By Pamella S. Gronemeyer
Illinois Business Journal (Edwardsville), Jan. 2019

I am a physician and an employer, as well as a purchaser and a recipient of my own health care. I strongly support improved Medicare for All, a/k/a/ a single payer health care, because it is the most economically affordable, equitable and patriotic health care for this country. Most other industrialized nations have long ago realized that the health of their nation is no better than the health of their sickest individuals.

As a recent Medicare enrollee, I know that Medicare works. I have conventional Medicare with a supplemental plan and a prescription drug plan. I chose my supplemental plan with a company that treats providers with respect and pays fairly. As a Medicare enrollee, I have my choice of physicians and health-care facilities. I know that the bills will be paid. The downside, however, is that the Medicare supplemental plans and drug plans are not cheap. Many seniors cannot afford these outlays. That is why we need to improve Medicare when we expand it to the entire population. Medicare for All would incorporate dental and vision services as well. The issue of long-term care coverage is still being discussed.

For many years, I have known, as a provider, that Medicare pays a clean claim in 30 days. The Medicare rates are published every year online and are observed. Patients and providers are not pitted against each other in the payment process. Insurance companies often confuse both the health-care provider and patient by telling them conflicting information. Many insurance claims are unpaid beyond 60 days, and it is difficult to run a small business without consistent cash flow. Most insurance companies base their provider rates on a multiple of at least one times Medicare. However, unfairly, some change the rates without notification.

As a small-business owner, I provide health insurance to my employees and their dependents with as low a deductible as possible. I pay the premiums and they pay their deductibles and copays. I do this because I know that my employees are vital to the success of my business and I care about their health and the health of their families. For many years, my premiums rose more than 10 percent a year. While this increase stabilized under the ACA, the premiums rose again 8.2 percent this year. As my employees age (I have good employee retention) their rates go up based on their age. The fact that more and more money is needed to pay health-care premiums limits my ability to give raises. My employees use their health care wisely. The thought that health care for all would create abuse of the system is ridiculous. If we had Medicare for All, I could use the time and energy that it now takes me each October to review available plans, select a plan that is affordable and re-enroll to do my real job of providing pathology and cytology services.

Medicare for All could be paid for by an employer payroll tax that would replace the premiums that my business currently pays to the health insurance company. The employee may pay a small tax that would replace their co pays and deductibles. Would Medicare for All be more expensive than what people are currently paying? Credible economists and healthcare experts say uniformly “NO.” The additional taxes that a person would pay annually are far less than the average person is now paying in premiums to insurance companies. Also, the savings created by a system that spends money for health care and not administrative costs is indisputable. Medicare operates on an overhead of 2 percent to 3 percent; the overhead of private insurance companies is around 20 percent. In addition, the costs of workman’s compensation and retirees’ health benefits would disappear. Malpractice premiums would go down since settlements would no longer include payments for future medical care, because an improved Medicare for All would cover virtually everything.

The entrepreneurial character of Americans is well known. Starting a business would be easier with the knowledge that health-care costs would not discourage people from the process. People would no longer be restricted from creating a business or changing jobs because they are worried about their health care. Medicare for All is a win-win proposition for businesses and for the nation.

Dr. Pamella Gronemeyer is an anatomic and clinical pathologist. She is the director and owner of SEMC Pathology in Highland.

https://www.ibjonline.com…

By Dennis Grubaugh
Illinois Business Journal (Edwardsville), Jan. 2019

The epiphany for Wendell Potter came in 2007 when he saw the reality of health care in America, the difference between the haves and the have-nots.

After spending almost 20 years in health-care public relations and being paid to tout the industry line, he had become disheartened over the state of managed care. Insurance executives were promising the moon to patients but were far more concerned with investors and the effects of potential reforms. Insurance was becoming unaffordable. Millions were going without coverage.

He was aware of the growing crisis but saw it personally when, while visiting his home in Tennessee, he read about an event offering free health care at county fairgrounds in nearby Virginia. He decided to go see for himself the state of the industry.

“What I saw was something I never expected to see in this country,” he said. “People were lined up by the hundreds waiting to get care, some under tents, but a lot of those lines were leading up to barns and animal stalls. It looked like a refugee camp.”

Potter added: “I didn’t know anything like that existed, but I found out there were events like that all over the country.”

Very quickly, Potter went from insurance advocate to insurance reformer. Today, he is the one of the country’s foremost proponents of the Medicare for All movement, the idea of having a single payer — the government — pay for all people’s health care.

Potter spoke recently at Southern Illinois University Edwardsville where he appeared at the invitation of the Missouri Chapter of Physicians for a National Health Program and others.

Potter rose to prominence in 2009 when he testified in Congress during the first Obamacare debate, about the damage caused by the misinformation campaigns he says he helped create while vice president of communications for Cigna.

“I realized I had played some kind of a role in perpetuating the myth of the health-care system,” he said. “I knew as soon as my testimony was over that I would be known by my insurance industry colleagues as Public Enemy No. 1.”

It was quite a change for a man who was raised to believe in the free market.

“One of my first jobs in the industry came during the early Clinton years, when Bill and Hillary Clinton were trying to enact health-care reform. My industry didn’t like it so we teamed up with the drug companies, the big hospital companies and the medical device companies to develop a campaign to make sure it never happened. And, it never happened (until Obamacare).”

He referred to the early effort as a “FUD campaign” — sewing fear, uncertainty and doubt to make sure people were made afraid of any kind of health-care reform.

He said he worked for a system that had an offense and a defense. The offense encouraged people to believe that the U.S. had the best health-care system in the world. The defense was to respond to criticism from patients and doctors when particular cases got too loud.

“More often than not the company would reverse gears and approve whatever was being denied, just to make the story go away,” he said.

Those stories led to the backlash against managed care and led Potter to question what he was doing for a living.

He handled financial communications for Cigna corporate and got to understand how the company made money. Regularly, he fielded calls from the Wall Street Journal and others.

“Press releases and talking points were handed off to lawmakers, who we had contributed to and were friendly to us,” he said.

The manipulation wasn’t unique to Cigna, where he worked 15 years, or to Humana, another insurance company where he worked more than four years, he said. Every large insurance company was lobbying for footing.

As a former journalist for Scripps-Howard papers in Tennessee and elsewhere before his health career, he brings a certain credibility to the table in discussing the situation. He has now written three books on the industry’s shortfalls. He is also founder of the independent investigative journalism group, Tarbell.org.

Now, he talks about what has happened to Obamacare and where reforms need to go next, which he believes is a single-payer system that is likely to take years to approve.

“(Obamacare) has done some good,” Potter said. “More people are insured who were not before but the problem is the number of unemployed Americans is beginning to creep back up again and a lot of people are now underinsured. Their plans have such high deductibles they can’t afford to pay them and the cost keeps going up.”

The parts that people like about Obamacare — younger people being protected on their parents’ policies until they are 26 and coverage for people with pre-existing conditions — have thwarted attempts in Congress to overturn the law. However, a federal judge in Texas last month ruled that Obamacare is unconstitutional because of the mandate that people buy insurance. That makes it more likely that the validity of the Affordable Care Act will again go before the U.S. Supreme Court, which originally approved the law in 2010.

The Democrat surge resulting from the midterm elections will also mean more support for keeping a national health-care law in place. A Medicare for All caucus, comprised of 70 Democrats, was in place when the new Congress was seated early this month.

Insurance companies have doled out millions of dollars to members of both parties to protect their interests, and Potter believes that further reforms are not a question of if but when.

“A lot of the people who opposed Obamacare early on were not opposed to the reforms per se but the fact that they didn’t think it went far enough,” he said. “In my view, when it passed, it was the end of the beginning of reform. It moved us in the right direction, but it kept a lot of the infrastructure of a broken system in place.”

He’s not sure further reforms will come during the Trump administration but does think talks will continue.

“Where we need to be is a system that disciplines costs, brings us all into coverage, and includes outcomes,” he said.

Health-care premiums have risen from about $6,000 a year for families in 1999 to almost $20,000 today. Meanwhile, employers have been shifting more and more of the cost of the premiums from themselves to their workers.

Many people who do have insurance can barely afford the deductibles, which prevents them from getting care.

“Our employer-based system is unraveling,” he said. “Now, business owners are beginning to get on board and realize they can’t keep providing health care.”

Potter is president of the Business Initiative for Health Policy, a public education and advocacy effort focused on advancing the business and economic rationale for adopting a Medicare for All system in the United States, which is the only developed nation in the world without guaranteed universal health care.

The U.S. health-care system was dead last of developed countries before Obamacare was enacted, but is still that way today because of the law’s weaknesses, he said.

https://www.ibjonline.com…

By John Perryman, M.D.
Daily Herald (Arlington Heights, Ill.), Jan. 8, 2019

Shane Patrick Boyle, a Type 1 diabetic living in Texas, had to move to Arkansas to care for his sick mother. His health insurance did not provide coverage in that state, so he set up a GoFundMe page to help cover his medical expenses until he could obtain new insurance. He got within $50 of his goal, rationing his insulin until he could obtain more.

Then he died from complications of his diabetes.

This tragedy and many others like it demonstrate some of the many failings of American health care.

The United States spends more on health care than every other nation on earth, yet is the only rich country that does not guarantee it for its citizens. Our high costs put incredible strains on patients, their families, businesses and the economy. Medical costs are a leading cause of personal bankruptcy and mortgage foreclosures.

In 2017, the U.S. spent $3.5 trillion on health care, or about $10,700 per person. This represents 18 percent of GDP, or one dollar of every six spent in the American economy. And costs continue to rise.

One might be comforted if we had the best health care in the world. While this is true for some of us, the performance of our system as a whole is severely lacking. Based on reports from the Organization for Economic Cooperation and Development for the year 2017, we ranked 26th in the world in life expectancy, 31st in infant mortality and 26th in maternal mortality. We are the only wealthy nation where our new moms are dying at increasing rates.

Even with passage of the now endangered Affordable Care Act, we still have 28 million uninsured Americans. Based on reports in medical literature, this leads to over 36,000 deaths a year. Tens of millions more are underinsured, meaning that they can’t afford the high out-of-pocket costs of their insurance plan. When faced with a serious illness or injury, they have the choices of going into debt, going broke or going without care. Meanwhile, insurers make billions in profits.

We pay more, but we get less. Where is the money going?

One place where we spend more than other nations is on administrative costs and insurer profits. Commercial insurers have overhead of 12-20 percent, compared to traditional Medicare, which is around 3 percent. All told, higher administrative costs add hundreds of billions a year to our health care tab.

High drug prices are another major contributor. If we negotiated and paid what most other nations do for medicines, we would save about $150 billion a year. The pharmaceutical industry has been raising drug prices relentlessly and made over $40 billion in profits in 2017.

Rising insulin prices killed Shane.

Faced with all of these considerations; the costs, the suffering and death, it is clear that something fundamental needs to change.

A single-payer, improved Medicare for All system provides the best way forward.

Under such a plan, as proposed in house bill HR 676, a government funded, national health insurance system is created. Providers would remain private. All people are provided comprehensive coverage from birth to death for medical, drug, dental, vision and long-term care. Mental health and addiction treatment are covered.

Additionally, there are no out-of-pocket expenses; no co-pays, deductibles or co-insurance.

One might logically ask how we could afford such a system. When factoring in administrative savings from reduced overhead, lower drug costs brought about by negotiating with pharmaceutical companies and other cost reductions, many studies indicate that our health care expenditures would actually be less than what we pay now.

Further evidence of this is demonstrated by what other nations with guaranteed coverage pay. Most of them spend around 11-12 percent of GDP, versus our 18 percent. If we were spending 12 percent of GDP, that would represent a trillion-dollar reduction per year.

More importantly, no one would be financially ruined by illness. No one would die because of a lack of coverage.

These are goals worthy of America. A single-payer system is the best way to achieve them.

Dr. Perryman is a physician in the Rockford area and co-president of the northern Illinois branch of Physicians for a National Health Program.

https://www.dailyherald.com…

By Jenna Dooley
Northern Public Radio, January 4, 2019

John Perryman is a pediatrician with Mercyhealth in Roscoe. He sees patients struggling to afford medications. Some families, he says, disappear for stretches of time when they fall off an insurance plan. On this week’s Friday Forum, Jenna Dooley talks with Perryman about his view as well as from a major opponent of the idea.

Perryman is northern Illinois co-president of Physicians for National Health Program, or PNHP. The organization supports single payer insurance, also known as “Medicare for all.” In this scenario, the government handles the expenses so private plans become obsolete.

Perryman says the issue wasn’t on his radar until the Bernie Sanders campaign. As he did more research, he found the data compelling. Sanders didn’t make it to the White House but pieces of legislation remain calling for an overhaul of the U.S. healthcare system.

“It’s, I shouldn’t say perfect,” Perryman said. “It’s just so much better than what we have now in terms of outcomes, cost control, things of that nature.”

But implementing such a system could cost trillions of dollars.

Perryman argues the country is already spending more than the rest of the globe for healthcare and the outcomes don’t always compare well.

“You would be shifting funding from many private insurers to the government, but even now government spending accounts for about two thirds of healthcare spending already,” Perryman argues. “So we’re about two thirds of the way there already. When you factor in the efficiencies that single payer brings, the administrative efficacies, which are massive, savings on drug costs, savings on certain types of medical service costs, the savings will either equal or exceed the expenditure with adding more people and offering more services.”

Perryman notes there are major insurance companies and pharmaceutical companies with clout in Washington that do not support the single payer proposals and will stall anything that tries to make major changes.

There are a lot of jobs associated with those entities; Perryman acknowledges it is a significant number of workers.

“The number of jobs you’re talking about, I believe it’s about 1.7 million jobs,” Perryman acknowledged.  “But it’s about the number of people who get fired every month in this economy. And there are supports in place for those people, so they won’t just be left high and dry.”

There’s also the complexity of explaining a new system to patients. Perryman says the easiest way to explain the benefits of a single payer system is that is gives more control to patients.

“They could choose to see whoever they want to,” Perryman said. “The second is no out of pocket expenses. They don’t have a copay, they don’t have a deductible, anything like that. And that’s really important because that ends up limiting the amount of care that’s used when out pocket expenses are too high. So the two big practical things for them would be they don’t have to pay anything out of pocket and they can go where they want.”

So who or what pays for single payer?

“Taxes would have to make up for it,” Perryman said. “But with what we pay now in payroll taxes, we are already a good chunk of the way there. There would need to be some additional tax revenue somewhere. There are a variety of ideas in terms of what they would be. Perhaps a more graduated payroll tax, taxes on unearned income such as capital gains, state taxes, transaction taxes and stocks, things like that.”

Perryman says not overhauling the system leads to preventable deaths every day.

“What happens is [patients] don’t get the services they need. They don’t fill the prescriptions, they don’t go see the doctor. And there are tens of millions of people who fall into that category. So what ends up happening now with what we have is we have many people die and many people who suffer needlessly, or people who are bankrupted because of healthcare. So that’s why it has to change.”

But not everyone agrees that single payer is the magic bullet.

Robert Moffit is a senior fellow in Domestic Policy Studies at the Heritage Foundation, a conservative think-tank based in Washington D.C. He says it is a mammoth consideration because it would transfer all major decision making over healthcare to federal officials.

“In other words, there’s no alternative,” Moffit said. “If healthcare is an entitlement at the point of service, then, basically, government officials are going to make all the key decisions about who gets care, how they get care, when they get care, and under what circumstances they get care. So the key decisions in such a system are invariably political decisions.”

He fears medical decisions will be driven by budgets or government pricing outside of any kind of independent market.

“I think that that is likely to result in a highly impersonal and bureaucratic system of care delivery,” Moffit said.

Moffit acknowledges criticisms of corporate medicine, and says consumers should have more of a say in their healthcare plan.

“The fact of the matter is most Americans, for example, don’t pick their own health insurance plan or the benefits or the treatments or the medical procedures available to them,” Moffit said. “These decisions are all made by third parties.”

He argues that is the direct result of government policy which allows private insurers to make key decisions in what plans employers can offer.

“One of the arguments that my colleagues at the Heritage Foundation make is that we ought to basically change the fundamental structure of the system so people can pick and choose the kind of healthcare they want and carry it with them from job to job without a tax or a regulatory penalty,” Moffit said. “But the argument against third party payments is a good argument. The problem is that the Medicare bureaucracy is no more sensitive to consumer wants or needs than corporate health insurance.”

Moffit doubts any major overhaul will come in a single piece of legislation.

“The idea that you can solve the problems of the healthcare sector of the economy which is $3.5 trillion in one big bill — which is what President Obama really tried to do — is a huge mistake.” he said. “I don’t think that you can do it. I think the system is too big, it’s too complex to kind of try to do that. I do think we could make some very, very direct changes right now that would loosen things up a little bit and give people more options than they have today.”

For him, that includes giving states authority over insurance.

“Frankly, if California or Vermont or New York want to have a single payer system then they can do it,” he said. “But it will mean though that they’re not going to force the rest of us to finance it or bail them out.”

Moffit also belives individuals and families should have individual tax relief so they can purchase health insurance.

“And they can pick and choose the plan they want without a tax or a regulatory penalty, whether that plan is offered through their employer, or a trade association, or a religious organization, or any other type of group that would offer health insurance like a union or a fraternal organization,” Moffit said.

More consumer control, Moffit argues, would improve trust in the healthcare system.

“They can’t trust politicians. And I don’t think they can trust corporate executives,” Moffit said. “I think they should trust themselves and they should have the authority and the power over their own healthcare dollars and their own healthcare decisions. That’s a radical shift from what we have today where in fact you have no control over any of that.”

Like Perryman, Moffit says there are major obstacles to changing the existing structure.

“An awful lot of people do very well by defending and protecting the status quo,” Moffit said. “If you do not have to face intense competition for goods and services that you’re providing, that’s a pretty good situation.”

Both men agree systemic change is needed, but admit it will be difficult to achieve in a single sweep given competing interests in Washington D.C.

full audio:
https://www.northernpublicradio.org…