance abuses such as low annual dollar caps on coverage and administrative excesses that waste dollars that should be going to health care. Or did it?

Next year plans are required to provide a minimum of $750,000 in coverage, phasing to unlimited coverage in 2014. Also group plans are required to pay out at least 85 percent of premium revenues for health benefits (medical loss ratio). These regulatory changes are essential if health plans are going to benefit the insured, even though that would require plan redesign by employers such as McDonald’s and Jack in the Box that currently offer limited-benefit plans (mini-med plans) to their employees.

These plans offer as little as $2,000 a year in benefits. This could be perceived as a practical joke, but it certainly isn’t funny. This isn’t under-insurance; it’s virtually no insurance at all. Also, with so few benefits paid out, these plans cannot possibly meet the required medical loss ratios. Though ACA will not insure everyone and will not control costs, the new regulatory rules were supposed to bring an end to these abusive un-insurance programs.

Under ACA the Department of Health and Human Services (HHS) was given an expanded role in regulatory oversight, so what is their response to these plans? They have established an expedited process for these plans to be granted waivers exempting them from the new requirements!

What will happen in 2014? What changes will take place in the interim that will cause HHS to terminate the waiver program and require removal of dollar caps on coverage along with compliance with medical loss ratios? If the employers need the waivers now, they’ll certainly need them in 2014 when premiums are much higher because of the new regulatory requirements.

Is HHS really that sympathetic to employers while being so uncaring about the needs of their employees? I mean waivers… not just waivers… but expedited waivers! Just what was reform supposed to have accomplished?

As with so many of these daily messages, this would not even be a topic if Congress had enacted a single payer national health program – an improved Medicare for all.

Who will design and operate the accountable care organizations?

Health Care Providers, Insurers: Accountable Care Organizations Bring Legal Worries

By Jenny Gold and Phil Galewitz
Kaiser Health News
October 5, 2010

Doctors and hospitals eager to pursue a new model of health care being promoted by the Obama administration are raising concerns that they could run afoul of antitrust and anti-fraud laws, while insurers are warning that the new arrangements could lead to higher prices for medical care.

A key part of the health overhaul law encourages the development of “accountable care organizations” that would allow doctors to team up with each other and hospitals in new ways to provide medical services. Health care providers want to make sure their ACOs won’t be accused of stifling competition or trying to fix prices when they bargain with insurance companies. Insurers, meanwhile, are expressing concern that providers could use the leverage of ACOs to demand higher prices.

Whether ACOs – which are just a concept for now – can be made to work could determine whether the health care law ultimately succeeds in lowering costs and improving care for consumers.

The federal health program for the elderly and disabled is due to start trying out ACOs in 2012, and some providers are scrambling to figure out how to apply the idea to privately insured patients as well. The antitrust rules mostly concern the  private insurance market; in Medicare, the government sets the payment rates.

But America’s Health Insurance Plans, the insurers’ trade group, warned government officials against being too accommodating. It said in a recent letter  that ACOs won’t help consumers “if they are mere vehicles for price fixing or aggregating market power, and the antitrust agencies must continue their efforts in this area, using enforcement, guidance, and other tools.”

Cory Capps, an economist at Bates White Economic Consulting, said, “We could end up in the worst world,” one in which the delivery of care isn’t made more efficient but providers accumulate “greater pricing power.”

Susan DeSanti, director of policy planning at the FTC, said that the agency is working with CMS on the issues, and that guidance on ACOs will be issued to reduce uncertainty. “The antitrust laws are actually consistent with the goals of ACOs,” she said. “The antitrust laws encourage collaborations when they are going to produce good things for consumers, like improved health care, and the only caveat is that the creation of market power shouldn’t go along with that. But antitrust is not a barrier here.”

Humana Medical Director Dr. Tom James said the insurer wants to show that “health plans have a role with ACOs,” adding that it’s important that ACOs be seen as more than cost-cutters. “If not done right, it could give the whole movement a bad name,” he said. “We learned that with HMOs in the 1990s.”

http://www.kaiserhealthnews.org/Stories/2010/October/05/accountable-care-organizations.aspx

Comment: 

By Don McCanne, MD

The Patient Protection and Affordable Care Act (ACA) promises us greater affordability through the establishment of accountable care organizations (ACOs). By adopting an as-yet-to-be-defined team approach to health care, the organizations purportedly would improve quality while controlling costs, theoretically by eliminating the excess services demonstrated by the Dartmouth Atlas (even though our much greater problem is under-utilization as demonstrated by Commonwealth, RAND, and others).

Who will be making the decisions on the structure and then the operations of these teams? Will it be altruistic members of the medical, hospital, and policy communities? Very unlikely, based on the history of the HMOs. Although the original HMOs were designed with the intent of providing optimal patient care (through a team approach!), the enabling legislation that brought a surge in managed care also brought out the entrepreneurial minds that replaced health care altruism with a business ethic of health care.

There is absolutely no doubt that the same will occur now, and actually has already begun. The entrepreneurs will be in control before the altruists can develop a process to fulfill the vision for a health care utopia. Although the teams will be designed along business lines, purportedly to control costs, the motivation of those in control will be to make money. Even if the teams are not owned by passive investors, the physicians and hospital administrators will still be manipulating the structure and operations to serve their own interests first.

The vision of various teams competing with each other by offering higher quality and lower costs is a fantasy. These teams will use their oligopolistic and monopolistic powers to drive costs up. Markets do work very well for those who are able to pervert them. Just look at the perversions of the private insurance industry that has helped to orchestrate the most expensive health system in the world, while squandering the opportunities to bring some measure of quality to our system.

Congress and the Obama administration have brought us ACOs, and you would think that they would feel some obligation as government stewards to provide guidance and oversight. But what has been their response? Susan DeSanti of the Federal Trade Commission said that “the antitrust laws encourage collaborations,” and that “antitrust is not a barrier here.”

As Cory Capps of Bates White Economic Consulting stated, “We could end up in the worst world,” one in which the delivery of care isn’t made more efficient but providers accumulate “greater pricing power.”

The tragedy is that all of the attention that has been diverted to these ill-defined and perversely-incentivized ACOs has distracted our nation’s policy makers from seriously considering reform that actually would achieve our goal of quality, affordable care for everyone – an improved Medicare for all. Focus, folks.

Doctors push for single-payer at workers' rally

By Julian Pecquet
The Hill, Oct. 1, 2010

[PNHP note: This article in The Hill, published on the eve of the Oct. 2 “One Nation” march in Washington, was one of several news reports about the participation of single-payer, Medicare-for-all advocates in the gathering of 175,000 at the Lincoln Memorial. Early on Saturday morning, Mara Liasson on NPR mentioned that doctors were marching “and they want single payer,” and later that day The Associated Press noted, “There were people with union T-shirts and others participants who carried banners advocating expanding Medicare for all Americans.”]

Physicians who want a single-payer government health plan will be marching at Saturday’s “One Nation Working Together” rally in Washington, D.C. While the main focus of the march will be on jobs and the economy, part of the rally’s theme — “demanding the change we voted for” — relates to dissatisfaction with the health care reform law, according to Physicians for a National Health Program.
 
The group’s 18,000 members don’t believe the new health care reform law will put an end to rising health care costs, but rather it will make things worse by entrenching the role of private insurance companies.
 
“Reforming our health care system is unfinished business,” PNHP President Oliver Fein said in a statement. Physicians will be marching “to say we need a massive movement to press forward to the only rational remedy for our nation’s health care crisis: single-payer Medicare for all.”
 
http://thehill.com/blogs/healthwatch/health-reform-implementation/122093-doctors-to-push-for-single-payer-at-workers-rally

Doctors push for single-payer at workers’ rally

By Julian Pecquet
The Hill, Oct. 1, 2010

[PNHP note: This article in The Hill, published on the eve of the Oct. 2 “One Nation” march in Washington, was one of several news reports about the participation of single-payer, Medicare-for-all advocates in the gathering of 175,000 at the Lincoln Memorial. Early on Saturday morning, Mara Liasson on NPR mentioned that doctors were marching “and they want single payer,” and later that day The Associated Press noted, “There were people with union T-shirts and others participants who carried banners advocating expanding Medicare for all Americans.”]

Physicians who want a single-payer government health plan will be marching at Saturday’s “One Nation Working Together” rally in Washington, D.C. While the main focus of the march will be on jobs and the economy, part of the rally’s theme — “demanding the change we voted for” — relates to dissatisfaction with the health care reform law, according to Physicians for a National Health Program.
 
The group’s 18,000 members don’t believe the new health care reform law will put an end to rising health care costs, but rather it will make things worse by entrenching the role of private insurance companies.
 
“Reforming our health care system is unfinished business,” PNHP President Oliver Fein said in a statement. Physicians will be marching “to say we need a massive movement to press forward to the only rational remedy for our nation’s health care crisis: single-payer Medicare for all.”
 
http://thehill.com/blogs/healthwatch/health-reform-implementation/122093-doctors-to-push-for-single-payer-at-workers-rally

Who will design and operate the accountable care organizations?

Health Care Providers, Insurers: Accountable Care Organizations Bring Legal Worries

By Jenny Gold and Phil Galewitz
Kaiser Health News
October 5, 2010

Doctors and hospitals eager to pursue a new model of health care being promoted by the Obama administration are raising concerns that they could run afoul of antitrust and anti-fraud laws, while insurers are warning that the new arrangements could lead to higher prices for medical care.

A key part of the health overhaul law encourages the development of “accountable care organizations” that would allow doctors to team up with each other and hospitals in new ways to provide medical services. Health care providers want to make sure their ACOs won’t be accused of stifling competition or trying to fix prices when they bargain with insurance companies. Insurers, meanwhile, are expressing concern that providers could use the leverage of ACOs to demand higher prices.

Whether ACOs – which are just a concept for now – can be made to work could determine whether the health care law ultimately succeeds in lowering costs and improving care for consumers.

The federal health program for the elderly and disabled is due to start trying out ACOs in 2012, and some providers are scrambling to figure out how to apply the idea to privately insured patients as well. The antitrust rules mostly concern the  private insurance market; in Medicare, the government sets the payment rates.

But America’s Health Insurance Plans, the insurers’ trade group, warned government officials against being too accommodating. It said in a recent letter  that ACOs won’t help consumers “if they are mere vehicles for price fixing or aggregating market power, and the antitrust agencies must continue their efforts in this area, using enforcement, guidance, and other tools.”

Cory Capps, an economist at Bates White Economic Consulting, said, “We could end up in the worst world,” one in which the delivery of care isn’t made more efficient but providers accumulate “greater pricing power.”

Susan DeSanti, director of policy planning at the FTC, said that the agency is working with CMS on the issues, and that guidance on ACOs will be issued to reduce uncertainty. “The antitrust laws are actually consistent with the goals of ACOs,” she said. “The antitrust laws encourage collaborations when they are going to produce good things for consumers, like improved health care, and the only caveat is that the creation of market power shouldn’t go along with that. But antitrust is not a barrier here.”

Humana Medical Director Dr. Tom James said the insurer wants to show that “health plans have a role with ACOs,” adding that it’s important that ACOs be seen as more than cost-cutters. “If not done right, it could give the whole movement a bad name,” he said. “We learned that with HMOs in the 1990s.”

http://www.kaiserhealthnews.org/Stories/2010/October/05/accountable-care-organizations.aspx

The Patient Protection and Affordable Care Act (ACA) promises us greater affordability through the establishment of accountable care organizations (ACOs). By adopting an as-yet-to-be-defined team approach to health care, the organizations purportedly would improve quality while controlling costs, theoretically by eliminating the excess services demonstrated by the Dartmouth Atlas (even though our much greater problem is under-utilization as demonstrated by Commonwealth, RAND, and others).

Who will be making the decisions on the structure and then the operations of these teams? Will it be altruistic members of the medical, hospital, and policy communities? Very unlikely, based on the history of the HMOs. Although the original HMOs were designed with the intent of providing optimal patient care (through a team approach!), the enabling legislation that brought a surge in managed care also brought out the entrepreneurial minds that replaced health care altruism with a business ethic of health care.

There is absolutely no doubt that the same will occur now, and actually has already begun. The entrepreneurs will be in control before the altruists can develop a process to fulfill the vision for a health care utopia. Although the teams will be designed along business lines, purportedly to control costs, the motivation of those in control will be to make money. Even if the teams are not owned by passive investors, the physicians and hospital administrators will still be manipulating the structure and operations to serve their own interests first.

The vision of various teams competing with each other by offering higher quality and lower costs is a fantasy. These teams will use their oligopolistic and monopolistic powers to drive costs up. Markets do work very well for those who are able to pervert them. Just look at the perversions of the private insurance industry that has helped to orchestrate the most expensive health system in the world, while squandering the opportunities to bring some measure of quality to our system.

Congress and the Obama administration have brought us ACOs, and you would think that they would feel some obligation as government stewards to provide guidance and oversight. But what has been their response? Susan DeSanti of the Federal Trade Commission said that “the antitrust laws encourage collaborations,” and that “antitrust is not a barrier here.”

As Cory Capps of Bates White Economic Consulting stated, “We could end up in the worst world,” one in which the delivery of care isn’t made more efficient but providers accumulate “greater pricing power.”

The tragedy is that all of the attention that has been diverted to these ill-defined and perversely-incentivized ACOs has distracted our nation’s policy makers from seriously considering reform that actually would achieve our goal of quality, affordable care for everyone – an improved Medicare for all. Focus, folks.

Mad as Hell Doctors March in Santa Barbara

Universal Health Care Forum Draws Crowd

By Carla Amurao
Santa Barbara Independent, Oct. 1, 2010

Last night, the Mad as Hell Doctors, a group of activist physicians and health care providers, marched across town in an effort to raise awareness about universal health care and calling “Obamacare” a bare-minimum reform. From Anapamu Street to Canon Perdido, the sound of drums and cheers filled the air while passersby honked their horns and offered high fives and other plaudits.

The group of 50 marchers consisted of members of Physicians for a National Health Program, the Progressive Democrats, and the Santa Barbara and Santa Maria branches of Health Care for All (California). The march led into to a public forum at the Santa Barbara Central Public Library’s Faulkner Gallery hosted by Mike Huntington, a retired oncologist from Corvallis, Oregon. Organized with the help of Santa Barbara healthcare activists Peter and Paulina Conn, the forum drew a crowd of over 100.

Mad as Hell Doctors (MAHD) will head to Sacramento on October 12. They argue that the Patient Protection and Affordable Care Act of March 2010 just doesn’t cut it. They hope their tour will strengthen efforts to pass, in this state, Senate Bill 810, the California Universal Healthcare Act. MAHD also wants to pass House Resolution 676, also known as the United States National Health Care Act or the Expanded and Improved Medicare for All Act, which would reduce up to 75 percent of out-of-pocket costs.

Single-payer health care calls for a pool of funds, contributed by taxpayers, to pay for healthcare, cutting out middle-man: health insurance companies. According to members of this movement, insurance companies primarily create hassles, and take up to 30 percent of funds to pay for administration, political campaigns, and profits for investors. An increase of profit is achieved by denying coverage—a tactic implemented by insurance companies far too often.

If SB 810 and HR 676 pass, there would be no more need for private health insurance companies—out-of-work employees would be eligible for training and first preference for jobs under the new health care system, and would be provided up to two years of unemployment under HR 676.

In the event SB 810 passes, the ideal of “Everybody in, nobody out” would be implemented and overall health care would not see an increase in spending, according to Bill Smiley, a local activist. The reason why single-payer health care has not yet been approved is that insurance companies are constantly seeking a profit, he said.

“If California adopts [SB 810], it would sweep through the U.S. like wildfire,” said Smiley, in reference to this being California’s fourth attempt to establish a more beneficial health care system.

Local physicians Dr. Van Hamilton from Sansum and Dr. William Mellers from Med Center were present at the forum and spoke about the inefficiency of the United States current health care system, which they called one of the weakest in the world. Also present were physicians Norman Castillo, Marc Sapir, and Margaret Flowers. The latter has been arrested on three separate occasions during demonstrations for universal health care. A Congressional Fellow for Physicians for a National Health Program, Flowers took the campaign to Congress in 2009, claiming perks include saving and improving lives, saving money, and increasing life expectancy.

“Single-payer health reform is the approach approved by the majority of Americans,” said Flowers, during the demonstration in Santa Barbara. “Health insurance companies don’t care about your health,” she added. “Congress needs to listen to people, not health insurance companies. Health care is a human right.”

The Mad as Hell Doctors are also mad because, frankly, not enough people, especially young people, are mad. MAHD encourages people to build a broad social movement, to speak out, spread the word, join organizations, and rally for the cause.

MAHD accepts tax-deductible donations and shares them with local organizations that help them assemble public forums.

http://www.independent.com/news/2010/oct/01/mad-hell-doctors-march-santa-barbara/

‘Single payer is sound medicine’: doctors on Calif. tour

The following interviews with three members of the Mad as Hell Doctors who are presently on a 24-city tour of California appeared in the Visalia (Calif.) Times-Delta, Oct. 2, 2010.
 
Radiation oncologist: ‘Single payer is sound medicine’
 
By Mike Huntington, M.D.
 
I’m Mad As Hell because Americans aren’t getting the information they need to make an educated decision about health care. The fact is that a single-payer health care system has been working in other countries for decades and it can work here. But there is so much misinformation, so much undue corporate influence, that the truth doesn’t penetrate. People need to know that single-payer is not socialism, it’s not communism, it’s sound medicine for a sick system. Plain and simple.
 
I have enjoyed my 36-year career as a radiation oncologist. But I have become concerned about the geometric progression of costs in my specialty and other medical specialties over the years and the effects of those costs on affordability of health insurance and accessibility of health care.
 
Between 1996 and 2006, new tests and treatment techniques doubled and tripled the costs of certain radiation treatment courses, often without proof of commensurate improvements in outcomes.
 
I knew that insurance premiums rose proportionately to the cost of such expensive technology, driving many people off the bottom rungs of affordable insurance.
 
Some of these uninsured or under-insured individuals would later become my patients after their early cancers progressed to untreatable cancers because of these individuals’ inability to access medical care and an early diagnosis.
 
We must design a system that prioritizes services to make the best use of existing resources and keeps costs low so that all citizens gain access to good essential care.
 
We need to de-emphasize the high-tech non-essential care that currently brings in revenue to finance our health institutions but is breaking the societal bank.
 
Good sustainable health care systems based on the single-payer model have been achieved in most of the industrialized world. These systems work well and they belie the wealth-care propaganda that trumpets the relatively few shortcomings of these systems.
 
Mike Huntington, M.D. is a radiation oncologist with a practice in Corvallis, Ore.
 
http://www.visaliatimesdelta.com/article/20101002/OPINION09/10020321/1014/OPINION/Radiation+oncologist

Family practice doctor: Save lives, money by removing insurers from health system
 
By Marc Sapir, M.D.
 
I’m Mad As Hell because rather than deal with the root causes of illness, many doctors are only able to perform tests and pass out pills. I’m really mad as hell because our politicians ignore the 70 percent of Americans and 55 percent of their doctors calling for a single-payer national health care plan! The time is now!
 
I’ve provided health/medical care to patients in nonprofit and public clinics in California for more than 38 years. The most disturbing thing about health care in the U.S. is that we actually deny or limit access to so many people. I have many patients right now who have lost insurance because they lost their jobs or their employer stopped covering the workers as the cost of insurance skyrockets. Our public clinics can’t serve all of these patients.
 
We have allowed the medical-industrial complex to inflate health costs at 15 percent to 20 percent a year. As a result, waiting time for care with us in Alameda County is up to 6 months. Almost 2 million people go bankrupt each year in the U.S. because of health care debt. The new federal reform won’t change that, because even with subsidies, people will not be able to afford the private insurance they are required to buy. Costs for everyone will rise and benefits will shrink as before.
 
No one goes broke due to health debt in other countries. Other countries treat health care as a human right. Our system leads to discontinuous, spotty health care, bad health outcomes and needless suffering. Many of us find our insurance companies trying to dump us when we get very sick. With Medicare, patients can go to any willing doctor, hospital or service provider, without any red tape, period. We could save a ton of money and improve our care as doctors by getting the insurance companies out of our care system and out of our offices and clinics.
 
We can and should fortify and improve Medicare, and at the same time make it available to all, as a single payer, national health insurance program with everybody in, and nobody out except for the insurance companies.
 
Marc Sapir M.D., M.P.H., is a primary care physician who practices in Alameda County, Calif.
 
http://www.visaliatimesdelta.com/article/20101002/OPINION09/10020323/1014/OPINION

Emergency room physician: ‘We have a broken, non-system of care’
 
By Paul Hochfeld, M.D.
 
I’m Mad As Hell because we have a broken, non-system of health care in this country designed and implemented around profit, not people. It not only represents a health crisis, it is also a fiscal disaster that threatens the solvency of our government. Some form of single payer is the only solution.
 
As an emergency physician, I regularly observe people suffer from financial barriers to timely care while others suffer from overtreatment.
 
In 2006, I channeled my frustration into an exploration with the goal of producing a video.
 
What I discovered is we have a sick care “non-system” that’s more about fear and money than health. It’s beyond ailing or broken. It’s dumb.
 
Subsequently, I created a film, “Health, Money and Fear,” which addresses three questions about our health care “system.”
 
* Why does it cost so much? Advances in technology, fear of liability, abuses of pharmaceutical companies, unrealistic expectations (especially toward the end of life), chaos in medical records, a scarcity of primary care providers, and an abundance of perverse incentives that motivate physicians to do more and more, without regard for actually doing better. Furthermore, insurance companies use tax payer subsidies to creatively avoid having to cover those at greatest risk, whose care gets paid for by, of course, the taxpayer. Servicing the insurance industry adds 25 percent to 30 percent to the total cost of health care.
 
* What does it say about us? We fear death more than we fear suffering, even in futility. We fear the U.S. government more than we fear United Healthcare (who only cares about the bottom line).
 
Our political system, manipulated by corporate interests, generates public policy that is more about sustaining corporate profits than making sure the taxpayer is receiving value for the money “we” are spending on health care.
 
* What can we do about it? Put everybody in the same risk pool. Get the most health and the least suffering we can get for the precious money we are spending.
 
We cannot afford to continue servicing the health insurance industry, which adds substantially to cost without adding anything to health.
 
Paul Hochfeld, M.D., is an emergency room doctor who practices in Good Samaritan Regional Medical Center, Corvallis, Ore.
 
http://www.visaliatimesdelta.com/article/20101002/OPINION09/10020322/Emergency-room-physician

Model exists to provide health insurance for all – it's called Medicare

By Dr. James C. Mitchiner
Ann Arbor News, Oct. 3, 2010

The announcement last month by the Census Bureau that the number of uninsured increased last year to a record 50.7 million individuals should come as no surprise to those who understand the uniquely American tradition of linking health insurance to employment.

Combined with the corresponding finding that the rate of employer-based insurance has decreased, the conclusion is obvious: in a declining economy, as unemployment rates increase and employer payrolls tighten, the number of people lacking health insurance goes up.

Why is this? I have never understood why health insurance must be associated with employment. Historically, I recognize how businesses’ response to FDR’s wartime wage and price controls lead to the situation we have now. But I fail to see how a model first applied in the 1940s should continue to operate in the 21st century. Other forms of insurance – car, home, boat, flood, and universal life insurance – are not linked to a job, so why should health insurance have this unique relationship?

Imagine a world where your health care coverage would not be predicated on what you did or where you worked, where you lived under a system that provided continual access to care as you moved from job to job or state to state, and guaranteed your health security even if you were laid off or terminated. Picture yourself in such a world where “choice” refers not to your choice of health insurer, but instead to the freedom to choose your own doctor and hospital, based on whatever criteria you and you alone deem to be personally relevant. And imagine a world where more than 95 percent of your contribution to health insurance was actually spent on health care, with no substantial contributions to a bloated and mindless bureaucracy.

The good news is that such a model exists. It is called a single-payer, Medicare-for-All program. It is a plan modeled on Medicare, a popular program that is universal, portable, affordable, non-profit, non-discriminatory, and administratively efficient. An expanded Medicare program would sever the link between employment and health insurance for all Americans, and use as its sole entry criteria nothing more than U.S. citizenship. Such a program would drastically reduce the number of uninsured, at a total cost much less than what we are paying now. And, under a single-payer system, private insurance firms would be used for simple administrative functions only, and not for decisions that place greedy corporate profits over an individual’s right to medical care.

And the bad news? The United States remains the only western democracy that does not have universal single-payer health insurance. For illogical reasons, we as a country continue to have blind faith in the ability of the private insurance industry to solve the dual problems of access to care and cost containment. If for-profit insurance has not fixed the problems with health care after over 60 years of existence, why would anyone believe it would happen now under the recently passed health care reform act, where private insurance continues to play a dominant role? Clearly, the only logical solution is to insure everyone, and the most efficient way to do that is through single-payer national health insurance.

Dr. James Mitchiner, an Ann Arbor physician, is the former president of the Washtenaw County Medical Society and a member of Physicians for a National Health Program.

http://www.annarbor.com/news/opinion/model-exists-to-provide-health-insurance-for-all—its-called-medicare/

Model exists to provide health insurance for all – it’s called Medicare

By Dr. James C. Mitchiner
Ann Arbor News, Oct. 3, 2010

The announcement last month by the Census Bureau that the number of uninsured increased last year to a record 50.7 million individuals should come as no surprise to those who understand the uniquely American tradition of linking health insurance to employment.

Combined with the corresponding finding that the rate of employer-based insurance has decreased, the conclusion is obvious: in a declining economy, as unemployment rates increase and employer payrolls tighten, the number of people lacking health insurance goes up.

Why is this? I have never understood why health insurance must be associated with employment. Historically, I recognize how businesses’ response to FDR’s wartime wage and price controls lead to the situation we have now. But I fail to see how a model first applied in the 1940s should continue to operate in the 21st century. Other forms of insurance – car, home, boat, flood, and universal life insurance – are not linked to a job, so why should health insurance have this unique relationship?

Imagine a world where your health care coverage would not be predicated on what you did or where you worked, where you lived under a system that provided continual access to care as you moved from job to job or state to state, and guaranteed your health security even if you were laid off or terminated. Picture yourself in such a world where “choice” refers not to your choice of health insurer, but instead to the freedom to choose your own doctor and hospital, based on whatever criteria you and you alone deem to be personally relevant. And imagine a world where more than 95 percent of your contribution to health insurance was actually spent on health care, with no substantial contributions to a bloated and mindless bureaucracy.

The good news is that such a model exists. It is called a single-payer, Medicare-for-All program. It is a plan modeled on Medicare, a popular program that is universal, portable, affordable, non-profit, non-discriminatory, and administratively efficient. An expanded Medicare program would sever the link between employment and health insurance for all Americans, and use as its sole entry criteria nothing more than U.S. citizenship. Such a program would drastically reduce the number of uninsured, at a total cost much less than what we are paying now. And, under a single-payer system, private insurance firms would be used for simple administrative functions only, and not for decisions that place greedy corporate profits over an individual’s right to medical care.

And the bad news? The United States remains the only western democracy that does not have universal single-payer health insurance. For illogical reasons, we as a country continue to have blind faith in the ability of the private insurance industry to solve the dual problems of access to care and cost containment. If for-profit insurance has not fixed the problems with health care after over 60 years of existence, why would anyone believe it would happen now under the recently passed health care reform act, where private insurance continues to play a dominant role? Clearly, the only logical solution is to insure everyone, and the most efficient way to do that is through single-payer national health insurance.

Dr. James Mitchiner, an Ann Arbor physician, is the former president of the Washtenaw County Medical Society and a member of Physicians for a National Health Program.

http://www.annarbor.com/news/opinion/model-exists-to-provide-health-insurance-for-all—its-called-medicare/