PNHP

Inequality at core of high health care spending

Inequality at core of high health care spending

Note:  This rather wonkish article is much easier to read on the website (link below) since it includes a series of graphs that helps to visualize the concepts presented.

Inequality Is At The Core Of High Health Care Spending: A View From The OECD

By Richard “Buz” Cooper
Health Affairs Blog, October 9, 2013 It is commonly said that the US spends more than twice as much on health care as other developed countries, yet its outcomes are worse. The inference is that too much care is provided, to no good end. Such international comparisons are drawn from the Organization of Economic Cooperation and Development (OECD), a group of 34 developed countries. Analyzing these data is a multi-step process, like peeling an onion, and the truth resides deep within its core. The process starts by adjusting health care spending for “purchasing power parity” (PPP) and expressing it in US dollars. By that measure, per capita spending in the US is 160 percent more than the OECD mean, and this is the basis for the notion that the US spends more than twice as much. But it is only the first layer. The second layer is the economy. The US spends more principally because it is wealthier, but even in proportion to its gross domestic product (GDP), the US spends more, about 60 percent more. But that is only the second layer. The third layer is price. Health care prices are inordinately high in the US and inordinately low in many other countries, particularly those that exercise price controls. Therefore, to understand how much care is given, comparisons of health care spending must be adjusted for the purchasing power parity of health care (HC-ppp). When so adjusted, spending in the US is still higher relative to its GDP, but by only 31 percent. This represents the core difference in services. Some are administrative, but most are health care services. What explains this 31 percent? A large body of evidence suggests that it results from poverty and income inequality, which are more prevalent in the US than in any other OECD country except Chile, Mexico and Turkey. And poverty is associated with substantial increments in spending. For example, the poorest decile of Medicare beneficiaries spends 30-40 percent more than the wealthiest; overall hospital utilization rates in large urban areas are 25-35 percent more than in their wealthiest Zip codes; and hospital readmissions are most prevalent from poor neighborhoods and in safety-net hospitals. Much of this relates to chronic illness, which is most prevalent among the poor. And chronic illness rates are higher in the US than in most other OECD countries, higher than Canada or England and higher than the average of France, Germany, Italy, Japan, Spain and the UK. Similarly, obesity, which is most common among the poor, is most prevalent in US. And the rates of infant, maternal and preventable mortality, which are often taken as measures of health care effectiveness but are actually markers of poverty and the burden of disease, are all higher in the US than in any other advanced economy. The Gini coefficient is a measure of income inequality. To estimate the impact of income inequality on health care spending, it was applied to the spending level in each of the OECD countries. So doing erased the difference between the price-adjusted level expected from GDP and the actual expenditures in the US. Thus, while the US spends more than twice as much on health care than the mean of other OECD countries, its greater GDP and higher prices explain most of it, and income inequality offers an explanation for the rest. But there is more, and it is the core of the core. The OECD measures a host of spending categories in addition to health care. In most, spending in the US is proportional to its GDP. Health care, which exceeds the OECD norm, is one exception. A second is social spending, and it deviates in the opposite direction. Social spending in the US is 33 percent less than predicted from GDP. And recent trends are constraining it further by limiting funds for food stamps, housing subsidies, and programs that serve youth, the elderly, and the homeless. It is difficult not to connect the dots from inadequate social spending to excess poverty and income inequality to more chronic illness and higher health care spending. These dots reside in the core of the OECD onion, and the failure to cope with them is placing an unsustainable burden on our health care system. http://healthaffairs.org/blog/2013/10/09/inequality-is-at-the-core-of-high-health-care-spending-a-view-from-the-oecd/

Comment:

By Don McCanne, M.D. In this article, Richard “Buz” Cooper develops the theme that income inequality and excess poverty along with our inadequate compensatory social spending are the primary reasons that our health care spending is so high. Others might prefer to frame the reasons in different terms, but that does not change the fact that it is imperative that we establish policies to cope with these societal deficiencies. As an aside, he does mention that some of the core differences in U.S. services are administrative, but then does not mention that much of that administrative waste could be recovered by establishing a more effective and efficient health care financing system (i.e., single payer). Buz Cooper’s Health Affairs biography states, “He has rediscovered the essential role of professionalism in health care and the central importance of poverty in the growth of health care spending.” Let’s see what we can do to help the rest of the policy community and our politicians make the same discovery.

]]>

Seattle Children's Hospital excluded from most exchange plans

Majority of Washington’s Health Benefit Exchange Insurance Plans Fail to Cover Care at Seattle Children’s; Hospital Sues Seeking Adequate Network Coverage for Children and Families

Seattle Children’s Hospital, October 4, 2013 Today, Seattle Children’s Hospital filed suit citing the failure of Washington state’s Office of the Insurance Commissioner (OIC) to ensure adequate network coverage in several Washington’s Health Benefit Exchange (Exchange) plans. We believe strongly that the OIC and the majority of plans on the Exchange have failed to meet their mandate, as they do not currently cover care provided at Children’s. Children’s is the only pediatric hospital in King County and the preeminent provider of many pediatric specialty services in the Northwest. Some of these specialized services not available elsewhere in our area or region include acute cancer care, level IV neonatal intensive care and heart, liver and intestinal transplantation. Without inclusion of Children’s, current and future patients and families who obtain insurance from several plans offered will not be able to access care at Children’s as an in-network provider. This lack of suitable access to pediatric services means that families enrolled in these plans may not receive the most timely, appropriate care, and face larger out-of-pocket amounts. “Every child should have access to essential healthcare and the intent of the new Exchange is to make it available to all families,” said Thomas Hansen, MD, CEO, Seattle Children’s. “However, we are very concerned about the limited networks being offered by some Exchange insurance plans. Omitting coverage for care at a facility like Children’s prevents families from accessing vital services they may desperately need.” http://www.seattlechildrens.org/Press-Releases/2013/Majority-of-Washington’s-Health-Benefit-Exchange-Insurance-Plans-Fail-to-Cover-Care-at-Seattle-Children’s;-Hospital-Sues-Seeking-Adequate-Network-Coverage-for-Children-and-Families/

Comment:

By Don McCanne, M.D. This press release from Seattle Children’s Hospital presents only one side of the story. Children enrolled in most of the plans to be offered in Washington’s insurance exchange will not have in-network access to the crucial, highly specialized services only offered by Seattle Children’s Hospital. The financial exposure to those families could be enormous. So what is the other side to this story? There is tremendous pressure on the exchange plans to keep premiums competitive. Although rates generally had been ratcheted down as low as the market will tolerate, they could squeeze a little more out from some providers by negotiating slightly lower rates in exchange for excluding health care competitors. These limited networks are an insurer-driven, cost-containment element of the new ACA exchanges. Imagine a Seattle child with a major malignancy or with the need for an organ transplant. Is it really reasonable that our “reformed” health care system still exposes that family to severe financial hardship and possibly bankruptcy? This is not what we should have expected from comprehensive health care reform. We need to go back and do it right – enact a single payer national health program that removes financial barriers to all essential care for everyone. Any child in Seattle that requires the specialized services offered by Seattle Children’s Hospital should have them. No exceptions.

]]>

Jon Stewart Grills Kathleen Sebelius On Obamacare Issues, Makes Strong Case For Single-Payer

By Paige Lavender & Nick Wing
Huffington Post, October 8, 2013

Department of Health and Human Services Secretary Kathleen Sebelius was grilled by Jon Stewart on Comedy Central’s “The Daily Show” on Monday, where she appeared to address glitches that have plagued the Obamacare website in its first week since going online.

Stewart challenged Sebelius on why individuals aren’t able to delay Obamacare, even though businesses have been given option.

“If I’m if an individual I’m wondering — well, an individual who doesn’t want this because there are individuals clearly that want this — but if I’m an individual that doesn’t want it, it would be hard for me to look at big business getting a waiver and not having to do it and me having to because I would think, ‘geez, it looks like because I don’t have a lobbying group,'” Stewart said. “I would feel like you are favoring big business because they lobbied you to delay it because they didn’t want to do this year but you are not allowing individuals that same courtesy.”

“Why is it that individuals, though, couldn’t say they didn’t want to do it just for a year?” Stewart continued.

“Well they can. They pay a fine,” Sebelius said. “They pay a fine at the end of the year, but they don’t have to — they can say, ‘I don’t want to do it.’ The theory is they can’t pick and choose if they are hit by a bus or diagnosed with an illness.”

In the second interview segment, Stewart admitted that he had broader concerns about what many saw as “incompetence” in Obamacare’s implementation over the last week.

See part 1 of the segment above, and watch part 2 below (story continues below video):

When Sebelius again defended the importance of making sure more people have health insurance and aren’t relying on treatment at the emergency room, Stewart said he believed this goal would have been best achieved through a single-payer system.

“I don’t understand the idea of staying with a market-based solution for a problem where people can’t be smart consumers. There are too many externalities in health care that I honestly don’t understand, why businesses would jump at the chance to decouple health insurance from their responsibility, and why the government wouldn’t jump at the chance to create a single-payer that simplifies this whole gobbledegook and creates the program that I think America deserves,” Stewart said.

Sebelius said she understood Stewart’s point, but thought “the president did not want to dismantle the health care that 85 percent of the country have and start all over again.” She also noted that the Republican response to Obamacare suggested that they wouldn’t have been too excited about the idea of a single-payer system run by the federal government.

http://www.huffingtonpost.com/2013/10/08/kathleen-sebelius-jon-stewart_n_4063267.html]]>

Reasons to Lose Sleep over the Shutdown and Obamacare

By Scott McLarty
CommonDreams, Oct. 6, 2013 Sure, the government shutdown and Republican demands regarding the Affordable Care Act (ACA) are reprehensible, but let’s not delude ourselves about the ACA itself. It’s needlessly complex. It preserves medical treatment as a commodity rather than a right: low-cost policies will provide low-quality insurance. It imposes a direct public subsidy to feed the insurance industry, which helped write the legislation. It isn’t universal. Millions of people who lacked it will now have health insurance, but the coverage they get won’t approach the level of health-care access guaranteed to every citizen in every other democratic nation. Obamacare is a Republican idea. It’s based on the individual mandate, an idea introduced by the conservative pro-business Heritage Foundation, promoted by Republican leaders, and enacted in Massachusetts by Gov. Romney. Republicans only began to detest it circa 2009 when President Obama and Democrats made it part of Obamacare. Conversely, progressives only began to support it when the ACA was introduced. Barack Obama opposed it during his presidential campaign but changed his mind in 2009. Is it obnoxious to suggest that the dispute over Obamacare was always more about partisan loyalties than substance? The shutdown will probably end when establishment Republicans convince Sen. Ted Cruz (R-Tex.) and his fellow Tea Partiers that they’ve had their fun and now it’s time to let adults run the show again. The main GOP objection to Obamacare is the “Obama” part. The legislation’s real defects aren’t important to the GOP. GOP Agenda and Obamacare Republicans are expert at aggravating crises and using instability to ram through their agenda: destroying social programs, privatizing resources and services, deregulating big business, recreating the dismal economic conditions of the Robber Baron Era. (Naomi Klein described this in her book “Shock Doctrine.”) Republicans can usually count on Democratic presidents and congressional leaders (who are subject to the same lobby and campaign-contribution influences as the GOP) to capitulate or compromise, sometimes without a fight, as President Obama did during the summer 2011 budget talks that resulted in sequestration. They often rely on Dems to pursue GOP agenda without GOP help. President Obama’s secretly negotiated Trans-Pacific Partnership trade pact, proposed Social Security reductions, and debt-expanding military actions would have been recognized as Republican ten years ago — as would the ACA. The ACA became a capitulation from the moment Sen. Max Baucus (D-Mont.), Chair of the Senate Finance Committee, declared single-payer national health care “off the table” during health-care reform panels in 2009. Single-payer advocates were barred from the panels, while insurance and other health-care industry representatives were invited to make sure their own interests were protected in the new legislation. Even the public option was dropped. The capitulation has serious consequences, a few of which I mentioned above. One consequence was reported in the New York Times on October 2: “A sweeping national effort to extend health coverage to millions of Americans will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance, the very kinds of people that the program was intended to help…. Because they live in states largely controlled by Republicans that have declined to participate in a vast expansion of Medicaid, the medical insurance program for the poor, they are among the eight million Americans who are impoverished, uninsured and ineligible for help.” By sacrificing universal health care, the new law accommodated Republican disregard for the poor in the 26 states that have rejected Medicaid expansion. The ACA isn’t a victory for the millions, maybe tens of millions of Americans for whom insurance and medical costs will remain beyond reach or require a hefty percentage of their income. Or for those who will still face financial ruin over a medical emergency. (For a more detailed critique, see Scott Tucker’s interview with Dr. Don McCanne of Physicians for a National Health Program.) These consequences won’t be disturbed when the shutdown ends and immediate funding for the ACA prevails. The ACA was designed to be partial solution to the crisis of skyrocketing medical costs that bankrupt working Americans, even those with insurance, and the lack of insurance for millions more. Useful Idiots The context of the government shutdown is a dispute within the GOP between traditional types and “kill the government” fundamentalists associated with the Tea Party. Are we witnessing an implosion of the GOP? We can only hope so, but it’s more likely we’ll see a return to bipartisan business as usual: two factions of a corporate-money party arguing over the best way to satisfy the country’s One-Percenters. (See “The Shutdown Game” by Glen Ford in Black Agenda Report, Oct. 2) One Percent aren’t really interested in shrinking government. They prefer laws and government that more efficiently and generously serve their interests. They want Washington to remove barriers to markets, profits, and consolidation into monopolies and cartels, even when it means destroying the middle class and plunging working Americans into helplessness. Plutocracy’s sole interests are money and power. Ideologies and economic theories are for little people, endowed academic seats, bow-tie wearing newspaper columnists, and other suckers. To the plutocrat, the Tea Party libertarian is a useful idiot. The plutocrat is grateful that the libertarian supports Walmart as a beacon of free-market competition and prosperity, while Walmart crushes small-business competitors and hires employees at wages that force them to rely on social services. The plutocrat thanks the libertarian for demanding deregulation of Wall Street derivatives in the name of free movement of capital, while ordering pet politicians to insure derivatives trading with taxpayers’ money against multi-billion and multi-trillion dollar losses. Plutocrats (with some exceptions, like the Koch brothers) transcend party and can live with any law or policy that allows them to boost the bottom line. The health-care debate between Dems and Repubs was rigged from the beginning by the One Percent, which made sure that insurance companies would continue to make a killing whether the ACA was passed or defeated. What About Medicare For All? Let’s imagine another scenario. A bloc of Democratic Congress members is willing to shut down government rather than vote yea on a budget with funding for another war like the 2003 invasion of Iraq. Good or bad? What if several Congress members had risked a shutdown in 2009 over the declaration that Medicare For All was “off the table” and that pro-single-payer physicians and consumer advocates would be banned from the health-care reform panels? These are fantasies. Anti-war and progressive Democrats in Congress are too timid to consider such actions. In contrast, Tea Partiers in Congress, fueled by the generosity of billionaire plutocrats, have no reservations about how they accomplish their goals. The only solution for America’s dismal health-care delivery system is Medicare For All — a single-payer plan that guarantees universal care. We’ll only win Medicare For All with a movement that goes beyond polite lobbying, with street protest as vigorous as Occupy Wall Street and a concerted effort to replace politicians in office. The latter requires a voter rebellion and campaigns that are independent of the two corporate-money parties. It means resisting the predictable claim o f Democratic leaders, after the shutdown ends, that the GOP’s retreat on the ACA is a victory for everyone who opposes the Tea Party and we shouldn’t complicate that victory by demanding Medicare For All. If we lose sleep during the government shutdown, I hope it’s because we’re pondering ways to surpass the Tea Party in asserting our own political power. Scott McLarty serves as media coordinator for the Green Party of the United States and for the DC Statehood Green Party. He can be reached at mclarty@greens.org. http://www.commondreams.org/view/2013/10/06

]]>

Switch to single-payer system for equity, solidarity and cost control

By Edgar Lopez, M.D., F.A.C.S.
Louisville (Ky.) Medicine, Letters, October 2013 I wanted to address some of the statements made by Dr. Gordon Tobin in “A Trillion Here, A Trillion There …” (Louisville Medicine, June 2013). 1. You fail to create a distinction between the original Medicare and the one administered by the profiteers of the private health insurance industry: the so-called Advantage Plans. The advantage plans (I would call them “disadvantage plans”) suck the money from the taxpayers in the form of excessive administrative expenses, decrease reimbursement to physicians and providers and the collateral damage is suffered by the Medicare system that is administered directly by the government. Sounds like a “conspiracy” or rather is working like such. If we would ever have (not with the bipartisan corrupted political system that we have) Expanded and Improved Original Medicare for All without the participation of the private health industry, all the physicians and providers would be reimbursed faster, better and equitably, meaning: taking in consideration high-tech specialties like yours and the primary care specialties that have a heavy dose of uncompensated cognitive work that goes unaccounted. 2. By the way, it is time that the specialty societies and the specialists that occupy prominent positions in the many medical societies start working in creating a bridge of solidarity with the primary care specialties which after all are the referring heath care providers to the specialty fields. There is a continental divide between the primary care providers and the multiple surgical specialties that needs to be erased with mutual generosity and cohesive solidarity to defend the medical profession against pseudo-medical organizations that claim magic cures for illness and all sort of medical problems. There is no room for arrogance among medical colleagues. (I got off track a little but this needs to be said.) 3. Agree with you that all type of physicians in all fields of primary care and specialties and subspecialties must be part of the cost control process and that includes the total elimination of conflict of interests when a physician is providing and advising medical care whether as treating physician or as a consultant. 4. The premium benefit imbalance that you so well explain in your note of the Doctors’ Lounge article would be immediately solved by switching to a single-payer system based on H.R. 676: The Expanded and Improved Medicare for All Act, devoid of the participation of the private health insurance profiteers. There is plenty of money in the Social Security and Medicare system unless we continue compromising with the insurance companies and continue the AMA self-destroying concept of incremental heath care reform that only gives us inadequate health care reform like the already failing Patient Protection and Affordable Care Act and gives chance to the corrupted political system to perpetuate our dysfunctional health care delivery and health care financing system. I almost say “cruel medical care system.” 5. There is only one viable solution: Comprehensive health care reform under the guidelines of H.R. 676. But to get to that we have to deal as a solid group of professionals with our corrupted bipartisan political system and that is another conversation.

Note: Dr. Lopez is a retired plastic surgeon. He is a member of Physicians for a National Health Program. https://www.glms.org/Content/User/Documents/Publications/LouisvilleMedicineOctober2013.pdf

]]>

Mercer update on changes in employer health benefits

Employers Hold the Line on Health Benefit Cost Per Employee in 2014

Mercer, October 1, 2013 Based on early responses from a major survey conducted annually by Mercer, employers expect health benefit cost per employee will rise by 4.8% on average in 2014 “The recession has been one factor behind slower cost growth, by dampening utilization,” said Beth Umland, Mercer’s director of research for health and benefits. “But employers have made fundamental changes in their health benefit programs in recent years that have put the brakes on unsustainable cost growth.”
 
Employers estimate that if they made no changes to their current plans, health benefit cost per employee would rise by 7% on average in 2014. One of the key strategies employers are using to manage cost growth is implementing consumer-directed health plans, which give employees financial incentives and information resources to seek more cost-effective care and are typically paired with an employee-controlled account. Another is health management (or “wellness”) programs focused on improving workforce health. And an emerging trend for 2014 that is expected to accelerate in 2015 is the use of private exchanges, such as Mercer Marketplace, which make it easier for employers to offer a range of medical plan options and voluntary benefits and which can be a tool in cost management. About a third of all large employer health plan sponsors (those with 500 or more employees) do not currently offer coverage to all employees working 30 or more hours per week, as will be required under the Affordable Care Act (ACA) beginning in 2015. Industries that rely heavily on part-time workers will be the hardest hit by this rule. About half of respondents in retail and hospitality currently do not offer coverage to all employees working 30 or more hours per week.
 
Some employers will minimize the number of newly eligible employees by cutting back on hours for at least a portion of their workforce – 11% of all large employers say they will do so. But most employers affected by the rule will simply open their plans to all employees working 30 or more hours per week and brace for rising enrollment. “Rising enrollment will be an even bigger issue in 2015 when the shared responsibility penalty goes into effect,” said Ms. Watts. “While some employers are going ahead with plans to expand eligibility in 2014 despite the delay, most of those with the big part-time populations are holding off and will feel the pinch in 2015.” Few large employers – just 5% – say it’s likely they will terminate their health plans within the next five years, even though public insurance exchanges will provide another source of health coverage. About a fifth of employers with fewer than 200 employees say it’s likely they will terminate their plans; employers of this size are much less likely to offer coverage to begin with. Under the ACA, beginning in 2018 employers will pay a 40% tax on the cost of health coverage in excess of $10,200 for an individual or $27,500 for a family. “This tax has been dubbed the ‘Cadillac tax’ but that’s really a misnomer,” said Ms. Watts. “Health coverage can often be expensive without being overly generous.”
 
Based on cost data collected in 2011, Mercer estimates that about 40% of employers would have to pay the tax on at least one plan if they made no changes to current plan design. Nearly a third of all large employers say they are taking steps in 2014 to avoid the tax in 2018 – in many cases, by adding a high-deductible consumer-directed health plan or taking steps to increase enrollment in an existing plan. http://www.mercer.us/press-releases/1557830

Comment:

By Don McCanne, M.D. These preliminary findings just released by Mercer indicate that employers will continue to take steps to reduce their own costs of their health benefit programs, by shifting even more costs to their employees. One of the more shocking new numbers is that nearly a third of large employers are taking steps in 2014 to avoid the 40 percent excise tax on expensive plans – a tax that will be assessed in 2018. These expensive plans do not have overly generous benefits, but they are expensive only because health care has become so expensive. To avoid the tax, most employers will be offering high-deductible, consumer-directed health plans which expose employees to greater out-of-pocket expenses. Although only 5 percent of large employers say that they will terminate their plans within the next five years, the deterioration in coverage will surely cause a backlash from those who need care and cannot afford the out-of-pocket expenses. It may be that those who currently feel secure with the plans they get through their work may be the ones who will eventually clamor for single payer once they see how exposed their plan revisions will leave them.

]]>

Obamacare is a continuation of the business model for insurance

By Joseph Jarvis, M.D.
Deseret News (Salt Lake City), Oct. 4, 2013 I agree with Dan Liljenquist that the cost of Obamacare has been grossly underestimated (“Obamacare will lead to single-payer health care,” Sept. 26). It is also likely that many more employees than originally predicted by the smoke and mirrors estimates offered at the time of passage of the Affordable Care Act will lose their employment-based health benefits, thus the now increasingly strident opposition of organized labor to the implementation of this legislation. Obamacare is neither affordable nor about care. But it is also not a stepping stone to single payer, nor was it ever intended to be. Dan Liljenquist offers no facts in support of his conspiracy theory that the end goal of Obamacare is to create “single-payer, socialized health care” in this country. Rather than taking us halfway to single payer, Obamacare is a continuation of many decades of government preference for the most wasteful health care financing scheme ever invented: the private, for-profit health insurance business model. Both parties are responsible for the continuing dominance of this useless business model. Federal tax policies and state regulations with bipartisan support over many decades have locked Americans into buying health insurance, despite the well documented fact that the health insurance business model features $400 billion per year excess administrative costs and still fails to hold down health care price inflation. Despite all of the incredibly wasteful claims reviews, American health insurers cannot effectively discriminate between high and low quality care. The perverse incentives of the American health care system occur because providers of care can make better margins by being reimbursed from health insurers for mediocre care. Obamacare is just one more governmental intervention on the side of the health insurers and against patients and taxpayers. During its deliberations preceding the passage of Obamacare, Congress explicitly excluded single-payer advocates from participating in hearings. Some single-payer activists were arrested when they tried to provide testimony at a Senate Finance Committee hearing. The public option, contrary to Liljenquist’s conspiracy theory, was explicitly voted down by Congress. Obamacare is the fruit of Obama’s deal with American health insurance interests, according to Frontline. Far from being the pathway to single payer, Obamacare is a guarantee to American health insurance that despite the massive wastefulness of its business model, American patients and taxpayers will be mandated to purchase its useless product in perpetuity. Ultimately, the ridiculous cost of this bipartisan worship of private, for-profit health insurance will undermine Obamacare. We cannot afford to continue to outspend the rest of the industrialized world on health care nearly two to one. What cannot be, therefore, will not be. It remains to be seen, however, whether we Americans will have the sense to ignore voices like Dan Liljenquist and stop fearing single payer soon enough to avoid a health system breakdown and the consequential economic meltdown. Obamacare is not a halfway house to single payer. It is the full realization of the bipartisan American government support of the private, for-profit health insurance business model over many decades. Without this political support, now including a mandate to purchase this worthless product, American health insurance would not survive. No one needs health insurance. It is time for Americans to stop fearing real change in how we do health care business. Let’s go to work replacing Obamacare with something that we really can afford. Start by looking at the solution proposed by the Utah Healthcare Initiative. Dr. Joseph Jarvis is chairman of the Utah Healthcare Initiative. http://www.deseretnews.com/article/865587634/Obamacare-is-a-continuation-of-the-business-model-for-insurance.html

]]>

Is Obamacare enough? Without single payer, patchwork U.S. health care leaves millions uninsured

Interview with Dr. Steffie Woolhandler and John McDonough

By Amy Goodman
Democracy Now, Oct. 7, 2013

Despite helping expanding affordable insurance, “Obamacare” maintains the patchwork U.S. health care system that will still mean high costs, weak plans and, in many cases, no insurance for millions of Americans. We host a debate on whether the Affordable Care Act goes far enough to address the nation’s health crisis with two guests: Dr. Steffie Woolhandler, a primary care physician and co-founder of Physicians for a National Health Program; and John McDonough, a professor at the Harvard School of Public Health and former senior adviser on national health reform to the U.S. Senate Committee on Health, Education, Labor, and Pensions. Between 2003 and 2008, McDonough served as executive director of Health Care for All in Massachusetts, playing a key role in the passage of the 2006 Massachusetts health reform law, known as “Romneycare,” regarded by many as the model for the current federal health care law.

This following is a rush transcript. Copy may not be in its final form.

AMY GOODMAN: We turn to a discussion on whether Affordable Care Act, or “Obamacare,” goes far enough in addressing the nation’s health crisis. The New York Times recently reported the new health care law will leave out two-thirds of the nation’s poor blacks and single mothers and more than half the nation’s low-wage workers who don’t have insurance. That’s because they live in 26 states controlled by Republicans that have rejected the vast expansion of Medicaid.

We’re joined by two guests: Dr. Steffie Woolhandler, professor of public health at CUNY-Hunter College and a primary care physician, visiting professor at Harvard Medical School and co-founder of Physicians for a National Health Program; and we’re joined from Boston by John McDonough, professor at the Harvard School of Public Health, director of the New Center for Public Leadership. Between 2008 and ‘10, he served as a senior adviser on national health reform to the U.S. Senate Committee on Health, Education, Labor, and Pensions. And between 2003 and 2008, he served as executive director for Health Care for All in Massachusetts, playing a key role in the passage of the 2006 Massachusetts health reform law known as “Romneycare,” regarded by many as the model for the current health care law. He recently wrote the book Inside National Health Reform.

We welcome you both back to Democracy Now! Let’s start in Boston with John McDonough. Your thoughts on this seven-day rollout, where most of the websites have not worked?

JOHN McDONOUGH: It was predicted, and it’s disappointing, and we hope they will get it fixed up as quickly as possible. And we recall what happened in 2006 with the rollout of the Medicare prescription drug program, which was plagued for many months with significant technical problems, and those problems were dealt with and addressed, and hardly anybody remembers them right now. What they remember is that the program is working pretty well for the tens of millions of Americans who are in it.

AMY GOODMAN: And, Dr. Steffie Woolhandler, your thoughts on this program that started October 1st?

DR. STEFFIE WOOLHANDLER: OK, well, the completer glitches will get sorted out, but the complexity that caused the computer glitches is baked into “Obamacare.” The exchanges have to deal with millions of enrollees and doing income verification. They have to deal with thousands of private insurance plans. It’s a very complex system. And unfortunately, that complexity also contributes to high expense. The private insurance industry that’s offering the coverage through the plans has overhead costs that are about four times as high as traditional Medicare. And in addition, we’re going to have overhead of about 4 percent added to insurance overhead just for the exchanges. So it’s a complex system, a very expensive system, and when we see the way it’s performing, we understand why we need a simple single-payer system that could save about $400 billion on administrative simplification.

AMY GOODMAN: For people who don’t have insurance or want to get cheaper insurance, do you encourage them to go to the websites to sign up for the new – under these new exchanges?

DR. STEFFIE WOOLHANDLER: Well, absolutely people need to take a look, but they also need to know that many of the new plans have high co-payments, high deductibles. They can have very restrictive networks. So, for some people, this will be a great deal. If your income is in the low range and you get a big subsidy, it can be a very good deal. If you’re sort of middle-income, I think you’re going to find you’re paying an awful lot of money for some very skimpy coverage through the exchanges.

AMY GOODMAN: Your response, John McDonough?

JOHN McDONOUGH: Well, yes, the law and the system around the law are complicated, and our underlying health care system is incredibly complicated, far more than it needs to be. I don’t really have a disagreement with my – with my friend and colleague, Steffie Woolhandler, about a division of what we would like to see. The reality is that this was probably the best we could have gotten in 2009, 2010. Getting anything even close to this would be politically impossible today. And, you know, I hope this is a movement in the direction toward a more rational and less complex system, but it is an important start and an important step forward for potentially tens of millions Americans, a lot of whom are going to get coverage that’s going to be very affordable and at almost no cost.

AMY GOODMAN: Is this a road to single payer, Dr. Steffie Woolhandler?

DR. STEFFIE WOOLHANDLER: Well, it’s only a road to single payer if we fight for single payer.

AMY GOODMAN: And what does that mean when we say “single payer”?

DR. STEFFIE WOOLHANDLER: OK, well, single payer is also known as expanded and improved Medicare for all, also known as nonprofit national health insurance. It 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.

AMY GOODMAN: What do you mean, “index cards”?

DR. STEFFIE WOOLHANDLER: They didn’t have computers back in 1966, OK? So they expanded – went from zero to over 20 million people enrolled in Medicare in a period of six months. And because it was a simple system, based on the Social Security records, it was a tax-based system, you didn’t have hundreds of people programming the state of Oregon, thousands of different plans, tons of different co-payments, deductibles and restrictions – one single-payer plan, which is what we need for all Americans to give the Americans really the choice they want, which is not the choice between insurance company A or insurance company B. They want the choice of any doctor or hospital, like you get with traditional Medicare.

AMY GOODMAN: Democratic Senator Barbara Mikulski of Maryland has hailed “Obamacare” as a victory for women.

    SEN. BARBARA MIKULSKI: [Forty-two] million people in the United States of America don’t have a doctor, don’t have access to a doctor, but they have hope because the health care is being implemented. We speak for the 150 million women in the United States of America who now have health care because “Obamacare” has been implemented. Being a woman in the United States of America is no longer considered a pre-existing condition by the insurance companies. We have been denied health care because of pregnancy, because of domestic violence and because of other things.

AMY GOODMAN: That’s the Democratic Senator Barbara Mikulski of Maryland. Steffie Woolhandler?

DR. STEFFIE WOOLHANDLER: Well, that’s great that there’s some guaranteed issue, meaning that the insurance companies have to give you coverage if you apply. But much of the coverage is going to be extremely skimpy and not particularly affordable. And there will be 31 million Americans left out of “Obamacare,” and about five million of those 30 million uninsured will be uninsured because of the red state governors opting out of Medicaid. But 25 million of those uninsured are uninsured by the very design of “Obamacare.”

AMY GOODMAN: How?

DR. STEFFIE WOOLHANDLER: They were never included in the original estimations of the bill. That’s because you have to take money out of your pocket to buy insurance, and as you get up into the middle-income levels, the insurance is extremely expensive, and many people won’t be buying it. About one-third of those people will be undocumented immigrants, but two-thirds will be U.S. citizens, mostly working poor, who still cannot afford – afford health insurance under “Obamacare.”

AMY GOODMAN: John McDonough, your response to that and whether you – how you see this transitioning? I mean, do you ultimately see expanded Medicare for everyone as the answer in this country?

JOHN McDONOUGH: Two very big questions, Amy. So, on the first piece, on the 25 million, so, you know, when Medicaid was started in 1965, it was voluntary for states to get in. It wasn’t until the 1970s that most – nearly all states were in, and it wasn’t until 1982 that all 50 states were in. Arizona was the last state to join, in 1982. I would predict that within five years all 50 states will be participating in this new Medicaid expansion, because the benefits of it are so great for states, and it’s – it will be a lot easier when the temperature on “Obamacare” as a political issue diminishes.

The other thing to keep in mind, of the 25 million, about a third of them are people who will be eligible for Medicaid and who fail to sign up for Medicaid. We would like those folks obviously to sign up and get all of the preventive care and primary care, but the important thing to understand is that when those folks show up at a clinic, at a hospital for care, they won’t be told, “We can’t treat you.” They can get signed up and qualify for Medicaid on the spot. So it’s a different relationship in terms of who will still be uncovered. There will still be a significant number uncovered, but they will have access to services, and they will not walk in and say, “Sorry, you’re going to have to pay, or we won’t treat you.” It’s going to be a very different situation for those people.

Whether this leads to a Medicare single payer, I think it’s way too early to say. I would hope that it would, because, frankly, I didn’t see any particular traction in terms of trying to move to that direction before “Obamacare.” And I think there’s enough changes going on right now that there may be some changes in terms of the prospects.

AMY GOODMAN: Dr. Woolhandler?

DR. STEFFIE WOOLHANDLER: Yeah, well, I’m very doubtful that people can just walk into any doctor’s office and say, “I’m uninsured,” and get care because somebody there happens to think they might get Medicaid. That’s not how things work now, and I don’t see why it would work that way under “Obamacare.” I mean, unfortunately, “Obamacare” is –

JOHN McDONOUGH: It works that way in Massachusetts now.

DR. STEFFIE WOOLHANDLER:  – is a very expensive program that offers halfway coverage to half of the people who need it. And we need to be moving forward to single payer to make sure every single American can go to any doctor they want and be able to afford that.

AMY GOODMAN: President Obama –

JOHN McDONOUGH: The way –

AMY GOODMAN: Oh, go ahead. Go ahead, John McDonough.

JOHN McDONOUGH: No, I mean – no, the way it works in Massachusetts and the way it has worked since the health reform law in 19 – in 2007 is that if you are eligible for Medicaid, categorically eligible, and you go into a clinic, a community health center or a hospital, and you can get enrolled in Medicaid, you get enrolled in Medicaid on the spot. And so, you walk in – so, yeah, you were uninsured. You need medical services, you go in, and you’re covered. So, and that is the model for how the system is designed to work under the ACA beginning on January 1st.

AMY GOODMAN: President Obama has cited a woman named Natoma Canfield as inspiration for his Affordable Care Act.

    PRESIDENT BARACK OBAMA: You know, there’s a framed letter that hangs in my office right now. It was sent to me during the health care debate by a woman named Natoma Canfield. For years and years, Natoma did everything right. She bought health insurance. She paid her premiums on time. But 18 years ago, Natoma was diagnosed with cancer. And even though she had been cancer-free for more than a decade, her insurance company kept jacking up her rates, year after year. And despite her desire to keep her coverage, despite her fears that she would get sick again, she had to surrender her health insurance and was forced to hang her fortunes on chance. I carried Natoma’s story with me every day of the fight to pass this law.

AMY GOODMAN: Steffie Woolhandler, would a woman like Natoma Canfield now have better options than before?

DR. STEFFIE WOOLHANDLER: Well, it really depends on her income. If her income is hovering around 400 percent of the poverty line, the health insurance would be very, very expensive indeed. And what we need is something that just covers everyone automatically.

AMY GOODMAN: So how are you doing that work now? I mean, you talk about how expanded Medicare, you know, Medicare for all, would be the path to go, but you see now the – just “Obamacare” alone has brought down the government. Or do you see “Obamacare” not as a step to single payer, that it makes sense to you that even – that Republicans would be objecting to this, as well?

DR. STEFFIE WOOLHANDLER: Well, “Obamacare” is the law of the land. And there are some good things. Certainly expanding the Medicaid program is a good thing. But we need to be thinking about single payer, moving forward. And our group, Physicians for a National Health Program, has about 17,000 members. And as you can imagine, there’s some disagreement. Some people are very pro-”Obamacare.” Some people are more tepid, like myself. But we all agree that it is not a solution, that we still need single payer, and we need to be moving forward and building the movement to go forward to single payer.

AMY GOODMAN: Dr. John McDonough, the issue of Medicaid being denied to so many millions of people around the country – was “Obamacare” framed around them actually getting that Medicaid so – what is your response to that?

JOHN McDONOUGH: Yeah, Title II of the Affordable Care Act deals with Medicaid. And the way it was written by the folks in the House and the Senate was that all states, on January 1, 2014, are required to open up their Medicaid programs to all uninsured people with incomes below 138 percent of the federal poverty line, which is about $14,000 to $15,000 for a single adult. And it was the U.S. Supreme Court decision in June of 2012 that changed that. The one substantive change the Supreme Court made in the ACA was to say that the Medicaid expansion had to be a state option. And so, we are faced with this really awful situation where, beginning January 1 of next year, the only Americans who will not have some form of health insurance available to them as a matter of law are poor individuals who live in states that have chosen not to expand Medicaid. So, it is probably one of the most cruel and despicable forms of rationing I can imagine that it is folks who are among the most vulnerable in some of the neediest states who are denied this coverage. I do think it’s going to change. I do think it’s going to happen relatively quickly. And again, I’d say within five years, I think just about all states are going to be part of this expansion.

AMY GOODMAN: Your response to that, Dr. Steffie Woolhandler? And how are you organizing for expanded Medicare, Medicare for all?

DR. STEFFIE WOOLHANDLER: OK, well, it depends a lot on your definition of “affordable.” Under “Obamacare,” someone my age with an income of about $45,000 a year or more would have to pay $8,300 a year in premiums, more than $8,000 a year in premiums. And very few people have room for that in their budget. And that’s why many middle-income people will remain uninsured under “Obamacare.” Plus, they’ll be paying a penalty for not purchasing that expensive insurance. It’s simply not going to be affordable.

Our group, Physicians for a National Health Program, has been working with Health care-NOW!, has been working with unions, and mostly working in our own community – that is, the physician community – to educate people about single payer, to advocate for single payer, to continue to push for single payer both at the state level and at the national level. And we feel that once people see what “Obamacare” really is, that it is not a solution to the health care crisis, once they realize “Obamacare,” whatever its strengths, is not a solution, they’ll be motivated to join the movement for single payer.

AMY GOODMAN: And how do they get – what do you think is the most critical first step now in that movement, given how the Republicans are even responding to this?

DR. STEFFIE WOOLHANDLER: Well, I think people need to educate themselves about single payer. They need to work in their communities around single payer. I think that the – what the Republicans are doing is reprehensible. I’m not supportive of that, obviously. But I think we need to be pushing, saying we want single payer. I mean, the Republicans have made a big deal out of about half of Americans reject “Obamacare,” but what they don’t tell you is that a third of those people reject “Obamacare” because they didn’t think it went far enough. And, in fact, in The New York Times on Saturday, they interviewed a very conservative guy in Georgia who said, “I hate ‘Obamacare.’ I support the Republicans. What we need is a single-payer system.” So, I think a lot of people are coming around to that view, and we need to continue to put that out there and push for that, because that’s what Americans need.

AMY GOODMAN: If we were going to single payer, expanded Medicare, today – or let’s say October 1st – what would have happened?

DR. STEFFIE WOOLHANDLER: Well, we could have just enrolled everyone automatically through the Social Security Administration, which already has the names of everyone through Social Security numbers or ITNs. It already knows our income. It knows at least where we work and probably where we live, so he wouldn’t have had to set up all these exchanges and new systems with all of these glitches and all this expense, because by going with a Social Security-based system, like they have in Canada, like they have in most of Europe, you save all that paperwork cost, and that allows you to devote more money to care. You know, other nations have nonprofit national health insurance and spend substantially less than we do and cover everyone, largely because they save on that administrative complexity and expense.

AMY GOODMAN: I want to thank you both for being with us, Dr. Steffie Woolhandler, now at CUNY-Hunter College – that’s City University of New York – and a founder of Physicians for a National Health Program; John McDonough, with us from Boston, the Harvard School of Public Health, has written the book Inside National Health Reform. He contributed to shaping “Romneycare” and then “Obamacare.”

This is Democracy Now! When we come back, an exclusive conversation with Ladar Levison, who ran the website Lavabit, until he shut it down. Edward Snowden used the email service, and the FBI came a-knocking. Ladar Levison will explain what happened next. Stay with us.

http://www.democracynow.org/2013/10/7/is_obamacare_enough_without_single_payer

]]>

Congress gets the gold, and the people get silver? bronze?

Changes in Health Coverage FAQs

U.S. Office of Personnel Management Members of Congress and Designated Staff How will Members of Congress and designated congressional staff obtain health coverage in 2014? House of Representatives and Senate offices will provide health coverage to Members of Congress and designated staff through the Marketplace.  OPM has determined the most appropriate Marketplace is the Small Business Health Options Program (SHOP). SHOPs were established to administer group health benefits to employees of small businesses. Given the location of Congress in Washington D.C., OPM has determined that the DC SHOP, known as the DC Health Link Small Business Market administered by the DC Health Benefit Exchange Authority, is the appropriate SHOP from which Members of Congress and designated congressional staff will purchase health insurance in order to receive a Government contribution. From which “Metal Level” on the DC SHOP will Members of Congress and designated congressional staff choose their plans? Members of Congress and designated staff will choose from plans on the Gold Metal Level of the DC SHOP, which currently includes 112 choices. While all plans have the same “essential health benefits” (EHB), plans vary in copays, coinsurance, deductibles, and benefits beyond the EHB. Plans include fee-for-service, HMOs, Point of Service, and HSA-compatible plans. http://www.opm.gov/healthcare-insurance/changes-in-health-coverage/changes-in-health-coverage-faqs/#SHOPHealthCoverage

Comment:

By Don McCanne, M.D. Supposedly requiring Members of Congress and their staffs to participate in the insurance exchanges established by the Affordable Care Act was to make their coverage comparable to what the rest of us would have (an oversimplification since most of us will not be enrolled in the exchanges). Yet the benchmark plans setting the subsidies in the exchanges are silver tier plans with an actuarial value of 70 percent, and the plans which qualify for Federal Employees Health Benefits (FEHB) premiums for Members of Congress are limited to the gold tier plans with an actuarial value of 80 percent. This is much more significant than it appears to be. The gold plans for the Members of Congress pay about 80 percent of their health care costs, and about three-fourths of their premiums are paid by the taxpayers. This is comparable to the more traditional employer-sponsored plans that most of us considered to be good insurance coverage. In essence, as members of Congress and their staffs move into the exchanges, they are being assured that they will have coverage very close to that which they now have in the FEHB program. The standard silver tier for individuals selecting their plans though the exchanges will leave the patient responsible for paying 30 percent of costs out-of-pocket, though lower income individuals will qualify for subsidies that are considered to be inadequate. Also the narrow networks of the exchange plans risk exposing patients to 100 percent of sometimes unavoidable out-of-network costs, with no cap on spending. Further, because of their lower premiums, many will choose the bronze plans at 60 percent actuarial value, risking greater financial hardship should significant health care be required. This is a huge difference since the 80 percent actuarial value plans for Congress are considered to be standard insurance, whereas the 60 to 70 percent actuarial value plans for the general public are considered to be underinsurance – plans that do not provide adequate financial security in the face of medical need. We didn’t get this right. A gold standard for Congress and a lesser standard for the people? Let’s “Occupy Congress” by replacing those in Congress who don’t seem to get it with legislators who will bring us what we need – a single payer, improved Medicare that covers everyone.

]]>

Health Care for All Colorado gives info on Initiative 12

By Christy Steadman
Canon City (Colo.) Daily Record, Oct. 3, 2013 Community members gathered Wednesday to hear information on Colorado’s ballot Initiative 12, “Right to Health Care,” at Shepherd of the Hills Lutheran Church for a free public forum sponsored by Health Care for All Colorado. “It’s important to me to have the community I live in be healthy. That makes my chances of being healthy better,” said Anne C. Courtright, M.D., of the Southeast (Pueblo) Chapter of HCAC. Speaking at the event was Donna Smith, executive director of HCAC, and Dr. Louis Balizet, Pueblo oncologist and member of HCAC and Physicians for a National Health Plan. “We feel that health care is a human right and that every American should have some way to access health care regardless of financial status,” Balizet said. According to the HCAC website, Initiative 12 “will give Coloradans an opportunity to vote in November 2014 to establish health care as a human right and public good in the Colorado constitution.” It will “amend the Colorado constitution to provide one public health insurance program,” which “must allow all Colorado residents access to a single standard of health care” to cover “medical, mental health, dental and long-term care services,” stated the website. According to the website, “the department of revenue (would) collect a premium not to exceed nine percent of an individual’s income to fund the plan” and would “prohibit the control or administration of premiums by a for-profit, nonpublic entity or corporation.” A hand-out written by the HCAC says “the individual and employer mandate of the Affordable Care Act (Obamacare) are expanded to require all Colorado residents to have health insurance.” “Health insurance is not health care. Health insurance is a financial product,” Smith said. “But somehow they’ve worked it to make it sound like it’s something more — and it’s not.” Smith said states are allowed to innovate their own plan by 2017 if they can prove that it can “cover as many people, and do so as well” as Obamacare. “I am quite committed that the Affordable Care Act of Obamacare is not the answer to universal access to health care,” said Balizet. “Even at a most optimistic projection.” The HCAC is in the process of gathering the 86,105 signatures needed for Initiative 12 by their Oct. 25 deadline. “If we haven’t accomplished anything else in the course of trying to collect our necessary number of signatures,” Courtright said. “We have at least increased the number of people that know there is a problem and that there is a solution.” According to the HCAC website, the HCAC is a “nonprofit social welfare organization, which began in 2001 in response to the increasing numbers of Coloradans who are not able to secure basic health care in our current health care system.” They advocate “the adoption of a single-payer system, which ensures that all Coloradans have access to affordable and comprehensive health care services.” For more information, visit healthcareforallcolorado.org or call Courtright at (719) 543-5148. http://www.canoncitydailyrecord.com/news/canoncity-local-news/ci_24236046/health-care-all-colorado-gives-info-initiative-12

]]>

Blacks disproportionately being left uninsured

Millions of Poor Are Left Uncovered by Health Law

By Sabrina Tavernise and Robert Gebeloff
The New York Times, October 2, 2013 A sweeping national effort to extend health coverage to millions of Americans will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance, the very kinds of people that the program was intended to help, according to an analysis of census data by The New York Times. Because they live in states largely controlled by Republicans that have declined to participate in a vast expansion of Medicaid, the medical insurance program for the poor, they are among the eight million Americans who are impoverished, uninsured and ineligible for help. Those excluded will be stranded without insurance, stuck between people with slightly higher incomes who will qualify for federal subsidies on the new health exchanges that went live this week, and those who are poor enough to qualify for Medicaid in its current form, which has income ceilings as low as $11 a day in some states. The 26 states that have rejected the Medicaid expansion are home to about half of the country’s population, but about 68 percent of poor, uninsured blacks and single mothers. About 60 percent of the country’s uninsured working poor are in those states. Among those excluded are about 435,000 cashiers, 341,000 cooks and 253,000 nurses’ aides. “The irony is that these states that are rejecting Medicaid expansion — many of them Southern — are the very places where the concentration of poverty and lack of health insurance are the most acute,” said Dr. H. Jack Geiger, a founder of the community health center model. “It is their populations that have the highest burden of illness and costs to the entire health care system.” The disproportionate impact on poor blacks introduces the prickly issue of race into the already politically charged atmosphere around the health care law. Race was rarely, if ever, mentioned in the state-level debates about the Medicaid expansion. But the issue courses just below the surface, civil rights leaders say, pointing to the pattern of exclusion. Every state in the Deep South, with the exception of Arkansas, has rejected the expansion. Opponents of the expansion say they are against it on exclusively economic grounds, and that the demographics of the South — with its large share of poor blacks — make it easy to say race is an issue when it is not. Blacks are disproportionately affected, largely because more of them are poor and living in Southern states. In all, 6 out of 10 blacks live in the states not expanding Medicaid. In Mississippi, 56 percent of all poor and uninsured adults are black, though they account for just 38 percent of the population. Dr. Aaron Shirley, a physician who has worked for better health care for blacks in Mississippi, said that the history of segregation and violence against blacks still informs the way people see one another, particularly in the South, making some whites reluctant to support programs that they believe benefit blacks. http://www.nytimes.com/2013/10/03/health/millions-of-poor-are-left-uncovered-by-health-law.html?emc=edit_tnt_20131003&tntemail0=y&_r=0&pagewanted=all

Comment:

By Don McCanne, M.D. When the Supreme Court relieved the states of the requirement to expand their Medicaid programs as a condition of continuing to receive federal Medicaid contributions, it was understood that, in those states that did not voluntarily participate, many low-income people who were not eligible for plans to be offered in the exchanges (since they were to have been covered by Medicaid) would now also remain ineligible for Medicaid. Thus the most vulnerable are to be left with no coverage at all. What this New New York Times analysis adds to our understanding is that the sector hardest hit is poor blacks, especially those living in the South. State politicians must carry much of the blame for this egregious health care injustice. If they agreed to participate, the states eventually would be required to fund only ten percent of this expansion, and none of the costs at the beginning. These politicians fully understood the demographics of the populations they refused to cover. So why did they refuse to authorized the quite modest expenditures that would bring health care to these people? Was it because they are poor? Or is it because they are predominantly black? Regardless, we can blame not only these politicians, but also the voters who keep them in office. It is heartbreaking to realize that that so much of Martin Luther King’s Dream remains only a dream. We still desperately need reform that is truly equitable and egalitarian. The Affordable Care Act didn’t get us there.

]]>

Despite ACA’s improvements, many big holes and problems will remain

By Steffie Woolhandler, M.D.
“To the Point,” KCRW – PRI radio, Oct. 1, 2013

The following text represents the comments of Dr. Steffie Woolhandler, one of PNHP’s co-founders, taken from an unofficial transcript of a radio program that was broadcast by KRCW in Santa Monica, Calif., and Public Radio International on Oct. 1. The host was Warren Olney. The panelists were Mary Agnes Carey of Kaiser Health News, Harold Pollack of the University of Chicago, Dr. Fitzhugh Mullan of George Washington University, and Dr. Woolhandler, who is professor of public health at the City University of New York.

Warren Olney: Dr. Woolhandler, you’re concerned about the Affordable Care Act, as I understand it. Why?

Dr. Steffie Woolhandler: Let’s be clear. The Affordable Care Act is going to leave 31 million people uninsured, and even if the Red state governors had never stepped in, even if the Supreme Court had never stepped in, Obamacare as written was designed to leave 25 million people uninsured. So it’s a very partial solution that, even if enacted as written, would have left half of uninsured Americans still uninsured. And 25 million uninsured is unacceptable to me as a physician, as is 31 million uninsured. We should have gone to a single-payer system, also known as nonprofit national health insurance, also known as expanded and improved Medicare for all, and then the money we spent on health care would have been enough to cover 100 percent of everyone and then we would also have enough to remove co-payments and deductibles from people who have insurance already. So our group, Physicians for a National Health Program, is still pushing for single-payer national health insurance, like they have in Canada and most of Western Europe.

WO: What are the prospects, though? The Affordable Care Act doesn’t even include a public option.

SW: Well, I think as soon as people see the problems in Obamacare – and I do want to agree with the other panelists, there are some improvements that we got through Obamacare. Certainly a lot of people ended up getting Medicaid that didn’t have it before. But there’s still a lot of holes and problems, not the least the 31 million uninsured, not the least the fact that that you end up paying a lot of money for very skimpy coverage on those insurance exchanges — including policies with deductibles of $2,000, co-insurance of 20 percent. When people actually see Obamacare in action, they’re going to say we need to move forward to single payer, we have not solved the problem yet, and single payer is still necessary.

WO: Would single payer eliminate the insurance companies and the amount that’s spent on their overhead?

SW: Absolutely. The insurance companies are allowed an overhead of 15 percent under Obamacare. That’s seven times more than the overhead in single-payer systems like Canada’s, seven times more than is spent in traditional Medicare for overhead. So 15 percent is just pathetic, and we need to be getting the kind of administrative cost savings that are only possible through single-payer systems.

WO: Dr. Woolhandler, if [the previous speaker’s claims are] true, that is, if the Affordable Care Act is so much better than what we have now, what then are the prospects for there being a sufficient amount of backlash that we may actually see a single-payer system?

SW: It may be better, but there are plenty of problems for lots of people, not just the 31 million uninsured. People are going to be shocked to see how skimpy these policies are, particularly if you’re not eligible for subsidies or you’re at the high end of that income range and your subsidy is very small. People are going to be paying premiums of $9,000 a year, they’re going to be paying deductibles of $2,000 per year. It’s part of a trend of insurance policies getting skimpier and skimpier, and Obamacare is actually contributing to that trend. So I think lots of people are going to be dissatisfied, and you know polls already show the majority of Americans support the idea of Medicare for all, a government insurance program funded through taxes. The block to that kind of health reform was not public opinion, it was the money of the insurance industry and Big Pharma, and that’s what we’re going to have to combat to get single payer.

WO: One thing we haven’t talked about is the individual mandate and what it means. [Here another panelist recaps the specific provisions of the law, the fines, etc.] Dr. Woolhandler, does that sound fair to you, as a way of getting enough people enrolled in insurance who will be able to pay the freight?

SW: No. The mandate is a terrible idea. Why is the federal government using its authority to force individuals to hand their money to private health insurance? If they want to do a public, universal system, then it should be paid for through taxes. But citizens should not be required to hand their money over to a private insurance industry. That makes no sense.

For the full radio program, visit: http://www.kcrw.com/news/programs/tp/tp131001the_government_shutd

PNHP note: This week several other PNHP leaders and activists gave broadcast interviews about the Affordable Care Act and the need for single payer, including Dr. Oliver Fein of New York City; Dr. Paul Song of Santa Monica, Calif.; Dr. Margaret Flowers of Baltimore; Dr. Philip Caper of Brooklin, Maine.

]]>