PNHP

Sacramento rally pushes for single-payer, universal health care

Sacramento rally pushes for single-payer, universal health care

By Kathy Robertson
Sacramento Business Journal, Feb. 12, 2013

SACRAMENTO, Calif. — “Everybody in, nobody out” was the chant by a couple hundred people gathered at the Capitol at noon on Monday to rally for a single-payer, universal health care system in California.

Some have unsuccessfully rallied in Sacramento for eight years, only to see the initiative flounder before lawmakers or be vetoed. In the meantime, focus has turned to President Barack Obama’s federal health care overhaul.

This is the first time supporters do not have an author for a universal health care bill, but that could have change because supporters canvassed the Capitol after the rally, searching for an author.

“Enough is enough,” Kathy Kennedy, a registered nurse in the neonatal intensive care unit at Kaiser’s Roseville hospital, said from a podium on the Capitol steps. “We support the ACA’s expansion of Medi-Cal and restraining the abuses by insurance companies, but we have a lot of Californians still without health care — and that is not right.”

Kennedy also serves on the board of directors for the California Nurses Association, a longtime supporter of universal health care and one of the rally organizers.

The Affordable Care Act does not cover undocumented immigrants, estimated at about 2 million in California.

Kathy Robertson is senior staff writer at the Sacramento Business Journal.

http://www.bizjournals.com/sacramento/blog/kathy-robertson/2013/02/rally-pushes-for-single-payer-health.html

Where is WellPoint headed?

WellPoint Names New Chief Executive

By Anna Wilde Mathews and Jon Kamp
The Wall Street Journal, February 12, 2013

WellPoint Inc. named Joseph R. Swedish as its new chief executive, unexpectedly turning to a hospital-industry veteran to lead the second-largest U.S. health insurer through the challenging implementation of the health-care overhaul.

Mr. Swedish, 61 years old, will take over as CEO on March 25, the company said. Since 2004, he has been president and CEO of Trinity Health, a Catholic operator of 47 hospitals with revenue of around $9 billion last year.

The choice is likely to surprise investors, whose displeasure with previous WellPoint CEO Angela Braly helped lead to her resignation last August. Mr. Swedish’s career has been spent on the provider side of health care, and recently at nonprofit institutions, so he isn’t a familiar face for managed-care investors.

Mr. Swedish’s hospital experience could be viewed as helpful, but investors were generally predicting WellPoint would pick a managed-care veteran, said Thomas Carroll, an analyst at Stifel Nicolaus. “This individual is completely out of the blue from an investor-expectation standpoint,” he said.

In general, lines between insurers and health-care providers have been increasingly blurring, and Mr. Swedish said both sides are facing similar “strategic bets” as the industry changes. Indianapolis-based WellPoint is already working on collaborations with providers, and he wants to “accelerate that at a very rapid pace,” he said. WellPoint is expanding the operations of CareMore Health Group, a Medicare plan it bought that also operates its own care centers, and it has launched an initiative aimed at paying primary-care doctors more to coordinate patients’ care.

Trinity is a “well-managed health system,” with stable operations and a strong balance sheet, said Kay Sifferman, a vice president at Moody’s. Both Moody’s and Standard & Poor’s rate Trinity’s bonds highly. Before his announced departure, Mr. Swedish was moving toward consummating a major combination, with Catholic Health East, that would create the fifth-largest U.S. hospital system.

WellPoint has said it is planning and investing heavily to ensure it will have a strong presence on the new health exchanges, as well as doing extensive consumer research to ensure it crafts products that will resonate with buyers. “We will continue to progress with what they have already initiated,” Mr. Swedish said. “Quite frankly, I like our chances.”

WellPoint includes 14 Blue Cross and Blue Shield plans and has a major presence in California, often seen as a tough market for health insurers. The company has “to execute to win,” Mr. Swedish said. “We are all very attentive to that.”

http://online.wsj.com/article/SB10001424127887324880504578300432881680410.html

Comment:

By Don McCanne, M.D.

According to The Wall Street Journal, “lines between insurers and health-care providers have been increasingly blurring,” a fact we already knew. The appointment of a hospital CEO, who is currently involved in major consolidation efforts, as the new CEO of WellPoint – the nation’s second largest insurer – seems to blur even further the line between insurers and health care providers.

Health care providers take care of patients. Insurers take care of business. With consolidation on all fronts, insurers are blending into the providers. With this new model, the insurer/health care provider is becoming well positioned to take care of… well… business. And the patients? As the incoming WellPoint CEO says, the company has “to execute to win.” Isn’t there something Freudian about “execute”?

Where is WellPoint headed?

WellPoint Names New Chief Executive

By Anna Wilde Mathews and Jon Kamp
The Wall Street Journal, February 12, 2013
WellPoint Inc. named Joseph R. Swedish as its new chief executive, unexpectedly turning to a hospital-industry veteran to lead the second-largest U.S. health insurer through the challenging implementation of the health-care overhaul.
Mr. Swedish, 61 years old, will take over as CEO on March 25, the company said. Since 2004, he has been president and CEO of Trinity Health, a Catholic operator of 47 hospitals with revenue of around $9 billion last year.
The choice is likely to surprise investors, whose displeasure with previous WellPoint CEO Angela Braly helped lead to her resignation last August. Mr. Swedish’s career has been spent on the provider side of health care, and recently at nonprofit institutions, so he isn’t a familiar face for managed-care investors.
Mr. Swedish’s hospital experience could be viewed as helpful, but investors were generally predicting WellPoint would pick a managed-care veteran, said Thomas Carroll, an analyst at Stifel Nicolaus. “This individual is completely out of the blue from an investor-expectation standpoint,” he said.
In general, lines between insurers and health-care providers have been increasingly blurring, and Mr. Swedish said both sides are facing similar “strategic bets” as the industry changes. Indianapolis-based WellPoint is already working on collaborations with providers, and he wants to “accelerate that at a very rapid pace,” he said. WellPoint is expanding the operations of CareMore Health Group, a Medicare plan it bought that also operates its own care centers, and it has launched an initiative aimed at paying primary-care doctors more to coordinate patients’ care.
Trinity is a “well-managed health system,” with stable operations and a strong balance sheet, said Kay Sifferman, a vice president at Moody’s. Both Moody’s and Standard & Poor’s rate Trinity’s bonds highly. Before his announced departure, Mr. Swedish was moving toward consummating a major combination, with Catholic Health East, that would create the fifth-largest U.S. hospital system.
WellPoint has said it is planning and investing heavily to ensure it will have a strong presence on the new health exchanges, as well as doing extensive consumer research to ensure it crafts products that will resonate with buyers. “We will continue to progress with what they have already initiated,” Mr. Swedish said. “Quite frankly, I like our chances.”
WellPoint includes 14 Blue Cross and Blue Shield plans and has a major presence in California, often seen as a tough market for health insurers. The company has “to execute to win,” Mr. Swedish said. “We are all very attentive to that.”
http://online.wsj.com/article/SB1000142412788732488050457830043288168041…

According to The Wall Street Journal, “lines between insurers and health-care providers have been increasingly blurring,” a fact we already knew. The appointment of a hospital CEO, who is currently involved in major consolidation efforts, as the new CEO of WellPoint – the nation’s second largest insurer – seems to blur even further the line between insurers and health care providers.
Health care providers take care of patients. Insurers take care of business. With consolidation on all fronts, insurers are blending into the providers. With this new model, the insurer/health care provider is becoming well positioned to take care of… well… business. And the patients? As the incoming WellPoint CEO says, the company has “to execute to win.” Isn’t there something Freudian about “execute”?

Summary: H.R. 676, The Expanded & Improved Medicare For All Act

PNHP note: The following text draws heavily upon the summary of H.R. 676 provided by Rep. John Conyers Jr. when he introduced his bill in 2011. PNHP has made some slight alterations, chiefly to reflect new estimates of cost savings. The full text of his current bill (115th Congress) is here.

Brief summary of legislation

H.R. 676 establishes a unique American universal health insurance program with single-payer financing. The bill would create a publicly financed, privately delivered health care system that improves and expands the already existing Medicare program to all U.S. residents, and all residents living in U.S. territories. The goal of the legislation is to ensure that all Americans will have access, guaranteed by law, to the highest quality and most cost effective health care services regardless of their employment, income or health care status. In short, health care becomes a fundamental human right, with no financial barriers or financial harm resulting from seeking care. With 42 million uninsured Americans, and many millions more who are underinsured, the time has come to change our inefficient and costly fragmented non-system of health care. The current for-profit health care system in the U.S. is not financially sustainable over the long run, hence the need for a unique nonprofit, universal single-payer health care system.

Who is eligible

Every person living or visiting in the United States and the U.S. Territories would receive a “Medicare For All Card” and ID number once they enroll at the appropriate location. Social Security numbers may not be used when assigning ID cards.

Health care services covered

This program will cover all medically necessary services, including primary care, medically approved diet and nutrition services, inpatient care, outpatient care, emergency care, prescription drugs, durable medical equipment, hearing services, long term care, palliative care, podiatric care, mental health services, dentistry, oral surgery, eye care, chiropractic, and substance abuse treatment. Patients have their choice of physicians, providers, hospitals, clinics, and practices. There are no co-pays or deductibles allowed under this act.

Conversion to a nonprofit health care system

Doctors, hospitals, and clinics will continue to operate as private entities. However, they will be unable to issue stock. Private health insurers shall be prohibited under this act from selling coverage that duplicates the benefits of the Improved Medicare For All program. Exceptions to this rule include coverage for cosmetic surgery, and other medically unnecessary treatments. Those workers who are displaced as the result of the transition to a nonprofit health care system will be the first to be hired and retrained under this act. Furthermore, workers would receive their same salary for up to two years, and would then be eligible for unemployment benefits. The conversion to a not-for-profit health care system will take place as soon as possible, but not to exceed a 15-year period, through the sale of U.S. Treasury bonds.

Cost containment provisions/ reimbursement

The Improved Medicare for All program will negotiate reimbursement rates annually with physicians, allow for global budgets (monthly lump sums for operating expenses) for hospitals, and negotiate prices for prescription drugs, medical supplies and equipment. A “Medicare for All Trust Fund” will be established to ensure a dedicated stream of funding. An annual congressional appropriation is also authorized to ensure optimal levels of funding for the program, in particular, to ensure the requisite number of physicians and nurses need in the health care delivery system.

Families and individuals will pay less

Currently, health care costs for a typical family of four in the most common health plan offered by employers are an average of $8,584 a year — $5,114 in premiums and another $3,470 in out-of-pocket medical services, drugs, and supplies. Employers pay an additional $12,144 towards the coverage, for a total cost per family of $20,728 (Milliman Medical Index, www.publications.milliman.com).  Fiscal studies by economists Dean Baker (2007) and Gerald Friedman (2013) have estimated that under H.R. 676, 95 percent of U.S. households would be paying less than they now for all health care costs.  Most businesses would pay less too.

Containing annual health care costs, while covering all Americans

Savings from reduced administration, bulk purchasing, and coordination among providers will allow coverage for all Americans while reducing health care inflation in the long term. Annual savings from enacting H.R. 676 have been estimated at $387 billion (Baker, 2008) to $592 billion (Friedman, 2013).

Proposed funding for the Improved Medicare for All program

¨    Maintain current federal funding for health care.

¨    Increase personal income tax on the top 5 percent of income earners

¨    Institute a modest and progressive excise tax on payroll and self-employment income.

¨    Instituting a modest tax on unearned income.

¨    Institute a small tax on stock and bond transactions.

Who needs to know what a hip replacement costs?

Availability of Consumer Prices From US Hospitals for a Common Surgical Procedure

By Jaime A. Rosenthal; Xin Lu, MS; Peter Cram, MD, MBA
JAMA Internal Medicine, February 11, 2013

Objective – To examine whether we could obtain pricing data for a common elective surgical procedure, total hip arthroplasty (THA).

We found it difficult to obtain price information for THA and observed wide variation in the prices that were quoted. Many health care providers cannot provide reasonable price estimates.

Comment (excerpts):

The results of this study provide insight into the availability of pricing information for a common elective medical procedure, THA. We found that only 16% of a randomly selected group of US hospitals were able to provide a complete bundled price, though an additional 47% of hospitals could provide a complete price when hospitals and health care providers were contacted separately.

First and foremost, understanding our results requires an understanding of the rationale behind calls for greater pricing transparency. The desire for pricing transparency is based in fundamental principles of economics; the assumption that if patients know the prices of medical services, they will make rational decisions by avoiding high-cost health care providers ceteris paribus.

Our results are somewhat remarkable considering the support expressed by virtually all stakeholders for pricing transparency.

Irrespective of the reason for the variation we encountered, we would actually view our results with a modicum of optimism. The nearly $100 000 range in pricing that we encountered suggests that a savvy and determined customer may find opportunities for significant savings with comparison shopping. Alternatively, it is equally possible to argue that our results suggest that less-educated or less-savvy patients could pay exorbitantly high prices.

http://archinte.jamanetwork.com/article.aspx?articleid=1569848

And…

What Does a Hip Replacement Cost?

Comment on “Availability of Consumer Prices From US Hospitals for a Common Surgical Procedure”
By Andrew Steinmetz, BA; Ezekiel J. Emanuel, MD, PhD
JAMA Internal Medicine, February 11, 2013

As Rosenthal and colleagues write, there are many potential solutions for reining in costs and improving quality in American health care, but they require access to reliable information on price and quality for patients to make informed decisions. Free markets need price and quality transparency to function properly.

The history of the automobile industry shows that information asymmetry is treatable. Health care will need to travel down a similar path. It is time we stop forcing people to buy health care services blindfolded — and then blame them for not seeing. The transparency imperative is here, and one way or another the public will soon be empowered to choose their health care based on reliable data on price and quality.

http://archinte.jamanetwork.com/article.aspx?articleid=1569849

Comment:

By Don McCanne, M.D.

There is a terrible epidemic of a mental derangement that has befouled the minds of not only those in the political, policy and academic communities, but also the minds of the public at large. This mass hysteria is exemplified by this statement extracted from the Rosenthal et al article: “Our results are somewhat remarkable considering the support expressed by virtually all stakeholders for pricing transparency.”

Almost everyone seems to be fixated on the concept that if we make health care pricing transparent, we will be able to place every individual in charge of getting the health care that they need while eliminating excessive prices and unnecessary care. The massive shift taking place to higher deductibles and other consumer-driven cost sharing is based on this principle.

Implementation of the Affordable Care Act is pushing us towards innovative changes in the way we pay for health care, such as this article which implicitly supports “bundling” as a means of obtaining a single price for complex services – to be used to shop around for cheaper providers.

With our current budgetary problems on the state and local levels, let’s look how this might play out if we expand the concept from health care to other social services.

Imagine creating price sensitivity for community fire services. Suppose we bundle the payment for putting out a house fire. Not only would we need competing fire services, but we would also need access, through a 911 call, for the various bundled prices. Or a car fire? You can be transferred to the 911 car fire operator who has the car fire bundled prices. Or a preventive fire safety inspection of your home – mandated by the Affordable Fire Act? Instead of 911, you can access eFireInspection providers for competitive fire inspection bundles, which provide basic inspection services, with options such as purchasing a place at the front of the queue in the event of multiple fires.

The police? Easy. Competing bundled prices on home invasion robberies. Murder? No problem – bundled packages with or without conviction and imprisonment of the murderer. Maintaining the peace? Are you kidding? With price transparency who would waste their money on that unnecessary service?

Education bundles? Park and recreation bundles? Public street and highway bundles? City sanitation bundles? How about bundles for politicians? You could buy only the politicians that you need.

Of course all of this is totally ridiculous. So why have we separated out our health care social services to be placed under the control of price shoppers? Isn’t there a better way?

Everyone recognizes the silliness of the examples above because we all understand that such social services are financed through global budgets established by the stewards of our taxes. With minor exceptions, the services are provided automatically without the necessity of establishing price sensitivity on accessing those services. Any additional funding requirements are addressed through the budget process.

Likewise, as in Canada, our hospitals should be globally budgeted. To do so would introduce administrative simplicity and lower costs due to greater efficiency. Physicians’ rates can be kept fair and reasonable through negotiation with the single public payer. Most other nations have shown that you can provide comprehensive care at much lower costs without requiring price transparency for health care shoppers.

Look again at the authors’ statement: “Our results are somewhat remarkable considering the support expressed by virtually all stakeholders for pricing transparency.” Price transparency as a solution for our outrageous health care costs? It’s time to bury this terribly unsound idea and move on with a system that works – a single payer national health program.

Who needs to know what a hip replacement costs?

Availability of Consumer Prices From US Hospitals for a Common Surgical Procedure

By Jaime A. Rosenthal; Xin Lu, MS; Peter Cram, MD, MBA
JAMA Internal Medicine, February 11, 2013
Objective – To examine whether we could obtain pricing data for a common elective surgical procedure, total hip arthroplasty (THA).
We found it difficult to obtain price information for THA and observed wide variation in the prices that were quoted. Many health care providers cannot provide reasonable price estimates.
Comment (excerpts):
The results of this study provide insight into the availability of pricing information for a common elective medical procedure, THA. We found that only 16% of a randomly selected group of US hospitals were able to provide a complete bundled price, though an additional 47% of hospitals could provide a complete price when hospitals and health care providers were contacted separately.
First and foremost, understanding our results requires an understanding of the rationale behind calls for greater pricing transparency. The desire for pricing transparency is based in fundamental principles of economics; the assumption that if patients know the prices of medical services, they will make rational decisions by avoiding high-cost health care providers ceteris paribus.
Our results are somewhat remarkable considering the support expressed by virtually all stakeholders for pricing transparency.
Irrespective of the reason for the variation we encountered, we would actually view our results with a modicum of optimism. The nearly $100 000 range in pricing that we encountered suggests that a savvy and determined customer may find opportunities for significant savings with comparison shopping. Alternatively, it is equally possible to argue that our results suggest that less-educated or less-savvy patients could pay exorbitantly high prices.
http://archinte.jamanetwork.com/article.aspx?articleid=1569848
And…

What Does a Hip Replacement Cost?

Comment on “Availability of Consumer Prices From US Hospitals for a Common Surgical Procedure”
By Andrew Steinmetz, BA; Ezekiel J. Emanuel, MD, PhD
JAMA Internal Medicine, February 11, 2013
As Rosenthal and colleagues write, there are many potential solutions for reining in costs and improving quality in American health care, but they require access to reliable information on price and quality for patients to make informed decisions. Free markets need price and quality transparency to function properly.
The history of the automobile industry shows that information asymmetry is treatable. Health care will need to travel down a similar path. It is time we stop forcing people to buy health care services blindfolded — and then blame them for not seeing. The transparency imperative is here, and one way or another the public will soon be empowered to choose their health care based on reliable data on price and quality.
http://archinte.jamanetwork.com/article.aspx?articleid=1569849

There is a terrible epidemic of a mental derangement that has befouled the minds of not only those in the political, policy and academic communities, but also the minds of the public at large. This mass hysteria is exemplified by this statement extracted from the Rosenthal et al article: “Our results are somewhat remarkable considering the support expressed by virtually all stakeholders for pricing transparency.”
Almost everyone seems to be fixated on the concept that if we make health care pricing transparent, we will be able to place every individual in charge of getting the health care that they need while eliminating excessive prices and unnecessary care. The massive shift taking place to higher deductibles and other consumer-driven cost sharing is based on this principle.
Implementation of the Affordable Care Act is pushing us towards innovative changes in the way we pay for health care, such as this article which implicitly supports “bundling” as a means of obtaining a single price for complex services – to be used to shop around for cheaper providers.
With our current budgetary problems on the state and local levels, let’s look how this might play out if we expand the concept from health care to other social services.
Imagine creating price sensitivity for community fire services. Suppose we bundle the payment for putting out a house fire. Not only would we need competing fire services, but we would also need access, through a 911 call, for the various bundled prices. Or a car fire? You can be transferred to the 911 car fire operator who has the car fire bundled prices. Or a preventive fire safety inspection of your home – mandated by the Affordable Fire Act? Instead of 911, you can access eFireInspection providers for competitive fire inspection bundles, which provide basic inspection services, with options such as purchasing a place at the front of the queue in the event of multiple fires.
The police? Easy. Competing bundled prices on home invasion robberies. Murder? No problem – bundled packages with or without conviction and imprisonment of the murderer. Maintaining the peace? Are you kidding? With price transparency who would waste their money on that unnecessary service?
Education bundles? Park and recreation bundles? Public street and highway bundles? City sanitation bundles? How about bundles for politicians? You could buy only the politicians that you need.
Of course all of this is totally ridiculous. So why have we separated out our health care social services to be placed under the control of price shoppers? Isn’t there a better way?
Everyone recognizes the silliness of the examples above because we all understand that such social services are financed through global budgets established by the stewards of our taxes. With minor exceptions, the services are provided automatically without the necessity of establishing price sensitivity on accessing those services. Any additional funding requirements are addressed through the budget process.
Likewise, as in Canada, our hospitals should be globally budgeted. To do so would introduce administrative simplicity and lower costs due to greater efficiency. Physicians’ rates can be kept fair and reasonable through negotiation with the single public payer. Most other nations have shown that you can provide comprehensive care at much lower costs without requiring price transparency for health care shoppers.
Look again at the authors’ statement: “Our results are somewhat remarkable considering the support expressed by virtually all stakeholders for pricing transparency.” Price transparency as a solution for our outrageous health care costs? It’s time to bury this terribly unsound idea and move on with a system that works – a single payer national health program.

Dancing for single-payer health care at California Capitol

By Jeremy B. White
The Sacramento Bee, Capitol Alert, Feb. 11, 2013

SACRAMENTO, Calif. — The prospect of a single-payer health care system has advocates dancing in the streets — or at least on steps of the state Capitol.

Health care professionals, medical students and advocates gathered at the Capitol for a raucous rally in favor of a single-payer system on Monday. The demonstration, which was organized by the California Health Professional Student Alliance, featured a sea of white lab coats — many of them bearing the insignia of local medical schools — and a choreographed number by scrubs-clad dancers.

Speakers urged the adoption of a government managed, single-payer health care system, saying anything short of that would be inadequate. Sen. Bill Monning, D-Carmel, said the Obama administration’s health care overhaul bill was only a start.

“As you know, we’re currently trying to move California forward with implementation of the affordable care act,” Monning said. “In my view this represents a stepping stone to achieving true universal coverage and a healthcare system based on the promotion of health and wellness, not the treatment of disease and illness.”

Assemblyman Paul Fong, D-Cupertino, called a single-payer system “the only model where we can achieve true universal healthcare.” You can see the dance routine below:

Read more here: http://blogs.sacbee.com/capitolalertlatest/2013/02/dancing-for-health-care-video.html#storylink=cpy

North Carolina Gets Bill for Single-Payer Health care

By David Swanson
War is a Crime blog, Feb. 8, 2013

RALEIGH, N.C. — State Representative Marcus Brandon has introduced a bill for a single-payer system in the 2013 General Assembly session. While Republican lawmakers are content to simply block President Obama’s healthcare exchange system, Rep. Brandon offers a real solution to the problems of rising healthcare costs.

“It’s not enough to just say no,” Brandon said in reference to these obstructionist attempts. “We can’t just have Republicans saying no in Congress, and we can’t just have Democrats opposing everything in Raleigh either. We have to present viable solutions. My single-payer bill does that.”

While Republicans are sure to try to defeat this bill, Brandon knows that this is a struggle worth fighting for. “We have to talk about our issues, what it is that we say about ourselves. This is not just about Democrats and Republicans, it’s bigger than that. It’s about finding real solutions instead of just offering up another political talking point.”

“Single Payer, Not for Profit healthcare is the only sustainable plan for NC” Brandon continued. “Healthcare costs continue to sky rocket, and you can make any law you want, but as long as you have a for profit system you will never control cost. Eventually, our flawed system of tying healthcare to employment will no longer be feasible and more and more people will lose coverage, and the state will have to provide services for these people.”

The current edition and status of the bill can be found here:
http://www.ncleg.net/gascripts/BillLookUp/BillLookUp.pl?Session=2013&BillID=H70.

The bill is unlikely to get much traction in a General Assembly dominated by Republicans. However, Brandon is not planning to give up without a fight.

http://warisacrime.org/content/north-carolina-gets-bill-single-payer-healthcare

Students for single payer

They’re getting ready to lobby their legislators

By Paul O’Rourke-Babb and Joseph Katz
Chico News & Review, Feb. 7, 2013

CHICO, Calif. — In the fall of 2011 a few Chico State students founded the local chapter of the California Health Professional Student Alliance (CaHPSA). CaHPSA is a student-based advocacy group working alongside Physicians for a National Health Program (PNHP) to institute a public single-payer health-insurance system in the state of California.

The goal of CaHPSA is to promote awareness of current health-care legislation in California as well as strengthen the leadership and advocacy skills of students and future health-care professionals.

Last January the founding members of CaHPSA Chico State atttended Sacramento Lobby Day, CaHPSA’s biggest annual event. Lobby Day consists of more than 300 students and health-care professionals throughout the state gathering to meet with our California legislators and lobby on behalf of the California Universal Health Care Act, previously Senate Bill 810.

Lobby Day is actually two full days. This year’s “training day” will be held on Sunday, Feb. 10, when students meet with physicians, public officials and health-policy experts to gain insight on current health-care policy and single-payer and to learn to effectively lobby their state representatives. The following day, Monday, Feb. 11, is the actual lobby day in which students and other advocates have scheduled meetings with state representatives.

CaHPSA members attending Lobby Day last year managed to meet with nearly all members of the Legislature. Unfortunately SB 810 failed to pass in the Senate, receiving 19 of the necessary 21 votes.

All students who attended gained significant insight on the status of health care in California, potential reform through single-payer, and the type of work that will be necessary for successfully instituting a comprehensive single-payer health-care system in our state.

As a nurse practitioner, I’m well aware of the critical need to establish a universal health-insurance system in which premiums are paid only for direct health-care needs. It’s cheaper, broader and fairer.

For more information about both CaHPSA and PNHP, including the local chapters, you can contact us at pobnkin@sunset.net or 530-321-9646. CaHPSA and PNHP will once again be hosting Lobby Day this year, and we invite you to join the students on Feb. 11 in Sacramento. Because it’s time we stop letting our health and health care be held hostage by the insurance and pharmaceutical industries.

http://www.newsreview.com/chico/students-for-single-payer/content?oid=8999969

Profits should not be put above patients’ well-being

By J. Wesley Boyd, M.D.
The Boston Globe, Letters, Feb. 10, 2013

Re “Steward is already a force for change” (Page A1, Feb. 3): Although the for-profit Steward Health Care System might be investing in repaved parking lots, nicer waiting areas in their facilities, or other renovations, nobody should discount the significant negative impact on patient well-being of cuts in nurse staffing, stifling demands on physicians to see ever-increasing numbers of patients, or disgruntled employees in general.

The fact that Cerberus, owner of Steward Health Care, has been a major owner of weapons manufacturers blatantly illustrates that it does not care about health per se but instead about generating revenue. The final sentence of the article nicely sums this up when an observer states that the goal of Steward executives “in the end … is to make money for their investors.”

Practically speaking, this means whenever there is a choice that Steward needs to make between turning a profit or improving health, one can expect profit to win out every time. Most Americans believe that health care is a right, and subjecting anything that is a right to the whims of the marketplace places our humanity in jeopardy.

Dr. J. Wesley Boyd is a psychiatrist at Cambridge Health Alliance and an assistant clinical professor of psychiatry at Harvard Medical School. He resides in Needham.

http://bostonglobe.com/opinion/letters/2013/02/10/profits-should-not-put-above-patients-well-being/Dby5eYepSYXFiOlJlj2aaJ/story.html

Strength through integration?

Moody’s: Doctor integration vital to stronger hospital finances

By Sue Ter Maat
American Medical News, February 11, 2013

For the sixth year in a row, Moody’s Investors Service is issuing a “negative outlook” to nonprofit hospital finances. Yet the bond-rating agency notes that the facilities have collectively improved their bottom lines in recent years.

In part, Moody’s said, the unexpected gains have come because of physicians. Closer relationships with physician practices, including outright acquisitions, have helped hospitals stabilize their market shares and find ways to cut costs, Moody’s said. “The theme is for tighter and closer alignment and integration [of doctors] with hospitals,” said Lisa Martin, senior vice president of Moody’s Healthcare Team.

Nonprofit hospitals’ three-year compound annual growth rate of revenue fell from 7.3% in 2008 to 5.4% in 2011, Moody’s said. The measure looks at changes over the previous three years and assigns an average annual value to them.

But hospitals have taken positive steps that have prevented an even greater negative impact, Martin said. Among them are mergers and acquisitions of other hospitals, long-term care facilities and physician practices. These forces have meant that doctors are being drawn more closely into hospital operations and decision-making through joint ventures and hospital board memberships, especially as more doctors are employed instead of working in their own practices, she said.

Mergers and acquisitions are expected to continue through 2013 and 2014, as hospitals prepare for full implementation of the ACA. Moody’s analysts consider this activity positive, because it has led to consolidation of services and reduced expenses.

But Moody’s warned that mergers and acquisitions could be difficult in the short term because of turnaround challenges at takeover targets, merging cultures and difficulty closing services after mergers.

http://www.ama-assn.org/amednews/2013/02/11/bisc0211.htm?utm_source=nwltr&utm_medium=heds-htm&utm_campaign=20130211

Comment:

By Don McCanne, M.D.

Consolidation. Mergers. Acquisitions. Between hospitals. Between physicians. Between hospitals and physicians. Between physicians and insurers. Within a framework of integrated affordable care organizations.

Our political leaders’ decision to choose a market model of health care reform led by private insurers is resulting in the shutting down of whatever minimal semblance there was of a free market between competing health plans, as we convert to health care delivery oligopolies and monopolies.

Does anyone really believe that the private insurers are going to be able to drive costs lower and quality higher by their market skills in leveraging the forces of competition between health care delivery systems? The insurers already understand that this model is fading rapidly. That is why they are involved in designing managed care products that shift the insurance risk to others while greatly expanding their market in administrative services. Plus they are gaining control of sectors of the actual health care delivery system.

Our policy experts say, “Yes, but by establishing accountable care organizations, this is the way that we can start to pay for quality instead of volume.” Accountable to whom? Not the patients nor the taxpayers.

ACA health insurance tax

Tax hikes you may have forgotten about

By Alex Brill, research fellow, American Enterprise Institute
The Hill, February 7, 2013

One of the next ACA taxes scheduled to take effect is a health insurance tax that will hit small businesses and their employees particularly hard. The tax is officially imposed on health insurance companies, but the greatest effect will be felt by their customers because the insurance companies will pass most of the burden on through higher premiums. An analysis by the nonpartisan Joint Committee on Taxation found that the tax will raise insurance premiums on average by $350–$400 per affected family in 2016.

The higher premiums caused by the new tax will also prompt some employers to self-insure rather than purchase true insurance for their workers. The tax exempts employers who self-insure, as well as certain nonprofit insurers who provide more than 80 percent of their services to Medicare, Medicaid, CHIP, or dual-eligible plans.

Normally, when some taxpayers change their behavior and avoid a tax, the tax raises less revenue than might otherwise be expected. Oddly, the insurance tax is designed in a way that prevents any revenue decline. The ACA presets the insurance tax’s total revenue yield at $8 billion next year, rising to $14.3 billion by 2018. To make this possible, each year’s tax is calculated in the following year, with the preset total tax burden allocated among insurance companies based on each company’s share of the market.

If insurance companies raise premiums to cover the tax and some employers respond by self-insuring, the result will be a bigger tax on the employers that remain in the insurance market. Of course, the bigger tax would fuel another round of premium hikes, causing more employers to self-insure, further premium increases, and so on.

According to the Kaiser Family Foundation’s 2012 Survey of Employer Health Benefits, 15 percent of the smallest employers self-insure, roughly half of employers with 200–999 workers self-insure, and 93 percent of firms with more than 5,000 workers do so. Because the smallest employers almost never self-insure, they will end up bearing the brunt of the tax. Midsized firms will be most likely to shift to self-insuring their workers.

Congress and the public may not view insurance companies as sympathetic figures. But it’s the insurance companies’ customers who will be most penalized by this new tax, whether through $400 premium increases or by being forced to run the risks of self-insuring.

http://thehill.com/blogs/congress-blog/economy-a-budget/281749-tax-hikes-you-may-have-forgotten-about

Comment:

By Don McCanne, M.D.

When we are talking about financing our health care system – 17 percent of our GDP – we have to get tax policy right. One tax being imposed by the Affordable Care Act – a tax on health insurers – will surely be passed on to purchasers of health plans in the form of higher premiums. When health health insurance premiums are already unbearable for many, it doesn’t seem wise to adopt a tax policy that pushes premiums even higher.

Another peculiarity about this tax is that self-insured employers are exempt. We have already written about the serious problems with the current trend of small businesses self-insuring – less regulatory oversight, exemption from some of the provisions of the Affordable Care Act, and the vagaries of stop-loss insurance for the self-insured. Yet the insurance tax will increase this unfortunate trend.

Since the global amount of the tax is set in law and it is assessed proportionately amongst the insurers, as many employers convert to self-insurance, the tax payment required of those continuing to be insured through private plans will rise disproportionately. Although this might not reach the level of a death spiral, the distribution would certainly be inequitable.

One of the most important features of a single payer national health program is that it would be funded through equitable tax policies. Everyone pays their fair share, based on ability. Not only could we fix our health care system through single payer reform, but we would have the additional advantage of moving us much closer to an equitable system of taxation.