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The Obamacare We Deserve

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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Americans are paying for health care with more than money

By Philip Caper, M.D.
Bangor (Maine) Daily News, Dec. 19, 2013 Americans now spend close to $3 trillion a year for health care, around 18 percent of our GDP. That works out to almost $9,000 per person in Maine, almost twice as much per person as the average for other wealthy nations that provide health care for all their people. Not only do we pay more, but we pay in far more ways than any other country. Some are obvious. They include health insurance premiums, “out of pocket” co-pays and deductibles, and payments for health care products and services that are not covered by insurance. Out-of-pocket payments are increasing every year as insurers shift more of the rising costs to their customers and employers to their employees. We also pay in ways that are not so obvious. We all pay federal, state and local taxes to support programs such as Medicare and Medicaid, health care for federal, state and local employees, military personnel, the Veterans Affairs and many others. Since employment-related health insurance is tax exempt, we also pay around $250 billion a year in the form of lost tax revenues, that is then made up by higher taxes on all of us. Other ways we pay are almost invisible, but we feel them anyway. Workers no longer bargain for increased wages or better working conditions. In a weak economy, any small gains they have made in total compensation have been more than consumed by increases in health care costs. As a result, real wages are declining. At a recent national health care conference I attended, there was a panel discussion about the effects health care costs on a small central Maine town. Employee health care costs have risen dramatically over recent years. Benefits for the town’s 11 employees now total $18,000 each for a total of almost $200,000. This has forced severe cutbacks in other services such as road maintenance, public safety, libraries, education, and (ironically) emergency medical services. Diminished public services and a deteriorating quality of life is one more way we pay for our health care. This should come as no surprise. During the past sixty years or so Americans have generously poured money into our health care system through thousands of channels that are individually difficult and collectively impossible to control. Since Americans view health care as a business, we’ve allowed our health care system to become populated by thousands of profit seeking companies (some nominally nonprofit), each trying to maximize profits and competing for a larger share of an ever-growing pie. Many of these private businesses are heavily subsidized by tax-supported health care programs and tax breaks. So far, we have been unwilling to put any effective restraints around the growth of this huge pot of gold. This is not a failure of capitalism or corporations. They are simply doing what they are supposed to do — create wealth for their owners. It’s a massive failure of public policy. It’s the fault of all of us, including our political leaders, for failing to put any meaningful constraints around our health care system to keep it affordable for everybody. The result has been the creation of a gargantuan medical-industrial complex that has become the pac-man of public and private budgets. It is riddled with inefficiency and waste including unjustifiably high prices and excessive use of lucrative services and products, many of them without demonstrated value or downright harmful. The Affordable Care Act begins to make some timid efforts at addressing this problem. Nobody I know thinks they will be sufficient. After seven years of “RomneyCare” (after which the Affordable Care Act was patterned), Massachusetts now has almost everybody insured, but it has the highest health care costs of any state in the country. Some public figures there are beginning to suggest moving toward a statewide single-payer system. As I’ve written before, the market forces the ACA is trying to harness have not, will not and cannot solve this problem. As most other wealthy countries have done, we need to channel the many existing health care revenue streams together into a single funnel with a publicly managed flow-control valve, and then muster the political will to use it. That is what our neighbors in Vermont are now in the process of trying to do. As one Canadian conference participant put it, “It breaks my heart to see Americans destroying your schools, libraries and public safety to pay for health care.” It breaks my heart, too. We can do a lot better. Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at pcpcaper21@gmail.com. http://bangordailynews.com/2013/12/19/health/americans-are-paying-for-health-care-with-more-than-money/

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'Sticker shock' over Obamacare bolsters single-payer argument

New reporting by AP underscores systemic problems with healthcare system based on for-profit insurance model

By Jon Queally
Common Dreams, Dec. 23, 2013 As the political uproar surrounding the Affordable Care Act has played out over recent months, one single fact remains: the private insurance model—on which the law widely known as Obamacare is based—is more complicated, more expensive, and provides less coverage than a simple, “everybody in/nobody out,” single-payer model that almost every other advanced country in the world enjoys. And even within the debate about whether or not Obamacare is a “step forward” or a “step back” for healthcare delivery in the U.S., what’s become increasingly clear—as was predicted by progressive critics of the Obamacare model—is that though portions of the law undoubtedly improve the kinds of coverage that some people receive, others are still excluded from the system entirely and among those who are now purchasing insurance for the first time in their lives many will face “sticker shock” at the high premiums or out-sized deductibles. As new reporting by The Associated Press highlights: “As a key enrollment deadline hits Monday, many people without health insurance have been sizing up policies on the new government health care marketplace and making what seems like a logical choice: They’re picking the cheapest one. “Increasingly, experts in health insurance are becoming concerned that many of these first-time buyers will be in for a shock when they get medical care next year and discover they’re on the hook for most of the initial cost. “The prospect of sticker shock after Jan. 1, when those who sign up for policies now can begin getting coverage, is seen as a looming problem for a new national system that has been plagued by trouble since the new marketplaces went online in the states in October.” What the AP goes on to describe is how the economic hardships that most middle- and low-income Americans experience on a daily basis compel them to choose insurance policies with the lowest monthly premium, but don’t realize that the huge deductibles attached to those plans mean that they may have huge medical bills to pay before their coverage kicks in. In addition, because the state-level exchanges from which participants in Obamacare must purchase their plans are so complicated, many consumers—especially those with little experience navigating the private insurance marketplace—won’t possess the technical or financial savvy to calculate the best plan for themselves or their family. “I am so deeply clueless about all of this,” said 29-year-old Adrienne Matzen, an actor in Chicago, told the AP. She’s been  mostly without insurance since she turned 21, but must now figure out how to receive coverage she can afford while living with two chronic illnesses and earning less than $20,000 a year. Someone like Matzen—who ultimately may or may not be individually better off under the ACA—exemplifies why the overall system is still so far from the ideal that progressive critics of Obamacare say is possible.  The choices available to her  depend on the state she lives in, her ability to navigate the choices, and a host of other complex factors. As the AP reports: “The complexities of insurance are eye-glazing even for those who have it. Only 14 percent of American adults with insurance understand deductibles, according to one recent study.” On the other hand, a single-payer or Medicare-For-All approach, according to its proponents, would cut out both the complexity and an enormous part of the expense that has historically plagued private insurance industry and will remain under Obamacare. This summer, Gerald Friedman, a professor of economics at the UMass Amherst, released a study showing that a single-payer system like the one described in Rep. John Conyers’ HR 676 could save as much as $592 billion a year in U.S. healthcare costs. According to his fiscal assessment, those savings would be more than enough to cover all 44 million people the government estimates will be uninsured in the coming year while also improving the existing coverage for everyone else. “Paradoxically, by expanding Medicare to everyone we’d end up saving billions of dollars annually,” Friedman said of his findings. “We’d be safeguarding Medicare’s fiscal integrity while enhancing the nation’s health for the long term.” And as Dr. Steffie Woolhandler, a spokeswoman for Physicians for a National Health Program, recently explained on Democracy Now!: “[Single payer/Medicare for all] means you would get a card the day you’re born, and you’d keep it your entire life. It would entitle you to medical care, all needed medical care, without co-payments, without deductibles. And because it’s such a simple system, like Social Security, there would be very low administrative expenses. We would save about $400 billion, which would allow us to afford the system. I mean, I just want to remind you that when Medicare was rolled out in 1966, it was rolled out in six months using index cards. So if you have a simple system, you do not have to have all this expense and all this complexity and work.” Jon Quealy is a staff writer at Common Dreams. http://www.commondreams.org/headline/2013/12/23-3

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Simple solution — single payer

By Rochelle Dworet, M.D.
Health Policy Solutions (Denver, Colo.), Dec. 23, 2013 So the Affordable Care Act is finally being implemented, even online.  Our state has its own exchange, which seems to run better than the national model.  The people in the states that implemented their own exchanges are all busy heaping accolades on each other. However, the real question is, “Where is the single-payer solution that would save hundreds of millions of dollars and lives?” Our fiscally prudent cohorts should want a system of private care or whatever the provider fancies with a low overhead to administer, and one that covers everyone — namely single payer.  After all, let’s remember that Medicare was implemented within six months of passage using one’s Social Security number and all the relevant information documented on index cards.  No fancy computer system was required with exorbitant expenditures to make it work. Now seniors love their Medicare, as witnessed by the signs, “Government, hands off my Medicare.” Unfortunately, the big PR firms, lobbyists and corporate giants that control the medical empire make way too much in salaries and bonuses to care about what is good for people. We recently mourned the loss of one of the greatest civil and human rights activists ever, Nelson Mandela.  Yet, we forget that the United Nations decreed that health care is a human right.  We, as a civil society, have an obligation to all our brothers and sisters to afford them health care regardless of financial means. But no, as Steven Brill pointed out in “The Bitter Pill,” his Time Magazine article last March,  hospitals and clinics charge as much as they can get away with based on some medical fiction called the “Chargemaster,” a system more suited to a Star Wars movie than to humanity.  Is it any wonder that we are the only developed nation with a 62 percent bankruptcy rate due to medical debt, and two-thirds of those people had insurance! As a physician, I know that medicine does not fit a business model.  Each time a patient enters into a discussion and examination for care, she breaks the mold of another algorithm and diagnostic code.  Providers need to use their skills to fullest capacity and be compensated fairly whether they are in primary care or a narrower specialty.  It is a team approach that creates success at wellness. Our current system of grabbing for dollars perpetuates greed and discontent among healers. The answer to the problems with Obamacare is exactly what Mark Shields said on Inside Washington on Oct. 27, “Two words: single payer.” Dr. Rochelle “Shelley” Dworet is president of Health Care for All Colorado, a group advocating for a public universal health care system in Colorado. http://www.healthpolicysolutions.org/2013/12/23/opinion-simple-solution-single-payer/

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Incrementalism predicted for 2014

With Health Law Cemented, G.O.P. Debates Next Move

By Jonathan Weisman
The New York Times, December 26, 2013 Senator Kelly Ayotte, Republican of New Hampshire, said she was teaming up with Democrats on a host of incremental changes to the law, such as expanding health savings accounts and repealing a tax on medical devices. And other Republicans are wondering aloud how long they can keep up the single-minded tactic of highlighting what is wrong with the law without saying what they would do about the problems it was supposed to address. http://www.nytimes.com/2013/12/27/us/politics/as-health-law-cements-its-place-gop-ponders-how-to-attack.html?ref=politics&pagewanted=all

Comment

By Don McCanne, M.D. Democrats want to repair some of the defects in the Affordable Care Act. Republicans want to include some of their favorite proposals such as expansions of health savings accounts and catastrophic plans, and loosening restrictions on sale of insurance products across state lines. Members of both parties wish to curry the favor of the voters before the November elections. This is a setup for mediocre incrementalism when what we really need is… well, the most popular NYT reader response (out of 475 at moment) says it well: Atikin – North Carolina
The only logical solution: single-payer.

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Don’t forget New York

Single Payer for New York

The New York Times, December 23, 2013 To the Editor: Re “Under Health Law, Independent Practitioners in City Face Canceled Policies” (news article, Dec. 14): The Affordable Care Act makes important repairs to our broken health care system. The problem is that it leaves insurance companies in charge — with high premiums, high deductibles and co-pays; too much control over which doctors or hospitals we can go to and what care they can provide; and high administrative costs. The exchanges are complicated because the system requires means-testing to see who is eligible for Medicaid or subsidies, and then requires people to select from multiple plans. We could cover everyone, provide better coverage and save billions through publicly sponsored, single-payer health coverage, like an improved version of Medicare for everyone — and no insurance companies. Washington might not be ready to act, but individual states have long been the “laboratories of democracy.” New York can do better.

Richard N. Gottfried
New York, Dec. 14, 2013 (The writer, chairman of the New York State Assembly Health Committee, is the author of a bill in the New York Legislature to establish a state single-payer health plan.) http://www.nytimes.com/2013/12/24/opinion/single-payer-for-new-york.html?ref=opinion&_r=0 A.5389/S.2078, New York Health – an act to establish a single payer health program: http://assembly.state.ny.us/leg/?sh=printbill&bn=A05389&term=2013

Comment

By Don McCanne, M.D. As the Affordable Care Act unfolds it becomes all too obvious that the repairs in our system of financing health care are falling far too short of the goals of universality, affordability, administrative simplicity, and accessibility with free choice of hospitals and health care professionals. Clearly we need a single payer system that would easily achieve these goals. New York, with the leadership of Assemblyman Richard Gottfried, has joined other states in attempting to enact a state-based single payer system. What we desperately need is a federal government that partners with states – all states – in enacting legislation that will bring single payer to all of us. With the surge in a renewed interest in single payer, we need grassroots and coalition efforts to be sure that people understand the single payer approach and then will demand it when they go to vote. Let’s pull out all stops between now and next November.

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