PNHP

The power of universal health care

The power of universal health care

By Winthrop C. Dillaway III, M.D.
The Star-Ledger (N.J.), April 18, 2012

In 2009, when President Obama began his term of office, the U.S. health care system was painfully dysfunctional. He announced an initiative for health care reform. Early on, “universal health care” garnered thought and attention. Unfortunately, with the ensuing debate and politics, the concept of universal health care faded and disappeared.

On March 23, 2010, the health care reform bill was signed into law with considerable fanfare. Genuine goodwill and effort contributed to the final product and many aspects of the law are laudable. Nevertheless, two years later, the health care system in the United States remains painfully dysfunctional. Why? What is right? What is wrong? And whatever happened to universal health care?

T.R. Reid, Pulitzer Prize-winning journalist and author of the best-selling book “The Healing of America,” makes three powerful observations: First, all other leading countries provide universal health care at half the cost and higher quality than the United States does. Second, he points to the remarkable variety of health care systems in those successful countries. Third, and most important, what those successful systems have in common is universal health care. Reid states, “Every developed country except the United States has reached the same conclusion: Everyone should have access to medical care.”

The questions about universal health care jump out. Is it a fluke? Why and how do 100 percent of those societies achieve universal health care while America doesn’t come close? Or, perhaps, does universal health care intrinsically offer leverage over management of cost and quality?

Two major obstacles prevent serious comparison of U.S. health care to that of other countries. First is the sheer enormity of the U.S. system; size, cost, complexity, competing expectations, history, politics and, especially, vested interests. Second, that success elsewhere comes with so many different systems. It is nearly impossible to imagine how or what could be captured to improve the U.S. system. Nevertheless, the key to simplifying, clarifying and moving toward a functional, cost-effective and fair health care system is hidden in a paradigm shift to the concept of universal health care.

Here’s how: All health care systems face the triple challenges of access, cost and quality. With universal health care, access is fixed, leaving only two variables: cost and quality. Furthermore, policy makers who want to provide health care to all would naturally be forced to focus on cost and temporarily set aside the third variable, quality.

To focus on cost, all successful health care systems (in fact, all successful businesses) must and do have overall budgeting, accounting, overhead control and insurance risk-pooling. The U.S. system fails and ignores all four areas. No wonder the U.S. system, even reformed, is so dysfunctional. Of course, the vested interests would lobby fiercely against change in these four areas. Nevertheless, this exposure would finally allow Americans to understand what is wrong and what is right, and to see a clear path to legitimate reform.

And what about that third variable, quality, that was temporarily set aside to focus on cost? It’s no fluke that essentially all successful health care systems boast higher quality than that of the United States. (It’s a fallacy that the United States has superior quality health care.) With budgeting, accounting, overhead control and reasonable risk-pooling in place, patients are going to demand the most for their money. Quality becomes the ultimate and lasting focus for any decent health care system.

Society and policy makers need not be overwhelmed by the complexities of health care systems.

Reid points to an invaluable paradigm: simply determining, first, that access to health care be available to all leads to solutions for cost and quality. Confounded by deep experiences and the complexities of life, it is human nature to overlook the obvious.

Imagine the profound benefits to all with the discovery and implementation of this simple paradigm shift to the power of universal health care.

Winthrop C. Dillaway III, M.D., of Morris Plains is president of the New Jersey chapter of Physicians for a National Health Program.

http://blog.nj.com/njv_guest_blog/2012/04/the_power_of_universal_health.html

Is the Basic Health Program option a good idea?

The Role of the Basic Health Program in the Coverage Continuum: Opportunities, Risks and Considerations for States

By Deborah Bachrach, Melinda Dutton, Jennifer Tolbert and Julia Harris
Kaiser Family Foundation, March 2012

The Basic Health Program (BHP) is an optional coverage program under the Patient Protection and Affordable Care Act (ACA) that allows states to use federal tax subsidy dollars to offer subsidized coverage for individuals with incomes between 139-200% of the federal poverty level (FPL) who would otherwise be eligible to purchase coverage through state Health Insurance Exchanges. States can use the BHP to reduce the cost of health insurance coverage for these low-income consumers, a highly price-sensitive population with high rates of uninsurance. Depending on how it is designed, the BHP also can help consumers to maintain continuity among plans and providers as their income fluctuates above and below Medicaid levels. 
 
As states weigh whether to implement a BHP, they face significant questions and challenges. Critical among these are how to design the BHP to enhance continuity of coverage as people move among Medicaid, the BHP, and coverage through qualified health plans (QHPs) in the Exchange; how to assess the BHP’s impact on the viability and effectiveness of state Exchanges; and how to estimate revenues and costs to evaluate the financial feasibility of the BHP.

Conclusion

Federal officials have yet to provide details about how the program will be financed, administered and certified, and states are struggling to evaluate the BHP’s impact on the viability and effectiveness of state Exchanges. Federal regulations will inform state deliberations, but are unlikely to fully resolve the complexity or eliminate the risk. Ultimately, states that opt for a BHP will want to design BHP programs so as to minimize the state’s financial exposure and address any negative impacts on the Exchange. States in which a BHP is not a viable option may want to consider alternative strategies to advance affordability and continuity goals.

http://www.kff.org/healthreform/upload/8283.pdf

Comment: 

By Don McCanne, MD

The Basic Health Program is designed for individuals with incomes between 139-200% of the federal poverty level – a population that otherwise would be very vulnerable to cost sharing provisions of purchasing and using plans in the state insurance exchanges.

This report explains the moving levers that are required to construct such plans while being sure that benefits are adequate while costs are controlled for both the beneficiaries and the state and federal governments. With eligibility frequently shifting between Medicaid, the Basic Health Program, and the state exchange plans, it is clear that stability cannot be achieved. It is highly unlikely that plans can even be constructed that would meet the various goals for the patients, providers and state and federal governments, and, regardless, they would create an administrative nightmare.

Since the purpose of the Basic Health Program is to remove financial barriers to care for this vulnerable group, it only seems logical that this highly flawed plan should be discarded and replaced with an administratively simplified plan that removes access barriers not just for them, but for everyone – an improved Medicare for all.

Is the Basic Health Program option a good idea?

The Role of the Basic Health Program in the Coverage Continuum: Opportunities, Risks and Considerations for States

By Deborah Bachrach, Melinda Dutton, Jennifer Tolbert and Julia Harris
Kaiser Family Foundation, March 2012
The Basic Health Program (BHP) is an optional coverage program under the Patient Protection and Affordable Care Act (ACA) that allows states to use federal tax subsidy dollars to offer subsidized coverage for individuals with incomes between 139-200% of the federal poverty level (FPL) who would otherwise be eligible to purchase coverage through state Health Insurance Exchanges. States can use the BHP to reduce the cost of health insurance coverage for these low-income consumers, a highly price-sensitive population with high rates of uninsurance. Depending on how it is designed, the BHP also can help consumers to maintain continuity among plans and providers as their income fluctuates above and below Medicaid levels.
As states weigh whether to implement a BHP, they face significant questions and challenges. Critical among these are how to design the BHP to enhance continuity of coverage as people move among Medicaid, the BHP, and coverage through qualified health plans (QHPs) in the Exchange; how to assess the BHP’s impact on the viability and effectiveness of state Exchanges; and how to estimate revenues and costs to evaluate the financial feasibility of the BHP.
Conclusion
Federal officials have yet to provide details about how the program will be financed, administered and certified, and states are struggling to evaluate the BHP’s impact on the viability and effectiveness of state Exchanges. Federal regulations will inform state deliberations, but are unlikely to fully resolve the complexity or eliminate the risk. Ultimately, states that opt for a BHP will want to design BHP programs so as to minimize the state’s financial exposure and address any negative impacts on the Exchange. States in which a BHP is not a viable option may want to consider alternative strategies to advance affordability and continuity goals.
http://www.kff.org/healthreform/upload/8283.pdf

The Basic Health Program is designed for individuals with incomes between 139-200% of the federal poverty level – a population that otherwise would be very vulnerable to cost sharing provisions of purchasing and using plans in the state insurance exchanges.
This report explains the moving levers that are required to construct such plans while being sure that benefits are adequate while costs are controlled for both the beneficiaries and the state and federal governments. With eligibility frequently shifting between Medicaid, the Basic Health Program, and the state exchange plans, it is clear that stability cannot be achieved. It is highly unlikely that plans can even be constructed that would meet the various goals for the patients, providers and state and federal governments, and, regardless, they would create an administrative nightmare.
Since the purpose of the Basic Health Program is to remove financial barriers to care for this vulnerable group, it only seems logical that this highly flawed plan should be discarded and replaced with an administratively simplified plan that removes access barriers not just for them, but for everyone – an improved Medicare for all.

Kucinich: Single-payer the only 'obviously constitutional' health care plan

By Sam Baker
The Hill, April 16, 2012

Rep. Dennis Kucinich (D-Ohio) is continuing to argue for a single-payer health care system, saying it would not raise the same constitutional questions that have dogged President Obama’s health care law.

Kucinich on Monday highlighted a recent report that said a single-payer system would save the state of Minnesota nearly $190 billion over 10 years.

“Single-payer health care is inevitable in the U.S. and the states are the first to recognize it,” Kucinich said in a statement.

The study, prepared by The Lewin Group, said a single-payer system in Minnesota would bring savings to the state as well as employees and their families.

Kucinich also noted that single-payer — because it would be funded through taxes, similar to Medicare — wouldn’t raise the same kind of legal questions as Obama’s health care overhaul. The Supreme Court is expected to rule by June on whether the law’s individual mandate is constitutional.

“Regardless of the Supreme Court ruling on the Affordable Care Act, health care costs continue to rise, jeopardizing budgets and preventing people from getting the health care they need,” Kucinich said. “Single-payer is the only solution that is obviously constitutional and can meet our nation’s needs.”

http://thehill.com/blogs/healthwatch/other/221723-kucinich-single-payer-the-only-obviously-constitutional-healthcare-plan

PNHP note: The full text of Rep. Kucinich’s news release follows:

Nearly $200 Billion in Savings if Minnesotans Demand Single-Payer Solution for Families, Businesses

Constitutional Approach Cuts Costs, Provides Universal Coverage

WASHINGTON (April 16, 2012) – Congressman Dennis Kucinich (D-OH), coauthor of H.R. 676, Medicare for All, today released the following statement highlighting a report by respected health care analytical group, The Lewin Group, showing the State of Minnesota would save $189.5 billion over ten years by providing universal, single-payer health care for all residents.

“Single-payer health care is inevitable in the U.S. and the states are the first to recognize it.  Single-payer would cover all residents, reduce costs, increase the quality of care, lower costs to businesses, lower costs to families, increase worker pay, and relieve the state governments of enormous financial burdens that come with our health care system,” said Kucinich.

“Regardless of the Supreme Court ruling on the Affordable Care Act, health care costs continue to rise, jeopardizing budgets and preventing people from getting the health care they need. Single-payer is the only solution that is obviously constitutional and can meet our nation’s needs.”

The report from The Lewin Group showed that enacting a single-payer system in Minnesota would reduce health spending for the State by $4.1 billion (8.8%) in 2014. State and local governments would save an addition $35.7 million. Employers would save $1,214 per worker (“for employers offering health insurance coverage prior to the ACA”). Families would save an average $1,362 and the statewide savings would be $189.5 billion between 2014 and 2023.

“Insurance companies make money by NOT providing health care,” said Kucinich. “Americans are now mandated to pay massive subsidies to bail out the for-profit health insurance industry.

“One out of every three of our health care dollars goes to activities OTHER than providing care, like a massive lobbying effort to protect their profits.  Your total comes to 900 billion dollars every year.

“We have been mandating that the American people pay this much more for health care because Congress and the President have refused for decades to take on health insurance companies. This report is a wake up call for states, businesses and families struggling to deal with the rising costs of health care.

Congressman Kucinich introduced an amendment to the Affordable Care Act in 2009 in the Education and Labor Committee. The amendment, passed on a bipartisan vote but stripped from the bill, would have helped states pursue single-payer if that is what their residents wanted.

Fourteen studies by expert health care consulting firms have modeled the expected financial results if a state enacted a single-payer health care system to cover its residents.

State Annual Single-payer Savings Year
New Mexico1 $151,800,000 1994
Delaware2 $229,000,000 1995
Minnesota1 $718,000,000 1995
Massachusetts3 $1,800,000,000 – $3,600,000,000 1998
Maryland1 $345,000,000 2000
Vermont1 $118,000,000 2001
California1 $7,500,000,000 2002
Maine4 $0 2002
Rhode Island5 $270,000,000 2002
Missouri6 $1,700,000,000 2003
Georgia1 $716,000,000 2004
California1 $8,000,000,000 2005
Colorado1 $1,400,000,000 2007
Kansas1 $869,000,000 2007
Minnesota1 $19,000,000,000 2012

1.         Lewin Group
2.         Solutions for Progress
3.         Lewin Group, Solutions for Progress/Boston University School of Public Health
4.         Mathemetica Policy
5.         Solutions for Progress/Boston University School of Public Health
6.         Missouri Foundation for Health

Fourteen of the fifteen studies showed very significant savings in health care costs while at the same time insuring everyone. Maine was the exception, showing no increase/decrease in state health spending under single-payer but providing health care to an additional 150,000 residents. 

http://kucinich.house.gov/news/email/show.aspx?ID=L6KLEKV7RO3HSGKNESSI2RAXJA

Kucinich: Single-payer the only ‘obviously constitutional’ health care plan

By Sam Baker
The Hill, April 16, 2012

Rep. Dennis Kucinich (D-Ohio) is continuing to argue for a single-payer health care system, saying it would not raise the same constitutional questions that have dogged President Obama’s health care law.

Kucinich on Monday highlighted a recent report that said a single-payer system would save the state of Minnesota nearly $190 billion over 10 years.

“Single-payer health care is inevitable in the U.S. and the states are the first to recognize it,” Kucinich said in a statement.

The study, prepared by The Lewin Group, said a single-payer system in Minnesota would bring savings to the state as well as employees and their families.

Kucinich also noted that single-payer — because it would be funded through taxes, similar to Medicare — wouldn’t raise the same kind of legal questions as Obama’s health care overhaul. The Supreme Court is expected to rule by June on whether the law’s individual mandate is constitutional.

“Regardless of the Supreme Court ruling on the Affordable Care Act, health care costs continue to rise, jeopardizing budgets and preventing people from getting the health care they need,” Kucinich said. “Single-payer is the only solution that is obviously constitutional and can meet our nation’s needs.”

http://thehill.com/blogs/healthwatch/other/221723-kucinich-single-payer-the-only-obviously-constitutional-healthcare-plan

PNHP note: The full text of Rep. Kucinich’s news release follows:

Nearly $200 Billion in Savings if Minnesotans Demand Single-Payer Solution for Families, Businesses

Constitutional Approach Cuts Costs, Provides Universal Coverage

WASHINGTON (April 16, 2012) – Congressman Dennis Kucinich (D-OH), coauthor of H.R. 676, Medicare for All, today released the following statement highlighting a report by respected health care analytical group, The Lewin Group, showing the State of Minnesota would save $189.5 billion over ten years by providing universal, single-payer health care for all residents.

“Single-payer health care is inevitable in the U.S. and the states are the first to recognize it.  Single-payer would cover all residents, reduce costs, increase the quality of care, lower costs to businesses, lower costs to families, increase worker pay, and relieve the state governments of enormous financial burdens that come with our health care system,” said Kucinich.

“Regardless of the Supreme Court ruling on the Affordable Care Act, health care costs continue to rise, jeopardizing budgets and preventing people from getting the health care they need. Single-payer is the only solution that is obviously constitutional and can meet our nation’s needs.”

The report from The Lewin Group showed that enacting a single-payer system in Minnesota would reduce health spending for the State by $4.1 billion (8.8%) in 2014. State and local governments would save an addition $35.7 million. Employers would save $1,214 per worker (“for employers offering health insurance coverage prior to the ACA”). Families would save an average $1,362 and the statewide savings would be $189.5 billion between 2014 and 2023.

“Insurance companies make money by NOT providing health care,” said Kucinich. “Americans are now mandated to pay massive subsidies to bail out the for-profit health insurance industry.

“One out of every three of our health care dollars goes to activities OTHER than providing care, like a massive lobbying effort to protect their profits.  Your total comes to 900 billion dollars every year.

“We have been mandating that the American people pay this much more for health care because Congress and the President have refused for decades to take on health insurance companies. This report is a wake up call for states, businesses and families struggling to deal with the rising costs of health care.

Congressman Kucinich introduced an amendment to the Affordable Care Act in 2009 in the Education and Labor Committee. The amendment, passed on a bipartisan vote but stripped from the bill, would have helped states pursue single-payer if that is what their residents wanted.

Fourteen studies by expert health care consulting firms have modeled the expected financial results if a state enacted a single-payer health care system to cover its residents.

State Annual Single-payer Savings Year
New Mexico1 $151,800,000 1994
Delaware2 $229,000,000 1995
Minnesota1 $718,000,000 1995
Massachusetts3 $1,800,000,000 – $3,600,000,000 1998
Maryland1 $345,000,000 2000
Vermont1 $118,000,000 2001
California1 $7,500,000,000 2002
Maine4 $0 2002
Rhode Island5 $270,000,000 2002
Missouri6 $1,700,000,000 2003
Georgia1 $716,000,000 2004
California1 $8,000,000,000 2005
Colorado1 $1,400,000,000 2007
Kansas1 $869,000,000 2007
Minnesota1 $19,000,000,000 2012

1.         Lewin Group
2.         Solutions for Progress
3.         Lewin Group, Solutions for Progress/Boston University School of Public Health
4.         Mathemetica Policy
5.         Solutions for Progress/Boston University School of Public Health
6.         Missouri Foundation for Health

Fourteen of the fifteen studies showed very significant savings in health care costs while at the same time insuring everyone. Maine was the exception, showing no increase/decrease in state health spending under single-payer but providing health care to an additional 150,000 residents. 

http://kucinich.house.gov/news/email/show.aspx?ID=L6KLEKV7RO3HSGKNESSI2RAXJA

Dr. David Ansell on lessons from Chicago

By Ellen R. Hale
Louisville (Ky.) Medicine, April 2012

David A. Ansell, MD, MPH, visited Louisville in January to offer evidence from his long career as an internist in Chicago for a one-card national health program. Author of the recently published book “County: Life, Death and Politics at Chicago’s Public Hospital,” Dr. Ansell delivered a lecture to University of Louisville medical students and another to the general public. He also spoke at Grand Rounds for the Department of Family and Geriatric Medicine and the Annual Meeting of Physicians for a National Health Program-Kentucky.

Dr. Ansell criticized what he called the “death gap” in the United States – the difference in life expectancy of the insured versus the uninsured. “You can’t explain this by biological differences. The death gap is an issue of poverty, race and lack of insurance,” he said. “As a doctor, it’s completely unacceptable that people should die early simply because they’re poor.”

Dr. Ansell arrived at Cook County Hospital in 1978 for training and worked there 17 years. He then worked at Mount Sinai Hospital, a private safety-net hospital, before his current position as chief medical officer at Rush University Medical Center.

In 1986, he and several colleagues published an article in The New England Journal of Medicine titled “Transfers to a Public Hospital” documenting that 87 percent of patients transferred to County from other emergency departments lacked insurance. Many were unstable at the time of transfer. The article on “patient dumping” drew national media attention and led to Dr. Ansell’s testimony before Congress.

“We were doctors by day learning medicine but at nighttime saying, ‘OK, what are we going to do to keep the hospital open?’” he said. “It’s one thing to be all high and mighty about policy, but when you have a patient in front of you who needs something and you need to overcome the hurdles to get that patient treated, you can’t help but be moved.”

Through a breast cancer screening program he started, Dr. Ansell has found that mortality rates have decreased for white women while staying the same for black women. The Metropolitan Chicago Breast Cancer Task Force is seeking to decrease the disparity by improving the quality of breast cancer screening and care for minority women.

“We have a system that’s completely dependent on whether you have a card or not and what your card says,” Dr. Ansell said. His solution is a one-card “Medicare for all” system, which would be completely private with low administrative costs. He was critical of the Affordable Care Act for expanding Medicaid, which “doesn’t pay doctors,” while failing to address the inequalities in health care coverage that affect the ability to access services.

Asked about the debate in Louisville surrounding University Hospital, Dr. Ansell said that without a national solution, there will need to be a state or local solution. He suggested a hospital tax based on the amount of charity care performed, with revenues going to providers of indigent care. “Many hospitals that serve poor people are struggling to stay open not because of the capability of the administrators, the doctors or the nurses, but because of the design of our health care system and the way that it’s funded,” he said.

Dr. Ansell recognizes that the right to health care remains a political issue among the American people. Until it’s a right, and not a mandate and not a privilege, he said, inequality will persist.

Ellen R. Hale is the communications associate for the Greater Louisville Medical Society. Louisville Medicine is one of the society’s publications.

https://www.glms.org/Content/User/Documents/Louisville%20Medicine/LM%202012/GLMS%20Mag_April%202012-Lo.pdf

Medicare for all

By Jack Bernard
Modern Healthcare, Letters, April 14, 2012

Assuming it is not overturned by a very highly politicized Supreme Court (“In the balance,” April 2, p. 6), millions of the uninsured will eventually receive coverage under the Patient Protection and Affordable Care Act. It is a first step. But the reforms did not go nearly far enough in cost containment. Or, we believe, in coverage. We are building on a shaky foundation: expansion of private insurance companies.

Political opponents warn that the ACA’s health care reforms will result in rationing. There is already tremendous rationing of care in America despite the fact that our nation has by far the world’s highest per capita health care expenditures.

Why? Because we have chosen to administer our system through private insurance companies. Their goal is to benefit shareholders and employees—particularly top executives, many of whom have seven-figure incomes. To turn a profit, they must exclude those individuals who are the most likely to require expensive care.

This is the way that the health care free-market works, maximizing returns for shareholders, not helping patients. If you don’t believe we have rationing, talk to the demoralized doctors who spend so much of their time trying to persuade insurance companies to provide their recommended care to sick patients.

A majority, or 58 percent, of physician respondents in a survey published in the New England Journal of Medicine support an expansion of Medicare to Americans ages 55 to 64. This route was proposed, but then quickly dropped during the debates over health reform. At a minimum, Congress should have made this interim move toward universal coverage. Then, we could have expanded Medicare each year to cover more of the population until truly universal coverage was achieved and costs contained.

Along these lines, the organization Physicians for a National Health Program has determined that the most cost-effective route is Medicare for all. Medicare’s administrative costs are 3 percent, whereas private insurance runs 31 percent. The additional funds could be utilized to cover the uninsured.

Yes, there are some waiting lines in Canada for elective procedures, but Canada spends about half what we do per capita on health care. With our current spending level, we need not have lines here. In any case, under universal Medicare, any rationing that might someday be required would be based on medical need as determined by your physician, not by insurance companies.

The only way to get a handle on both costs and access is universal Medicare. That is the solution, not privatization and placing the burden directly on a powerless consumer/patient with little information and even less clout relative to providers. Because of the meekness shown by Congress in its reform efforts, we suspect that the situation will be much worse in another 15 or 20 years when it is next addressed by our children.

Jack Bernard is a retired health care executive who lives in Monticello, Ga.

http://www.modernhealthcare.com/section/articles?tagID=144

Insurer and hospital fight while children suffer

CT Children’s, Anthem provider pact expires

By Greg Bordonaro
Hartford Business Journal Online, April 16, 2012

Anthem Blue Cross and Blue Shield in Connecticut confirmed Monday morning that its provider contract with the Connecticut Children’s Medical Center has expired.

The two sides have been in contract talks for more than a year but failed to come to an agreement on new terms.

Children’s Medical Center is asking for higher reimbursement rates than Anthem is willing to offer. As a result, Anthem customers will be forced to pay higher, out of network rates or be forced to choose a different hospital.

http://www.hartfordbusiness.com/news23523.html

Comment: 

By Don McCanne, MD

Anthem Blue Cross and Blue Shield and Connecticut Children’s Medical Center have a hissy fit, Anthem walks away, and the children suffer.

What is the policy flaw that led to this? Simply that we allow a private, administratively wasteful, intrusive intermediary to create an artificial  product that serves its own business interests by taking away our choices of health care professionals and institutions. We have granted them the right to selectively contract with the health care delivery system as providers of health care, and with the patients as consumers of health care.

Wouldn’t it be far better for us to dump the wasteful, intrusive private insurers and fund Children’s with a global budget administered by a single payer national health program? We can still do that.

Insurer and hospital fight while children suffer

CT Children’s, Anthem provider pact expires

By Greg Bordonaro
Hartford Business Journal Online, April 16, 2012
Anthem Blue Cross and Blue Shield in Connecticut confirmed Monday morning that its provider contract with the Connecticut Children’s Medical Center has expired.
The two sides have been in contract talks for more than a year but failed to come to an agreement on new terms.
Children’s Medical Center is asking for higher reimbursement rates than Anthem is willing to offer. As a result, Anthem customers will be forced to pay higher, out of network rates or be forced to choose a different hospital.
http://www.hartfordbusiness.com/news23523.html

Anthem Blue Cross and Blue Shield and Connecticut Children’s Medical Center have a hissy fit, Anthem walks away, and the children suffer.
What is the policy flaw that led to this? Simply that we allow a private, administratively wasteful, intrusive intermediary to create an artificial  product that serves its own business interests by taking away our choices of health care professionals and institutions. We have granted them the right to selectively contract with the health care delivery system as providers of health care, and with the patients as consumers of health care.
Wouldn’t it be far better for us to dump the wasteful, intrusive private insurers and fund Children’s with a global budget administered by a single payer national health program? We can still do that.

Montana Dems come out for single-payer health system

By Dustin Hurst
Montana Watchdog, April 13, 2012

MISSOULA — As Americans struggle with the rising health care costs, some Montana Democrats say the controversial single-payer system would harness those out-of-control expenses.

Five of seven candidates seeking to become Montana’s lone congressman responded to the federal Patient Protection and Affordable Care Act, the national health care law and domestic centerpiece of President Barack Obama’s administration, during a debate Thursday on the University of Montana campus here.

They are competing for the lone U.S. House of Representative seat being vacated by Denny Rehberg, a Republican, who is challenging Democratic U.S. Sen. Jon Tester for his U.S. Senate seat.

Helena lawyer Rob Stutz said either the federal government should create a single-payer insurance program or go with the public option.

Under the single-payer model, residents would pay the government for health insurance coverage and then the feds would pay for medical services. The government could contract for health care from private organizations or could own and employ health-care services and personnel.

Stutz emphasized that state and local governments already cover medical expenses for those who cannot afford to do so, such as unpaid emergency room visits. A single-payer structure, he said, would streamline the system.
“I think it will save us money,” he said. “We’re all absorbing the cost in very inefficient way.”

State Rep. Franke Wilmer, D-Bozeman, said the patchwork of single-payer systems the government now offers, including veterans’ Tri-Care and Medicare and Medicaid, could be combined into a single program down the road.
“I don’t care how we do it, but we need to get to smarter health care that covers everybody, certainly everybody who works,” Wilmer said.

Instead of forcing the program on states, Wilmer supported a federal insurance plan that allows states to “opt-in.”
The public option, which was lost in the federal health-care debate, would have allowed the federal government to sell insurance coverage in the private marketplace.

Whitefish entrepreneur Diane Smith backed the single-payer idea, though she said that if Congress would stop “coddling” the insurance industry, the private sector might develop a program “almost as good” as single-payer system.

Billings farmer Jason Ward said he wouldn’t mind going to a single-payer model, but wants the federal government to fix problems with the health insurance industry before constructing a larger coverage scheme.

Billings Realtor Sam Rankin supported the single-payer plan but said he doubts it will come up soon.

“We’re going to get there,” Rankin said. “The health care system we have now is a mess and everyone knows it.”
The single-payer approach also would remove politics from the insurance argument, as evidenced with contraceptive coverage, Stutz said.

Missoula City Councilman Dave Strohmaier and state Rep. Kim Gillan, D-Billings, addressed the contraceptive issue at the debate. When Montana Watchdog contacted them for comment on the single-payer system, Strohmaier refused to comment and Gillan was unable to do so.

http://statehousenewsonline.com/2012/04/13/mt-dems-come-out-for-single-payer-health-system/

Insurers still in control in Obamacare

By Jonathan D. Walker, M.D.
The Journal Gazette (Fort Wayne, Ind.), April 15, 2012

Obamacare is the nickname for the Patient Protection and Affordable Care Act, or PPACA for short. It has been a target for criticisms that range from valid concerns to groundless fear mongering, and soon the Supreme Court will decide whether the mandate to buy insurance is constitutional. But there is one fundamental problem with the law that is rarely mentioned. To understand that problem, you need some background.

America’s Health Insurance Plans is the main lobbying organization for the private health insurance industry – companies such as Anthem, WellPoint and Cigna.

If you went to their website in the years preceding enactment of the PPACA, you would have found their recommendations for health care reform. Those recommendations were based on their business model: profitability largely depends on trying to cover healthy people and avoid covering sick people. The basic structure of the PPACA almost exactly matches those recommendations.

First, the companies know that most of the population is healthy and won’t cost them much, so they wanted a mandate to force people to buy their product – that guarantees them a lot of extra income. But they also knew that most people can’t afford what they sell, so they wanted taxpayers to provide subsidies so that people could actually purchase the insurance the law required them to buy. Finally, they agreed to try to cover people regardless of their health status, but they wanted to be sure that sick people could still be unloaded onto taxpayers through government programs such as Medicare, Medicaid and state-run high-risk pools.

There are aspects of the PPACA that represent a big improvement, such as trying to stop companies from denying insurance for pre-existing conditions. Still, the basic structure of the law is very favorable to private insurance companies and not so favorable to taxpayers and patients. This is not surprising, given the amount of political influence these companies wield (for instance, a former executive from WellPoint helped write the law). In fact, back in 2009, Business Week reported that the insurance companies had “won” – that whatever shape health care reform would take, it was clear that it would be very close to what those corporations wanted.

Problems arise when we give that much control to companies whose financial survival depends on not paying for people when they are sick – they even refer to payouts for health care as a medical loss. For years there has been so much extra money in our health care system that those companies could easily provide shareholders with profits and also take care of sick people. But as health care costs go up, those companies are feeling pinched, and that means they are raising premiums, increasing copays and deductibles and creating even more onerous rules and restrictions. But the role of private insurance is so ingrained in our minds and in the minds of our politicians that we accept all of these costs and hassles without question. The real irony is that those companies will remain in control whether the PPACA is overturned or not.

In fact, private insurers manage the debate so effectively that unless you are poor, disabled or older than 65, you are forbidden to have any insurance other than what they offer. And that is the real problem with Obamacare.

It is structured to benefit corporations that are obligated to place the needs of shareholders over the needs of patients, and that costs us all. There are ways to change that, but we have to start by asking our politicians to create a health care system that isn’t designed for the benefit of companies that, by their very nature, consider our health care to be a “loss.”

Dr. Jonathan D. Walker is an assistant professor at IU Medical School in Fort Wayne and a partner with Allen County Retinal Surgeons. He wrote this for The Journal Gazette.

http://www.journalgazette.net/article/20120415/EDIT05/304159971/1147/EDIT07

Funding a National Single-Payer System

“Medicare for All” would save billions, and could be distributive.

By Gerald Friedman
Dollars and Sense, March/April 2012

“The Expanded & Improved Medicare for All Act” (HR 676) would establish a single authority responsible for paying for health care for all Americans.

Providing universal coverage with a “single-payer” system would change many aspects of American health care. While it would raise some costs by providing access to care for those currently uninsured or under-insured, it would save much larger sums by eliminating insurance middlemen and radically simplifying payment to doctors and hospitals.

While providing superior health care, a single-payer system would save as much as $570 billion now wasted on administrative overhead and monopoly profits. A single-payer system would also make health care financing dramatically more progressive by replacing fixed, income-invariant health care expenditures with progressive taxes. This series of charts and graphs shows why we need a single-payer system and how it could be funded.

Click here to view the charts and graphs.

Gerald Friedman is a professor of economics at the University of Massachusetts-Amherst.