PNHP

Single-payer system is only way to keep health costs down

Single-payer system is only way to keep health costs down

By Bernie Fetterly
Ithaca Journal, Jan. 17, 2013

To “fix the debt,” we should focus on fixing the economy. Investment in jobs and growth will reduce the costs of high unemployment raise more revenue and reduce the debt burden.

Why should fairer taxes from the rich be allowed only if accompanied by less health care for the old or vulnerable?

Cuts to Medicare are aimed at the wrong target. We don’t have an “entitlements” problem; we have a broken health care system. If nothing is done to that system, the rising cost of health care will cause Medicare and other publicly funded health care programs to consume an even larger portion of the budget.

The real problem is runaway health care costs, driven by the entrenched corporate interests — the drug and insurance companies and the private hospital complexes — that have made our health care the most expensive in the world.

Since vouchers are out, conservatives have another strategy to weaken Medicare: raise the age of eligibility and eliminate benefits for 65- and 66-year-olds.

Denying Medicare to 65- and 66-year-olds will actually cost more money than it saves. The best estimate is that $5.7 billion in projected federal savings in Medicare will end up forcing individuals, states and employers to pay an additional $11.4 billion for health care. If the overall U.S. health care system controlled costs as well as most European countries, both Medicare and overall health care costs would be fully affordable.

To do that, you have to take on the drug companies, insurance companies and hospital complexes that drive up costs. Cutting benefits — or eliminating them for 65- and 66-year-olds — doesn’t control costs. It simply shifts the costs from the public budget to individual seniors or their families. Medicare is more cost-effective than private insurance because Medicare uses its leverage to keep doctor and hospital rates in check. “Improved Medicare for all” would be best because it would bargain for lower drug prices and “Medicare for All” would have a very large risk pool. So why would we want to push more people into the private health care system?

Hospitals under an “improved Medicare for all” system would be nonprofit and financed by global budgets. That alone would eliminate a huge problem of hospital complexes and greatly improve efficiency.

Today, more than 50 million older Americans and people with disabilities have access to health care thanks to Medicare. But Medicare can be improved if we apply it to cover every American. If conservatives succeed in raising the Medicare eligibility age, many 65- and 66-year-old retirees will find themselves uninsured. Others will try to stay at work, adding to their employers’ health care burden while limiting job opportunities for younger workers. Employer health insurance costs will rise as a result. Still others will seek coverage through the new health insurance exchanges — if they can afford it.

Two-thirds of people 65 and 66 (3.3 million people) would face an average of $2,200 more each year in premiums and cost-sharing. Medicare itself would be weakened, with fewer people in the program and less leverage to reduce health care costs. Such short-sighted conservative “reform” will result in chaos in the lives of people making the transition from work to retirement — and it would end up increasing the costs to our overall health care system.

To bring down Medicare costs, we need to make our health care system as cost effective as other nations that deliver more coverage and better care at lower cost. There is only one way to do that and that would be a system of “improved Medicare for all.”

If means-testing became law in Medicare, it would change Medicare from a universal program that serves all Americans into an underfunded health care program that serves only the elderly poor.

Medicare would be even more cost-effective if Congress — in the pocket of big drug companies and the rest of the medical industrial complex — hadn’t forbidden Medicare from negotiating with big drug companies or paying fair prices for a variety of health care goods.

If you consider private health care premiums as a tax, because under the Affordable Care Act you will be mandated to buy or have private insurance, you will be required to pay much higher taxes under the ACA than if you had “improved Medicare for all” — a single-payer system.

Do the math: We cannot afford the ACA or the hardship it will bring. What we need is a single-payer system. Insist on it — demand it. We will have several progressive organizations across the nation working together on this issue. Our local, state, and federal politicians need to support single-payer policy and not the ACA. What we do now is crucial.

Fetterly is the director of the Tompkins County Health Care Task Force.

http://www.theithacajournal.com/article/20130117/VIEWPOINTS02/301170099/Guest-Viewpoint-Single-payer-system-is-only-way-to-keep-health-costs-down?nclick_check=1

ACA administrative costs escalating

State's health insurance exchange gets $674-million federal grant

By Chad Terhune
Los Angeles Times, January 18, 2013

Federal officials awarded California’s new health insurance exchange a $674-million grant, providing money for a crucial marketing campaign aimed at millions of uninsured consumers.

The state-run insurance exchange, Covered California, is seeking to fundamentally reshape the health insurance market by negotiating with insurers for the best rates and helping consumers choose a plan.

In addition to “top down” advertising, Lee said, the exchange will be giving grants to religious groups and other community organizations for education at the grass-roots level.

The exchange also has the task of helping millions of Californians determine whether they qualify for an expansion of Medi-Cal, the state’s Medicaid program for the poor, or federally subsidized private coverage.

In addition to marketing, Covered California will use the federal grant money to help fund operations through January 2015, when the online marketplace will rely on fees assessed on health policies sold through the exchange.

Separately Thursday, the California Endowment said it would spend $225 million over the next four years to help implement the federal healthcare law in the state.

http://www.latimes.com/business/la-fi-health-insurance-grant-20130118,0,5154422.story

Comment:

By Don McCanne, M.D.

The administrative waste in our health care system far exceeds that of any other nation. During the political process of crafting the Affordable Care Act, we warned that this model would greatly add to this administrative waste. We are now beginning to see the extent of that expanded waste.

On just California’s insurance exchange alone, taxpayers are having to foot additional costs of two-thirds of a billion dollars just for administration and marketing of the exchange plans. In the future, these additional administrative costs will be downloaded to us through new fees assessed on the health policies sold through the exchange. Just think of all of the other administrative expenses for the multitude of other features of the Affordable Care Act, not just in California but throughout the nation. And not one cent of this additional administrative spending goes to health care. Sick!

Although taxpayers have already invested way too much in this wasteful program, we can still cut our losses and move on with an administratively efficient single payer system – an improved Medicare for all.

Doctor sees shift to single-payer care

By Mark Sommer
Buffalo News, Jan. 17, 2013

Single-payer health care remains the only way to meet public health needs, and demand for it will reignite as changes brought by the Affordable Care Act fail to make health care cheaper and continue to leave tens of millions uninsured, the head of a national physicians organization said Thursday.Dr. Andy Coates

Dr. Andy Coates, president of Physicians for a National Health Program, which represents more than 18,000 members, spoke to The Buffalo News Editorial Board. He later spoke at a forum sponsored by Partnership for the Public Good.

Coates, who practices in a community hospital in Albany and teaches in the departments of medicine and psychiatry at the University at Albany, said he constantly sees rising premiums and deductibles force low-income patients to choose between critical health needs and basic survival.

“I had a man [recently] who bled half of his blood volume, and he insisted on discharge because he had a day-by-day hospital co-pay of over $200, had no savings and hadn’t been able to pay his bills because it hadn’t snowed enough to plow snow like he usually does. He just absolutely insisted on going home when our advice was that he should be in a hospital making sure he didn’t continue to bleed,” Coates said.

“This kind of thing is unbelievably common.”

He predicted changes under way in health care will fall far short.

“The data we’ve seen most recently suggests that even in 2019, with the [Affordable Care Act] fully implemented, there would still be 36 million people without health insurance. It’s not fundamental reform, and the proven cost savings are none.”

Coates, who compared doctors to “lawyers for the poor,” said the country eventually will have to turn to single payer because “nothing else will work.”

He said studies and polls have shown a majority of the public and physicians would support single payer, but the idea remains outside mainstream acceptability among the political class.

He also promotes a more holistic approach to health care and was joined by Dr. Kathleen Grimm and Jessica Bauer Walker of the Community Health Worker Network of Buffalo.

Members of the 2-year-old network of health care and public health advocates operate as community educators and organizers who, through social networks, help people underserved by traditional health systems.

“Our way of working is based on trust, which is a very different framework for those who are providing and receiving services,” said Walker, the group’s executive director.

Grimm, co-chairwoman of the health network, noted the U.S. ranked 17th in a 2007 study by the Institute of Medicine and the National Research Council of life expectancy among high-income countries.

“The one distinguishing factor is that the United States does not have universal health coverage,” Grimm said, “and the other 16 do.”

Mark Sommer is a Buffalo News staff reporter.

http://www.buffalonews.com/apps/pbcs.dll/article?AID=/20130117/CITYANDREGION/130119215

ACA administrative costs escalating

State’s health insurance exchange gets $674-million federal grant

By Chad Terhune
Los Angeles Times, January 18, 2013
Federal officials awarded California’s new health insurance exchange a $674-million grant, providing money for a crucial marketing campaign aimed at millions of uninsured consumers.
The state-run insurance exchange, Covered California, is seeking to fundamentally reshape the health insurance market by negotiating with insurers for the best rates and helping consumers choose a plan.
In addition to “top down” advertising, Lee said, the exchange will be giving grants to religious groups and other community organizations for education at the grass-roots level.
The exchange also has the task of helping millions of Californians determine whether they qualify for an expansion of Medi-Cal, the state’s Medicaid program for the poor, or federally subsidized private coverage.
In addition to marketing, Covered California will use the federal grant money to help fund operations through January 2015, when the online marketplace will rely on fees assessed on health policies sold through the exchange.
Separately Thursday, the California Endowment said it would spend $225 million over the next four years to help implement the federal healthcare law in the state.
http://www.latimes.com/business/la-fi-health-insurance-grant-20130118,0,…

The administrative waste in our health care system far exceeds that of any other nation. During the political process of crafting the Affordable Care Act, we warned that this model would greatly add to this administrative waste. We are now beginning to see the extent of that expanded waste.
On just California’s insurance exchange alone, taxpayers are having to foot additional costs of two-thirds of a billion dollars just for administration and marketing of the exchange plans. In the future, these additional administrative costs will be downloaded to us through new fees assessed on the health policies sold through the exchange. Just think of all of the other administrative expenses for the multitude of other features of the Affordable Care Act, not just in California but throughout the nation. And not one cent of this additional administrative spending goes to health care. Sick!
Although taxpayers have already invested way too much in this wasteful program, we can still cut our losses and move on with an administratively efficient single payer system – an improved Medicare for all.

Misdirected efforts aren’t making Americans any healthier

By Philip Caper, M.D.
Bangor Daily News, Jan. 18, 2013

We Americans seem to be obsessed with our health. You cannot watch TV, read a magazine or surf the Web without being inundated with articles and ads touting some new way get healthier. As one result, we spend about double what other countries do on health care for our people. But are many of those resources being misdirected?

A report released recently by the Institute of Medicine and the National Research Council suggests they are. Their report documents the fact that, despite our high health care spending, Americans persistently die younger and live in poorer health than residents of most other wealthy countries. The life expectancy of Americans is now near the bottom among all developed countries.

A report released last September — that I discussed in an earlier column — estimated that about 30 percent of what we as a nation spend on health care is spent on things that have little or no effect on curing illness or on improving our health — in other words, wasted. But even that which is spent effectively for medical care is directed mostly at fixing something that is already broken — a patient with a heart attack, for example — rather than preventing the illness in the first place. While we are able to cure infections, control hypertension or diabetes and treat or replace worn out joints, we are much less effective at preventing such illnesses.

It is becoming increasingly clear that many modern-day causes of disease, disability and mortality have their roots in what are known as “the social determinants of health.”

The IOM-NRC report pointed out that car accidents, gun violence and drug overdoses are major contributors to reduced life expectancy for Americans under age 50, as were high rates of heart attacks, lung disease and diabetes. Why, as a nation, are we so sick?

Some answers to that question can be found in a recent book, “The Spirit Level,” by British epidemiologists Kate Pickett and Richard Wilkinson. In it, they suggest an even more basic cause of our dismal national performance: extreme inequality of income, where the U.S. tops the list of wealthy countries. We are suffering from excessive accumulation of wealth at the top, growing poverty at the bottom, and a hollowing-out of the middle class.

Based on data from 23 rich countries and all 50 U.S. states, they compare the prevalence of nine types of physical and social pathology with the level of income inequality among each state in the U.S. and in each country. The U.S. is ranked at or near the top for income inequality among wealthy countries.

High levels of income inequality are associated with high rates of obesity, teenage pregnancy, violence, incarceration, mental health problems, drug abuse, school dropout rates, poor community life and social relations, poor physical health and low life expectancies. Among eight wealthy countries studied, the U.S. had the highest income inequality and lowest social mobility leading to the least opportunity for career and income advancement.

Wilkinson and Pickett have documented that in societies with high levels of inequality, many people suffer from low levels of self-esteem, high levels of insecurity and feelings of low status. These combine to produce high levels of chronic anxiety, which is thought to an important factor in causing cardiovascular disease (such as high blood pressure and heart attacks), and is known to stimulate the production of abnormally high levels of adrenal steroids which are a risk factor for diabetes with all of its consequences.

I’m all in favor of preventing illness as one way of lowering costs. These studies seem to indicate that a lot of factors other than medical care are important in doing so. Our high levels of social and physical pathology may be just the symptoms, not the underlying causes of our dismal performance.

There are a number of ways to reduce income inequality. Tax and social welfare policies are among them. In Maine and throughout the country we are now having a vigorous national debate about both.

American health care is far too wasteful and expensive. At almost 18 percent of our gross domestic product, it has to be a major contributor to our high and rising income inequality by shifting wealth from those who use health care products and services to those who provide them. Our health care system may be approaching the point where it is now doing more harm than good.

The bottom line of these findings seems to be that in nations with progressive taxes and a robust social safety net, that includes an efficient universal health care system, everybody is better off — including the very rich.

It seems to me that’s something worth thinking about as we continue our debate about national priorities.

Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at pcpcaper21@gmail.com.

http://bangordailynews.com/2013/01/18/health/misdirected-efforts-arent-making-americans-any-healthier/

Senator Kirk's recovery makes the case for single payer

By Philip Verhoef, M.D.
The State Register Journal (Springfield, Ill.), Jan. 17, 2013

U.S. Sen. Mark Kirk’s recovery from a devastating stroke is a testament to his strength and to many months of excellent rehabilitation care. As a concerned physician, I am heartened by his recent statement that he will be “much more focused on Medicaid and what (his) fellow citizens face,” noting that Medicaid patients only qualify for 11 rehab visits after a stroke.

However, his experience highlights some of the flaws in our current fragmented health care system, many of which are exacerbated by Obamacare.

While Kirk is covered by one of the high-level private insurance plans offered to federal employees, many Illinoisans are covered by less comprehensive health plans and do not have access to the type of care that our elected officials enjoy. By extension, there are a number of stroke patients who will not be able to return to the workforce the same way that Kirk will.

Obamacare props up our fragmented system by requiring insurers to offer support to working Illinoisans, with the most affordable plans covering only 60 percent of costs and containing high deductibles, and the most comprehensive plans being unaffordable. Thus, the costs of health care continue to fall on the people who can least bear it, as they choose the only affordable (sub-standard) insurance available.

Even though Kirk still incurred “major” out-of-pocket expenses, his story is still a happy one compared to those told by the poor — including the poor who have coverage.

More than a third of Illinois physicians refuse to see a single Medicaid patient, and those that do often limit the number of Medicaid patients seen. An important component of Obamacare is to actually expand Medicaid eligibility.

Kirk has already pointed out how inadequate the coverage is, coupled with the limited number of providers that accept Medicaid. Thus, the poor will have a vastly inferior insurance program, and they too will be forced to pay out-of-pocket for what should be the standard of care.

Finally, witness how the state of Illinois has cut Medicaid in the last year. Patients (including children) will only be allowed drug coverage for four of their prescriptions. In addition, Medicaid prescription benefits for senior citizens and the disabled have been eliminated. Medicaid will no longer cover most dental services, although it covers the cost of pulling rotted teeth. This is the flawed system that Kirk and Obamacare want to focus on? Medicaid is constantly underfunded, woefully inadequate, and accepted by far too few healthcare providers to meet the needs of Illinois citizens.

Why not create an expanded and improved Medicare system and extend it to everyone? Kirk could advocate for this system to provide coverage for stroke rehabilitation, primary care, mental health care (especially in light of the recent violent killings), and emergency care.

This coverage would be better than what Kirk currently has. He would have full choice of whatever doctor or hospital he would like to visit. And finally, it could be fully paid for by redirecting the money that we already pay for private health insurance, which costs tenfold more to administer than Medicare, while providing CEOs with multimillion-dollar salaries.

By supporting this single-payer system, he can assure that all Illinoisans receive the care that he did; isn’t that the least that we deserve?

Philip A. Verhoef is a physician in the adult and pediatric intensive care units at the University of Chicago and a member of Physicians for a National Health Program and the Illinois Single Payer Coalition.
 
http://www.sj-r.com/opinions/x1665863538/Philip-Verhoef-Senator-Kirks-recovery-makes-the-case-for-single-payer?zc_p=0

Business Roundtable attacks Medicare and Social Security

Social Security Reform and Medicare Modernization Proposals

Business Roundtable, January 2013

Business Roundtable (BRT) is an association of chief executive officers of leading U.S. companies with more than $7.3 trillion in annual revenues and nearly 16 million employees. BRT member companies comprise nearly a third of the total value of the U.S. stock market.

“Medicare and Social Security were not designed to cope with America’s new demographic realities. CEOs are calling for gradual changes that will modernize these programs and preserve the safety net for future generations of retirees.”
– Gary W. Loveman, Ph.D., Chairman, CEO & President, Caesars Entertainment Corporation, and Chair of BRT’s Health and Retirement Committee

Essential Elements of a Medicare Modernization Proposal

• Protect Medicare for Those Approaching Retirement: Medicare’s age of eligibility should be moved to age 70. However, this will not affect those age 55 or older today.

• Expand Competitive Models of Care: By 2015, Medicare should offer seniors the opportunity to choose among competing and comprehensive private plans and traditional Medicare. The private plans would offer a benefit similar to the existing Medicare program with the flexibility to innovate, sell across state lines, and create greater value strategies. Plans would be required to accept all applicants and would risk adjust the premium to take into account age and health status. The traditional fee-for-service program would compete for enrollment with private plans on cost, quality and a more innovative benefit structure. We believe that competition in the provision of health care to America’s seniors will bring substantial benefits, as it has to most all other categories of personal expenditure. The recent experience of competition in the Medicare Part D program serves as a persuasive indication of the potential savings and improvement in care available through the provision of choice to well-informed seniors.

• Reduce Taxpayer Costs for Upper-Income Beneficiaries: Today, the Part B premium (physician services) and the Part D premium are means-tested and other types of means testing should be explored. By 2015, additional means testing for Medicare services should be considered.

• Protect the Safety Net for Low-Income Americans: Low-income beneficiaries should retain the existing financial support received today. Improvements should be made in care-coordination and a focus on wellness and chronic care management.

(Social Security recommendations available at this link.)

http://businessroundtable.org/studies-and-reports/social-security-reform-and-medicare-modernization-proposals/

And…

Doctoring Health Care, I

By Barbara Dreyfuss
The American Prospect, December 17, 2006

In early 2006, Glen Barton, the retired CEO of Caterpillar and former head of the Business Roundtable’s health-care task force, said the solution to the health-care crisis is a single-payer system, citing Medicare as a model.

http://prospect.org/article/doctoring-health-care-i

Comment:

By Don McCanne, M.D.

Although the slick brochure from these wizards of industry at the Business Roundtable might make it look like these gentlemen are doing us a great favor by showing us how to save Medicare and Social Security from bankruptcy, their recommendations are, in fact, taking a supercilious approach to diminishing the effectiveness of America’s highly regarded social insurance programs.

This cavalier attitude is expressed in a comment by Caesars’ Gary Loveman, chairman of Business Roundtable’s Health and Retirement Committee that released this report. “Those of us who are in the BRT are paid to try to solve very difficult problems effectively. I would tell you that most of them are a lot harder than this, frankly” (Politico Pulse, Jan. 17).

What do they have in mind for Medicare? They would increase eligibility age to 70 – a disaster for future retirees. They would privatize the traditional Medicare program by throwing it into a market of private plans – a devious scheme to shift health care costs onto the backs of those with greater health care needs. They would also means-test benefits, losing the support of the wealthier individuals who have the strongest political voice, threatening to convert Medicare into a welfare program.

And Social Security? They would also increase Social Security retirement age to 70. And in a stroke of genius, they recommend that Americans simply save more for their retirement. Why didn’t we think of that before?

A word needs to be said about their recommendation to reduce future Social Security cost of living adjustments by converting to the chained-CPI. When individuals are forced into a frugal existence they learn to cut back and do without just so that they will have enough money for basic food and housing at the end of the month, if that. Under chained-CPI, the government assumes that this frugality represents the new, lower consumer price index for this sector, and so they adjust out the savings that the Social Security beneficiaries have accrued merely for the purpose of getting them all of the way through to the end of the month. Pretty cruel.

A decade ago, Glen Barton, Chairman and President of Caterpillar, led the BRT Health and Retirement Committee, currently headed by Gary Loveman. What a contrast. Glen Barton’s experience motivated him to become an advocate of “a single-payer system, citing Medicare as a model.” Lovemen? Well, you read it above. What a difference a decade made.

Class warfare? Ugly label, but…

Business Roundtable attacks Medicare and Social Security

Social Security Reform and Medicare Modernization Proposals

Business Roundtable, January 2013
Business Roundtable (BRT) is an association of chief executive officers of leading U.S. companies with more than $7.3 trillion in annual revenues and nearly 16 million employees. BRT member companies comprise nearly a third of the total value of the U.S. stock market.
“Medicare and Social Security were not designed to cope with America’s new demographic realities. CEOs are calling for gradual changes that will modernize these programs and preserve the safety net for future generations of retirees.”
– Gary W. Loveman, Ph.D., Chairman, CEO & President, Caesars Entertainment Corporation, and Chair of BRT’s Health and Retirement Committee
Essential Elements of a Medicare Modernization Proposal
• Protect Medicare for Those Approaching Retirement: Medicare’s age of eligibility should be moved to age 70. However, this will not affect those age 55 or older today.
• Expand Competitive Models of Care: By 2015, Medicare should offer seniors the opportunity to choose among competing and comprehensive private plans and traditional Medicare. The private plans would offer a benefit similar to the existing Medicare program with the flexibility to innovate, sell across state lines, and create greater value strategies. Plans would be required to accept all applicants and would risk adjust the premium to take into account age and health status. The traditional fee-for-service program would compete for enrollment with private plans on cost, quality and a more innovative benefit structure. We believe that competition in the provision of health care to America’s seniors will bring substantial benefits, as it has to most all other categories of personal expenditure. The recent experience of competition in the Medicare Part D program serves as a persuasive indication of the potential savings and improvement in care available through the provision of choice to well-informed seniors.
• Reduce Taxpayer Costs for Upper-Income Beneficiaries: Today, the Part B premium (physician services) and the Part D premium are means-tested and other types of means testing should be explored. By 2015, additional means testing for Medicare services should be considered.
• Protect the Safety Net for Low-Income Americans: Low-income beneficiaries should retain the existing financial support received today. Improvements should be made in care-coordination and a focus on wellness and chronic care management.
(Social Security recommendations available at this link.)
http://businessroundtable.org/studies-and-reports/social-security-reform…
And…

Doctoring Health Care, I

By Barbara Dreyfuss
The American Prospect, December 17, 2006
In early 2006, Glen Barton, the retired CEO of Caterpillar and former head of the Business Roundtable’s health-care task force, said the solution to the health-care crisis is a single-payer system, citing Medicare as a model.
http://prospect.org/article/doctoring-health-care-i

Although the slick brochure from these wizards of industry at the Business Roundtable might make it look like these gentlemen are doing us a great favor by showing us how to save Medicare and Social Security from bankruptcy, their recommendations are, in fact, taking a supercilious approach to diminishing the effectiveness of America’s highly regarded social insurance programs.
This cavalier attitude is expressed in a comment by Caesars’ Gary Loveman, chairman of Business Roundtable’s Health and Retirement Committee that released this report. “Those of us who are in the BRT are paid to try to solve very difficult problems effectively. I would tell you that most of them are a lot harder than this, frankly” (Politico Pulse, Jan. 17).
What do they have in mind for Medicare? They would increase eligibility age to 70 – a disaster for future retirees. They would privatize the traditional Medicare program by throwing it into a market of private plans – a devious scheme to shift health care costs onto the backs of those with greater health care needs. They would also means-test benefits, losing the support of the wealthier individuals who have the strongest political voice, threatening to convert Medicare into a welfare program.
And Social Security? They would also increase Social Security retirement age to 70. And in a stroke of genius, they recommend that Americans simply save more for their retirement. Why didn’t we think of that before?
A word needs to be said about their recommendation to reduce future Social Security cost of living adjustments by converting to the chained-CPI. When individuals are forced into a frugal existence they learn to cut back and do without just so that they will have enough money for basic food and housing at the end of the month, if that. Under chained-CPI, the government assumes that this frugality represents the new, lower consumer price index for this sector, and so they adjust out the savings that the Social Security beneficiaries have accrued merely for the purpose of getting them all of the way through to the end of the month. Pretty cruel.
A decade ago, Glen Barton, Chairman and President of Caterpillar, led the BRT Health and Retirement Committee, currently headed by Gary Loveman. What a contrast. Glen Barton’s experience motivated him to become an advocate of “a single-payer system, citing Medicare as a model.” Lovemen? Well, you read it above. What a difference a decade made.
Class warfare? Ugly label, but…

Can we control costs through checkups and wellness programs for the healthy?

General Health Checks in Adults for Reducing Morbidity and Mortality From Disease

By Allan V. Prochazka, MD, MSc; Tanner Caverly, MD
JAMA Internal Medicine, January 14, 2013

The concept of general health checkups to identify disease at a stage at which early intervention could be effective has been promoted for nearly 100 years. Both patients and primary care physicians are interested in such examinations, which can include detailed history taking, physical examination, extensive laboratory testing, and imaging.

General health checks do not improve important outcomes and are unlikely to ever do so based on the pooled results of this meta-analysis spanning decades of experience. We should be clear about what a general health check is. A general health check is a visit dedicated solely to preventive counseling and screening tests. Other names, such as annual physical, preventive health examination, or periodic health evaluation, are often used. These terms exclude preventive care that occurs during visits for other reasons, such as during chronic care or acute care visits. In other words, we are talking about screening and counseling in addition to the prevention measures that occur during routine medical care.

General health checks are one of the most common reasons adults seek medical care, with an estimated 44 million seeing a physician for this reason each year from 2002 through 2004. During these health checks, an estimated $322 million is spent annually on laboratory tests that no guideline groups recommend. The costs of downstream testing and overtreatment are likely to be much larger. For example, the costs of mammography might be $4 billion a year assuming biennial screening. The cost of follow-up biopsies of normal breasts triggered by false-positive mammogram results alone is probably in the range of $14 to $70 billion annually. It is likely that follow-up testing from general health checks substantially contributes to the estimated $210 billion in annual spending on unnecessary medical services.

http://archinte.jamanetwork.com/article.aspx?articleid=1556801

And…

Is It Time To Re-Examine Workplace Wellness ‘Get Well Quick’ Schemes?

By Al Lewis and Vik Khanna
Health Affairs Blog, January 16, 2013

Virtually unheard of thirty years ago, workplace wellness is now embedded in large self-insured companies. These firms pay their workers an average of $460/year to participate in worksite wellness programs. Further, wellness is deeply enough engrained in the public policy consciousness to have earned a prominent place in the Affordable Care Act, which allows large employers to tie a significant percentage of health spending to employee health behavior and provides direct subsidies for small businesses to undertake these workplace wellness programs.

Yet the implausible, disproven, and often mathematically impossible claims of success underlying the “get well quick” programs promoted by the wellness industry raise many questions about the wisdom of these decisions and policies. In this post, we lay out the evidence demonstrating that the industry consistently mis-measures and overstates the direct healthcare cost savings. We suggest several strategies to prevent this and to re-allocate wellness dollars from “get well quick” schemes to the much more challenging, but ultimately more rewarding, task of truly creating a culture of wellness, a workplace that can attract and retain healthier, presumably more productive, people than competitors do. There is no guarantee that strategy would work and no easy way to implement it, but clearly the easy approach isn’t working.

While we do not believe that employers need to adopt military-style standards, we do propose that it is illogical to expect sustainable reductions in medical care spending if corporate leaders treat their environments, personnel policies, practices, and procedures with the insouciance of people who believe that they can just wish something into existence.

HR departments need to reconfigure their benefits consulting relationships, since with few exceptions the latter have not provided critical thinking about wellness (and other “value-added” programs) on a par with that of insurers, who have universally shunned these programs for their fully insured members. (Most insurers will happily sell them to self-insured employers even so, because they clearly understand that “invalid” is not the same as “unprofitable,” especially when you do not bear risk for the outcomes and the customer’s consultants are demanding the service.)

http://healthaffairs.org/blog/2013/01/16/is-it-time-to-re-examine-workplace-wellness-get-well-quick-schemes/

Comment:

By Don McCanne, M.D.

In discussions of our exorbitant health care spending, we frequently hear that we need to change from a system that treats disease to a system that promotes prevention and wellness, as if prevention and wellness programs would displace disease and injury.

First, let’s be clear that the benefits of effective prevention programs are undeniable. But much of prevention is out in the community at large and not so much within the health care delivery system. Examples are public health services, community planning for safety and to promote physical activity, the promotion of healthy food choices, industry design of safer products such as automobiles, public policies to reduce hazards such as the ubiquitous accessibility of firearms, and innumerable other measures that are or should be promoted through both public and private efforts.

So what about routine preventive health checkups? The comprehensive meta-analysis published in the current JAMA Internal Medicine reveals that “general health checks do not improve important outcomes and are unlikely to ever do so,” but “it is likely that follow-up testing from general health checks substantially contributes to the estimated $210 billion in annual spending on unnecessary medical services.”

However, specific examples of preventive care that are a part of and integrated within the provision of care for acute and chronic disorders have been shown to be of some benefit and should not be abandoned  until new evidence demonstrates that there are compelling reasons to do so. Nevertheless, we cannot look to the medical practice environment to find the health care paradise that will displace sick care with well care.

Which brings us to employer-sponsored wellness programs. Simply stated, they fall into the spectrum between naivete and outright fraud. As stated in the Health Affairs Blog article briefly excerpted above, “Even the iconic Safeway story of achieving a zero medical cost trend through wellness – the inspiration for the wellness provisions in the Affordable Care Act – turns out to be made up.”

If you wish to know the shocking truth on wellness programs (yes, shocking), you should read the entire article available at the link above. The fact that insurers promote these programs, but only for their non-risk bearing contracts with self-insured employers, certainly is revealing.

Pretending that we can control health care spending with checkups and wellness programs no longer cuts it. We need to tackle costs with proven methods that would ensure quality care for everyone. We should begin by enacting an improved Medicare for all.

Can we control costs through checkups and wellness programs for the healthy?

General Health Checks in Adults for Reducing Morbidity and Mortality From Disease

By Allan V. Prochazka, MD, MSc; Tanner Caverly, MD
JAMA Internal Medicine, January 14, 2013
The concept of general health checkups to identify disease at a stage at which early intervention could be effective has been promoted for nearly 100 years. Both patients and primary care physicians are interested in such examinations, which can include detailed history taking, physical examination, extensive laboratory testing, and imaging.
General health checks do not improve important outcomes and are unlikely to ever do so based on the pooled results of this meta-analysis spanning decades of experience. We should be clear about what a general health check is. A general health check is a visit dedicated solely to preventive counseling and screening tests. Other names, such as annual physical, preventive health examination, or periodic health evaluation, are often used. These terms exclude preventive care that occurs during visits for other reasons, such as during chronic care or acute care visits. In other words, we are talking about screening and counseling in addition to the prevention measures that occur during routine medical care.
General health checks are one of the most common reasons adults seek medical care, with an estimated 44 million seeing a physician for this reason each year from 2002 through 2004. During these health checks, an estimated $322 million is spent annually on laboratory tests that no guideline groups recommend. The costs of downstream testing and overtreatment are likely to be much larger. For example, the costs of mammography might be $4 billion a year assuming biennial screening. The cost of follow-up biopsies of normal breasts triggered by false-positive mammogram results alone is probably in the range of $14 to $70 billion annually. It is likely that follow-up testing from general health checks substantially contributes to the estimated $210 billion in annual spending on unnecessary medical services.
http://archinte.jamanetwork.com/article.aspx?articleid=1556801
And…

Is It Time To Re-Examine Workplace Wellness ‘Get Well Quick’ Schemes?

By Al Lewis and Vik Khanna
Health Affairs Blog, January 16, 2013
Virtually unheard of thirty years ago, workplace wellness is now embedded in large self-insured companies. These firms pay their workers an average of $460/year to participate in worksite wellness programs. Further, wellness is deeply enough engrained in the public policy consciousness to have earned a prominent place in the Affordable Care Act, which allows large employers to tie a significant percentage of health spending to employee health behavior and provides direct subsidies for small businesses to undertake these workplace wellness programs.
Yet the implausible, disproven, and often mathematically impossible claims of success underlying the “get well quick” programs promoted by the wellness industry raise many questions about the wisdom of these decisions and policies. In this post, we lay out the evidence demonstrating that the industry consistently mis-measures and overstates the direct healthcare cost savings. We suggest several strategies to prevent this and to re-allocate wellness dollars from “get well quick” schemes to the much more challenging, but ultimately more rewarding, task of truly creating a culture of wellness, a workplace that can attract and retain healthier, presumably more productive, people than competitors do. There is no guarantee that strategy would work and no easy way to implement it, but clearly the easy approach isn’t working.
While we do not believe that employers need to adopt military-style standards, we do propose that it is illogical to expect sustainable reductions in medical care spending if corporate leaders treat their environments, personnel policies, practices, and procedures with the insouciance of people who believe that they can just wish something into existence.
HR departments need to reconfigure their benefits consulting relationships, since with few exceptions the latter have not provided critical thinking about wellness (and other “value-added” programs) on a par with that of insurers, who have universally shunned these programs for their fully insured members. (Most insurers will happily sell them to self-insured employers even so, because they clearly understand that “invalid” is not the same as “unprofitable,” especially when you do not bear risk for the outcomes and the customer’s consultants are demanding the service.)
http://healthaffairs.org/blog/2013/01/16/is-it-time-to-re-examine-workpl…

In discussions of our exorbitant health care spending, we frequently hear that we need to change from a system that treats disease to a system that promotes prevention and wellness, as if prevention and wellness programs would displace disease and injury.
First, let’s be clear that the benefits of effective prevention programs are undeniable. But much of prevention is out in the community at large and not so much within the health care delivery system. Examples are public health services, community planning for safety and to promote physical activity, the promotion of healthy food choices, industry design of safer products such as automobiles, public policies to reduce hazards such as the ubiquitous accessibility of firearms, and innumerable other measures that are or should be promoted through both public and private efforts.
So what about routine preventive health checkups? The comprehensive meta-analysis published in the current JAMA Internal Medicine reveals that “general health checks do not improve important outcomes and are unlikely to ever do so,” but “it is likely that follow-up testing from general health checks substantially contributes to the estimated $210 billion in annual spending on unnecessary medical services.”
However, specific examples of preventive care that are a part of and integrated within the provision of care for acute and chronic disorders have been shown to be of some benefit and should not be abandoned  until new evidence demonstrates that there are compelling reasons to do so. Nevertheless, we cannot look to the medical practice environment to find the health care paradise that will displace sick care with well care.
Which brings us to employer-sponsored wellness programs. Simply stated, they fall into the spectrum between naivete and outright fraud. As stated in the Health Affairs Blog article briefly excerpted above, “Even the iconic Safeway story of achieving a zero medical cost trend through wellness – the inspiration for the wellness provisions in the Affordable Care Act – turns out to be made up.”
If you wish to know the shocking truth on wellness programs (yes, shocking), you should read the entire article available at the link above. The fact that insurers promote these programs, but only for their non-risk bearing contracts with self-insured employers, certainly is revealing.
Pretending that we can control health care spending with checkups and wellness programs no longer cuts it. We need to tackle costs with proven methods that would ensure quality care for everyone. We should begin by enacting an improved Medicare for all.

Life disruptions from high out-of-pocket health expenditures

Life Disruptions for Midlife and Older Adults With High Out-of-Pocket Health Expenditures

By David Grande, MD, MPA, Frances K. Barg, PhD, Sarah Johnson, BA and Carolyn C. Cannuscio, ScD
Annals of Family Medicine, January/February 2013

ABSTRACT

PURPOSE  Out-of-pocket cost sharing for health care expenses is a growing burden. Prior research has emphasized the medical consequences of cost sharing. This study investigates the range of social, medical, financial, and sometimes legal disruptions from high out-of-pocket health expenses.

METHODS  We conducted open-ended, semistructured interviews with 33 insured patients (two-thirds covered by Medicare). All had chronic illnesses and sought philanthropic financial assistance.

RESULTS  We found that high levels of cost sharing precipitated considerable anxiety and substantial debt problems, as well as disruptions of medical care. Participants described various borrowing strategies (eg, credit cards), legal problems (eg, debt collections), and threats to their nonmedical household budgets (eg, food, housing). Participants described explicit and rank-ordered strategies for coping with new medical expenses. Participants understood their health benefits with exceptional detail but described considerable anxiety about changes to those benefits that could easily disrupt carefully managed household budgets. Benefit designs that resulted in large variations in financial liability from month to month (eg, large deductibles or coverage gaps) imposed considerable financial challenges.

CONCLUSIONS  As health care cost sharing grows, policy makers will need to consider the consequences of high cost sharing for families facing strained household budgets. Although the generosity of health insurance is important, continuity of benefits and month-to-month stability of financial liability are also important and may be undervalued in policy discussions.

And..

From the Results:

Four issues figured prominently. First, the structure of health insurance—especially gaps in coverage, such as the Medicare Part D “doughnut hole” — powerfully affected financial well-being. Second, financial stress and debt from medical expenditures had a strong influence on day-to-day personal, financial, and medical decision making. Third, participants turned to family and other sources to help manage the costs of their illnesses, which resulted in financial, emotional, and social challenges for all family members. Fourth, participants managed high out-of-pocket health care costs using a range of strategies that were potentially disruptive to their medical care.

http://annfammed.org/content/11/1/37.full.pdf+html

Comment:

By Don McCanne, M.D.

We have plenty of studies which demonstrate that out-of-pocket cost sharing for health care can expose patients to significant financial burdens and impair their access to care. This study provides a valuable addition to our knowledge base because it demonstrates just how disruptive these expanding innovations in cost sharing can be.

This study does not quantify the problem, nor was it intended to. Rather it provides us with a qualitative assessment of those who do face insurance-induced financial barriers to care, including, significantly, cost sharing in the Medicare program (part of the reason we want an improved Medicare).

Read the last paragraph in the excerpts above, under “From the Results.” These insurance innovations that supposedly are designed to make patients better shoppers of health care are causing severe financial stresses, unwise but unavoidable choices in forging health care, while fostering “financial, emotional, and social challenges for all family members.”

How well will the Affordable Care Act address these problems? First, the design of the essential health benefits required of the plans, although fairly broad, allows important benefits to be excluded as long as there is token representation of each general category of benefits. Also most exchange plans will penalize patients for obtaining care outside of their networks – again impairing affordability and access to important services that may be available only outside of the networks.

Probably the most significant disruptive element in the exchange plans is that most people will be enrolled in plans with either 60 or 70 percent actuarial value. Most of the plans will achieve these low actuarial values by requiring high deductibles and perhaps co-payments or coinsurance – some of the very tools that result in the disruptions described in today’s article. Although the Affordable Care Act does provide subsidies for both premiums and out-of-pocket expenses, for many individuals these subsidies will not be adequate to prevent the disruptions described.

Many nations with far lower total health care costs than ours are able to provide comprehensive health care for everyone – with first dollar coverage! They do not need to use disruptive out-of-pocket cost sharing to keep their level of spending sustainable. It is no secret how they do it. So why do our policy makers seem to want to keep it a secret here in the Unites States?

Life disruptions from high out-of-pocket health expenditures

Life Disruptions for Midlife and Older Adults With High Out-of-Pocket Health Expenditures

By David Grande, MD, MPA, Frances K. Barg, PhD, Sarah Johnson, BA and Carolyn C. Cannuscio, ScD
Annals of Family Medicine, January/February 2013
ABSTRACT
PURPOSE  Out-of-pocket cost sharing for health care expenses is a growing burden. Prior research has emphasized the medical consequences of cost sharing. This study investigates the range of social, medical, financial, and sometimes legal disruptions from high out-of-pocket health expenses.
METHODS  We conducted open-ended, semistructured interviews with 33 insured patients (two-thirds covered by Medicare). All had chronic illnesses and sought philanthropic financial assistance.
RESULTS  We found that high levels of cost sharing precipitated considerable anxiety and substantial debt problems, as well as disruptions of medical care. Participants described various borrowing strategies (eg, credit cards), legal problems (eg, debt collections), and threats to their nonmedical household budgets (eg, food, housing). Participants described explicit and rank-ordered strategies for coping with new medical expenses. Participants understood their health benefits with exceptional detail but described considerable anxiety about changes to those benefits that could easily disrupt carefully managed household budgets. Benefit designs that resulted in large variations in financial liability from month to month (eg, large deductibles or coverage gaps) imposed considerable financial challenges.
CONCLUSIONS  As health care cost sharing grows, policy makers will need to consider the consequences of high cost sharing for families facing strained household budgets. Although the generosity of health insurance is important, continuity of benefits and month-to-month stability of financial liability are also important and may be undervalued in policy discussions.
And..
From the Results:
Four issues figured prominently. First, the structure of health insurance—especially gaps in coverage, such as the Medicare Part D “doughnut hole” — powerfully affected financial well-being. Second, financial stress and debt from medical expenditures had a strong influence on day-to-day personal, financial, and medical decision making. Third, participants turned to family and other sources to help manage the costs of their illnesses, which resulted in financial, emotional, and social challenges for all family members. Fourth, participants managed high out-of-pocket health care costs using a range of strategies that were potentially disruptive to their medical care.
http://annfammed.org/content/11/1/37.full.pdf+html

We have plenty of studies which demonstrate that out-of-pocket cost sharing for health care can expose patients to significant financial burdens and impair their access to care. This study provides a valuable addition to our knowledge base because it demonstrates just how disruptive these expanding innovations in cost sharing can be.
This study does not quantify the problem, nor was it intended to. Rather it provides us with a qualitative assessment of those who do face insurance-induced financial barriers to care, including, significantly, cost sharing in the Medicare program (part of the reason we want an improved Medicare).
Read the last paragraph in the excerpts above, under “From the Results.” These insurance innovations that supposedly are designed to make patients better shoppers of health care are causing severe financial stresses, unwise but unavoidable choices in forging health care, while fostering “financial, emotional, and social challenges for all family members.”
How well will the Affordable Care Act address these problems? First, the design of the essential health benefits required of the plans, although fairly broad, allows important benefits to be excluded as long as there is token representation of each general category of benefits. Also most exchange plans will penalize patients for obtaining care outside of their networks – again impairing affordability and access to important services that may be available only outside of the networks.
Probably the most significant disruptive element in the exchange plans is that most people will be enrolled in plans with either 60 or 70 percent actuarial value. Most of the plans will achieve these low actuarial values by requiring high deductibles and perhaps co-payments or coinsurance – some of the very tools that result in the disruptions described in today’s article. Although the Affordable Care Act does provide subsidies for both premiums and out-of-pocket expenses, for many individuals these subsidies will not be adequate to prevent the disruptions described.
Many nations with far lower total health care costs than ours are able to provide comprehensive health care for everyone – with first dollar coverage! They do not need to use disruptive out-of-pocket cost sharing to keep their level of spending sustainable. It is no secret how they do it. So why do our policy makers seem to want to keep it a secret here in the Unites States?