PNHP

States are still good ‘laboratories’

States are still good ‘laboratories’

By Froma Harrop
The Spokesman-Review (Spokane, Wash.), Jan. 18, 2014

In the beginning, Massachusetts opened the gates to same-sex marriage and universal health coverage. California started to liberalize drug laws by legalizing medical marijuana. The sky didn’t fall on any of these efforts, initially regarded as dangerous social experiments by many conservatives.

Now red states such as Kentucky are launching state-run health insurance exchanges. Federal judges in conservative Utah and Oklahoma are calling bans on gay marriage unconstitutional. And purple Colorado has legalized recreational marijuana use.

Most of us have a vision of the way things ought to be. It is human nature to want others to see the same light we do.

Conservative foes of abortion hold deep convictions that ending a pregnancy is a moral travesty. Liberals make similar arguments against a health care system that lets thousands of Americans die for lack of medical attention, which happens when market forces run the show.

Social activists who live and breathe their cause often seek to impose their views on a diverse nation. They don’t realize that they can more easily get what they want in states whose culture shares their views. Showing that a state has enacted their ideas with good effect is the most expedient way of spreading their ideas coast to coast.

But putting such power in state hands doesn’t always sit well. Liberals, especially, point to slavery and Jim Crow laws as great evils that flew under the banner of states’ rights. These were moral outrages that the federal government had to stop, and did.

True, but many less momentous struggles can be more peaceably and efficiently won through example. As the late U.S. Supreme Court Justice Louis Brandeis famously said, states can serve as the “laboratories of democracy.”

Many liberals are enthusing over a bill introduced last month by Sen. Bernie Sanders, a liberal Vermont independent, and Rep. Jim McDermott, a Washington state Democrat, which would create a national single-payer health care system.

I happen to think the Sanders-McDermott proposal – actually a modified single-payer plan allowing private supplemental coverage – is splendid. But it also has zero chance of passage. Recall how even the modest “public option” – a government plan to compete with the private insurers – couldn’t get past Congress, including some Democratic members.

The best hope for national single-payer is to let Vermont show that its homegrown version will work. If Vermont can cut its health care spending by over 30 percent under single-payer, as is projected, other states will copy it, with no pressure needed from Washington.

Gay activists regard laws banning same-sex marriage as a great injustice, and with reason. But simply waiting for a Supreme Court decision making same-sex marriage legal nationwide, no certainty, would have been a massive waste of time. Marriage is a state responsibility, so what better place to change the laws than in states open to it?

New Mexico’s Supreme Court just ruled that the ban on gay marriage was unconstitutional. In Virginia, another purple state, the Democratic leaders are going full speed ahead. They are bolstered by polls showing that 56 percent of Virginians are in favor of same-sex marriage, a reversal from the 57 percent supporting a ban in 2006. This tide of change would not have rolled in had liberal states not demonstrated what happens to the broader society when gay couples marry: very little.

Some states will do things noxious to liberals, for example, on gun control and public financing for education. Conservatives will dislike decisions made in liberal places. Fine. Let’s all make a pact to stop trying to make everyone else over in our own image.

Nothing convinces like successful examples. Liberals, above all, should have more confidence in their own.

Froma Harrop is a columnist for Creators Syndicate.

http://www.spokesman.com/stories/2014/jan/18/froma-harrop-states-are-still-good-laboratories/

Medical debt: Medicare for All for everyone

By Richard A. Damon, M.D.
Ravalli Republic (Hamilton, Mont.), Letters, Jan. 19, 2014

Medical debt in this nation is rampant. One in three Americans report difficulty paying medical bills. The uninsured have the greatest challenge, but most people with difficulty paying medical bills actually have health insurance. Out-of-pocket medical expenses, before insurance kicks in, contribute greatly to individual medical debt. If you experience it, you know it can be severe and have far-reaching effects on your life.

People with unaffordable medical bills report higher rates of many related individual problems – like unaffordable housing, paying basic necessities, unpaid credit card bills, bankruptcy proceedings, transportation costs, chronic health conditions, rising premiums, insurance exclusions, job loss, income loss from illness, damaged credit, mounting drug costs, emotional distress and worry, depleted savings, cost of caring for sick family members.

The Kaiser Family Foundation and Georgetown University say the Affordable Care Act, even when fully implemented, will still leave horrendous individual medical debt, particularly due to intolerable cost-sharing measures. If you look at the whole picture, there is generally wrong-headed thinking about not providing health care as a human right to health in this nation.

Many conservatives believe individuals should be responsible for their own lot and use insurance only for catastrophic illness. They oppose comprehensive prepaid health care, believing people should pay for health services to discipline their health care judgments. Other nations provide first dollar coverage for health care, and yet keep total health spending well below ours.

Both the for-profit, market-based model, and the government-funded model, can control spending, but the former unsuccessfully does it by depriving people of health care, whereas the latter enables everyone to receive the care they need.

Sen. Max Baucus, D.-Mont., figured out a way to get Medicare for All for the W.R. Grace victims of Libby; why not Medicare for All for everyone?

Dr. Richard A. Damon resides in Bozeman.

http://www.ravallirepublic.com/news/opinion/mailbag/article_0be4c0d2-d2bf-5ccd-b55d-ef475213e76e.html

Care act doesn’t solve core problems

By K.W. Hillis
The Lawton (Okla.) Constitution, Jan. 19, 2014

LAWTON, Okla. — Affordable Care Act reforms address some problems with health care in the U.S., but it doesn’t solve core issues, said Dr. Ed Weisbart, chair of the Physicians for a National Health Program (PNHP) — Missouri Chapter.

An advocate of a single-payer national health insurance system similar to Canada’s or Great Britain’s health care systems, Weisbart met with The Lawton Constitution editorial board last week to talk about those core issues and a new bill before Congress.

“We have a crisis in health care in the United States. It undermines our ability to compete globally. It places huge burdens on businesses and on families. It is the biggest driver of bankruptcy in the country. It makes people vulnerable to having real estate bankruptcies,” he said. “That is going on in the context of our wasting approximately a third of what we pay on health care on the administration of it compared to other countries, where they spend around 2-5 percent on health care (administration) … (we pay) 31 percent.”

The waste of that money “that doesn’t, in fact, impact health outcomes, drives me crazy,” said Weisbart, a self-described fiscal conservative who practiced as a family physician in Chicago for 20 years and then was the chief medical officer for Express Scripts in St. Louis, Mo., before retiring three years ago.

Fixing those problems and core issues will take a lot more than the ACA, which will still leave some people at risk for bankruptcy due to medical bills not covered by insurance, many not insured and more underinsured than before, he said.

The answer for him and members of the PNHP is a single-payer national health insurance program that is an “improved Medicare for everyone.”

 “Medicare’s overhead is roughly 2 percent … (and up to 5 percent according to some people). But it is nothing like we are spending today. So I look at that and I look at the fact that most seniors like their Medicare program and most seniors have to buy supplements to their Medicare because Medicare is imperfect. What I think makes the most sense is we somewhat fix those problems with Medicare, those gaps, embed those supplements into the core program and then get rid of the 65-year-old age limit and give it to everybody.”

The cost of covering everyone from birth would be covered by going from a 31 percent overhead to a 2-5 percent overhead, he said.

“It more than pays for delivering care to everyone and that makes us able to compete globally … it is a simple concept, really.”

This concept is laid out in a 30-page bill — H.R. 676, Expanded & Improved Medicare for All Act — which Rep. John Conyers, D-Mich., introduced to the House of Representatives in February 2013. The bill is now in committee and can be read in summary or in full at http://congress.gov.

The bill “establishes the Medicare for All Program to provide all individuals residing in the United States and U.S. territories with free health care that includes all medically necessary care, such as primary care and prevention, dietary and nutritional therapies, prescription drugs, emergency care, long-term care, mental health services, dental services, and vision care,” according to the bill’s summary at congress.gov.

Other key features of the bill, listed by PNHP, are: “Universal, comprehensive coverage; no out-of-pocket payments; a single insurance plan in each region, administered by a public or quasi-public agency; global operating budgets for hospitals, nursing homes, allowed group and staff model HMOs and other providers with separate allocation of capital funds; free choice of providers; public accountability … ; ban on investor-owned, for-profit health care providers; and protections of the rights of health care and insurance workers.”

The basic problem with the U.S. health care system, even with ACA, is that for other than high-tech health care — the U.S. leads in longest survival rates for those diagnosed with any cancer — the U.S. rates are surprisingly low in other areas, he said. Those areas include the numbers of maternal and infant deaths and that the U.S. ranks No. 51 in life expectancy. Before universal health care was introduced in Canada, Canadians had the same life expectancy as those in the U.S. “Now it is 2½ years longer than ours … The point is we don’t have a business model for the things that actually improve life-expectancy for most Americans.”

Even with the advent of ACA, many people who are under 100 percent of the poverty level will still lack any health coverage at all because half of the states did not expand Medicaid to cover those people. Getting insurance via the ACA marketplace “is better than being uninsured, but it is mediocre insurance,” he said, explaining that most insurance requires individuals to pay 10 to 30 percent of the costs, “so underinsurance is the new norm in this country.” ACA also won’t change the 31 percent administrative overhead or personal bankruptcies due to medical costs.

Horror stories about long waits for care and other problems in universal health care systems are often cited. Weisbart suggested that actual data from those countries and the context of that data paints a different picture.

One study examined the wait time for elective surgery in various countries, using waiting more than four months as the metric.

“In the the United States, less than 10 percent of people wait that long. In Canada, which is the worst in their study, 25 percent of people wait more than four months for elective surgery. That is not the image we have of 80 percent of people waiting months … the thing to think about is that Canadians and (other single-payer countries) spend only a small portion of what we spend on health care.”

Despite the wait, there is an upside, according to Canadians surveyed.

“Every one of them will say ‘that is awful.’ … they will all complain, but in the next breath they will say ‘but I know that when I get cancer, when I get this or that, I will be seen immediately, I will be seen for free … and if I have to make a tradeoff, I’d rather wait a few months for my elective surgery for the security of knowing that when I have a major problem I’ll be taken care of,’” he said.

Other stories about Canadians flocking to the U.S. for health care and physicians moving to the U.S. are also not supported by data, Weisbart said, explaining that valid data from health care systems worldwide can be accessed on the Organization for Economic Co-operation and Development’s website, www.oecd.org.

Weisbart said there are safeguards built into HR 676 for those who are worried about big government deciding what type of health care Americans get.

The safeguards include the premise that everyone in the country is covered under the plan so the people making the decisions of where monies go are invested in the results. Another safeguard is regional boards made up of patients, physicians and others.

The result of everyone getting the same access to care determined by the boards would allow the U.S. population to get what it wants most — “to see the doctor of their choice and go to the hospital of their choice,” he said.

With this plan, “the ones that lose are the insurance industry and the drug and (medical) device industry,” he said. Despite the reduced compensation and incentives to drug and medical device companies that help with medical breakthroughs, “the vast majority of medical breakthroughs in this country is funded by the National Institutes of Health … it is government funded.”

The ones that win “would be everybody else.” There would be a rise in taxes, but “without premiums or copays, 95 percent of the people would pay less, not more.”

He doesn’t expect the U.S. to really have a serious discussion about the proposed single-payer system until 2015, when those who didn’t get insurance under ACA will have to pay a tax penalty.

“Then I’m hopeful that … the country will be ready again to engage in a serious debate of a fundamental health care reform. (But) as we wait, more and more people die and more businesses can’t compete globally,” he said.

K.W. Hillis is a staff writer. Photo by Steve Miller.

Cancer, costs and single payer

Oncologists call for single payer in leading cancer journal

Physicians for a National Health Program, January 17, 2014

A feature article published today in the Journal of Oncology Practice contains an evidence-based appeal by two oncologists, including a past president of the American Society of Clinical Oncology (ASCO), for their colleagues to endorse a single-payer health system.

They say they do not believe that the Affordable Care Act, or “Obamacare,” will be able to solve the health care crisis that cancer patients face.

https://pnhp.org/news/2014/january/oncologists-call-for-single-payer-…

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Why Oncologists Should Support Single-Payer National Health Insurance

By Ray E. Drasga, MD and Lawrence H. Einhorn, MD

Journal of Oncology Practice, January 2014

Cancer leaves a patient in his or her most vulnerable state not only physically but financially. Oncologists are in a unique position to champion the cause of improving access to care for patients with cancer and easing the financial burden they and their families face.

With ACA now the law of the land, and its retention of the private insurance industry at the center of the health system, the trend toward high-deductible health plans, underinsurance, and cost shifting to patients will almost certainly worsen. 59 Years of private-sector solutions have failed. There needs to be a major paradigm shift in our approach to funding health care in the United States.

Because ACA will fail to remedy the problems of the uninsured, the underinsured, rising costs, and growing corporate control over caregiving, we cannot in good conscience stand by and remain silent. Life is short, especially for some patients with cancer; they need help now. We call on the American Society of Clinical Oncology (ASCO) to advocate for a single-payer national health insurance program. Our medical system must be oriented toward caregiving, not toward maximizing investors’ profits.

All of our patients deserve dignity. It is our moral and ethical obligation as physicians to advocate for universal access to health care. Oncologists, working in conjunction with ASCO, are well positioned to educate legislators about single-payer national health insurance. The time to start is now.

http://jop.ascopubs.org/content/10/1/7.extract

http://org.salsalabs.com/o/307/images/Drasga%20Einhorn%20authors%20proof-edited%20(1).pdf

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Patients’ Costs Skyrocket; Specialists’ Incomes Soar

By Elisabeth Rosenthal

The New York Times, January 18, 2014

Many specialists have become particularly adept at the business of medicine by becoming more entrepreneurial, protecting their turf through aggressive lobbying by their medical societies, and most of all, increasing revenues by offering new procedures — or doing more of lucrative ones.

That math explains why the incomes of dermatologists, gastroenterologists and oncologists rose 50 percent or more between 1995 and 2012, even when adjusted for inflation, while those for primary care physicians rose only 10 percent and lag far behind, since insurers pay far less for traditional doctoring tasks like listening for a heart murmur or prescribing the right antibiotic.

Oncologists benefit from the ability to mark up (and profit from) each dose of chemotherapy they administer in private offices, a practice increased dramatically in the late 1990s. The median compensation for oncologists nearly doubled from 1995 to 2004, to $350,000, according to the M.G.M.A. One study last year attributed 65 percent of the revenue in a typical oncology practice to such payments.

http://www.nytimes.com/2014/01/19/health/patients-costs-skyrocket-specia…

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New Truths That Only One Can See

By George Johnson

The New York Times, January 20, 2014

It has been jarring to learn in recent years that a reproducible result may actually be the rarest of birds. Replication, the ability of another lab to reproduce a finding, is the gold standard of science, reassurance that you have discovered something true. But that is getting harder all the time.

Fears that this is resulting in some questionable findings began to emerge in 2005, when Dr. John P. A. Ioannidis, a kind of meta-scientist who researches research, wrote a paper pointedly titled “Why Most Published Research Findings Are False.”

His work was just the beginning. Concern about the problem has reached the point that the journal Nature has assembled an archive, filled with reports and analyses, called Challenges in Irreproducible Research.

Among them is a paper in which C. Glenn Begley, who is chief scientific officer at TetraLogic Pharmaceuticals, described an experience he had while at Amgen, another drug company. He and his colleagues could not replicate 47 of 53 landmark papers about cancer. Some of the results could not be reproduced even with the help of the original scientists working in their own labs.

Given what is at stake, it seems like a moral failing that the titles of the papers were not revealed. That was forbidden, we’re told, by confidentiality agreements imposed by the labs.

http://www.nytimes.com/2014/01/21/science/new-truths-that-only-one-can-s…

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Drug development: Raise standards for preclinical cancer research

By C. Glenn Begley and Lee M. Ellis

Nature, March 28, 2012

What reasons underlie the publication of erroneous, selective or irreproducible data? The academic system and peer-review process tolerates and perhaps even inadvertently encourages such conduct. To obtain funding, a job, promotion or tenure, researchers need a strong publication record, often including a first-authored high-impact publication. Journal editors, reviewers and grant-review committees often look for a scientific finding that is simple, clear and complete — a ‘perfect’ story. It is therefore tempting for investigators to submit selected data sets for publication, or even to massage data to fit the underlying hypothesis.

Improving preclinical cancer research to the point at which it is reproducible and translatable to clinical-trial success will be an extraordinarily difficult challenge. However, it is important to remember that patients are at the centre of all these efforts. If we in the field forget this, it is easy to lose our sense of focus, transparency and urgency.

http://www.nature.com/nature/journal/v483/n7391/full/483531a.html

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Oncology Market Access

By Jill Sackman, D.V.M., Ph.D. & Michael Kuchenreuther, Ph.D

eyeforpharma

Confronted with unsustainable costs and inconsistent quality of patient outcomes, the U.S. healthcare segment has been embroiled in a national debate over healthcare reform. While nearly every division of the industry has come under fire because of high healthcare costs, one therapeutic area that has continued to win premium reimbursement is oncology. Historically, cancer drugs have enjoyed premium pricing and widespread off-label usage because of their designation for patients with generally incurable diseases. Furthermore, new drugs have been rapidly adopted despite weak clinical evidence and overall questionable value. Thus, it is not surprising that spending on these drugs in the U.S. has risen at twice the rate of total drug spending in recent years.

http://www.eyeforpharma.com/oncologyusa/numerof-whitepaper.php

Cancer has become outrageously expensive to manage. A major factor in the increased spending is the use of high-priced cancer drugs. The newest drugs are priced at about $10,000 per month – a level at which coinsurance payments by patients may not be affordable, if the drug is even covered by the patient’s plan.

What is particularly disconcerting is that the science behind these new drugs is particularly weak. We are paying a lot for drugs that often are not particularly effective and that frequently make people sick. Many of these drugs are introduced into the market after showing scant improvement but were approved because the nominal benefit reached the level of statistical significance. Factors determining the prices of these drugs include costs of research and marketing, like other drugs, but the firms also include “what is a life worth” adjustments – capitalizing on the grief of cancer patients and their families.

Of course there are therapeutic interventions in cancer that are very effective, sometimes curative. With today’s emphasis on outcomes, should the oncologists be paid very high fees for the successful outcomes while being paid little for futile therapy? Of course not. Their incomes should depend on their provision of professional services regardless of the prognosis of their patients.

The article in the Journal of Oncology Practice by Ray Drasga and Lawrence Einhorn explains the rationale of a single payer system – a rationale that should appeal to all oncologists who have faced the dilemma of being able to offer only very expensive drugs that provide unwarranted hope in a futile clinical situation, especially when the drugs may impose a major financial hardship on the patient.

Imagine a situation in which money is removed from that scenario, made possible by a single payer system. The patient does not have to consider out-of-pocket costs when discussing options with her physician. The physician receives the same income regardless of what clinical course the patient selects. Clinical decisions are made by the patient using the best information available, provided to her by her physician. Cost decisions are made by the public administrator, including negotiated pricing for cancer drugs, in an environment totally removed from the clinical scene.

Cancer can be a very cruel disease over which physicians frequently agonize, acutely aware of the physical and emotional pain of the patient. We really need a system in which all of our attention can be devoted to obtaining the very best care for the patient, totally removed from the “business” aspect of medicine. A well designed single payer system would do that.

Martin Luther King Jr would support Oxfam’s recommendations to the World Economic Forum

Working for the Few

Oxfam, January 20, 2014

In November 2013, the World Economic Forum released its ‘Outlook on the Global Agenda 2014’, in which it ranked widening income disparities as the second greatest worldwide risk in the coming 12 to 18 months. Oxfam shares its analysis, and wants to see the 2014 World Economic Forum make the commitments needed to counter the growing tide of inequality.

Given the scale of rising wealth concentrations, opportunity capture and unequal political representation are a serious and worrying trend. For instance:

• Almost half of the world’s wealth is now owned by just one percent of the population.

• The wealth of the one percent richest people in the world amounts to $110 trillion. That’s 65 times the total wealth of the bottom half of the world’s population.

• The bottom half of the world’s population owns the same as the richest 85 people in the world.

• Seven out of ten people live in countries where economic inequality has increased in the last 30 years.

• The richest one percent increased their share of income in 24 out of 26 countries for which we have data between 1980 and 2012.

• In the US, the wealthiest one percent captured 95 percent of post-financial crisis growth since 2009, while the bottom 90 percent became poorer.

Recommendations

Those gathered at Davos for the World Economic Forum have the power to turn around the rapid increase in inequality. Oxfam is calling on them to pledge that they will:

• Not dodge taxes in their own countries or in countries where they invest and operate, by using tax havens;

• Not use their economic wealth to seek political favors that undermine the democratic will of their fellow citizens;

• Make public all the investments in companies and trusts for which they are the ultimate beneficial owners;

• Support progressive taxation on wealth and income;

• Challenge governments to use their tax revenue to provide universal healthcare,

education and social protection for citizens;

• Demand a living wage in all the companies they own or control;

• Challenge other economic elites to join them in these pledges.

Oxfam Briefing Paper – Summary: http://www.oxfam.org/sites/www.oxfam.org/files/bp-working-for-few-political-capture-economic-inequality-200114-summ-en.pdf

World Economic Forum – Outlook on the Global Agenda 2014: http://www3.weforum.org/docs/WEF_GAC_GlobalAgendaOutlook_2014.pdf

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Oxfam: 85 richest people as wealthy as poorest half of the world

By Graeme Wearden

The Guardian, January 20, 2014

As World Economic Forum starts in Davos, development charity claims growing inequality has been driven by ‘power grab’

Winnie Byanyima, the Oxfam executive director who will attend the Davos meetings, said: “It is staggering that in the 21st Century, half of the world’s population – that’s three and a half billion people – own no more than a tiny elite whose numbers could all fit comfortably on a double-decker bus.”

Working for the Few – Oxfam report

http://www.theguardian.com/business/2014/jan/20/oxfam-85-richest-people-half-of-the-world

Comment:

By Don McCanne, M.D.

Although Martin Luther King Jr is no longer here in body, he did leave with us his moral guidance, reinforcing our ability to recognize social injustice when we see it. It is left to us to seek an end to these injustices.

Of industrialized nations, the United States is the world leader in expanding the injustices of inequality – a first for us that matches our first place in health care spending in a nation that is in last place amongst wealthier nations in meting the goal of universality.

From the perspective of those of us who are morally outraged over health care injustice, we need to “challenge governments to use their tax revenue to provide universal health care.” We cannot possibly do this without adopting policies that would “counter the growing tide of inequality.”

If Martin Luther King could speak to us today, he would certainly challenge us to demand the opportunity for everyone to have an adequate education which would help them understand better the injustices inflicted upon us by, yes, the wealthy who control our plutocracy, and to understand what our remedies should be. He would challenge us to demand not only the right but also the opportunity for everyone to vote for the government we need, especially a government that would create a health care system that serves the health care needs of the people first rather than the business goals of the insurers and the rest of the medical-industrial complex. As he famously said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

Listen. You can hear him now. Let’s march.

Single-payer system the best option for health care

By Daniel Schaffer M.D.
The Spokesman-Review (Spokane, Wash.), Jan. 18, 2014

By now, almost everyone has developed an opinion about the status of health care in our country, and it usually divides along ideological lines, with the word “Obamacare” in the middle. This is unfortunate if it ends the discussion, because both advocates and opponents agree that the Affordable Care Act (ACA) is not the final solution to our current health care dilemma.

We are still left with the fact that up to 10 percent of our population will continue to lack health care coverage. Some would rather pay the tax penalty than sign up for insurance; some because they cannot afford the rates even with a subsidy, some because their employers have cut their hours to part time, and others because their states have elected not to expand Medicaid. We also have not addressed the inevitable increased cost of fully enacting the ACA but once again have “kicked the can down the road.”

There are many factors that will determine what our health care system will eventually look like, but one of the most important is the mechanism of paying for those services. Unlike the other industrialized nations, our payment system for those under age 65 has evolved using private insurance companies, both for-profit and nonprofit. The result is that “health care” and “insurance” have unfortunately become fused into a single term.

Insurance is designed to protect people from events that will rarely occur, such as an automobile accident or a house fire. The system works because the majority of people paying their premiums will never collect any benefit, so there is a substantial cash reserve to pay for those who do.

Health care, however, is something that everyone will utilize at some time and, in fact, should be utilizing even more than they currently do to obtain preventive services. To create a large enough cash reserve, in addition to paying for administrative costs and dividends to shareholders, insurance rates continue to escalate. This is made even worse when only the people with health problems that require expensive treatment are the ones who have insurance. This system is unsustainable in the long term because at some point premiums will exceed what individuals and employers are willing to pay, or co-pays and deductibles will reach the point where having insurance will be beyond the means of most people.

If we as a society decide, like all of the other industrialized countries, that health care is a public good – like defense, police and fire protection – and infrastructure such as highways, then it should be funded like our other public goods through taxes. Since we are already paying twice as much for health care as other countries, and since a single system of payment will lower the overall cost by reducing administrative expenses and eliminating the need to pay shareholders, it seems like this option should be given serious consideration.

The simplest way to achieve this would be to expand Medicare to cover everyone. The system is already in place and has shown that it can pay for services with an overhead of about 5 percent, as opposed to 20 percent-plus for the insurance industry.

The political environment in Congress makes this a non-starter at the present time, but the current ACA legislation allows that individual states can be the testing ground for such a solution provided that such state-specific coverage increases access and gives coverage at least equivalent to the federal law. Vermont has already passed legislation that will put this type of payment system into place starting in 2017. Washington has similar legislation already drafted, the Washington Health Security Trust Act, which is in the Health and Wellness committee of the House of Representatives as HB 1085.

The insurance industry has had over 50 years to solve the problem of health care funding, and its involvement has resulted in ever-escalating cost, complexity and reduced access to care.

It is time for us to stop quibbling about what we have and start thinking about what we want. A society burdened with health care insecurity is not a well-functioning society. We need to decide if having a healthy population free of the risk of bankruptcy caused by health care debt is a priority. If so, then let’s look at all the options. I have suggested what is known as a “single payer” system for financing our health care needs. If there is a better plan to achieve this goal, then bring it forward.

Daniel Schaffer practiced urgent care and occupational medicine at Group Health before retiring three years ago. He was also a co-owner of 1st Care Med-Centers, which became Rockwood Urgent Care.

http://www.spokesman.com/stories/2014/jan/18/special-to-the-spokesman-review-single-payer/

Martin Luther King Jr would support Oxfam’s recommendations to the World Economic Forum

Working for the Few

Oxfam, January 20, 2014

In November 2013, the World Economic Forum released its ‘Outlook on the Global Agenda 2014’, in which it ranked widening income disparities as the second greatest worldwide risk in the coming 12 to 18 months. Oxfam shares its analysis, and wants to see the 2014 World Economic Forum make the commitments needed to counter the growing tide of inequality.

Given the scale of rising wealth concentrations, opportunity capture and unequal political representation are a serious and worrying trend. For instance:

• Almost half of the world’s wealth is now owned by just one percent of the population.

• The wealth of the one percent richest people in the world amounts to $110 trillion. That’s 65 times the total wealth of the bottom half of the world’s population.

• The bottom half of the world’s population owns the same as the richest 85 people in the world.

• Seven out of ten people live in countries where economic inequality has increased in the last 30 years.

• The richest one percent increased their share of income in 24 out of 26 countries for which we have data between 1980 and 2012.

• In the US, the wealthiest one percent captured 95 percent of post-financial crisis growth since 2009, while the bottom 90 percent became poorer.

Recommendations

Those gathered at Davos for the World Economic Forum have the power to turn around the rapid increase in inequality. Oxfam is calling on them to pledge that they will:

• Not dodge taxes in their own countries or in countries where they invest and operate, by using tax havens;

• Not use their economic wealth to seek political favors that undermine the democratic will of their fellow citizens;

• Make public all the investments in companies and trusts for which they are the ultimate beneficial owners;

• Support progressive taxation on wealth and income;

• Challenge governments to use their tax revenue to provide universal healthcare,

education and social protection for citizens;

• Demand a living wage in all the companies they own or control;

• Challenge other economic elites to join them in these pledges.

Oxfam Briefing Paper – Summary: https://templatelab.com/working-for-the-few-research/

World Economic Forum – Outlook on the Global Agenda 2014:http://www3.weforum.org/docs/WEF_GAC_GlobalAgendaOutlook_2014.pdf

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Oxfam: 85 richest people as wealthy as poorest half of the world

By Graeme Wearden

The Guardian, January 20, 2014

As World Economic Forum starts in Davos, development charity claims growing inequality has been driven by ‘power grab’

Winnie Byanyima, the Oxfam executive director who will attend the Davos meetings, said: “It is staggering that in the 21st Century, half of the world’s population – that’s three and a half billion people – own no more than a tiny elite whose numbers could all fit comfortably on a double-decker bus.”

Working for the Few – Oxfam report

http://www.theguardian.com/business/2014/jan/20/oxfam-85-richest-people-…

Although Martin Luther King Jr is no longer here in body, he did leave with us his moral guidance, reinforcing our ability to recognize social injustice when we see it. It is left to us to seek an end to these injustices.

Of industrialized nations, the United States is the world leader in expanding the injustices of inequality – a first for us that matches our first place in health care spending in a nation that is in last place amongst wealthier nations in meting the goal of universality.

From the perspective of those of us who are morally outraged over health care injustice, we need to “challenge governments to use their tax revenue to provide universal health care.” We cannot possibly do this without adopting policies that would “counter the growing tide of inequality.”

If Martin Luther King could speak to us today, he would certainly challenge us to demand the opportunity for everyone to have an adequate education which would help them understand better the injustices inflicted upon us by, yes, the wealthy who control our plutocracy, and to understand what our remedies should be. He would challenge us to demand not only the right but also the opportunity for everyone to vote for the government we need, especially a government that would create a health care system that serves the health care needs of the people first rather than the business goals of the insurers and the rest of the medical-industrial complex. As he famously said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

Listen. You can hear him now. Let’s march.

Oncologists call for single payer in leading cancer journal

Article in leading cancer journal calls on oncologists to support single-payer national health insurance

FOR IMMEDIATE RELEASE, January 17, 2014

Contact: 
Mark Almberg, communications director, Physicians for a National Health Program, mark@pnhp.org

A feature article published today in the Journal of Oncology Practice contains an evidence-based appeal by two oncologists, including a past president of the American Society of Clinical Oncology (ASCO), for their colleagues to endorse a single-payer health system.

The authors are Dr. Ray Drasga, a longtime community-based oncologist who founded a free clinic in his own community of Crown Point, Ind., and Dr. Lawrence Einhorn, a distinguished professor of medicine at Indiana University Hospital in Indianapolis. 

Einhorn is perhaps best known for his pioneering research in the treatment of testicular cancer; his successful treatment of cyclist Lance Armstrong received widespread media attention. His research interests also include tumor oncology and lung cancer.

Einhorn is also past president of ASCO, the largest and most respected oncology society in the world, and has won numerous professional awards for his achievements in clinical cancer research.

“With the costs of cancer care skyrocketing out of control, most people with cancer are burdened not only physically but also financially,” said Dr. Drasga, the lead author. “They delay or do not receive care due to their inability to pay.

“The crisis in health care is much more pronounced in cancer due to the high costs of drugs, tests, and procedures,” he said. “For example, the cost of a new cancer drug has increased to a median price of $10,000 per month since 2010, and some drugs cost much more.

“The situation is worsening,” he said. “We need a fundamental shift in our approach to funding health care in the United States.”

The authors ask their fellow oncologists and their society, ASCO, to endorse a single-payer system of national health care insurance. They say they do not believe that the Affordable Care Act, or “Obamacare,” will be able to solve the health care crisis that cancer patients face.

The Journal of Oncology Practice is a publication of the American Society of Clinical Oncology. Its focus is on providing oncologists and other oncology professionals with information aimed at enhancing practice efficiency and promoting a high standard for quality of patient care.

A copy of the article is available here.

*****

“Why Oncologists Should Support Single-Payer National Health Insurance,” by Ray E. Drasga, M.D., and Lawrence H. Einhorn, M.D. Journal of Oncology Practice, January 17, 2014. jop.ascopubs.org.

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 the study described above.

In health care, need is trumped by profit

By Laura Berger
Wisconsin State Journal, Letters, Jan. 17, 2014

I was surprised and pleased to see the large ad in Wednesday’s State Journal by the Tri-County Medical Society, including Barron, Burnett and Washburn counties, about the high cost of medical care in the United States. We need more voices about health care from rural areas.

I agree that reading Time magazine writer Steven Brill’s March 2013 piece “Bitter Pill” will show our need to shift discussion from “how do we pay for health care” to “‘why is it so expensive?”

The Wisconsin Physicians for a National Health Care Program has launched a petition to state government officials urging uniform, transparent and affordable pricing for all health care services (see www.pnhp.org/states/wisconsin).

What is undermining health care is not government, but corporate profits and inefficiencies. Instead of government’s impossible and complex attempts to walk a line between public need and corporate profit, let’s acknowledge there’s another way.

An elegant and simple solution to achieving affordable health care for all can be found in Canada and in U.S. House Resolution 676. Call it expansion of Medicare or single payer — that is how we get there.

Laura Berger is a public health nurse in Madison and Dane County.

http://host.madison.com/news/opinion/mailbag/in-health-care-need-is-trumped-by-profit–/article_4ff96040-5419-59d6-b7ad-8d900e8bbb51.html#ixzz2qfWBUqwi

Why not income-related premiums for Medicare beneficiaries?

Raising Medicare Premiums for Higher-Income Beneficiaries: Assessing the Implications

By Juliette Cubanski, Tricia Neuman, Gretchen Jacobson, and Karen E. Smith

Kaiser Family Foundation, January 2014

As policymakers consider ways to slow the growth in Medicare spending as part of broader efforts to reduce the federal debt or offset the cost of other spending priorities, some have proposed to increase beneficiary contributions through higher Medicare premiums.

Modifications to Medicare’s current income-related premiums have been proposed recently by several policymakers and groups, including the Obama Administration as part of the President’s Fiscal Year (FY) 2013 and FY 2014 budgets, the Bipartisan Policy Center (BPC), the Center for American Progress (CAP), and the Moment of Truth Project (headed by Erskine Bowles and Alan Simpson, co-chairs of the National Commission on Fiscal Responsibility and Reform).

Conclusion

Some recent proposals to address concerns about federal spending have included recommendations to reduce the growth in Medicare spending by increasing beneficiaries’ contributions towards their health care costs. These include proposals to increase the share of beneficiaries who would pay Medicare’s Part B and Part D income-related premiums and increase the portion of program costs they would pay.

Part of the appeal of requiring higher-income beneficiaries to pay a greater share of Medicare costs is that these higher costs would only be imposed on those beneficiaries who arguably have greater financial means to bear the additional expenses. In the context of current federal budget discussions, some consider an approach that includes this type of progressive financing to be preferable to one that imposes higher premiums or cost sharing across the board, without regard to beneficiaries’ incomes. There is some concern, however, that the income thresholds used to trigger the imposition of higher premiums for higher-income Medicare beneficiaries ($85,000/individual, $170,000/couple) are substantially lower than the thresholds often used to define higher-income individuals in other policy discussions. For example, the ACA imposed higher Medicare Part A payroll taxes on individuals with income of $200,000 and couples with income of $250,000.

For many higher-income beneficiaries, the proposed increase in Medicare premiums might not be a financial hardship. However, if the income thresholds are frozen over a longer period of time relative to current law, then a growing share of elderly and disabled people who would not be considered high income by today’s standards would face higher premiums, and as the income-related premium amounts increase over time, they would consume a larger share of income. In addition, there is some possibility that such changes could lead some higher-income beneficiaries to drop out of Medicare Part B and instead self-insure, which could result in higher premiums for all others who remain on Medicare if the dropout group is large and relatively healthy.

Amid ongoing concerns about the nation’s debt and the future financial stability of Medicare, policymakers are likely to continue their discussion of alternative Medicare savings proposals. In light of the financial vulnerability of many people on Medicare and the difficulty they may have paying for rising health care costs on limited budgets, the proposal to require higher-income beneficiaries to pay more in Medicare premiums, rather than raise premiums for all beneficiaries, would protect those with relatively modest incomes. Yet, given the relatively low incomes of most people on Medicare, a significant amount of savings from this proposal is only possible by going relatively far down the income scale to reach a sizeable share of beneficiaries—at which point the affordability of these additional costs could be called into question.

http://kaiserfamilyfoundation.files.wordpress.com/2014/01/8276-02-raising-medicare-premiums-for-higher-income-beneficiaries.pdf

Comment:

By Don McCanne, M.D.

We already require higher-income individuals to pay larger premiums for Medicare Part B (physician services) and Part D (drugs), and now there are serious proposals to increase those amounts in order to reduce federal spending on Medicare. Is this wise?

In order to have more than a negligible impact on the federal budget both the numbers of individuals paying higher premiums and the increase in the premiums would have to be significant.

This report shows that lowering the income threshold at which higher premiums would be assessed would include individuals who would find paying the premium to be a hardship, simply because there are not enough seniors with very high incomes.

So suppose instead we increase even more the premiums that higher-income individuals would pay. Since there are so few of them, the premium increases would have to have to be significant to have any real impact on the federal budget. What would happen then? It is likely that many of those who are financially secure and relatively healthy would drop out of the Medicare B and D programs and simply self-insure. The premiums that these healthier individuals would have paid will instead be paid by higher premiums for those staying in the program and by a greater contribution from general tax revenues.

Some have suggested that deductibles also be increased for higher-income individuals. This would surely anger our wealthy citizens – those who have the greatest political influence – and undermine support for Medicare. That would risk us eventually ending up with an underfunded, austere Medicare program, while the wealthy could continue to buy all the care that they would want.

No. We need to have the full support of the wealthy for a high quality system that would serve them well, while serving all of us well. We need to eliminate premiums, deductibles and other cost sharing so that the system provides us all with equal access based on medical need rather than ability to pay. The wealthy could still have access to luxurious suites and other amenities that they might prefer and be willing to pay for.

We still need progressive financing, but we can do that easily by using equitable taxes to fund Medicare – Improved Medicare for All, that is.

Why not income-related premiums for Medicare beneficiaries?

Raising Medicare Premiums for Higher-Income Beneficiaries: Assessing the Implications

By Juliette Cubanski, Tricia Neuman, Gretchen Jacobson, and Karen E. Smith

Kaiser Family Foundation, January 2014

As policymakers consider ways to slow the growth in Medicare spending as part of broader efforts to reduce the federal debt or offset the cost of other spending priorities, some have proposed to increase beneficiary contributions through higher Medicare premiums.

Modifications to Medicare’s current income-related premiums have been proposed recently by several policymakers and groups, including the Obama Administration as part of the President’s Fiscal Year (FY) 2013 and FY 2014 budgets, the Bipartisan Policy Center (BPC), the Center for American Progress (CAP), and the Moment of Truth Project (headed by Erskine Bowles and Alan Simpson, co-chairs of the National Commission on Fiscal Responsibility and Reform).

Conclusion

Some recent proposals to address concerns about federal spending have included recommendations to reduce the growth in Medicare spending by increasing beneficiaries’ contributions towards their health care costs. These include proposals to increase the share of beneficiaries who would pay Medicare’s Part B and Part D income-related premiums and increase the portion of program costs they would pay.

Part of the appeal of requiring higher-income beneficiaries to pay a greater share of Medicare costs is that these higher costs would only be imposed on those beneficiaries who arguably have greater financial means to bear the additional expenses. In the context of current federal budget discussions, some consider an approach that includes this type of progressive financing to be preferable to one that imposes higher premiums or cost sharing across the board, without regard to beneficiaries’ incomes. There is some concern, however, that the income thresholds used to trigger the imposition of higher premiums for higher-income Medicare beneficiaries ($85,000/individual, $170,000/couple) are substantially lower than the thresholds often used to define higher-income individuals in other policy discussions. For example, the ACA imposed higher Medicare Part A payroll taxes on individuals with income of $200,000 and couples with income of $250,000.

For many higher-income beneficiaries, the proposed increase in Medicare premiums might not be a financial hardship. However, if the income thresholds are frozen over a longer period of time relative to current law, then a growing share of elderly and disabled people who would not be considered high income by today’s standards would face higher premiums, and as the income-related premium amounts increase over time, they would consume a larger share of income. In addition, there is some possibility that such changes could lead some higher-income beneficiaries to drop out of Medicare Part B and instead self-insure, which could result in higher premiums for all others who remain on Medicare if the dropout group is large and relatively healthy.

Amid ongoing concerns about the nation’s debt and the future financial stability of Medicare, policymakers are likely to continue their discussion of alternative Medicare savings proposals. In light of the financial vulnerability of many people on Medicare and the difficulty they may have paying for rising health care costs on limited budgets, the proposal to require higher-income beneficiaries to pay more in Medicare premiums, rather than raise premiums for all beneficiaries, would protect those with relatively modest incomes. Yet, given the relatively low incomes of most people on Medicare, a significant amount of savings from this proposal is only possible by going relatively far down the income scale to reach a sizeable share of beneficiaries—at which point the affordability of these additional costs could be called into question.

http://kaiserfamilyfoundation.files.wordpress.com/2014/01/8276-02-raisin…

We already require higher-income individuals to pay larger premiums for Medicare Part B (physician services) and Part D (drugs), and now there are serious proposals to increase those amounts in order to reduce federal spending on Medicare. Is this wise?

In order to have more than a negligible impact on the federal budget both the numbers of individuals paying higher premiums and the increase in the premiums would have to be significant.

This report shows that lowering the income threshold at which higher premiums would be assessed would include individuals who would find paying the premium to be a hardship, simply because there are not enough seniors with very high incomes.

So suppose instead we increase even more the premiums that higher-income individuals would pay. Since there are so few of them, the premium increases would have to have to be significant to have any real impact on the federal budget. What would happen then? It is likely that many of those who are financially secure and relatively healthy would drop out of the Medicare B and D programs and simply self-insure. The premiums that these healthier individuals would have paid will instead be paid by higher premiums for those staying in the program and by a greater contribution from general tax revenues.

Some have suggested that deductibles also be increased for higher-income individuals. This would surely anger our wealthy citizens – those who have the greatest political influence – and undermine support for Medicare. That would risk us eventually ending up with an underfunded, austere Medicare program, while the wealthy could continue to buy all the care that they would want.

No. We need to have the full support of the wealthy for a high quality system that would serve them well, while serving all of us well. We need to eliminate premiums, deductibles and other cost sharing so that the system provides us all with equal access based on medical need rather than ability to pay. The wealthy could still have access to luxurious suites and other amenities that they might prefer and be willing to pay for.

We still need progressive financing, but we can do that easily by using equitable taxes to fund Medicare – Improved Medicare for All, that is.

Bare-bones plans still with us

Bare-Bones Health Plans Survive Through Quirk in Law

By Theo Francis
The Wall Street Journal, January 16, 2014

The health-care overhaul was supposed to eliminate insurance plans that offer skimpy coverage at cut rates. But a quirk in the law stands to help some companies keep them going for years to come.

AlliedBarton Security Services, a closely held firm that employs more than 63,000 people nationwide, has offered a modestly updated version of its so-called mini-med plan to employees this year and it intends to do so in 2015 as well, even though the cheap coverage fails to meet requirements of the Affordable Care Act.

What makes the no-frills plan attractive is that it will save money for AlliedBarton and for its security-guard employees who don’t incur substantial medical bills, many of whom want a low-cost option, according to the company.

What makes it possible under the health law: As long as companies offer at least one plan that complies with the law’s requirements, they are free to keep offering ones that don’t.

That has enabled companies to find ways to comply with the law while minimizing increases in their health-care costs. The result has been an increase in lean insurance offerings such as “fixed-indemnity” plans.

Such plans, which might cost an employee just $80 a month in premiums, generally pay a set amount for specific medical services—$70 for a doctor’s visit, for example, or $20 for a prescription—without regard to the underlying cost. They limit the amount of payments or care available in a year, and can exclude entire areas of coverage, such as mental-health care. When catastrophic injury or illness strikes, they often pay little.

AlliedBarton intends to offer its employees two low-cost insurance options—one that meets the law’s requirements for both scope of coverage and affordability, and a cheaper plan that falls short. Offering the compliant plan heads off the law’s penalties. And offering the cheaper plan—which the company thinks most of its security guards will pick—keeps costs down.

Employees who pick the cheaper plan could have to pay the individual penalty—though that could still cost them less than signing up for the more expensive plan.

Fixed-indemnity coverage “violates the spirit of the law,” said Jay Angoff, a Washington lawyer who previously headed the federal insurance-oversight office and served as Missouri’s insurance commissioner. “There’s a strong argument that it is inherently misleading, and it provides so little coverage that it shouldn’t be sold at all.” Such plans, he adds, “were never intended to survive past 2014.”

AlliedBarton’s Mr. Buckman countered that workers are good at weighing medical and financial trade-offs. “To a lot of people for a lot of good reasons, fixed-indemnity plans may be a better choice, and we think it’s appropriate for people to be able to make choices,” he said.

http://online.wsj.com/news/articles/SB10001424052702303754404579312760133827256

Comment:

By Don McCanne, M.D.

What kind of rule is this? As long as employers offer to their employees a plan that complies with the requirements of the Affordable Care Act (ACA), but a plan that the employees cannot afford to purchase, then the employers are relieved of their penalties for providing them with almost worthless “fixed indemnity” plans, even though that means that the employees may have to pay a penalty for failing to be insured with a qualified plan.

ACA was designed to interfere as little as possible with employer-sponsored plans since supposedly that large sector of the health insurance market was working so well. But it wasn’t for far too many. Employers offering mini-med style fixed indemnity plans is only one of the potential deficiencies of employer-sponsored coverage, others being high deductibles, narrow provider networks, and forgone wage increases to pay for the coverage.

Right now, several respected journalists are criticizing single payer advocates for being critical of the health care gains under the Affordable Care Act. They have it all wrong. We are not critical of the gains; we are critical of the failure to correct the major deficiencies in our system that cause so much suffering and financial hardship. Instead of tweaking a mediocre system, we should fix it. We could do that with a single payer national health program – an improved Medicare that covers all of us.