Democrats’ Plan B For Medicare: Medicare For All

By Sally Pipes
Forbes, September 6, 2011

Democrats know the individual mandate might go up in smoke. So they’ve started strategizing a constitutionally sound means of achieving the ever-elusive goal of “universal coverage.”

Their preferred remedy? “Medicare-for-All,” a term popularized by the late Senator Edward Kennedy (D-Mass.) who supported a single-payer, government run healthcare system.

Former Clinton labor secretary Robert Reich laid out the basic idea in a recent op-ed for the San Francisco Chronicle. “So what do Obama and the Democrats do if the individual mandate in the new health care law gets struck down by the Supreme Court?” Reich asked. “Immediately propose what they should have proposed right from the start — universal health care based on Medicare-for-All, financed by payroll taxes.”

This notion has been floated in progressive policy circles in the past. It’s a pure distillation of their government-heavy approach to health care reform. Typically, though, the idea’s been shelved out of fears of political blowback.

Today, when the government extracts Medicare taxes from people’s paychecks, it’s forcing them to assent to this deal: Hand over a slice of your paycheck now, and get government-sponsored health insurance in old age.

Of course, Americans are not allowed to opt out of that deal — just like they won’t be able to opt out of the individual mandate. But unlike the mandate, the taxes that finance Medicare are not in danger of being deemed unconstitutional.

If the individual mandate is actually struck down, Medicare-for-All may become the new rallying cry for progressive luminaries. And if President Obama wins a second term, he may look to heed that cry.

http://www.forbes.com/sites/sallypipes/2011/09/06/democrats-plan-b-for-medicare-medicare-for-all/

As a Canadian libertarian now serving as President and CEO of the Pacific Research Institute, an organization advocating for free market solutions to America’s problems, Sally Pipes is issuing a warning that “Medicare-for-All may become the new rallying cry for progressive luminaries.” Further, “if President Obama wins a second term, he may look to heed that cry.” Don’t we wish!

By Emily Berry
American Medical News, September 5, 2011

With potentially more than 50 state-based versions of a public health insurance exchange set to emerge by 2014, another version of a post-health reform insurance market is emerging: the private exchange.

A private exchange is an existing concept taking on a new name. The idea also has been pitched as a “defined benefit” plan and has been part of a package with a health reimbursement account. Simply put, a private exchange is an alternative to a group health benefit plan. Rather than paying a portion or all of a premium, an employer pays each of its workers a flat amount and sends each to choose his or her plan.

Here’s how a private health exchange works:

An employer decides what it can afford to pay for health benefits — for example, $1,000 per employee per month. Rather than enrolling every employee in the same plan and using the $1,000 to pay for a portion of a premium, the employer puts $1,000 in an account for each worker.

Then one of two things happens: One, the employee works with a third party that acts as a clearinghouse. The worker chooses from any plan available in the individual market, with the clearinghouse administering the employee’s HRA, and helping connect brokers and health plans with the employees who want to buy coverage.

Under the second scenario, the employer sends the worker to a third party that gives him or her a limited set of choices, for instance a range of plans offered by the state’s Blues plan.

A private exchange would be a better deal for the employer than not offering health benefits, because the company can still reap the tax advantage of offering health benefits and avoid the penalty that would apply to companies with 50 or more employees if they decided not to offer benefits, analysts said.

http://www.ama-assn.org/amednews/2011/09/05/bisb0905.htm

Comment: 

By Don McCanne, MD

Employers who want to reduce their roles in providing health insurance for their employees, yet do not want to turn their employees over to the state insurance exchanges and pay penalties for doing so, seem to have another option – private exchanges.

One of the greatest benefits for the employer is that they can convert their health benefit programs from a defined benefit to a defined contribution. This shifts the burden of future health care cost increases onto their employees.

In the next couple of years we can anticipate seeing many other similar efforts to skirt the provisions of the Affordable Care Act. It is really tragic that we are going to have to wait until far too many more people are destitute and suffer and die before we are ready to enact the reform we really need – an improved Medicare for all.

Private exchanges offer yet another alternative to group health plans

By Emily Berry
American Medical News, September 5, 2011

With potentially more than 50 state-based versions of a public health insurance exchange set to emerge by 2014, another version of a post-health reform insurance market is emerging: the private exchange.

A private exchange is an existing concept taking on a new name. The idea also has been pitched as a “defined benefit” plan and has been part of a package with a health reimbursement account. Simply put, a private exchange is an alternative to a group health benefit plan. Rather than paying a portion or all of a premium, an employer pays each of its workers a flat amount and sends each to choose his or her plan.

Here’s how a private health exchange works:

An employer decides what it can afford to pay for health benefits — for example, $1,000 per employee per month. Rather than enrolling every employee in the same plan and using the $1,000 to pay for a portion of a premium, the employer puts $1,000 in an account for each worker.

Then one of two things happens: One, the employee works with a third party that acts as a clearinghouse. The worker chooses from any plan available in the individual market, with the clearinghouse administering the employee’s HRA, and helping connect brokers and health plans with the employees who want to buy coverage.

Under the second scenario, the employer sends the worker to a third party that gives him or her a limited set of choices, for instance a range of plans offered by the state’s Blues plan.

A private exchange would be a better deal for the employer than not offering health benefits, because the company can still reap the tax advantage of offering health benefits and avoid the penalty that would apply to companies with 50 or more employees if they decided not to offer benefits, analysts said.

http://www.ama-assn.org/amednews/2011/09/05/bisb0905.htm

Employers who want to reduce their roles in providing health insurance for their employees, yet do not want to turn their employees over to the state insurance exchanges and pay penalties for doing so, seem to have another option – private exchanges.

One of the greatest benefits for the employer is that they can convert their health benefit programs from a defined benefit to a defined contribution. This shifts the burden of future health care cost increases onto their employees.

In the next couple of years we can anticipate seeing many other similar efforts to skirt the provisions of the Affordable Care Act. It is really tragic that we are going to have to wait until far too many more people are destitute and suffer and die before we are ready to enact the reform we really need – an improved Medicare for all.

By John Geyman, M.D.

What are the dimensions of the crisis in primary care? How did we get here? How and why have past efforts to resolve it failed? And how can we succeed in rebuilding our crumbling foundation of health care in this country? In Part I, we will outline the dimensions of this crisis; its impacts on our system, patients and their families; and consider what we can learn from failed attempts to rebuild primary care. In Part II, we will look at various policy alternatives, summarize what can be learned from other countries, and propose a comprehensive agenda for rebuilding primary care.

This is admittedly a challenging problem that requires a long view, most likely over one or two generations. Present trends are very unfavorable, and a complete re-orientation of the goals of health care, the roles of physicians and other health care professionals, and fundamental changes in the way we finance health care will be required if we are to deal effectively with the primary care problem.

http://copernicus-healthcare.org/books-by-copernicus.html

Both the book and the Kindle ebook are available at Amazon.com:
http://www.amazon.com/Breaking-Point-Primary-Endangers-Americans/dp/0983773408

Comment: 

By Don McCanne, MD

In “Breaking Point,” John Geyman explains why it is crucial for us to rebuild our primary care infrastructure, and how we can do it. Highly recommended!

Breaking Point: How the Primary Care Crisis Endangers the Lives of Americans

By John Geyman, M.D.

What are the dimensions of the crisis in primary care? How did we get here? How and why have past efforts to resolve it failed? And how can we succeed in rebuilding our crumbling foundation of health care in this country? In Part I, we will outline the dimensions of this crisis; its impacts on our system, patients and their families; and consider what we can learn from failed attempts to rebuild primary care. In Part II, we will look at various policy alternatives, summarize what can be learned from other countries, and propose a comprehensive agenda for rebuilding primary care.

This is admittedly a challenging problem that requires a long view, most likely over one or two generations. Present trends are very unfavorable, and a complete re-orientation of the goals of health care, the roles of physicians and other health care professionals, and fundamental changes in the way we finance health care will be required if we are to deal effectively with the primary care problem.

http://copernicus-healthcare.org/books-by-copernicus.html

Both the book and the Kindle ebook are available at Amazon.com:
http://www.amazon.com/Breaking-Point-Primary-Endangers-Americans/dp/0983773408

In “Breaking Point,” John Geyman explains why it is crucial for us to rebuild our primary care infrastructure, and how we can do it. Highly recommended!

UnitedHealth Buys California Group of 2,300 Doctors

By Anna Wilde Mathews
The Wall Street Journal, September 1, 2011

UnitedHealth Group Inc. will acquire the operations of a major southern California physician group, in the latest example of how lines are blurring between insurance companies and health-care providers.

The purchase of the management arm of Monarch HealthCare, an Irvine, Calif., association that includes approximately 2,300 physicians in a range of specialties, establishes United’s Optum health-services unit as a formidable presence in the region. Optum had previously taken over the management arms of two smaller southern California groups, AppleCare Medical Group and Memorial HealthCare Independent Practice Association.

In California, deals involving control of medical groups are structured to comply with rules that block most entities from directly employing practicing physicians. Typically, a company like Optum might buy non-clinical assets and sign a long-term management agreement with an independent practice association of physicians such as Monarch.

United has said in the past that providers acquired by Optum will not work exclusively with United’s health plan, and will continue to contract with an array of insurers. But in one sign of the potential complications that might ensue, Monarch is currently in an arrangement with United competitor WellPoint Inc. to create a cooperative “accountable-care organization” aimed at bringing down health-care costs and improving quality.

http://online.wsj.com/article/SB10001424053111903895904576542553422509280.html

Consolidation is accelerating, and the largest insurers are positioning themselves to be at the top of the heap.

Excuse a personal note, but this particular merger is difficult for me to observe. Having practiced in Orange County, I watched the founding and expansion of Monarch HealthCare until they dominated health care in our region. As an early opponent of managed care as it was playing out, I certainly had no interest in joining them. Probably because my practice included large numbers of Medicaid, uninsured, and undocumented patients (so many that they crowded out my privately insured patients even though I worked extended hours), Monarch also never communicated an interest in including me in their panel.

What defines a successful health care system? It always seemed to me that success would be when everyone could receive quality health care that was appropriate and without financial barriers that would impair access. Yet The Wall Street Journal implies that success is when you can organize and control the delivery system and corner the portion of the market that has the highest monetary resources.

Although I was far busier than other primary care physicians in our region, I ended up retiring earlier than I intended because the composition of my practice eventually resulted in an unsustainable negative cash flow.

By most standards, at least by the dominant standards of today, I was unsuccessful, and Monarch HealthCare was highly successful. I’m not sure that my patients who couldn’t get past the appointment desks of Monarch physicians would agree when they had success in negotiating past my appointment desk.

Not to be defeated, I made a decision to devote my remaining productive years to promoting a concept of success that serves patients – all patients – without the intrusion of intermediaries such as UnitedHealth and Monarch HealthCare that glom onto the money and try to keep all that they can. Haven’t we had enough of Wall Street’s version of success?