PNHP

Time for a single-payer health care system

Time for a single-payer health care system

By Dave Dvorak, M.D.
Duluth (Minn.) News Tribune, Letters, Dec. 28, 2013

The efforts of the Tri-County Medical Society to address skyrocketing American health costs are commendable (“Doctors’ group calls for ‘radical’ change in health care system,” Dec. 6). But its proposed solutions overlook the elephant in the exam room: the fact that the American health “system” is actually a patchwork dominated by a highly profitable and grossly inefficient private insurance industry. In its eternal quest to attract the healthiest customers, the insurance industry devours our health care dollars, wasting them on advertising, marketing, underwriting, lobbying and profligate executive salaries.

It’s long past time to stop feeding this beast and adopt an efficient, fair, single-payer system that would slash administrative waste, get control of our health spending, and, most importantly, guarantee quality coverage for all citizens.

Dr. Dave Dvorak resides in Minneapolis.

http://www.duluthnewstribune.com/event/article/id/287162/group/Opinion/

While Obamacare enrollment continues to lag, labor builds support for improved Medicare for All

By Pearl Korn
The Huffington Post, Dec. 30, 2013

The 113th Congress will likely be remembered as the most unproductive in our history, and with an overall approval rating of 9 percent, it is safe to say that most Americans do not consider this bunch to be a noble group of public servants engaged in good works for the people of this country. It is rare that any member of Congress is honored on any level these days, but one truly worthy exception is Rep. John Conyers (D-MI), who early in December was honored with a breakfast celebration attended by some 40 union representatives at a restaurant on East 29th Street in New York City.

Those present included leaders from Actors Equity, The International Alliance of Theatrical Stage Employees (IATSE) and the New York City Central Labor Council (NYCCLC), whose President, Vincent Alvarez, declared his support for Mr. Conyers’ bill HR 676, The Expanded and Improved Medicare for All Act, and promised to deliver their 1.3 million members to back this cause. This is a very significant development, as the 300 unions under the umbrella of the NYCCLC are made up of truck drivers, teachers, nurses, operating engineers, construction workers, janitors, train operators, electricians, fire fighters, retail workers and many more hardworking Americans who, along with everyone else in our nation, would benefit greatly from this revolutionary healthcare plan. They are the face of American labor today, and Mr. Alvarez spoke of the need for labor and the general public to unite and work together for this imperative cause: providing affordable, quality healthcare to all Americans. 

We might recall that it was labor that gave us the middle class during the post World War II years as they worked to indeed lift all boats in that time of unprecedented prosperity. Can they lead our nation once again in this time of unprecedented need? They have been taking quite a beating, and have been decimated in several states by the lackeys of the 1 percent. But their values are America’s values, and it is critical that they remain a vibrant force for change in this country.

Mr. Conyers was introduced by his longtime friend, TV talk show host Phil Donahue, and other speakers that morning included Robert Score, Recording-Corresponding Secretary of Local 1 of IATSE, and Stephen Shaff, speaking on behalf of Progressive Democrats of America. Mr. Conyers himself noted that it took him 15 years to move Congress to declare a national holiday for Dr. Martin Luther King, so he is prepared for a long haul to achieve Medicare For All. He has reintroduced HR 676 in every Congress since 2003, and has now garnered support from 54 other House members, along with an impressive 609 union organizations, including 146 Central Labor Councils/Area Federations and 44 State AFL/CIOs. Obamacare’s failure to address the Taft Hartley Plans and the operating procedures under which they work could create even more union support for the Single Payer movement. The president must address this issue.

Meanwhile, support from the public also continues to build, as the warts on the ACA become more apparent and the questions about its viability grow louder on almost a daily basis. This will undoubtedly drag into the 2014 election and continue to send shock waves throughout the political world into the 2016 race for the White House, as the Conservatives will remain active in their attacks and continuing efforts to end Obamacare.

Following the breakfast, Mr. Conyers and his policy director Mike Darner met with 15 of his core Single Payer activist leaders from organizations like Physicians For A National Health Program and Healthcare-Now! — as well as some doctors — to discuss strategy and continue building the movement. This group is definitely in it for the long haul, too, as they have supported Mr. Conyers and his bill for years. This is a bill that would deliver all necessary health services at less than half the cost we pay now, eliminating co-pays, deductibles and co-insurance while providing long-term care — including all of those expensive dental specialties. The estimated savings would be in the range of $592 billion a year. Better healthcare at lower costs — what’s not to like? And if you like your doctor, you actually could keep him or her — did you hear that, Mr. President? You can also pick any doctor you like — no more provider networks. These healthcare professionals would be able to become doctors once again, instead of a “provider” or “vendor,” and we could become patients again, ending our dehumanizing role as a “consumer” or “customer.”

Of late, we have been reading about Medicare For All from such luminaries as Robert Reich, Ralph Nader and William Greider in The Nation, among others. Even Bill Clinton mentioned it during President Obama’s second campaign. If Hillary were to acknowledge that Medicare For All is the next logical step after Obamacare, she would gain tremendous support and a second opportunity to get the right healthcare plan in place for her presumed 2016 run for president. Unfortunately, Hillary has proven herself to be far from progressive on many issues in the past, so we will have to wait and hear from her what her healthcare plan actually is if she decides to run.

Meanwhile, in the past few weeks Vermont Senator Bernie Sanders and Rep. James McDermott (D-WA) — who is also a doctor — have both introduced Single Payer bills. Bernie’s bill is a Medicare-for-All proposal known as the American Health Security Act of 2013 (S.1782), which would be administered by the states and transferable between states. The McDermott bill also moves the initiative outside of D.C., leaving it up to the states to develop their own plans based on their diversity and individual needs. As Massachusetts was the template for the ACA, it makes sense to finally introduce Single Payer on a state-by-state level.

Vermont has approval in both of its houses for a Single Payer plan, but it needs a waiver from the ACA to implement it in 2017. Can’t the federal government speed up that process? There are also plans at the ready in New York and in Rep. McDermott’s home state of Washington. And what of California, which has come so close in the past? One state can lead the country toward this monumental goal, the way Massachusetts did with the ACA. We just need to find the will.

In the Greider article in this month’s The Nation, entitled “Reviving The Fight For Single Payer,” he raises the question many of us ask: Can Obamacare deliver what it promised? One of the major problems he notes is that “…the reformed system will also still rely on the market competition of profit-making enterprises, including insurance companies.” Rep. McDermott was interviewed for this article, and he pointed out another major flaw in the ACA: “In the long arc of healthcare reform, I think [the ACA] will ultimately fail, because we are trying to put business-model methods into the healthcare system. We’re not making refrigerators. We’re dealing with human beings, who are way more complicated than refrigerators on an assembly line.”

Rep. McDermott – an advocate for Single Payer for decades – further wondered if hospitals will become “too big to fail” as they continue to merge and buy up private practices, and continue hiring younger doctors as salaried employees. Mr. Greider also made the following revelation: “An AMA survey in 2012 found the majority of doctors under 40 are salaried employees.” Rep. McDermott sees the troubling direction of this trend, noting that many new doctors “…will simply be serfs working for the system,” and Mr. Greider referred to another key point in the AMA research, noting that “…hospitals focus on employing primary-care physicians in order to maintain a strong referral base for high-margin specialty service lines.” Mr. Greider added further insight from Rep. McDermott: “Big hospitals need a feeder system of salaried doctors, McDermott explained, to keep sending them patients in need of surgery or other expensive procedures.” Even so, Rep. McDermott remains optimistic that stronger health care systems resembling Single Payer will spring up moving forward.

The New York Daily News offered a scathing editorial on December 24th entitled “Can This Patient Be Saved?” in which we were given a blow-by-blow analysis of the devastatingly mishandled rollout of the Obamacare exchanges and the problems millions of Americans have been having signing up for them. The situation was so bad that the deadline was extended until Christmas Eve for those to sign up who wanted their insurance to kick in on January 1, 2014. The CBO projects seven million will sign up in 2014, in addition to the about 1.1 million this year — well below the Administration’s projections. Meanwhile, millions will be losing their current plans due to the mandate. The question of more people losing their insurance than gaining it as a result of the president remaking the “healthcare economy” was also raised in this Op Ed piece.

Key provisions of the bill have already been waived in the past three years since its passage, and an additional postponement of the requirement for companies with fifty or more employees to offer health insurance or pay a tax penalty has now been postponed until 2015.

The individual mandate requiring most Americans to find coverage by April is also waiving penalties for those who had insurance and lost it this year. Most glaring in this critical article is the fact that there is “little reliable” information on who is getting what as far as coverage is concerned, and at what cost. The even larger question is, will those younger and healthier people opt in at all? If not, financially this boondoggle will sink. Obamacare is counting on them.

As the tinkering continues on the ACA, a major architect of this mess has just been rewarded by the president with an ambassadorship offer to China. Senator Baucus, do you not know the meaning of the word “retire?”

All good wishes for a (hopefully) healthy and happy New Year!

Jonathan Stone also contributed to this post.

http://www.huffingtonpost.com/pearl-korn/while-obamacare-enrollmen_b_4516708.html?utm_hp_ref=politics

Contrasting the rollout of Medicare and Obamacare

Medicare’s Rollout vs. Obamacare’s Glitches Brew

By David Himmelstein and Steffie Woolhandler
Health Affairs Blog, January 2, 2014

The smooth and inexpensive rollout of Medicare on July 1, 1966 provides a sharp contrast to the costly chaos of Obamacare.

We won’t rehearse the chaos part here, just the costs.

As of March, 2013, federal grants for Obamacare’s state exchanges totaled $3.8 billion.  Spending for the federal exchange is harder to pin down because funding has come from multiple accounts, including: the $1 billion Health Insurance Implementation Fund; DHHS’ General Departmental Management Account and General Departmental Management Account; CMS’s Program Management Account and the Prevention and Public Health Fund.  CMS estimates fiscal 2014 spending for the federally-operated exchanges at $2 billion.  So it’s safe to say that the costs of getting the exchanges up and running, and (hopefully) enrolling 7 million people in the program’s first year will exceed $6 billion.

Bear in mind that the exchanges won’t actually pay any medical bills, just sign people up for coverage.  So billions more in overhead costs will show up on the books of the private insurers and state Medicaid programs that will actually process medical claims.

Back in 1966, Medicare started paying bills for 18.9 million seniors (99 percent of those eligible for coverage) just 11 months after Pres. Johnson signed it into law.  Overhead costs for the first year totaled $120 million (equivalent to $867 million in 2013).  But that figure includes the cost of processing medical bills, not just the enrollment costs

Moreover, Medicare and Medicaid (which was passed at the same time) displaced several smaller federal health assistance programs, saving about $376 million on their overhead costs (2013 dollars).

Signing up most of the elderly for Medicare was simple; they were already known to Social Security Administration, which handled enrollment.  To find the rest, the feds sent out mailings to seniors, held local meetings, and asked postal workers, forest rangers and agricultural representatives to help contact people in remote areas.  The Office for Economic Opportunity spent $14.5 million to hire 5,000 low income seniors who went door-to-door in their neighborhoods.

Despite predictions of chaos, and worries that the newly-insured seniors would flood the health care system, there were few bottlenecks.  Hospitals continued to operate smoothly and no waiting lists materialized.  The only real “glitch” was that many hospitals in the Deep South initially refused to integrate their facilities – which Medicare required for certification and payment.  But by the end of the first month, 99.5 percent of hospitals had signed on.

Obamacare’s start-up has been rocky because complexity is “baked in” to the design, just as simplicity was “baked in” to Medicare.  Obamacare’s exchanges must coordinate thousands of different plans, with premiums, co-payments, deductibles and provider networks that vary county-by-county; Medicare offered a single, uniform plan.  The exchanges must calculate subsidies for each applicant after first verifying income, family size and immigration status; Medicare offered free hospital coverage, with a minimal ($22) uniform premium for doctor coverage.  Instead of setting up a new bureaucracy to collect premiums from millions of enrollees and funnel them to private insurers, Medicare relied on the existing payroll and income tax system to garner funds.

Obamacare’s byzantine complexity reflects the contortions required to simultaneously expand coverage and appease private insurers.  And private insurers will exact a steep ongoing toll.  Medicare’s overhead is just 2 percent, vs. an average of 13 percent for private plans (on top of the Exchanges’ costs, roughly 3 percent of premiums).  A single payer plan that excluded private insurers could save hundreds of billions in transaction costs.

Medical quality improvement experts often advise hospitals to “avoid workarounds”; fix system defects rather than force doctors and nurses to sidestep problems like faulty equipment, understaffing, or illegible handwritings.  This advice is equally valid for health reform.  To avoid glitches and wasteful expense, design the system right; eliminate private insurers and cover everyone under a single payer program.

http://healthaffairs.org/blog/2014/01/02/medicares-rollout-vs-obamacares-glitches-brew/

PNHP’s press release: https://www.pnhp.org/news/2014/january/medicare%E2%80%99s-1966-glitch-free-rollout-a-sharp-contrast-with-obamacare-health-affairs

Comment:

From PNHP’s press release:

“Obamacare is a giant workaround crafted to keep private insurers at the center of the health care system,” said co-author Dr. David Himmelstein, a primary care physician, professor of public health at the City University of New York and lecturer in medicine at Harvard Medical School.

“The simple single-payer, Medicare-for-all approach would save more than $400 billion annually on bureaucracy, enough to give every American first-dollar coverage. But to get those savings you have to break private insurers’ stranglehold on health care and on Washington,” he said, adding, “The glitches in Obamacare’s rollout don’t come from government incompetence, but from political cowardice.”

Contrasting the rollout of Medicare and Obamacare

Medicare’s Rollout vs. Obamacare’s Glitches Brew

By David Himmelstein and Steffie Woolhandler
Health Affairs Blog, January 2, 2014

The smooth and inexpensive rollout of Medicare on July 1, 1966 provides a sharp contrast to the costly chaos of Obamacare.

We won’t rehearse the chaos part here, just the costs.

As of March, 2013, federal grants for Obamacare’s state exchanges totaled $3.8 billion.  Spending for the federal exchange is harder to pin down because funding has come from multiple accounts, including: the $1 billion Health Insurance Implementation Fund; DHHS’ General Departmental Management Account and General Departmental Management Account; CMS’s Program Management Account and the Prevention and Public Health Fund.  CMS estimates fiscal 2014 spending for the federally-operated exchanges at $2 billion.  So it’s safe to say that the costs of getting the exchanges up and running, and (hopefully) enrolling 7 million people in the program’s first year will exceed $6 billion.

Bear in mind that the exchanges won’t actually pay any medical bills, just sign people up for coverage.  So billions more in overhead costs will show up on the books of the private insurers and state Medicaid programs that will actually process medical claims.

Back in 1966, Medicare started paying bills for 18.9 million seniors (99 percent of those eligible for coverage) just 11 months after Pres. Johnson signed it into law.  Overhead costs for the first year totaled $120 million (equivalent to $867 million in 2013).  But that figure includes the cost of processing medical bills, not just the enrollment costs

Moreover, Medicare and Medicaid (which was passed at the same time) displaced several smaller federal health assistance programs, saving about $376 million on their overhead costs (2013 dollars).

Signing up most of the elderly for Medicare was simple; they were already known to Social Security Administration, which handled enrollment.  To find the rest, the feds sent out mailings to seniors, held local meetings, and asked postal workers, forest rangers and agricultural representatives to help contact people in remote areas.  The Office for Economic Opportunity spent $14.5 million to hire 5,000 low income seniors who went door-to-door in their neighborhoods.

Despite predictions of chaos, and worries that the newly-insured seniors would flood the health care system, there were few bottlenecks.  Hospitals continued to operate smoothly and no waiting lists materialized.  The only real “glitch” was that many hospitals in the Deep South initially refused to integrate their facilities – which Medicare required for certification and payment.  But by the end of the first month, 99.5 percent of hospitals had signed on.

Obamacare’s start-up has been rocky because complexity is “baked in” to the design, just as simplicity was “baked in” to Medicare.  Obamacare’s exchanges must coordinate thousands of different plans, with premiums, co-payments, deductibles and provider networks that vary county-by-county; Medicare offered a single, uniform plan.  The exchanges must calculate subsidies for each applicant after first verifying income, family size and immigration status; Medicare offered free hospital coverage, with a minimal ($22) uniform premium for doctor coverage.  Instead of setting up a new bureaucracy to collect premiums from millions of enrollees and funnel them to private insurers, Medicare relied on the existing payroll and income tax system to garner funds.

Obamacare’s byzantine complexity reflects the contortions required to simultaneously expand coverage and appease private insurers.  And private insurers will exact a steep ongoing toll.  Medicare’s overhead is just 2 percent, vs. an average of 13 percent for private plans (on top of the Exchanges’ costs, roughly 3 percent of premiums).  A single payer plan that excluded private insurers could save hundreds of billions in transaction costs.

Medical quality improvement experts often advise hospitals to “avoid workarounds”; fix system defects rather than force doctors and nurses to sidestep problems like faulty equipment, understaffing, or illegible handwritings.  This advice is equally valid for health reform.  To avoid glitches and wasteful expense, design the system right; eliminate private insurers and cover everyone under a single payer program.

http://healthaffairs.org/blog/2014/01/02/medicares-rollout-vs-obamacares…

PNHP’s press release: https://pnhp.org/news/2014/january/medicare%E2%80%99s-1966-glitch-fre…

“Obamacare is a giant workaround crafted to keep private insurers at the center of the health care system,” said co-author Dr. David Himmelstein, a primary care physician, professor of public health at the City University of New York and lecturer in medicine at Harvard Medical School.

“The simple single-payer, Medicare-for-all approach would save more than $400 billion annually on bureaucracy, enough to give every American first-dollar coverage. But to get those savings you have to break private insurers’ stranglehold on health care and on Washington,” he said, adding, “The glitches in Obamacare’s rollout don’t come from government incompetence, but from political cowardice.”

Medicare’s 1966 glitch-free rollout a sharp contrast with Obamacare: Health Affairs blog

CUNY researchers say new health law’s ‘contortions to appease private insurers’ have resulted in costly complexity, with enrollment price tag alone exceeding Medicare’s by nearly 700 percent

FOR IMMEDIATE RELEASE
January 2, 2014

Contact:
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org

An article published today at the Health Affairs blog compares the costly and chaotic rollout the Affordable Care Act to the efficient 1966 implementation of Medicare. It finds that the ACA’s launch will cost almost seven times as much as Medicare’s.

The price tag of getting the ACA’s exchanges up and running and enrolling what the government hopes will be 7 million people in the first year of the program will exceed $6 billion, write health policy experts Drs. David Himmelstein and Steffie Woolhandler.

In contrast, when Medicare went into effect on July 1, 1966 – just 11 months after President Johnson signed it into law – it had already enrolled 19 million seniors, 99 percent of those eligible for coverage. Medicare’s overhead costs in its first year totaled just $867 million (in today’s dollars), a figure that includes both enrollment costs and the costs of processing medical bills during its start-up year. The ACA figure only reflects enrollment expenses.

Even the $867 million figure overstates Medicare’s startup costs since the program replaced several existing government programs whose overhead was eliminated. In short, Medicare’s launch was even more cost-effective than the dollar comparison suggests.

“Obamacare is a giant workaround crafted to keep private insurers at the center of the health care system,” said co-author Dr. David Himmelstein, a primary care physician, professor of public health at the City University of New York and lecturer in medicine at Harvard Medical School.

“The simple single-payer, Medicare-for-all approach would save more than $400 billion annually on bureaucracy, enough to give every American first-dollar coverage. But to get those savings you have to break private insurers’ stranglehold on health care and on Washington,” he said, adding, “The glitches in Obamacare’s rollout don’t come from government incompetence, but from political cowardice.”

The authors obtained their data from federal agencies, including the Department of Health and Human Services and the Centers for Medicare and Medicaid Services.

They review the simplicity and frugality of Medicare’s rollout, noting that simplicity was “baked in” to the single, uniform, public program, whereas complexity is “baked in” to Obamacare, due to the latter’s involvement with thousands of private insurance plans.

The authors found that today Medicare’s overhead expenses are 2 percent, in contrast to an average of 13 percent for private plans, not counting the costs associated with the new exchanges, which will add roughly 3 percent of premiums.

In contrast, “A single-payer plan that excluded private insurers could save hundreds of billions in transaction costs,” they write.

Himmelstein and Woolhandler’s research interests include a long-term study of the administrative costs of U.S. health care, particularly in comparison with Canada’s. They co-authored, with Terry Campbell, a landmark study in The New England Journal of Medicine in 2003 showing that administration consumes 31 percent of U.S. health spending, most of it waste.

The authors both teach at CUNY and Harvard Medical School, and are co-founders of Physicians for a National Health Program.

“Medicare’s Rollout vs. Obamacare’s Glitches Brew,” David U. Himmelstein, M.D., and Steffie Woolhandler, M.D., M.P.H. Health Affairs blog, January 2, 2014. 

The Obamacare We Deserve

By Michael Moore
The New York Times, Dec. 31, 2013

Today marks the beginning of health care coverage under the Affordable Care Act’s new insurance exchanges, for which two million Americans have signed up. Now that the individual mandate is officially here, let me begin with an admission: Obamacare is awful.

That is the dirty little secret many liberals have avoided saying out loud for fear of aiding the president’s enemies, at a time when the ideal of universal health care needed all the support it could get. Unfortunately, this meant that instead of blaming companies like Novartis, which charges leukemia patients $90,000 annually for the drug Gleevec, or health insurance chief executives like Stephen Hemsley of UnitedHealth Group, who made nearly $102 million in 2009, for the sky-high price of American health care, the president’s Democratic supporters bought into the myth that it was all those people going to get free colonoscopies and chemotherapy for the fun of it.

I believe Obamacare’s rocky start — clueless planning, a lousy website, insurance companies raising rates, and the president’s telling people they could keep their coverage when, in fact, not all could — is a result of one fatal flaw: The Affordable Care Act is a pro-insurance-industry plan implemented by a president who knew in his heart that a single-payer, Medicare-for-all model was the true way to go. When right-wing critics “expose” the fact that President Obama endorsed a single-payer system before 2004, they’re actually telling the truth.

What we now call Obamacare was conceived at the Heritage Foundation, a conservative think tank, and birthed in Massachusetts by Mitt Romney, then the governor. The president took Romneycare, a program designed to keep the private insurance industry intact, and just improved some of its provisions. In effect, the president was simply trying to put lipstick on the dog in the carrier on top of Mitt Romney’s car. And we knew it.

By 2017, we will be funneling over $100 billion annually to private insurance companies. You can be sure they’ll use some of that to try to privatize Medicare.

For many people, the “affordable” part of the Affordable Care Act risks being a cruel joke. The cheapest plan available to a 60-year-old couple making $65,000 a year in Hartford, Conn., will cost $11,800 in annual premiums. And their deductible will be $12,600. If both become seriously ill, they might have to pay almost $25,000 in a single year. (Pre-Obamacare, they could have bought insurance that was cheaper but much worse, potentially with unlimited out-of-pocket costs.)

And yet — I would be remiss if I didn’t say this — Obamacare is a godsend. My friend Donna Smith, who was forced to move into her daughter’s spare room at age 52 because health problems bankrupted her and her husband, Larry, now has cancer again. As she undergoes treatment, at least she won’t be in terror of losing coverage and becoming uninsurable. Under Obamacare, her premium has been cut in half, to $456 per month.

Let’s not take a victory lap yet, but build on what there is to get what we deserve: universal quality health care.

Those who live in red states need the benefit of Medicaid expansion. It may have seemed like smart politics in the short term for Republican governors to grab the opportunity offered by the Supreme Court rulings that made Medicaid expansion optional for states, but it was long-term stupid: If those 20 states hold out, they will eventually lose an estimated total of $20 billion in federal funds per year — money that would be going to hospitals and treatment.

In blue states, let’s lobby for a public option on the insurance exchange — a health plan run by the state government, rather than a private insurer. In Massachusetts, State Senator James B. Eldridge is trying to pass a law that would set one up. Some counties in California are also trying it. Montana came up with another creative solution. Gov. Brian Schweitzer, a Democrat who just completed two terms, set up several health clinics to treat state workers, with no co-pays and no deductibles. The doctors there are salaried employees of the state of Montana; their only goal is their patients’ health. (If this sounds too much like big government to you, you might like to know that Google, Cisco and Pepsi do exactly the same.)

All eyes are on Vermont’s plan for a single-payer system, starting in 2017. If it flies, it will change everything, with many states sure to follow suit by setting up their own versions. That’s why corporate money will soon flood into Vermont to crush it. The legislators who’ll go to the mat for this will need all the support they can get: If you live east of the Mississippi, look up the bus schedule to Montpelier.

So let’s get started. Obamacare can’t be fixed by its namesake. It’s up to us to make it happen.

Michael Moore is a documentary filmmaker whose 2007 film “Sicko” examined the American health care industry.

http://www.nytimes.com/2014/01/01/opinion/moore-the-obamacare-we-deserve.html?ref=opinion

4,832,000 of the most vulnerable remain in the coverage gap

The Impact of the Coverage Gap in States not Expanding Medicaid by Race and Ethnicity

Kaiser Family Foundation, December 17, 2013 Medicaid eligibility for adults is very limited. Many states limit Medicaid eligibility for parents to below poverty, and adults without dependent children have historically been excluded from the program. The ACA’s Medicaid expansion to adults with incomes at or below 138% FPL would significantly increase eligibility for parents in many states and end the exclusion of adults without dependent children from the program. The expansion was intended to occur nationwide as of January 2014 and serve as the base of coverage for low-income individuals, with premium tax credits available to moderate-income individuals above Medicaid limits to purchase Marketplace coverage. However, as a result of the Supreme Court decision on the ACA, implementation of the Medicaid expansion is now effectively a state choice. As of December 11, 2013, 26 states, including DC, are moving forward with the Medicaid expansion in 2014, while 25 states are not moving forward at this time. In states that do not expand Medicaid, nearly five million poor uninsured adults will fall into a “coverage gap.” These individuals would have been eligible for Medicaid if their state had chosen to expand coverage. In the absence of the expansion, they remain ineligible for Medicaid and do not earn enough to qualify for premium tax credits to purchase Marketplace coverage, which begin at 100% FPL. Most of these individuals have very limited coverage options and are likely to remain uninsured. These continued coverage gaps will likely lead to widening racial and ethnic as well as geographic disparities in coverage and access. Table 1: Nonelderly Poor Uninsured Adults in the Coverage Gap in States Not Expanding Medicaid by Race/Ethnicity Total, United States 4,832,000  –  All races/Ethnicities
2,248,000  –  White
1,327,000  –  Black
  992,000  –  Hispanic
  265,000  –  Other
2,584,000  –  People of Color http://kff.org/disparities-policy/issue-brief/the-impact-of-the-coverage-gap-in-states-not-expanding-medicaid-by-race-and-ethnicity/

Comment

By Don McCanne, M.D. Since it was decided to reject reform that would have been truly universal, you would think that at least we would be covering the most vulnerable segments of our population. But no, half of our states rejected federal funding for Medicaid expansion, leaving almost 5 million otherwise qualified individuals out of the Medicaid program, even though their incomes ironically are too low to qualify them for subsidies to purchase plans in the state insurance exchanges. Over half of these people left out are people of color, resulting in a widening of the unjust disparities in care already plaguing our nation. What a terrible way to start the first year of what is essentially the full implementation of the Affordable Care Act. It seems pretty obvious what our New Year’s resolution should be: Let’s bring health care to everyone through an improved and expanded Medicare for all.

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Minority physicians care for a majority of underserved patients in the U.S.

Minority physicians also play a large role in the care of patients with poorer health, according to a new study in JAMA Internal Medicine

FOR IMMEDIATE RELEASE, December 30, 2013
Contact: Mark Almberg, PNHP communications director; (312) 782-6006; mark@pnhp.org

CAMBRIDGE, Mass. – Black, Hispanic and Asian physicians play an outsized role in the care of disadvantaged patients nationally. Patients who have low incomes, are from racial and ethnic minority backgrounds, have Medicaid insurance, or who do not speak English – groups that historically have difficulty in accessing medical care – are substantially more likely to receive their care from a minority physician, according to a new study appearing online in today’s [Dec. 30] issue of the journal JAMA Internal Medicine. The study found that minority physicians care for 54 percent of minority patients and 70 percent of non-English-speaking patients. Other related findings include: * Asian, Hispanic and Black patients were 19-26 times more likely to be cared for by a minority physician of their same race. * Low-income patients were 1 1/2 to 2 times more likely to be cared for by Black, Hispanic and Asian physicians. * Medicaid patients were 2 times to nearly 4 times more likely to be cared for by Black, Hispanic and Asian physicians. Currently, African-Americans and Hispanics are substantially underrepresented in the physician workforce. Despite making up over 25 percent of the U.S. population, African-Americans and Hispanics make up less than 15 percent of the physicians. “Patients from disadvantaged groups have substantial problems accessing care,” said the lead author, Dr. Lyndonna Marrast, a physician at Cambridge Health Alliance. “The fact that minority physicians are much more likely to care for disadvantaged patients suggests that expanding the racial diversity of the physician workforce in the U.S. could be key to improving access to care.” The study, which analyzed data from a 2010 federal survey of 7,070 patients across the U.S., also showed that minority physicians were substantially more likely to care for patients with worse self-reported health status. For other measures of health, such as obesity, the picture was mixed: Black physicians were more likely, and Hispanic and Asian physicians less likely, to care for obese patients. The Patient Protection and Affordable Care Act, which is being rolled out currently in every state, is expected to expand insurance coverage for low-income, uninsured patients, many of whom will also be minorities. “There is a lot of concern that there will not be enough physicians willing and able to care for them,” said Dr. Danny McCormick, the study’s senior author and associate professor of medicine at Harvard Medical School. “In order to increase the number of Black and Hispanic physicians, medical schools will need to more fully consider the physician workforce needs of the health care system as a whole in admissions decisions.” “Our findings do not argue for strengthening the existing de facto segregation of medical care,” said Dr. Steffie Woolhandler, professor of public health at City University of New York, co-founder of Physicians for a National Health Program, and a study co-author. “But it is clear that doctors’ decisions on where to practice and patients’ decisions on where to go for care combine to create an outsized role for minority physicians in caring for the underserved.” ***** “Minority Physicians’ Role in the Care of Underserved Patients: Diversifying the Physician Workforce May Be Key in Addressing Health Disparities.” Lyndonna Marrast, M.D., Leah Zallman, M.D., M.P.H., Steffie Woolhandler M.D., M.P.H., David Bor, M.D., M.P.H., and Danny McCormick, M.D., M.P.H.  JAMA Internal Medicine, December 30, 2013. ***** Physicians for a National Health Program is a nonprofit research and education organization of more than 18,000 doctors who support single-payer national health insurance. PNHP had no role in funding or otherwise supporting the study described above.

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Mayo Clinic’s Eric Matteson endorses tax-supported universal healthcare

10 Questions: Eric Matteson, MD

By Nancy Walsh
MedPage Today, December 27, 2013 Eric L. Matteson, MD, of the Mayo Clinic, is the chair of rheumatology and professor of medicine.

1. What’s the biggest barrier to your practicing medicine today? Without a doubt, it is lack of access for many patients, especially the un- and underinsured.

2. What is your most vivid memory involving a patient who could not afford to pay for healthcare (or meds, tests, etc.) and how did you respond? I have a young woman with severe erosive RA who has limited mental ability who works 20 hours a week in a rural recycling center at a minimum wage job sorting recyclables. I see her in another state at a small clinic that’s 80 miles away. She has only Medicaid. She is able to afford methotrexate and hydroxychloroquine. We accept losses with the cost of monitoring, and also for the orthopedic surgeries she has required and she cannot afford. I have sought drug and assistance from every company with biologics on the market, some on more than one occasion, and to date have been turned down by all of them. She is not able to even afford gas, or the time off, to come to our center to participate in drug studies.

4. If you could change or eliminate something about the healthcare system, what would it be? I would have a tax-supported universal healthcare for at least minimum services. http://www.medpagetoday.com/Rheumatology/Arthritis/43597

Comment

By Don McCanne, M.D. Mayo Clinic’s Eric Matteson is yet another prominent physician who supports “tax-supported universal healthcare,” though he qualifies that with “for at least minimum services.” From his example, it seems that he would include most of his field of rheumatology as “minimal services,” though others might say “all essential services.” Nevertheless, there continues to be an increase in those who now are willing to speak out on the need for a publicly-financed health care system that covers everyone. There is a growing consensus that financial barriers to care need to be removed.

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Definitely not singing the praises of Anthem

By James Fieseher, M.D.
Portsmouth (N.H.) Herald, Dec. 26, 2013 Anthem: (n.) a song or hymn of praise or gladness. Anthem is also the name of the premiere health insurer in New Hampshire. There are many people in New Hampshire who believe Anthem is the model of health care. They believe that Anthem, and private health insurance companies like Anthem, rather than the government, should be in charge of your health care. Do they have a point? The Affordable Care Act (ACA) has had an inauspicious roll out, including President Obama’s “lie of the year” stating: “if you like your health insurance, you can keep it.” We have been told that we can’t trust our own government. Indeed, the two parties in Congress trust each other so little that they can’t make even the smallest of compromises. Should we turn the clock back and go back to the days of unrestricted private health care coverage? Do we really want the system that we had just five years ago? During President Bush’s administration in 2008, before the ACA was even a gleam in candidate Obama’s eye, Angela Braly, the CEO of Anthem’s parent company, Wellpoint, voted herself a 51 percent pay raise. Being a responsible businesswoman and knowing how to properly balance a budget, she then promptly raised insurance premiums 39 percent to pay for her raise. What does the CEO of a health insurance company do to merit a 51 percent pay raise — during the biggest recession since the Great Depression of the 1930s? Anthem made health care less affordable and less accessible for individuals and businesses struggling during the recession. Anthem did not improve health care. In fact, Anthem didn’t even provide health care. People who have Anthem health insurance are among the healthiest and wealthiest Americans; after all, you can’t get health insurance if you can’t afford it or have a pre-existing condition. She “merited” a pay raise because Anthem made a profit during the recession by collecting more money from its customers than it paid out in benefits. That represents the successful model of health care touted by the private insurance advocates. Anthem and all health insurance companies do not actually provide or even insure health. They cover medications for hypertension and diabetes, but don’t provide for counseling or the dietary factors that prevent or cure obesity, hypertension and diabetes. Exercise, a clean environment, proper dental care and mental health screening and counseling are all essentials for health management that are not covered by private health insurance companies. They manage disease, not health. Shouldn’t we have a health care system that rewards leaders who actually improve health care? Don’t we want a health care system that prevents high blood pressure, diabetes, strokes, cancer and cardiac disease? We should give raises to the health care insurers who make care more accessible and more affordable. Certainly, we should blame our politicians for focusing on all the wrong aspects of health care. We have a president who states he wants to improve health care and then promises people they can keep their faulty health care plans. We have Republicans who want to repeal the ACA and replace it with smaller, more expensive coverage dominated by businesses like Anthem. We have Democrats who cobbled a weak health care plan together and then weakened it further during implementation. But in truth, the fault lies with us, the voters. We’re fanatic about not raising taxes to pay for improved health care, but say nothing when a business “taxes” us with a 39 percent increase in premiums and then decreases coverage. We dismiss a “government option” where we actually have a say in policy and are silent when a private entity that we can’t control dictates our health care. If government is not the answer, what is? We need a national discussion about health care. Heck, I’ll even take a state or local discussion. We need to look beyond the ACA at what really matters in health care. It’s time to make a list of those qualities that improve health, improve accessibility and lower the cost of care. We need to be honest with ourselves and our neighbors and keep all our options on the table. Then, we need the courage to change the status quo to make it work. Now that deserves an anthem.

James Fieseher, MD, FAAFP, is a Portsmouth resident. http://www.seacoastonline.com/articles/20131226-OPINION-312260368

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Health care costs are the key to deficit reduction

By Thomas Clairmont, M.D.
Portsmouth (N.H.) Herald, Letters, Dec. 27, 2013 Sen. Susan Collins’ editorial, “Bipartisan budget moves economy forward,” (Portsmouth Herald, Dec. 22) states that this accord will save $23 billion over the next decade. She is so impressed by this figure that she mentions it twice. During this period, our government will spend over $45 trillion. This “savings” is the proverbial drop in the bucket. Right now, our national debt is increasing at a whopping $2.64 billion every day, $2 million every second. Her “savings” will be gone in nine days. At the end of this 10-year period, the national debt will be $23.5 trillion. We will be hearing that we shouldn’t be spending money we don’t have, that this debt is unsustainable, and about how the debt we are leaving our children and grandchildren is shameful. Once the election is over, the spending will continue on to infinity. Meanwhile, a serious proposal by economics professor Gerald Friedman of the University of Massachusetts Amherst gets no press at all. He said, “Under the single-payer system created by HR 676, the U.S. could save an estimated $592 billion annually by slashing the administrative waste associated with the private insurance industry ($476 billion) and reducing pharmaceutical prices to European levels ($116 billion). In 2014, the savings would be enough to cover all 44 million uninsured and upgrade benefits for everyone else. No other plan can achieve this magnitude of savings on health care.” This proposal “would cost less for 95 percent of households and reduce the deficit by $154 billion in the first year,” according to Friedman. Republicans have a deficit of ideas on health care reform that actually help people. Here is a thoughtful opportunity for Sen. Collins. Dr. Thomas Clairmont resides in Portsmouth. http://www.seacoastonline.com/articles/20131227-OPINION-312270364

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Some conservatives are coming around to single-payer health coverage

By William R. Davidson Jr., M.D.
The Patriot-News (Mechanicsburg, Pa.), Letters, Dec. 23, 2013 Advocates for single-payer health care reform (also known as “Medicare-for-all”) have persistently requested support from conservatives. After all, freedom to choose doctors and hospitals, as well as enormous economic savings, are consistent with conservative values. Nevertheless, conservatives have largely distanced themselves from single-payer movements. That might be changing. Former Secretary of State Colin Powell recently expressed his desire to see America adopt a single-payer system. Powell’s comments were similar to the sentiments heard only a few days earlier by Dr. Steven Nissen, the head of the department of cardiology at the world renowned Cleveland Clinic. When asked in an interview “What was the biggest barrier to his practice of medicine?”  Dr. Nissen stated quite succinctly: “The lack of a single payer system. We waste enormous amounts of time and energy dealing with insurance companies, whose major goal is figuring out how not to cover patients.” Powell made his comments at a meeting for survivors of prostate cancer. His own experience, as well as that of a close relative and friend, has made him acutely aware of the disparities inherent in our health care system that annually allows 50 million Americans to be uninsured, causes a half million medical bankruptcies, and tolerates spiraling, unsustainable costs. A world traveler, Powell believes all Americans should have a quality, affordable health care system “like those in Europe and Canada.” As a physician, Dr. Nissen has seen how the free market system based on the private insurance paradigm has led to incredible waste, to the point that one out of every three dollars spent on health care goes to administer it. His time and energy which should be spent on patient care and research is wasted wading through a morass of bureaucracy created by the insurance industry. Neither gentleman directly criticizes Obamacare but, by stating they prefer single payer they are pointing out that the Affordable Care Act just won’t get it done. Obamacare enlarges and enhances the influence of the private insurance industry, which has failed us for over 30 years. For many, single payer is the way. Dr. William R. Davidson Jr. resides in Jonestown. http://www.pennlive.com/opinion/index.ssf/2013/12/some_conservatives_are_coming_around_to_single_payer_health_coverage.html

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