PNHP

Everybody likes Medicare — so why not try it for everybody?

Everybody likes Medicare — so why not try it for everybody?

By Elizabeth Frost, M.D.
Twin Cities Daily Planet, July 31, 2011

The other day Representative Michelle Bachmann was taking a hit at President Obama: She accused the national health reform law of trying to destroy Medicare and force the evils of Obamacare onto the elderly. That Obama. But really, isn’t it interesting that even Michelle Bachman jumps up to defend one of our nation’s largest “socialist” programs? Why is that? Why is it so popular that Paul Ryan may meet his political demise by trying to gut it? This weekend Medicare has its 46th birthday, and I want to write a little about why we should be celebrating.

First of all, Medicare saves money. Its overhead is between 1-3%, in contrast to the private insurance industry that has administrative and profit overheads of 10-25%. That is a savings of 10 – 20%. Also costs don’t increase as fast in Medicare as they do in private insurance. We are a nation with a lot of new health technology, we live longer and this does cost money. For example since 1970 the cost of medical care adjusted to inflation has gone up 400%. That is a big increase, but the same time period from 1970 to today the cost of private insurance adjusted for inflation has gone up 700%.

We also know that Medicare is a good deal for the tax payers by looking at Medicare Advantage Insurance programs. This was the attempt by the Bush Administration to create “competition” by privatizing some Medicare programs. They have shown to waste billions of dollars by charging more for healthier patients and then dropping those same patients once they become sick. It is called “picking the cherries and spitting out the core” and it is a real phenomena. The Obama’s Affordable Care Act is slowly shutting down the wasteful private health insurance options for Medicare.

So all we need to do to make Medicare financially solvent is to increase the payroll tax by a small fraction of a percent. The rate has only been increased once, in the mid-80s, and it is time to do it again.

Medicare is an efficient, effective way of health care financing. It is what we all want for our parents and ourselves as we get older and heck — it probably is a good idea for the entire nation. If we had Medicare-For-All maybe it would be so popular that Michelle Bachmann would be forced to defend it, too.

Elizabeth Frost is a family doctor practicing in Minneapolis. She co-chairs the Minnesota Chapter of Physicians for a National Health Program.

What does Rick Scott mean by “choice”?

Florida submits Medicaid plan based on managed care to feds for approval

By John Kennedy
The Palm Beach Post, August 1, 2011

Florida officials sent a wide-ranging application Monday to the federal government for steering almost 3 million Medicaid patients into managed care, a major shift that has sparked heavy lobbying from critics who demand the Obama administration deny the move.

But Republican Gov. Rick Scott said he was confident the Centers for Medicare and Medicaid Services (CMS) would approve the request, which supporters say could save the state more than $1 billion when fully in place.

“I think that what we passed is going to be a model for Medicaid,” said Scott, a former health care executive. “A Medicaid recipient ought to have choice, just like all of us have choice for what insurance we want to buy. I think that’s positive.”

But he added, “We’ve got to make sure it’s a program we can afford as taxpayers. I think what we did will do those two things.”

http://www.palmbeachpost.com/news/state/florida-submits-medicaid-plan-based-on-managed-care-1681459.html

And…

State to limit HMOs in state employee insurance program

Health Beat
August 2, 2011

Florida is changing part of its state-employee health insurance program to offer only one HMO in each county.  The state Department of Management Services, which oversees employee insurance, said changes in the program would save an estimated $400 million over two years. The changes also would require thousands of state employees to switch to different HMOs, a process that would begin in late September.

Insurers UnitedHealthcare of Florida and Coventry Health Care of Florida filed formal protests Monday against the changes. United argued, for example, that the changes could actually increase costs. That is because United — which would be shut out of the program in much of the state — says it can negotiate better discounts than other HMOs.

But Gov. Rick Scott and DMS Secretary Jack Miles touted the savings from the plan.

“Saving taxpayer dollars wasn’t just a campaign gimmick,” Scott said in a news release. “I meant what I said when I ran for office, and I urge Secretary Miles and his team to keep pushing hard every day to deliver more savings and better results.”

http://health.nsfblogs.com/?p=220

Although Rick Scott was certainly tarnished when his company, Columbia/HCA paid the largest fraud settlement in U.S. history, he has nevertheless been chosen by Florida Republicans to serve as their governor. One of his messages was to achieve savings in health care by promoting choice. Is he touting a fundamental economic principle, or is he using this rhetoric to masquerade his conservative ideology?

Look at what he is trying to do with Medicaid in his state. He wants to force Medicaid patients into managed care organizations claiming that giving them the right to choose insurers will reduce costs. If so, then why isn’t taking away from them their right to choose their health care professionals and institutions going to increase costs?

What about the state employee health insurance program? He is going to save money by taking away the employees’ choice of HMOs, limiting each county to only one HMO for government employees.

His use of the term “choice” is another fraud, but it is no worse than the fraud that progressives perpetrated when they campaigned for health reform using the slogan of “CHOICE.” Their proposal offered only choice of restrictive private health plans while preventing true choice of health care professionals and institutions that people could have had through a Medicare-like national health program.

Today’s final passage of the Budget Control Act doesn’t bode well for the future of placing policy above political rhetoric. In the name of “saving the economy,” the Democrats cooperated with the Republicans in slashing public programs while failing to tap important revenue sources in our nation that happens to have one of the lowest tax burdens of all industrialized nations.

Will we ever have the choice of truly responsible political leaders? It seems unlikely as long as Americans rely on billionaire disinformation campaigns for their understanding of public policy options.

Impact of Budget Control Act on Medicare

TEXT OF BUDGET CONTROL ACT AMENDMENT

House of Representatives
Rules Committee, August 1, 2011

(a) SHORT TITLE.—This Act may be cited as the “Budget Control Act of 2011”

SEC. 302. ENFORCEMENT OF BUDGET GOAL

(8) IMPLEMENTING DIRECT SPENDING REDUCTIONS. — On the date specified in paragraph (4) during each applicable year, OMB shall prepare and the President shall order a sequestration, effective upon issuance, of nonexempt direct spending to achieve the direct spending reduction calculated pursuant to paragraphs (5) and (6). When implementing the sequestration of direct spending pursuant to this paragraph, OMB shall follow the procedures specified in section 6 of the Statutory Pay-As-You-Go Act of 2010, the exemptions specified in section 255, and the special rules specified in section 256, except that the percentage reduction for the Medicare programs specified in section 256(d) shall not be more than 2 percent for a fiscal year.

(9) ADJUSTMENT FOR MEDICARE. — If the percentage reduction for the Medicare programs would exceed 2 percent for a fiscal year in the absence of paragraph (8), OMB shall increase the reduction for all other discretionary appropriations and direct spending under paragraph (6) by a uniform percentage to a level sufficient to achieve the reduction required by paragraph (6) in the non-defense function.

http://www.rules.house.gov/Media/file/PDF_112_1/legislativetext/S365%20ct%201206.pdf

Comment: 

By Don McCanne, MD

The deficit reduction agreement will likely result in an automatic two percent reduction in Medicare payments. The only way that can be prevented is by an agreement of a special twelve member bipartisan Joint Select Committee on Deficit Reduction to find alternative methods of reducing the deficit, and then to have their recommendations approved by an up-or-down vote of both current houses of Congress.

The probability of reaching a complex and controversial agreement that leaves Medicare totally unscathed is almost zero in this dysfunctional Congress. President Obama has already demonstrated that he is quite willing to capitulate to the demands of the right-wing obstructionists in Congress. This next time it will be much easier since the terms of the extortion have already been included in this legislation. Since Medicare remains a prime target for the reactionaries, it is very unlikely that it can clear this hurdle without further reductions.

Medicare payment rates have not been increasing at the same level as private insurance rates, understandably creating considerable uneasiness amongst the providers of health care. The Affordable Care Act will further reduce some Medicare payments, and now the Budget Control Act of 2011 will reduce them even further.

These trends will motivate the wealthy owners of Congress to seek private options such as Paul Ryan’s premium support (voucher) proposal, while diminishing their support of Medicare as an egalitarian system of social insurance. With reductions in funding and departure of the healthy and wealthy, Medicare would inevitably transition into a welfare program.

Happy Birthday Medicare! (Oh, that wasn’t nice.)

Care can be universal, cheaper

By James T. Binder, M.D.
Saturday Gazette-Mail (Charleston, W.Va.), July 30, 2011

In the fall of 1982, when I working as a pediatrician in upstate New York, a mother made an appointment to have her child seen on an urgent basis. The child did not really need to be seen quickly, but the mother didn’t know better. She was just worried about her child. She arrived and checked into the clinic. The receptionist greeted her with, “I should have known — Medicaid.”

The humiliation that mother experienced was the price she paid to obtain health care for her child. She was poor.

It is almost 30 years later, and this condescension for those using Medicaid insurance persists. And, in many instances, the actual medical care provided is inferior. A number of health-care experts consider Medicaid close to having no medical insurance at all. The system is chronically and grossly underfunded.

The U.S. Government Accountability Office recently reported that less than half of physicians are willing to accept children with Medicaid and CHIP as new patients, and over four-fifths experienced difficulty referring Medicaid and CHIP children to specialty care. I can say, from my experience at Marshall University Department of Pediatrics over the last 11 years, that obtaining competent mental-health treatment in the Huntington area for children with Medicaid is sometimes close to impossible.

Many mental-health care clinicians, as well as other specialists, in Huntington and across the country, don’t accept Medicaid because payments are low and unreliable. It is understandable. However, it is likely this contributes to the overuse of psychotropic medications in children, since it makes it harder for them and their families to be referred for psychotherapy.

In addition to the inability to access specialty care, parents of the children with Medicaid insurance typically do not have medical coverage. Clinicians cannot possibly provide good health care for children without treating the family. A new mother with untreated depression can affect her child’s school performance years later; a father with an untreated chronic lung condition cannot play actively with his children.

I think one of the reasons the system remains in place, despite all its deficiencies, is covert prejudice against the poor. The poor have no political clout. Poverty is a very complex, multiproblem condition. It seems to me that promoting healthy bodies and healthy minds for all children living in poverty is essential to any efforts to help them overcome poverty. Universal, caring and comprehensive health care is needed.

There is a way to accomplish it. But we cannot listen to conservatives (e.g. Rep. Paul Ryan) who would eliminate government health insurance for the poor, and we cannot heed the liberals who want to place more and more people into a broken and inadequate system. Sixteen million more people will be added to Medicaid as a result of the health-care reform passed by congress and President Obama last year. And, sadly, private insurance will reap even more profit than they do now, once the new law takes effect.

We must advocate for a nontiered system and creation of a comprehensive national health insurance program. A universal plan would be equitably funded, based on the current tax structure. We already put enough money into health care to cover every American for all necessary medical care. Huge savings would result from eliminating the bureaucratic costs of private insurance (20 to 30 percent of health-care spending goes for unnecessary bureaucracy, advertising and private profits).

It would be an expanded and improved version of Medicare. Almost every other industrialized country provides some version of this for their citizens, and at a much lower cost. Everyone in; no one out!

Dr. Binder is associate professor of pediatrics at Marshall University School of Medicine in Huntington, W.Va., and a member of Physicians for a National Health Program.

http://wvgazette.com/Opinion/OpEdCommentaries/201107291961

Extending Medicare to everyone makes good economic sense

By James C. Mitchiner, M.D.
AnnArbor.com, July 31, 2011

In yet another attempt to bridge the debt ceiling impasse by reigning in entitlement spending, President Barack Obama recently proposed raising the eligibility age for Medicare from 65 to 67. As we pass Medicare’s 46th anniversary on July 30, I propose that rather than raising the age for Medicare, we consider lowering it instead. In fact, let’s lower it to zero.

This is not as offbeat as it sounds. Expanding and improving Medicare — essentially creating a Medicare-for-All national health insurance program — would eliminate the administrative duplication that pervades the private insurance industry, capture economies of scale, and use more of the health care dollar for actually improving health and preventing illness.

Medicare-for-All would create a system providing universal and portable health care so that all Americans could receive the same health benefit package regardless of where they lived, and one that would follow them if they relocated. An expanded Medicare system would embody a uniform set of rates and fees for hospitals and physicians, and medical records for patients, all supported by a universal health information technology platform.

Employers would have the health insurance monkey off their backs, allowing them to better compete in the global marketplace. And a national health program modeled on Medicare would allow the U.S. to join the ranks of other advanced democracies that provide health insurance to all their citizens.

Since its creation, Medicare has turned out to be an enormously successful program, as measured by universal access to benefits, portability, minimal administrative costs, and overall popularity among its 47 million current beneficiaries. And relative to private for-profit insurance, it has done a better job in pooling risk, bending the cost curve, and making timely payments to doctors and hospitals. Yet Medicare as it exists now is by no means perfect.

The average Medicare recipient is finding it increasingly harder to afford the growing out-of-pocket costs of health care. Many will skimp on necessary care, or just go without. And Medicare’s looming insolvency, currently projected to occur in 2024, is deeply concerning to beneficiaries, government actuaries, Congress and health policymakers alike.

Expanding Medicare to cover everyone would address these problems. Since young and middle-aged adults and their families are healthier than current Medicare beneficiaries, and therefore have lower health care expenses, an expanded risk pool under Medicare-for-All would have an average per-beneficiary cost that’s much less than the current cost for seniors (over $10,000 per current enrollee). And since expanded revenues would be greater than projected expenses, Medicare’s Trust Fund could be replenished, and personal out-of-pocket costs could be minimized. Of course, financing an expanded Medicare program would require the non-elderly to pay an increased tax on income, but this would be modest, progressive, and a fraction of the exorbitant private insurance premiums they’re paying now.

To my critics who would decry a universal Medicare program as “government-run health care” with its implied rationing and restrictions, think about how the for-profit insurance companies control your choices now. Then recall the image of the health care townhall protester in 2009 who shouted, “Keep your government hands off my Medicare.” Can you think of a better testimonial to the non-intrusiveness of the federal government in individual health care decisions? And as a physician, I find it much easier to deal with Medicare than with managed care plans.

It is clear that reducing government spending and thus forcing beneficiaries to pay more out-of-pocket will not by itself preserve Medicare and keep it sustainable for the baby boomers. Rather, what needs to be done is to find a better way of financing this important social insurance program so that it remains viable and available to future retirees. The solution is a single-payer national health insurance program modeled on the success of Medicare. That would be the icing on the Medicare birthday cake.

Dr. James Mitchiner, an emergency medicine physician, is the former president of the Washtenaw County Medical Society, and a member of Physicians for a National Health Program.

http://www.annarbor.com/news/opinion/extending-medicare-to-everyone-makes-economic-sense/

Medicare, an effective program, turns 46

By Ann Settgast, M.D.
Star Tribune (Minneapolis), July 30, 2011

Whether the debt ceiling is raised or not in the days ahead, Minnesotans and the nation have reason to celebrate this weekend. Saturday marked Medicare’s 46th birthday.

While we have a long way to go before our health care system works well for all patients, this anniversary gives us an opportunity to reflect on what we’ve done right.

Surprisingly, Medicare was born out of bitter controversy in 1965. It was condemned by some as “socialized medicine,” a threat to basic freedoms. As a physician, I’m embarrassed to say organized medicine was among its key opponents. It all seems silly today.

Since its inception, Medicare has afforded hundreds of millions of Americans access to high-quality health care. It has reduced poverty among seniors and improved the financial security of their families. It has become one of the most popular government programs in history.

Current political discourse is centered on spending cuts, including Medicare. But covering Americans via Medicare saves money. No, that is not a typo.

Medicare boasts far lower administrative costs than the leanest private insurance company. While it is true that Medicare spending has risen dramatically over time, its growth is far less than that of the private sector.

And remember that Medicare pays for the care of our sickest and oldest, while private insurers foot the bill for the young and healthier.

In fact, uninsured Americans in their late 50s and early 60s routinely delay needed care, only to become expensive Medicare recipients once they reach 65.

Medicare is not the cause of health care inflation; rather, it is a victim of our country’s sky-rocketing health care costs. Cuts to Medicare will not control these costs.

Rather, they will reduce access to care by the nation’s elderly, worsen their health status, and increase financial hardship among already-struggling Americans.

Not only is Medicare less expensive than private insurance, it provides superior service. An example is the free choice of doctor granted to patients under Medicare — a basic freedom many privately insured Americans are currently denied.

As a practicing internist, I can attest to the lower “hassle factor” doctors incur when dealing with Medicare rather than interacting with multiple private payers, each requiring different rules and regulations. Expecting us to treat patients differently because they have different or no insurance contradicts our professional responsibility.

Medicare is far from perfect, and it has some serious limitations. But for this weekend, let’s celebrate a government program that actually works incredibly well. Americans are proud of Medicare. It should be strengthened, expanded and improved to include all of us. A sustainable Medicare-for-all system is the reform our nation needs.

Ann Settgast, M.D., is a primary care doctor practicing in the Twin Cities. She co-chairs the Minnesota chapter of Physicians for a National Health Program.

http://www.startribune.com/opinion/otherviews/126430563.html

Impact of Budget Control Act on Medicare

TEXT OF BUDGET CONTROL ACT AMENDMENT

House of Representatives
Rules Committee, August 1, 2011

(a) SHORT TITLE.—This Act may be cited as the “Budget Control Act of 2011”

SEC. 302. ENFORCEMENT OF BUDGET GOAL

(8) IMPLEMENTING DIRECT SPENDING REDUCTIONS. — On the date specified in paragraph (4) during each applicable year, OMB shall prepare and the President shall order a sequestration, effective upon issuance, of nonexempt direct spending to achieve the direct spending reduction calculated pursuant to paragraphs (5) and (6). When implementing the sequestration of direct spending pursuant to this paragraph, OMB shall follow the procedures specified in section 6 of the Statutory Pay-As-You-Go Act of 2010, the exemptions specified in section 255, and the special rules specified in section 256, except that the percentage reduction for the Medicare programs specified in section 256(d) shall not be more than 2 percent for a fiscal year.

(9) ADJUSTMENT FOR MEDICARE. — If the percentage reduction for the Medicare programs would exceed 2 percent for a fiscal year in the absence of paragraph (8), OMB shall increase the reduction for all other discretionary appropriations and direct spending under paragraph (6) by a uniform percentage to a level sufficient to achieve the reduction required by paragraph (6) in the non-defense function.

http://www.rules.house.gov/Media/file/PDF_112_1/legislativetext/S365%20ct%201206.pdf

The deficit reduction agreement will likely result in an automatic two percent reduction in Medicare payments. The only way that can be prevented is by an agreement of a special twelve member bipartisan Joint Select Committee on Deficit Reduction to find alternative methods of reducing the deficit, and then to have their recommendations approved by an up-or-down vote of both current houses of Congress.

The probability of reaching a complex and controversial agreement that leaves Medicare totally unscathed is almost zero in this dysfunctional Congress. President Obama has already demonstrated that he is quite willing to capitulate to the demands of the right-wing obstructionists in Congress. This next time it will be much easier since the terms of the extortion have already been included in this legislation. Since Medicare remains a prime target for the reactionaries, it is very unlikely that it can clear this hurdle without further reductions.

Medicare payment rates have not been increasing at the same level as private insurance rates, understandably creating considerable uneasiness amongst the providers of health care. The Affordable Care Act will further reduce some Medicare payments, and now the Budget Control Act of 2011 will reduce them even further.

These trends will motivate the wealthy owners of Congress to seek private options such as Paul Ryan’s premium support (voucher) proposal, while diminishing their support of Medicare as an egalitarian system of social insurance. With reductions in funding and departure of the healthy and wealthy, Medicare would inevitably transition into a welfare program.

Happy Birthday Medicare! (Oh, that wasn’t nice.)

Save lives and money by expanding Medicare to all

By Dr. Quentin Young
FireDogLake, July 29, 2011

With media attention focused on the debt-ceiling drama in Washington, and with so many Americans rightly preoccupied with the frightening level of joblessness and bleak state of the economy, it might seem strange to urge a national celebration of Medicare’s 46th anniversary this Saturday, July 30.

After all, if we’re to believe top lawmakers, Medicare is part of the problem, right? Aren’t we supposed to be talking about raising the eligibility age from 65 to 67, reducing benefits, increasing seniors’ co-pays and deductibles or, even more dire, abolishing the program altogether and handing seniors vouchers to buy private insurance?

Wrong. Despite its market-obsessed detractors and those who would weaken the program in the name of deficit reduction, Medicare is the solution, not the problem. More precisely, an improved Medicare for all – a single-payer health system – is the right prescription for treating not only our health care woes, but our ailing economy as well.

How so?

The biggest albatross around the neck of our health care system is the private insurance industry, which remains firmly entrenched under the new federal health law.

Thanks to companies like UnitedHealthcare, WellPoint, Aetna, Humana and Cigna, our nation’s patients, businesses, and health providers are chronically tormented by skyrocketing premiums, denials of care, endless paperwork and bureaucracy, and the spectacle of obscene CEO salaries and insurance company profits.

And what does this so-called system get us? Fifty-one million people who have no coverage at all; 45,000 annual deaths linked to lack of coverage; a million personal bankruptcies annually (62 percent of the total) linked to illness or medical debt; and World Health Organization indicators that put us in 37th place globally, even though we spend twice as much per capita as any other nation.

Waste in our system is staggering. Research shows about 31 cents of each U.S. health care dollar is currently spent on administration, over half of which is unnecessary. That translates into $400 billion wasted annually. If we recaptured that money and applied it to clinical care – as we could under a single-payer system – we’d be able to assure everyone comprehensive, first-dollar, high-quality coverage.

So how does this relate to Medicare? As it happens, Medicare is an excellent model for a more rational, single-payer alternative to our present dysfunctional arrangements.

Medicare works. Patients go to the doctor or hospital of their choice. It’s efficient: its overhead is less than 3 percent, less than a quarter of private insurers’. Costs rise more slowly in Medicare than in the private insurance sector.

Medicare isn’t perfect, of course. The program can be empowered to negotiate with drug companies for lower prices. The deductibles and co-pays can be eliminated. Its funding can be augmented from general revenues or a miniscule tweaking of the general payroll tax rate.

But thanks to Medicare, the health and economic security of millions of seniors, the severely disabled, and our nation’s families have dramatically improved. It should not be weakened or destroyed. Those who advocate doing so will reap a whirlwind of popular rage, as GOP Rep. Paul Ryan, an exponent of ending Medicare, has found out.

In such an environment, the obvious approach of President Obama and Congress should be to join the American people in embracing Medicare, not to cut it. But right-wing ideologues, with personal assists from the president himself, have forced a debate on the wrong issue: the debt ceiling, as opposed to enhancing the health status of the American people.

The paradox in this flawed debate is that the solution to our nation’s fiscal problems would be greatly simplified by the creation of a streamlined, efficient and high-quality single-payer Medicare-for-all program. Data suggests that if we had a single-payer system like other industrialized nations, we’d currently have a federal budget surplus.

The 46th anniversary of Medicare should be a time to celebrate its achievements and to strengthen it by expanding it to all.

Quentin D. Young, M.D., is national coordinator of Physicians for a National Health Program (www.pnhp.org) and former chief of internal medicine at Cook County Hospital in Chicago.

http://my.firedoglake.com/quentonyoung/2011/07/29/save-lives-and-money-by-expanding-medicare-to-all/

The Commonwealth Fund compares twelve industrialized nations

The U.S. Health System in Perspective: A Comparison of Twelve Industrialized Nations

By David A. Squires
The Commonwealth Fund, July 2011

This analysis concentrated on 2010 OECD health data for Australia, Canada, Denmark, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

What is driving higher health care spending in the U.S.?

Spending on health care in the U.S. in 2008 far exceeded that seen in other countries. In both dollar figures and as a percentage of GDP, no country came within 70 percent of U.S. spending ($7,538 per capita, 16% GDP). This higher spending does not seem to simply reflect higher income.

There are many forces driving health care spending. An annual series of Commonwealth Fund-sponsored analyses of OECD health data dating back to 1999 has explored a number of potential factors, including: administrative complexity, the aging of the population, the practice of “defensive medicine” under threat of malpractice litigation, chronic disease burden, health care supply and utilization rates, access to care, resource allocation, and the use of technologically advanced equipment and procedures. These and other studies have found, contrary to often-cited explanations, the U.S. has a relatively young population, average or below-average rates of chronic conditions, and comparatively few doctor visits and hospitalizations compared with other industrialized countries. Instead, these studies suggest major reasons for higher spending include substantially higher prices and more fragmented care delivery that leads to duplication of resources and extensive use of poorly coordinated specialists.
 
A 2010 cross-national study conducted by The Commonwealth Fund ranked the U.S. sixth of seven countries in terms of quality, with average performance on effectiveness and patient-centeredness and low performance on safety and coordination.

These findings suggest that the U.S. health system is not delivering superior results despite being more expensive, indicating opportunities for cross-national learning to improve health system performance.

With chronic disease on the rise amidst an aging demographic and accounting for ever more health care spending, more effective treatment and management in primary care settings may have the potential to simultaneously improve patient care while preventing the unnecessary use of scarce and expensive resources.

http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2011/Jul/1532_Squires_US_hlt_sys_comparison_12_nations_intl_brief_v2.pdf

Comment: 

By Don McCanne, MD

This Commonwealth Fund report confirms, once again, that we spend far more than other nations for health care while receiving only mediocrity from a fragmented system. There is much that we can do to improve quality and value, but it needs to begin with a rational system of financing health care.

We don’t have such a system now and will not have it under the provisions of the Patient Protection and Affordable Care Act – a model of reform that is the most expensive and falls far short on goals of reform. We already have learned much from the other eleven nations discussed in this report, but we have failed to act on what we know. Clearly, a single payer national health program with reinforcement of our primary care infrastructure is the redirection that we need.

The Commonwealth Fund compares twelve industrialized

The U.S. Health System in Perspective: A Comparison of Twelve Industrialized Nations

By David A. Squires
The Commonwealth Fund, July 2011

This analysis concentrated on 2010 OECD health data for Australia, Canada, Denmark, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

What is driving higher health care spending in the U.S.?

Spending on health care in the U.S. in 2008 far exceeded that seen in other countries. In both dollar figures and as a percentage of GDP, no country came within 70 percent of U.S. spending ($7,538 per capita, 16% GDP). This higher spending does not seem to simply reflect higher income.

There are many forces driving health care spending. An annual series of Commonwealth Fund-sponsored analyses of OECD health data dating back to 1999 has explored a number of potential factors, including: administrative complexity, the aging of the population, the practice of “defensive medicine” under threat of malpractice litigation, chronic disease burden, health care supply and utilization rates, access to care, resource allocation, and the use of technologically advanced equipment and procedures. These and other studies have found, contrary to often-cited explanations, the U.S. has a relatively young population, average or below-average rates of chronic conditions, and comparatively few doctor visits and hospitalizations compared with other industrialized countries. Instead, these studies suggest major reasons for higher spending include substantially higher prices and more fragmented care delivery that leads to duplication of resources and extensive use of poorly coordinated specialists.

A 2010 cross-national study conducted by The Commonwealth Fund ranked the U.S. sixth of seven countries in terms of quality, with average performance on effectiveness and patient-centeredness and low performance on safety and coordination.

These findings suggest that the U.S. health system is not delivering superior results despite being more expensive, indicating opportunities for cross-national learning to improve health system performance.

With chronic disease on the rise amidst an aging demographic and accounting for ever more health care spending, more effective treatment and management in primary care settings may have the potential to simultaneously improve patient care while preventing the unnecessary use of scarce and expensive resources.

http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2011/Jul/1532_Squires_US_hlt_sys_comparison_12_nations_intl_brief_v2.pdf

This Commonwealth Fund report confirms, once again, that we spend far more than other nations for health care while receiving only mediocrity from a fragmented system. There is much that we can do to improve quality and value, but it needs to begin with a rational system of financing health care.

We don’t have such a system now and will not have it under the provisions of the Patient Protection and Affordable Care Act – a model of reform that is the most expensive and falls far short on goals of reform. We already have learned much from the other eleven nations discussed in this report, but we have failed to act on what we know. Clearly, a single payer national health program with reinforcement of our primary care infrastructure is the redirection that we need.

Profits vs. health

By Kay Tillow
Letters, The Lexington (Ky.) Herald, July 27, 2011

The Commonwealth Fund has published a June 2011 study of Medicaid managed care plans. The news is not good, but it is not surprising.

This study found that “publicly traded plans that focused primarily on Medicaid enrollees paid out the lowest percentage of their Medicaid premium revenues in medical expenses and reported the highest percentage in administrative expenses.”

The study by M.J. McCue and M.H. Bailit also found that the for-profit plans scored lower on quality, preventive care, treatment of chronic conditions, members’ access to care and customer service.

Kentucky has just handed over the care of our most vulnerable citizens to such companies. What do we expect to happen when for-profit companies are paid a flat rate per person? There will be a built-in financial incentive to boost profits by denying care.

When will we learn what the rest of the industrialized world learned long ago — that health care is too precious to be entrusted to profit-making enterprises? Profit-seeking inevitably distorts care and diverts resources from patients to investors.

We could cover everyone while reining in the costs if we would move to a single-payer system as embodied in HR 676, the Expanded and Improved Medicare for All Act. We have to stiffen our spines, stand up to corporations and get it done.

Kay Tillow is coordinator of the All Unions Committee for Single Payer Health Care, which builds union support for H.R. 676. She lives in Louisville, Ky.

http://www.kentucky.com/2011/07/27/1825368/letters-to-editor-july-27.html#ixzz1TKMJRmcm

National Health Expenditures in 2011 and 2020

National Health Spending Projections Through 2020: Economic Recovery And Reform Drive Faster Spending Growth

From the Office of the Actuary, Centers for Medicare and Medicaid Services
Health Affairs, July 28, 2011

National Health Expenditures, billions:
2011 – $2,708.4
2020 – $4,638.4

National Health Expenditures, per capita:
2011 – $8,648.5
2020 – $13,708.8

National Health Expenditures, as percent of GDP:
2011 – 17.7%
2020 – 19.8%

http://content.healthaffairs.org/content/early/2011/07/27/hlthaff.2011.0662.full

Comment: 

By Don McCanne, MD

This year we are spending $2.7 trillion on health care, or about $8,650 per person. What can we expect after the Patient Protection and Affordable Care Act is fully implemented? In 2020, we will be spending over $4.6 trillion, or about $13,700 per person. As a percent of GDP, our health care spending will increase from the current 17.7 percent to almost 20 percent.

Is the Affordable Care Act really affordable? A single payer national health program would be effective in controlling costs, but, much more importantly, it would ensure that all of us – no exceptions – would receive the health care that we need. The Affordable Care Act will cost us more while leaving far too many broke and without health care.

We can still have the health care system that we need, but we’ll have to replace our dysfunctional representatives in Congress. Can we do that?