PNHP

Making the case for efficient health care

Making the case for efficient health care

By Robert S. Levine, M.D.
The Grand Rapids (Mich.) Press, Letters, Dec. 5, 2012

Matt Miller’s column “The Business Man – Obama should use Romney to make health care more efficient” was right on target (The Press, Dec. 2). His suggestion that we “identify the major lessons and best practices” of other nations was totally ignored by Congress during the debate on the Affordable Care Act of 2010.

One feature of the health care systems in ALL other industrialized democracies is the non-profit status of the basic benefit package sold by insurers. This doesn’t mean that the government expropriates these companies, but it does define how the insurance industry must sell health care coverage products. T.R. Reid has clearly covered how this is done worldwide in his book “The Healing Of America” wherein he showed that it’s not all socialized medicine out there.

Dr. Steffie Woolhandler, a co-founder and board member of Physicians for a National Health Program, has identified six important principles for health care delivery system reform:

• Nonprofit.
• All capitation payments must be used for patient care. Surpluses are not
retained.
• Separate capital funding is based on regional planning. (eg., was a heart transplant program essential in Grand Rapids or simply approved to satisfy the growth agenda of one institution?)
• Eliminate insurance middlemen.
• Rich and poor in the same plan.
• Quality data used for improvement not financial reward.

Now we’re talking real efficiency and truly affordable universal care.

Robert S. Levine, M.D., retired, lives in Grand Rapids.

http://www.mlive.com/opinion/grand-rapids/index.ssf/2012/12/west_michigan_ceos_letter_list.html

Medi-Cal could implode

Court ruling could cut California spending on Medi-Cal

By Maura Dolan and Chris Megerian
Los Angeles Times, December 13, 2012
A federal appeals court decided unanimously Thursday that California may cut reimbursements to doctors, pharmacies and others who serve the poor under Medi-Cal.
A three-judge panel of the 9th Circuit U.S. Court of Appeals overturned injunctions blocking the state from implementing a 2011 law that slashed Medi-Cal reimbursements by 10%. Medi-Cal, a version of Medicaid, serves low-income Californians.
The ruling could make it harder to find doctors for as many as 2 million new patients who could become eligible for Medi-Cal under President Obama’s healthcare law — a possible 25% expansion of the program. California already provides one of the lowest rates of reimbursement in the nation for medical services to the poor, and there is a shortage of doctors to serve those patients.
According to the California HealthCare Foundation, Medi-Cal patients already have difficulty finding doctors.
A foundation study published in July 2010 said 25% of physicians provided care to 80% of Medi-Cal patients.
Although 90% of physicians told the foundation they were accepting new patients, only 57% said they were taking on new Medi-Cal patients.
http://www.latimes.com/news/local/la-me-medi-cal-20121214,0,4784104,full…

One of the major defects in the Affordable Care Act is that it perpetuates and expands the Medicaid program – a welfare program for low-income individuals. Because of political anti-welfare bias, it is vulnerable to budget cuts that would not be tolerated in a program like Medicare that benefits all of us.
California’s Medicaid program, Medi-Cal, exemplifies this problem. It has one of the lowest payment rates in the nation, not even meeting the expenses of many of the physicians still willing to see these patients.
There are already over 7 million Californians on the program, and there will be almost a million children added as California shuts down its CHIP program (Medi-Cal pays less than CHIP). There will be about 2 million more individuals added in 2014 under the provisions of the Affordable Care Act. Further, low-income Medicare patients also eligible for Medi-Cal are being transferred into Medicaid managed care plans.
In spite of California being at the bottom in Medicaid payment rates, this 9th Circuit Court of Appeals decision upholds the additional 10 percent cut enacted because of California’s budget crisis. The reduction was challenged based on the fact that federal law requires that the state ensure that Medicaid patients have access to adequate health care services, and underpayment reduces the number of willing providers. That argument was rejected by the court, though it is difficult to see how California’s physicians will be able to care for over 10 million Medi-Cal patients when they are effectively donating their services plus subsidizing their losses resulting from overhead expenses that are greater than reimbursement rates. As more physicians turn them away, the crowd out of privately insured patients will threaten the solvency of the few remaining dedicated physicians.
This underpayment has real consequences. Access to primary care is impaired, and specialized services are especially difficult to obtain since most specialists are particularly resistant to allowing these patients in their practices, no matter how great the need. Outcomes for Medicaid patients are not as favorable as for those who have Medicare or private insurance. In some studies, the outcomes are as bad as the outcomes for the uninsured.
What good is a Medi-Cal card if it won’t provide access to health care?
If we had a single improved Medicare that covered everyone, this problem wouldn’t exist. Everyone would have the level of care that we should expect from a high-performance health care system. Are there too many politicians who still believe that we should offer only inferior health care to the poor because that is all they deserve? The rhetoric of the recent elections doesn’t bode well for a more egalitarian approach.

The health care debate isn’t over: Let your voice be heard

By Samuel Metz, M.D.
Street Roots, Nov. 29, 2012

Does the specter of your family going bankrupt from a disease not covered by your health insurance keep you staring sleeplessly at the ceiling? Have you lost hope that our country will ever get the health care system we need?

There is a solution, and you can make it happen.

It is single-payer health care. Single payer applies the common characteristics of every successful health care system: (1) It includes everyone without discrimination against the sick, (2) it encourages patients to seek health care at the first suspicion of trouble, and (3) it finances health care with publicly accountable, transparent, not-for-profit agencies.

Will single-payer health care really work?

It already works. Around the world and in our own country, single-payer systems provide better care to more people for less money than our American insurance industry.

Example: Our Veterans Affairs system cares for America’s sickest patients with the best outcomes at the lowest cost with the highest patient satisfaction in the country. The VA is a single payer system.

Example: Almost every large American corporation abandons private health insurance and adopts their own single payer system (called “self-funding”).

Example: Nearly 40 percent of Americans already receive great health care through private and public single payer systems (through corporate self-funded plans, the VA, Medicare, etc.).

For those still skeptical, there are over 25 economic studies of statewide and nationwide single-payer proposals. All conclude single-payer will provide better care to its patients with better results at lower cost than any other proposal. There are no studies concluding single-payer cannot work.

Many free market advocates still cling to the desperate hope that the American private insurance industry will save us by doing more of what it has done for the past 60 years. This hope is misplaced. Never in recorded history has an American-style private insurance system reduced costs or improved health. Perhaps Neanderthals did so and simply forgot to write it down – but I doubt it.

Can you help Congress create a single payer system?

Let’s review three bill being considered right now in Washington.

HR 676, the Expanded & Improved Medicare for All Act, introduced in the House by Rep. John Conyers, would create America’s first nationwide single-payer system. Unfortunately, none of its 76 co-sponsors are Oregonians. Let’s correct that oversight with vigorous letters from readers urging them to sign on now.

Our own Sen. Ron Wyden plus Republican Sen. Scott Brown introduced the “Empowering States to Innovate Act.” The Affordable Care Act prevents states from creating any plan other than health exchanges without a waiver. Currently, states must wait until 2017 to receive one. The Wyden-Brown bill moves that date to 2014.

This is a great time to remind our Sen. Jeff Merkley to sign as a co-sponsor.

Sen. Bernie Sanders and Rep. Jim McDermott introduced more powerful legislation. The American Health Security Act of 2011 requires every state to create its own single-payer program. To sweeten the deal, the bill turns over all federal health care dollars in the state to the single payer agency. Every resident then receives publicly funded health care, prepaid with both federal and state tax dollars.

This legislation has no co-sponsors in the Senate and only nine in the House — again, none from Oregon. Every Oregon senator and representative should receive letters from readers encouraging them to sign. To learn more, please visit the Physicians for National Health Program website, pnhp.org.

As can be seen, we may have an All-Chicago World Series before Washington produces useful legislation.

Does single payer stand a better chance 3,000 miles away in Oregon?

Yes. In March of 2011, the Oregon House Health Committee held a hearing on House Bill 3510, the “Affordable Health Care for All Oregon Plan,” submitted by State Rep. Michael Dembrow. This hearing attracted statewide testimony and attention. Although the bill did not move out of committee, it gained widespread exposure and was endorsed by more than 40 organizations. Rep. Dembrow will resubmit his bill again in the 2013 legislative session. Wouldn’t it be great if your state representative knew how you feel about this bill?

To find out how I feel about the bill, please see my written testimony.

What can readers do right now? A lot. It’s time to get fired up.

Step 1: Write!

Write your senators and representatives a simple, three sentence letter. First – this is how our current health care system is destroying my life, my family, my business, or my clients. Second — I want Oregon to have publicly funded health care. Last – I want you to make it happen. Then sign it, “Sincerely, your constituent. PS. If you want my vote in the next election, you’ll tell me what you’ll do about it.”

Don’t be shy about writing again in a few months.

Imagine every legislator in Salem getting 10 letters like that in a week. And every week after that for the rest of their term. It certainly gets the message across that health care reform cannot be ignored.

Step 2: Join!

Join groups working for single-payer health care. Fortunately, Oregon is blessed with an exemplary organization: Health Care for All Oregon. HCAO represents more than 60 Oregon groups who advocate publicly funded universal care. I highly recommend readers visit the site and discover what they can do personally to make universal care a reality in Oregon.

Full disclosure: I represent the Portland Chapter of Physicians for a National Health Program to HCAO.

Step 3: Don’t accept “No”!

If your state legislator complains they are helpless, tell them to contact Health Care for All Oregon. We’ll tell them what they need to do, and in no uncertain terms.

Oregon legislators cannot ignore their constituents. Every reader is someone’s constituent. If you think single-payer health care in Oregon is vitally urgent, make sure your state legislator understands this clearly. Oregon is riding a crest of activism and we want the waves to wash across the Capitol floors.

We can make a difference.

We can leave our children a better world.

And we can bring to our families the health care we need and deserve.

Samuel Metz is a Portland anesthesiologist active in health care reform. He is also a member of two organizations advocating publicly funded universal health care: Mad As Hell Doctors and Physicians for a National Health Plan. He is the local chapter representative of Health Care for All Oregon, an umbrella organization of over 50 groups working for better health care in Oregon. He can be reached at 3Q9A@samuelmetz.com.

How to rein in Medicare costs

By Carl Berdahl, M.D.
Los Angeles Times, Letters, Dec. 13, 2012

Aside from partial measures like allowing Medicare to negotiate with drug companies for lower prices, the best way to assure Medicare’s fiscal stability is to improve and expand the program to cover all Americans. The resulting single-payer system would slash wasteful paperwork and bureaucracy, yielding savings of up to $400 billion annually. Furthermore, young and old alike would have a clearer stake in sustaining a single, equitable system.

With the amount our nation spends each year on healthcare, we can afford to provide universal coverage. However, we choose not to. Instead, we waste money on private health insurance companies. While Medicare allocates just a few percentage points of its revenue to overhead, private companies spend about 15% on overhead and profits.

We should expand Medicare, the nation’s most efficient health insurance system, rather than cutting it.

Carl Berdahl, M.D., resides in Los Angeles.

http://www.latimes.com/news/opinion/letters/la-le-1213-thursday-medicare-costs-20121213,0,4441374.story

Defending Public Healthcare in Madrid

Interview with Dr. Marciano Sanchez Bayle

By Andrew D. Coates, M.D.
Counterpunch, Dec. 13, 2012

Madrid’s physicians, nurses and other health professionals have been marching in the streets with their patients for over a month, protesting the government’s plan to privatize and sharply reduce public health services.

Spain’s National Health System (SNS), established in 1986, fulfills a mandate included in Spain’s national constitution. Article 43 guarantees healthcare to all Spaniards, including the right to adequate public health services.(1,2)

The attack on the SNS is being led by the government in Madrid. (Administration of the SNS is decentralized; each of Spain’s 17 semi-autonomous regions sets health budgets and priorities.)(3) At the beginning of November Madrid moved to privatize ten percent of public health centers as well as the administration of six hospitals – half of the hospitals in the region. Of the hospitals to be privatized, all were recently built.

The response: an unprecedented and massive mobilization of people in Madrid, now making mainstream news across the world.(4,5) Caregivers and patients together have joined protests at every public health clinic and hospital in Madrid. Marches have involved hundreds of thousands.(6) Caregivers have gone on strike and stopped traffic outside their workplaces.(7)

The Partido Popular, in power nationally as well as in Madrid, also proposed to convert La Princesa Hospital, a tertiary care center serving about 300,000 patients annually, into a specialty care center for patients over the age of 75. In addition to mass meetings and sit-ins at La Princesa Hospital, a petition in protest gained over 200,000 signatures.(8) The Mayor of Madrid, herself a member of the Partido Popular, signed on. The government has retreated from its plans at La Princesa Hospital yet the struggle continues.(9)

Last week a group of patients, nurses and physicians disrupted a speech at the Madrid regional Assembly, where the government’s economic counselor was explaining the hospital privatization plans. In this short news video (11), Dr. Marciano Sanchez Bayle chants for public healthcare beside a woman who unfurls a banner, the first to be led out by police. Note the Assembly members who stood to applaud the protesters.

Here is a short interview I conducted with Dr. Sanchez Bayle of the Federation of Associations for the Defense of Public Health (FADSP) this week.  He is a pediatrician who practices in Madrid.  (Any error in translation is my own.)

***

Dr. Andrew D. Coates: Many of us in the United States have difficultly imagining health care delivered by a public system. Would you please describe how patients in Madrid get their medical cares?

Dr. Marciano Sanchez Bayle: In Spain the health system is public and coverage is universal. This means that when a person thinks he or she has a health problem, they go their public health center. There they are attended by a doctor and/or a nurse who will make the appropriate decision whether to diagnose and treat, ask for diagnostic tests, refer the patient to a specialist or admit them to a hospital.

Of course, if the situation is serious or occurs outside regular treatment hours, patients can go to a hospital emergency room. Hospitals are also mostly public. Thus far all of these services are free, including the tests. A patient does have to pay a share of the cost of their prescriptions, however.

On a per capita basis, the Spanish system is four times less costly than in the U.S. Yet we achieve much better outcomes, according to basic health indicators.

Dr. Coates: How has the government proposed to change this in Madrid?

Dr. Sanchez Bayle: The proposal in Madrid is to privatize some of the hospitals and health centers, turning them over to private businesses.

Dr. Coates: How will this affect patients?

Dr. Sanchez Bayle: There will be an immediate and significant downsizing of personnel, resulting in diminished access to care. It will undermine the quality of care. It will substantially lengthen waiting lists.

In addition, these changes will result in what we call risk selection, whereby private entities will seek out the most profitable pathologies, i.e. those persons who are less sick. As a result, people will face more obstacles to getting the care they need, following the Tudor Hart law of inverse care (11) – medical attention will be dispensed in inverse proportion to the needs of the population.

These will be the short-term results, because it is clear to us that the Partido Popular, the conservative party, hopes to install a health care model based on private insurance. The disastrous results of such a model as the United States, are well known.

Dr. Coates: What will it mean to doctors and nurses?

Dr. Sanchez Bayle: First of all, there will be fewer of them employed, with layoffs and fewer facilities to practice in. For those remaining, it will result in overwork and a worsening of professional working conditions.

Dr. Coates: Please describe the protests that have emerged in response.

Dr. Sanchez Bayle: It would take a very long time to fully answer your question because there have been such a multitude of actions. Briefly, it has produced a strike by the staff of the centers — doctors, nurses, administrators, auxiliaries, etc. — which has been organized according to a rotating schedule, e.g. specific days a week. Health worker sit-ins, sometimes joined by patients, have also occurred. These started first in the hospitals, then in the health care centers. These protests have been going on for 30 days.

In addition, massive demonstrations have been held in Madrid, some with more than 100,000 people, professionals and patients. Every day there are demonstrations blocking traffic in front of the health centers. Last week an action was carried out under the slogan “Hug your Hospital,” in which human chains circled all the public hospitals of Madrid.

The most interesting thing is the supportive reaction of the citizenry. People are very committed to the defense of the public health care system. Of course, we Spanish continue to have a bit of the guerillero and anarchist spirit in us, so to speak, and many initiatives have been sprouting up like mushrooms.

Dr. Coates: What is the significance of the La Princesa Hospital in this struggle?

Dr. Sanchez Bayle: La Princesa Hospital is located in the center of Madrid. It has 600 beds and a high level of specialization. It is the referral center for many of the peripheral centers of Madrid and beyond.

The attempt to convert La Princesa into a geriatric center was the spark that lit the movement: the unions of the center started a sit-in which still continues. The sit-in has mobilized more that 90 percent of the facility’s workers. Citizens in the zone it serves have also joined in. The hospital’s governing council negotiated with some of the doctors, i.e. department heads, and the two sides arrived at an agreement which doesn’t seem bad. Yet the struggle to withdraw all the measures that affect health care in Madrid, including this issue, continues.

Dr. Coates: We have been hearing about many protests against austerity in Europe, in Spain, in Madrid. What is the justification used by the government to move to privatize the public system?

Dr. Sanchez Bayle: The government says that it’s the crisis and that there is no money, but it’s a lie. They have allocated 215,695 million pesetas to bail out the banks, and with these measures they say that they will save
7,000 million pesetas in health care. What they want to do is to use the excuse of the crisis to privatize health care, to put it in private hands in order to make a profit on the health of the people.

Dr. Coates: What is your view of this demand for austerity?

Dr. Sanchez Bayle: I have already said that they want to take away peoples’ rights in favor of the banks and private businesses.

Dr. Coates: Why did you disrupt the Madrid Assembly? Who was with you?

Dr. Sanchez Bayle: What we did was to try to demonstrate within the Assembly professionals’ and citizens’ rejection of this blatant act of aggression against health care. The elected representatives should not have deaf ears to the opinion of the immense majority. Keep in mind that the Partido Popular, now in government, didn’t include these measures in its election program. They gained their votes through trickery and are now attacking our public health care system.

Dr. Coates: What else would you like to share with people in North America about this struggle? What can we do to help?

Dr. Sanchez Bayle: The right to health care is a peoples’ right and should be defended as such. What is happening in Spain today may seem far-off to the people of the United States, but the world is globalized and interconnected. Every advance or retreat which happens in one part of the world has a repercussion for us all. Help can come in spreading word of the struggle so the problem is known, and also demonstrating solidarity through demonstrations in front of Spanish embassies and sending signed protest letters to entities and people in the government of Madrid.

Solidarity is very important, not only for those who receive it but also for those who practice it, because it makes us better people and benefits our common, concrete struggles.

Andrew D. Coates, M.D., will be president of Physicians for a National Health Program in 2013.

Notes:

(1) http://www.servat.unibe.ch/icl/sp00000_.html
(2) http://en.wikipedia.org/wiki/Spanish_National_Health_System
(3) http://www.spainthenandnow.com/spanish-travel/general-map-of-spain/default_92.aspx
(4) http://www.timesunion.com/news/article/Thousands-protest-Spain-s-health-care-austerity-4103126.php
(5) http://www.adelaidenow.com.au/news/breaking-news/thousands-protest-spains-health-care-cuts/story-e6frea7u-1226533310603?from=public_rss
(6) http://www.reuters.com/article/2012/12/09/us-spain-health-march-idUSBRE8B809H20121209
(7) http://www.thenation.com/blog/171670/how-strike-back-14n-dispatch-madrid
(8) http://www.larioja.com/videos/actualidad/espana/1951507741001-madrileno-hospital-princesa-lucha.html
(9) http://elpais.com/elpais/2012/11/13/inenglish/1352818341_939984.html
(10) http://www.telecinco.es/informativos/sociedad/Protestas-recortes_en_Sanidad-Sanidad-Asamblea_de_Madrid_2_1519905142.html
(11) http://en.wikipedia.org/wiki/Inverse_care_law

http://www.counterpunch.org/2012/12/13/defending-public-healthcare-in-madrid/

United Nations passes resolution supporting universal coverage

US backs United Nations measure in favor of universal health coverage

By Elise Viebeck
The Hill, December 12, 2012

The United States has backed a United Nations draft resolution favoring universal healthcare coverage.

The nonbinding measure calls on U.N. member states to ensure citizens’ access to health insurance, and was approved by the U.N. General Assembly on Wednesday.

http://thehill.com/blogs/healthwatch/public-global-health/272625-us-backs-un-measure-on-universal-health-coverage

And…

Adopting Consensus Text, General Assembly Encourages Member States to Plan, Pursue Transition of National Health Care Systems Towards Universal Coverage

General Assembly
United Nations, December 12, 2012

Recognizing the intrinsic role of health in achieving international development goals, the General Assembly today – through the unanimous adoption of a resolution on global health and foreign policy – encouraged Governments to plan or pursue the transition towards universal access to affordable and quality health-care services.

By that text, the Assembly, calling for more attention to health as an important cross-cutting policy issue, urged Member States, civil society and international organizations to incorporate universal health coverage in the international development agenda and in the implementation of the internationally agreed development goals, including the Millennium Development Goals.

The Assembly also recognized that improving social protection towards universal coverage “is an investment in people that empowers them to adjust to changes in the economy and the labour market and helps support a transition to a more sustainable, inclusive and equitable economy”.  As such, while planning or pursuing the transition towards universal coverage, Member States were encouraged to continue investing in health-delivery systems to increase and safeguard the range and quality of services and meet the health needs of their populations.

Further, Member States were encouraged to recognize the links between the promotion of universal health coverage and other foreign policy issues, such as the social dimension of globalization, inclusive and equitable growth and sustainable development.

http://www.un.org/News/Press/docs//2012/ga11326.doc.htm

And…

Agenda item 123

United Nations
General Assembly, Sixty-seventh session

Global Health and Foreign Policy

IV. Universal health coverage

56. Universal health coverage captures the aspiration that everyone will be able to obtain the high-quality health services they need without the risk of suffering severe financial hardship when using them. The goal of achieving universal health coverage has two important and interrelated components: coverage for everyone who needs health services (including prevention, promotion, treatment and rehabilitation) and coverage with financial risk protection.

57. Both components are critical to the fulfilment of the highest attainable level of health, a fundamental human right embedded in the WHO constitution of 1948 and in the Universal Declaration of Human Rights. At the same time, people value them for their own sake. They sleep securely at night knowing that the health services they might require are available and of good quality and that they can afford to use them.

http://www.un.org/ga/search/view_doc.asp?symbol=A/67/377

Population figures by country
http://www.nationsonline.org/oneworld/population-by-country.htm

Comment:

By Don McCanne, MD

It is terrific that the United States has voted for a United Nations resolution in support of universal health coverage for all Member States. But what about the United States? The Affordable Care Act will leave about 30,000,000 uninsured, more than the entire population of each of 183 countries and territories. Oh, of course… the U.N. resolution is nonbinding.

United Nations passes resolution supporting universal coverage

US backs United Nations measure in favor of universal health coverage

By Elise Viebeck
The Hill, December 12, 2012
The United States has backed a United Nations draft resolution favoring universal healthcare coverage.
The nonbinding measure calls on U.N. member states to ensure citizens’ access to health insurance, and was approved by the U.N. General Assembly on Wednesday.
http://thehill.com/blogs/healthwatch/public-global-health/272625-us-back…
And…

Adopting Consensus Text, General Assembly Encourages Member States to Plan, Pursue Transition of National Health Care Systems Towards Universal Coverage

General Assembly
United Nations, December 12, 2012
Recognizing the intrinsic role of health in achieving international development goals, the General Assembly today – through the unanimous adoption of a resolution on global health and foreign policy – encouraged Governments to plan or pursue the transition towards universal access to affordable and quality health-care services.
By that text, the Assembly, calling for more attention to health as an important cross-cutting policy issue, urged Member States, civil society and international organizations to incorporate universal health coverage in the international development agenda and in the implementation of the internationally agreed development goals, including the Millennium Development Goals.
The Assembly also recognized that improving social protection towards universal coverage “is an investment in people that empowers them to adjust to changes in the economy and the labour market and helps support a transition to a more sustainable, inclusive and equitable economy”.  As such, while planning or pursuing the transition towards universal coverage, Member States were encouraged to continue investing in health-delivery systems to increase and safeguard the range and quality of services and meet the health needs of their populations.
Further, Member States were encouraged to recognize the links between the promotion of universal health coverage and other foreign policy issues, such as the social dimension of globalization, inclusive and equitable growth and sustainable development.
http://www.un.org/News/Press/docs//2012/ga11326.doc.htm
And…

Agenda item 123

United Nations
General Assembly, Sixty-seventh session
Global Health and Foreign Policy
IV. Universal health coverage
56. Universal health coverage captures the aspiration that everyone will be able to obtain the high-quality health services they need without the risk of suffering severe financial hardship when using them. The goal of achieving universal health coverage has two important and interrelated components: coverage for everyone who needs health services (including prevention, promotion, treatment and rehabilitation) and coverage with financial risk protection.
57. Both components are critical to the fulfilment of the highest attainable level of health, a fundamental human right embedded in the WHO constitution of 1948 and in the Universal Declaration of Human Rights. At the same time, people value them for their own sake. They sleep securely at night knowing that the health services they might require are available and of good quality and that they can afford to use them.
http://www.un.org/ga/search/view_doc.asp?symbol=A/67/377
Population figures by country
http://www.nationsonline.org/oneworld/population-by-country.htm

It is terrific that the United States has voted for a United Nations resolution in support of universal health coverage for all Member States. But what about the United States? The Affordable Care Act will leave about 30,000,000 uninsured, more than the entire population of each of 183 countries and territories. Oh, of course… the U.N. resolution is nonbinding.

Delaware should move to single-payer health care

By Earl Jaques and John Kowalko
The News Journal, delawareonline.com, Dec. 11, 2012

The recent Supreme Court decision followed by the re-election of President Obama guarantees that the Affordable Health Care Act will be with us long into the future. As each day passes we have learned more about the law, what is contained in the bill and how states will play a major role in the implementation and funding of many portions of program. The Affordable Health Care Act requires everyone to have coverage but at a cost to be determined.

The ACA will not change your situation if you are currently in an employer-provided program (not exceeding 9.5 percent of a person’s income) or if you are enrolled in Medicare, Medicaid or Tricare.

The ACA will require you to purchase insurance through the Health Insurance Exchange program if you’re an individual or family with income between 139 percent-400 percent of the federal poverty level ($15,029-$43,500 for a single person and $30,844-$88,200 for a family of four) and your employer does not provide health care coverage.

Delaware has chosen the Blue Cross-Blue Shield Small Group plan as the benchmark for certification of Qualified Health Plans offered by insurers who wish to compete in the exchange that is being set up by the state. Coverage under this plan will be very basic, as determined by the insurance company as long as it meets the chosen standard. At this time, cost has not been determined. Delaware will receive 100 percent funding from the federal government through 2016. After that, Delaware’s share for newly eligible enrollees will be 5 percent in 2017, increasing to 10 percent in 2020 and beyond. Individuals who fail to have or purchase insurance will then be subject to a tax, as determined by the U.S. Supreme Court. Many experts have reported that it will be cheaper to pay the tax then to purchase insurance.

As the Affordable Care Act ultimately plays out, we know two things for certain: Millions and millions of Americans will remain uncovered; and it will leave the for-profit insurance industry in charge of prices and life-and-death treatment decisions.

So what is the answer? Many industrialized countries around the world have some type of “Healthcare-for-All” (single-payer) system. In our country, we have several of these systems: Medicare, Medicaid and Tricare, which have repeatedly received high marks for outstanding patient care at relatively low cost.

As Dr. Marcia Angell, former editor in chief of the New England Journal of Medicine put it, “Healthcare-for-All is not only the best health care reform, it’s the only health care reform that will cover everyone and control costs.”

As elected representatives, we are convinced that we need to move to a single-payer system as soon as possible. Although the Affordable Care Act has taken a step forward in health care access, it will still leave millions of Americans without coverage. Personal bankruptcies triggered by medical bills will continue to pile up. Medical bills are the No. 1 cause of personal bankruptcies in the United States.

We can’t afford to wait as health insurance costs continue to spin out of control. More and more companies are dropping health care plans for their employees because of the costs.

How long will the federal government or state governments be able to cover their share of medical costs?

It’s time to dispel the myths about a single-payer system.

It is not socialized medicine. It is guaranteed access to health care. You get a health care card and you can go to any doctor or hospital in the U.S. Doctors are not employees of the government and hospitals remain in private hands. You get free choice of doctor and hospital.

A single-payer system will not lead to rationing. In fact, currently, private health insurance companies ration care is based on cost and if you don’t have health insurance, you don’t get care. Costs will not skyrocket under single payer; in fact single payer is the only health care reform mechanism that will save enough money to insure everyone. Eliminating the health insurance industry will save millions of dollars each year in administrative costs and profits.

Drugs will be cheaper under single payer because of the advantage of bulk purchasing. The system will provide a buying power advantage similar to the health care provided veterans which includes a 40 percent discount on pharmaceuticals.

Single payer will mean a vast improvement in access to health care for a majority of Delawareans. All medically necessary care would be funded including all doctor visits, hospital care, prescriptions, mental health services, nursing home care, rehab, home care, eye care and dental with no more bills, deductibles or co-pays.

Under our proposed single-payer funding mechanism, we believe a majority of individuals and companies will save money. We have checked the numbers that are contained in our previous HB 392 and had those figures verified by the Secretary of Finance office.

Recently, pundits have said our country will eventually have a single-payer system in place, but the people cannot afford to wait. Not one more person should die from lack of access to proper health care and as representatives of the “First State,” we must move forward now.

Earl Jaques represents the 27th District and John Kowalko represents the 25th District in the Delaware House of Representatives.

http://www.delawareonline.com/article/20121212/OPINION07/312120013/State-should-move-single-payer-health-care?odyssey=mod|newswell|text|Opinion|p&nclick_check=1

Rising costs and eroding protection

State Trends in Premiums and Deductibles, 2003–2011: Eroding Protection and Rising Costs Underscore Need for Action

By Cathy Schoen, Jacob Lippa, Sara Collins, and David Radley
The Commonwealth Fund, December 2012

Across states, the total average premium reached $15,022 per year in 2011 for family coverage, an increase of 62 percent since 2003.

Although premiums are rising more slowly than they were before enactment of the recent reforms, private insurance spending per person is projected to continue to grow more rapidly than incomes over the next decade.

By 2011, there were 35 states in which the annual premium equaled 20 percent or more of income, compared with just one state in 2003. And there are now no states where premiums amount to less than 14 percent of median incomes, compared with 13 such states in 2003.

Although workers are paying more for insurance, their premiums are buying them less financial protection because of the rapid increase in deductibles from 2003 to 2011. The resulting shift of medical care costs onto workers and their families has led to higher out- of-pocket costs for medical bills — on top of higher premium costs. By 2011, 78 percent of workers faced a deductible, compared with about half (52 percent) in 2003.

With the recent recession, millions of workers lost their jobs or were otherwise unable to afford coverage and, as a result, joined the ranks of the uninsured. From 2008 to 2010, the percentage of people with employment-based insurance fell from 58.9 percent to 55.3 percent. An estimated 9 million adults ages 19 to 64 lost a job with health benefits and became uninsured during this period.

Along with rising numbers of uninsured, the nation has seen a rapid increase in the number of underinsured, those at risk of high out-of-pocket costs for medical care although insured all year. As of 2010, estimates indicate 81 million adults under age 65 (44% of all adults) were either uninsured during the year or underinsured, up from 61 million in 2003.

From 2003 to 2010, median family incomes increased by only 10 percent, on average, not enough to keep up with an inflation rate that has increased by 18.5 percent over these seven years.
 
To date, with highly concentrated insurance markets, the path of least resistance for insurers has been to simply pass on the rising costs of medical care and higher prices, while adding insurance administrative costs and profit margins. In fact, the major national private insurance companies have done well throughout the recession years, with strong pretax profit margins and administrative costs that have largely kept pace with increases in medical care costs.
 
The national debate on health care costs often centers on the federal deficit and on Medicare’s future. Less attention is focused on the costs of private insurance spending per person, which have been rising faster than Medicare spending per person and are projected to continue to do so over the next decade. The mounting stresses on businesses and families underscore the need for action on behalf of the private sector as well. Absent a significant change in the way private insurance and health care markets function, cost pressures will continue to push up private insurance costs and out-of-pocket medical expenses, if the past two decades are any guide.
 
The Affordable Care Act’s effectiveness in tackling costs, however, will require collaboration among public and private stakeholders to ensure that markets operate in the broad national interest of better health, more positive health care experiences, and lower future costs.

For full report, click “Issue Brief” at this link:
http://www.commonwealthfund.org/Publications/Issue-Briefs/2012/Dec/State-Trends-in-Premiums-and-Deductibles.aspx?omnicid=20

Comment:

By Don McCanne, MD

It just gets worse. Family insurance premiums are now over $15,000 – more than 20 percent of income in a majority of states. Family deductibles now average over $2000. Family incomes have not kept up with inflation, much less with the cost of health care. Yet private insurers are thriving.

Many are hoping that the Affordable Care Act will provide some relief. The PNHP website (www.pnhp.org) has a plethora of reports and studies indicating that there is no hope that that we will have truly substantial reform under this Act – only administratively-complex tweaks.

The authors of this report state that the Affordable Care Act’s effectiveness “will require collaboration among public and private stakeholders.” This is the fundamental reason that there is no hope. Under our current dysfunctional financing system, which was left in place by this legislation, that collaboration must be voluntary – an impossibility since each vested interest is jockeying for the most advantageous position.

Under a properly designed single payer system, the publicly-administered policies are designed to ensure collaboration of all parties. What works in the interests of the patients also works in the interests of the collaborators. Until the nation is ready to demand structural reform that benefits us all, we are going to continue to see the numbers in this report grow even worse.

Rising costs and eroding protection

State Trends in Premiums and Deductibles, 2003–2011: Eroding Protection and Rising Costs Underscore Need for Action

By Cathy Schoen, Jacob Lippa, Sara Collins, and David Radley
The Commonwealth Fund, December 2012
Across states, the total average premium reached $15,022 per year in 2011 for family coverage, an increase of 62 percent since 2003.
Although premiums are rising more slowly than they were before enactment of the recent reforms, private insurance spending per person is projected to continue to grow more rapidly than incomes over the next decade.
By 2011, there were 35 states in which the annual premium equaled 20 percent or more of income, compared with just one state in 2003. And there are now no states where premiums amount to less than 14 percent of median incomes, compared with 13 such states in 2003.
Although workers are paying more for insurance, their premiums are buying them less financial protection because of the rapid increase in deductibles from 2003 to 2011. The resulting shift of medical care costs onto workers and their families has led to higher out- of-pocket costs for medical bills — on top of higher premium costs. By 2011, 78 percent of workers faced a deductible, compared with about half (52 percent) in 2003.
With the recent recession, millions of workers lost their jobs or were otherwise unable to afford coverage and, as a result, joined the ranks of the uninsured. From 2008 to 2010, the percentage of people with employment-based insurance fell from 58.9 percent to 55.3 percent. An estimated 9 million adults ages 19 to 64 lost a job with health benefits and became uninsured during this period.
Along with rising numbers of uninsured, the nation has seen a rapid increase in the number of underinsured, those at risk of high out-of-pocket costs for medical care although insured all year. As of 2010, estimates indicate 81 million adults under age 65 (44% of all adults) were either uninsured during the year or underinsured, up from 61 million in 2003.
From 2003 to 2010, median family incomes increased by only 10 percent, on average, not enough to keep up with an inflation rate that has increased by 18.5 percent over these seven years.
To date, with highly concentrated insurance markets, the path of least resistance for insurers has been to simply pass on the rising costs of medical care and higher prices, while adding insurance administrative costs and profit margins. In fact, the major national private insurance companies have done well throughout the recession years, with strong pretax profit margins and administrative costs that have largely kept pace with increases in medical care costs.
The national debate on health care costs often centers on the federal deficit and on Medicare’s future. Less attention is focused on the costs of private insurance spending per person, which have been rising faster than Medicare spending per person and are projected to continue to do so over the next decade. The mounting stresses on businesses and families underscore the need for action on behalf of the private sector as well. Absent a significant change in the way private insurance and health care markets function, cost pressures will continue to push up private insurance costs and out-of-pocket medical expenses, if the past two decades are any guide.
The Affordable Care Act’s effectiveness in tackling costs, however, will require collaboration among public and private stakeholders to ensure that markets operate in the broad national interest of better health, more positive health care experiences, and lower future costs.
For full report, click “Issue Brief” at this link:
http://www.commonwealthfund.org/Publications/Issue-Briefs/2012/Dec/State…

It just gets worse. Family insurance premiums are now over $15,000 – more than 20 percent of income in a majority of states. Family deductibles now average over $2000. Family incomes have not kept up with inflation, much less with the cost of health care. Yet private insurers are thriving.
Many are hoping that the Affordable Care Act will provide some relief. The PNHP website (www.pnhp.org) has a plethora of reports and studies indicating that there is no hope that that we will have truly substantial reform under this Act – only administratively-complex tweaks.
The authors of this report state that the Affordable Care Act’s effectiveness “will require collaboration among public and private stakeholders.” This is the fundamental reason that there is no hope. Under our current dysfunctional financing system, which was left in place by this legislation, that collaboration must be voluntary – an impossibility since each vested interest is jockeying for the most advantageous position.
Under a properly designed single payer system, the publicly-administered policies are designed to ensure collaboration of all parties. What works in the interests of the patients also works in the interests of the collaborators. Until the nation is ready to demand structural reform that benefits us all, we are going to continue to see the numbers in this report grow even worse.

Means testing Medicare

Democrats warm to Medicare change that late Sen. Edward Kennedy opposed

By Elise Viebeck
The Hill, December 8, 2012

Democrats in Congress are changing their tune on means testing in Medicare, an idea the late Sen. Edward Kennedy (D-Mass.) resisted for decades.

Leading Democratic lawmakers have suggested that raising premiums for wealthy Medicare beneficiaries could be a matter of common ground with Republicans in the ongoing deficit-reduction talks.

“I think that is reasonable and certainly consistent with the Democratic message that those who are better off in our country should be willing to pay a little more,” Senate Majority Whip Dick Durbin (D-Ill.) said Thursday.

The idea of affluence testing is not new — wealthy Medicare recipients already pay higher premiums for doctor visits and prescription drug coverage.

But negotiations to avoid the so-called “fiscal cliff” open the door to new measures that would make Medicare costs more progressive based on income.

Last week, Senate Finance Committee Chairman Max Baucus (D-Mont.) called the idea “somewhat attractive” as a bargaining chip for talks on the so-called fiscal cliff.

Sen. Claire McCaskill (D-Mo.) remarked that “Donald Trump may need medication, but he certainly doesn’t need the government to pay for it.”

And Congressional Black Caucus Chairman Emanuel Cleaver (D-Mo.) called means testing a good way to bolster Medicare’s budget without cutting benefits.

“We already have a substantial amount of means-testing in the Medicare program — most significantly, there is no cap on the income subject to the Medicare tax,” said (Rep. Henry) Waxman in a statement to The Hill.

“That is the right way to ask the better-off to pay more. And in fact, we also have means testing now of the Part B and Part D premiums. It is a mistake to go further.”

http://thehill.com/blogs/healthwatch/medicare/271795-dems-warm-to-medicare-change-that-kennedy-opposed

Comment:

By Don McCanne, MD

Now that health care costs are unbearably high, Medicare must be progressively financed since moderate- and low-income individuals can no longer bear the full costs. A major step forward was the removal of the cap on wages subject to Medicare taxes, so higher income individuals pay more. The Affordable Care Act also added a new 0.9% Medicare tax for incomes over $200,000/$250,000.

In addition, in order to help cover Medicaid expansion and subsidies for the exchange plans, the Affordable Care Act also added a 3.8% tax on investment income, again for those with incomes over $200,000/$250,000. So we have already embarked on policies that make health care financing progressive, though we need to do more, but only on the financing end.

Medicare benefits should be the same for everyone. We should eliminate premiums and cost sharing, and we should expand benefits so that administratively wasteful Medigap and retiree health benefit programs are no longer necessary. Low income individuals should receive the same standard of care as the wealthy, just as was the intent in enacting the traditional Medicare program.

Introducing means testing, which we have already begun with Part B and Part D premiums, reduces support of wealthier beneficiaries who are annoyed by these additional charges. Once the principle of means testing is established, the budget hawks ratchet it up, driving wealthier individuals to look for private options, currently available as the Medicare Advantage plans. It is only one small additional step to introduce premium support – vouchers – where the wealthy will take their money and run. Once you lose support of wealthier individuals who have a strong political voice, then Medicare will descend down the path toward becoming a welfare program, like Medicaid.

We cannot allow this bipartisan attack on Medicare to proceed. Mobilize the forces!

Means testing Medicare

Democrats warm to Medicare change that late Sen. Edward Kennedy opposed

By Elise Viebeck
The Hill, December 8, 2012
Democrats in Congress are changing their tune on means testing in Medicare, an idea the late Sen. Edward Kennedy (D-Mass.) resisted for decades.
Leading Democratic lawmakers have suggested that raising premiums for wealthy Medicare beneficiaries could be a matter of common ground with Republicans in the ongoing deficit-reduction talks.
“I think that is reasonable and certainly consistent with the Democratic message that those who are better off in our country should be willing to pay a little more,” Senate Majority Whip Dick Durbin (D-Ill.) said Thursday.
The idea of affluence testing is not new — wealthy Medicare recipients already pay higher premiums for doctor visits and prescription drug coverage.
But negotiations to avoid the so-called “fiscal cliff” open the door to new measures that would make Medicare costs more progressive based on income.
Last week, Senate Finance Committee Chairman Max Baucus (D-Mont.) called the idea “somewhat attractive” as a bargaining chip for talks on the so-called fiscal cliff.
Sen. Claire McCaskill (D-Mo.) remarked that “Donald Trump may need medication, but he certainly doesn’t need the government to pay for it.”
And Congressional Black Caucus Chairman Emanuel Cleaver (D-Mo.) called means testing a good way to bolster Medicare’s budget without cutting benefits.
“We already have a substantial amount of means-testing in the Medicare program — most significantly, there is no cap on the income subject to the Medicare tax,” said (Rep. Henry) Waxman in a statement to The Hill.
“That is the right way to ask the better-off to pay more. And in fact, we also have means testing now of the Part B and Part D premiums. It is a mistake to go further.”
http://thehill.com/blogs/healthwatch/medicare/271795-dems-warm-to-medica…

Now that health care costs are unbearably high, Medicare must be progressively financed since moderate- and low-income individuals can no longer bear the full costs. A major step forward was the removal of the cap on wages subject to Medicare taxes, so higher income individuals pay more. The Affordable Care Act also added a new 0.9% Medicare tax for incomes over $200,000/$250,000.
In addition, in order to help cover Medicaid expansion and subsidies for the exchange plans, the Affordable Care Act also added a 3.8% tax on investment income, again for those with incomes over $200,000/$250,000. So we have already embarked on policies that make health care financing progressive, though we need to do more, but only on the financing end.
Medicare benefits should be the same for everyone. We should eliminate premiums and cost sharing, and we should expand benefits so that administratively wasteful Medigap and retiree health benefit programs are no longer necessary. Low income individuals should receive the same standard of care as the wealthy, just as was the intent in enacting the traditional Medicare program.
Introducing means testing, which we have already begun with Part B and Part D premiums, reduces support of wealthier beneficiaries who are annoyed by these additional charges. Once the principle of means testing is established, the budget hawks ratchet it up, driving wealthier individuals to look for private options, currently available as the Medicare Advantage plans. It is only one small additional step to introduce premium support – vouchers – where the wealthy will take their money and run. Once you lose support of wealthier individuals who have a strong political voice, then Medicare will descend down the path toward becoming a welfare program, like Medicaid.
We cannot allow this bipartisan attack on Medicare to proceed. Mobilize the forces!