Resource – Page 647

Vermont health reform signed into law, spurs interest in single-payer reform

May 26, 2011

Dear PNHP colleagues and friends,

Vermont Gov. Peter Shumlin signed into law today “An Act Relating to a Universal and Unified Health System.” We salute the single-payer activists in Vermont and applaud their efforts. Although this is not a single-payer bill, we will continue to support the struggle to achieve health care justice in Vermont and across the nation. PNHP’s full statement on the legislation is here.

One of the many obstacles facing any state seeking to enact a true single-payer system is obtaining necessary waivers from the federal government. Click here to sign our petition urging the granting of waivers to implement single payer.

PNHP has already received press coverage from this event, from PNHP co-founder Dr. David Himmelstein’s comments in Bloomberg News to an interview with PNHP past president Dr. Deb Richter on Democracy-Now! Please help us mark this momentous development by forwarding our viewpoint to your local newspaper and radio stations.

Cordially,

Quentin D. Young, M.D.
National Coordinator

Joe Jarvis and Brent James on Intermountain Healthcare

A recent Quote of the Day (May 19) discussed Intermountain Healthcare as an example of how an integrated health care system can help to control costs by emphasizing quality improvement. A co-author of the Health Affairs article cited, Dr. Brent C. James of Intermountain Healthcare, has discussed this topic with Dr. Joe Jarvis of the Utah Healthcare Initiative. Although their views on single payer differ, their discussion is a welcome addition to this dialogue.

Utah Health Care Initiative

IHC: A Quality Story
By Dr. Joe Jarvis
May 21, 2011
http://www.utahhealthcareinitiative.com/blog/2011/05/21/ihc-quality-story/

Dr. Brent James Responds
By Dr. Joe Jarvis
May 23, 2011
http://www.utahhealthcareinitiative.com/blog/2011/05/23/dr-brent-james-responds/

Brent James: Senate Testimony on quality
April 29, 2009
http://www.utahhealthcareinitiative.com/blog/2009/04/29/brent-james-md-senate-testimony/

Although Brent James has demonstrated that quality is attainable independently of the financing system for health care, his approach requires a degree of altruism which he posses but which has not permeated the entire health care delivery system.

Quality and financing are two different considerations, but there is a tremendous amount of overlap. A well designed single payer system provides tools and incentives for quality enhancement, just as a high quality system provides efficiencies for the financing system.

Dialogues such as this between Dr. Jarvis and Dr. James move the process forward bringing us closer to the day that we can experience a high quality health care system for all that is truly affordable – a financing system that is universal and equitable, and a high quality delivery system that makes it work.

US healthcare: Profits before patients

What is the point of having the world's best medical facilities if citizens don't have the money to access healthcare?

By Rose Aguilar
Opinion, Al Jazeera English, 4 May 2011

When Stan Brock started Remote Area Medical (RAM) in 1985, never in his wildest dreams did he think his services would be needed in the United States, the wealthiest country in the world.

RAM began as an all-volunteer mobile medical clinic that provided free and immediate health care to people living in remote areas of the Amazon rainforest. In 1992, he was asked to bring the clinic to Knoxville, Tennessee. He was shocked by what he saw.

“People were in desperate need of the most basic care,” he said at RAM’s most recent expedition in Oakland, California last month. “It didn’t occur to me when I first came to this country, but it wasn’t long before I could see there were similarities between people who don’t have access to healthcare in a place like the Amazon and people who have access but can’t afford it in America – and they’re all in the same boat.”

An estimated 50 million Americans are uninsured and another 25 million are underinsured, meaning they can’t pay the difference between what their insurance will cover and the total cost of their medical bills. Someone files for bankruptcy every 30 seconds in the US because of a serious health problem, according to a Harvard University study.

Since 1992, RAM has conducted 640 expeditions in the US. When the travelling medical clinic comes to town, the lines begin forming at around midnight. An average of 3,000 people are treated at a typical four-day event. Over 90 per cent of the patients are in desperate need of basic dental and vision care. Each clinic costs roughly $100,000 to run, requires over 1,000 volunteers, and takes an entire year to organise.

When patients entered the clinic at the Oakland Coliseum, they were greeted by smiling volunteers, rows upon rows of dental chairs, optometric stations, and tables covered with medical tools, gloves, and equipment.

When Milka Guiterrez heard that free healthcare was being offered, she moved her schedule around to get a good place in line. On Sunday night, long after her three kids were sound asleep, she left her house at 1am. She was number 474 in line.

Shortly before patients began entering the makeshift clinic five hours later, Guiterrez ran home, grabbed her kids, and returned with her fingers crossed. She got lucky.

She and her kids had eye exams and dental work. Her eight-year-old daughter Paloma was in pain from the drilling, but managed to crack a smile. “When I used to smile, there was yellow stuff everywhere,” she said wiping away tears. “I was so embarrassed. I stopped smiling when I was six. It hurts, but now I’m happy.”

After 12 years with the US Postal Service, Anita Moore was hurt on the job and lost her health insurance. She got in line at 3:30am. By 6pm, she had her eyes checked, her teeth cleaned, two fillings, and four extractions.

Six months ago, she had an injury and hasn’t been able to lift her arms above her shoulders. The pain went away after 15 minutes of acupuncture at the clinic. “I was so happy because I couldn’t lift. I was just shocked. Now I can move them around,” she said. “It’s a blessing.”

Les Kuller, an unemployed construction worker who got in line at 5:30am, lost his health insurance when his wife passed away two years ago. He got a molar fixed, had his blood pressure checked, was given a pair of eyeglasses, and had chiropractic and physical therapy work. He was so touched by the care he received and the volunteers he met, he came back the next day to join them.

“The least I could do is give back,” he said. “On one hand, this is so incredibly amazing that all these volunteers can pull this together. On the other hand, it’s a sad commentary about what the hell is going on in Washington and why the hell these knuckleheads can’t walk across the aisle and shake hands and figure this thing out.”

Kuller says he hopes people standing in overnight lines for basic medical care “embarrasses the hell” out of politicians. I heard similar sentiments from several people receiving care at the clinic.

When profit comes before care

Democratic politicians proudly point to the Patient Protection and Affordable Care Act, the bill that was signed by President Obama in March 2010, as real progress, but Physicians for a National Health Program (PNHP), an organisation of doctors who support healthcare for all, say the bill is nothing more than a false promise of reform.

Instead of eliminating the real problem, the new legislation will enrich and further entrench the profit-driven, private health insurance industry, and leave 23 million people still uninsured in 2019, according to PNHP.

If Republicans have their way, the 45 million seniors and people with disabilities who rely on Medicare will see their out-of-pocket costs double – or do without treatment altogether.

RAM founder Stan Brock doesn’t like to talk about politics. He’s too busy making sure people get treated. RAM’s next stop is in Pikeville, Kentucky. From there, he and his team will head to Cocke County, Tennessee, Wise County, Virginia, and Chicago, Illinois. Because he’s has had so many requests from all over the country, he sees no end in sight.

This is what happens when profit comes before care.

UnitedHealth’s first quarter profits this year rose 13 per cent to $1.35 billion from $1.19 billion last year. UnitedHealth CEO Stephen Hemsley’s total compensation of $101.96 million last year made him the highest paid executive in the country.

The US is the only major country in the industrialised world that doesn’t guarantee healthcare to all of its citizens. It’s unconscionable that 45,000 people in the US die every year because they can’t afford care.

Senator Bernie Sanders, an independent from Vermont who believes that the US should put patients over profits, recently re-introduced the American Health Security Act, which would provide every citizen with healthcare coverage through a state-administered, single payer program.

Here’s a fact from the PNHP that never made its way through the noise machine during the so-called healthcare debate – which was shaped by the insurance industry from the beginning. It should be repeated over and over again. the bureaucracy and paperwork of the profit-making health insurance industry consume one-third of every healthcare dollar.

Streamlining payment through a single-payer system would save more than $400 billion per year – which is enough to provide comprehensive, high-quality coverage for all.

RAM’s Stan Brock says a single-payer system, as long as it covers dental and vision, would put him out of business in the US. “That would allow us to go back to the Amazon, Central America, Haiti – and other places where we belong.”

Rose Aguilar is the host of Your Call, a daily call-in radio show on KALW in San Francisco. She’s the author of “Red Highways: A Liberal’s Journey into the Heartland.”

The views expressed in this article are the author’s own and do not necessarily represent Al Jazeera’s editorial policy.

http://english.aljazeera.net/indepth/opinion/2011/05/201152382145164217.html

Vermont health law spurs fresh interest in single-payer reform: doctors group

As governor signs a 'universal health care' bill, a national physicians group says the Vermont developments show that many Americans want to go beyond the new federal health law to more fundamental reform

FOR IMMEDIATE RELEASE
May 25, 2011

Contact:
Garrett Adams, M.D.
David Himmelstein, M.D.
Ida Hellander, M.D., or Ali Thebert, (312) 782-6006, info@pnhp.org

Gov. Peter Shumlin’s signing of Vermont’s health reform bill this Thursday is spurring renewed interest in single-payer health reform across the United States, even though the Vermont legislation is much more modest in its actual reach than a single-payer plan would be, a spokesperson for a national doctors group said today.

“The people of Vermont, including the state’s doctors, nurses and other health professionals, have inspired the entire nation by their unflagging dedication to winning a publicly financed, comprehensive and equitable health care system based on the principle that health care is a human right,” said Dr. Garrett Adams, president of the 18,000-member Physicians for a National Health Program. “We salute their efforts and the efforts of their many organizations, even as we share their conviction that their work has just begun.”

“This praise also extends to Gov. Peter Shumlin, who was elected to office on a single-payer platform and who has made many speeches in support of publicly financed care,” Adams said. “The governor has argued, for example, that single payer is the best way for Vermont to get its economy back on track and to create jobs.”

“Credit is also due to Sen. Bernie Sanders and other members of the state’s congressional delegation who are seeking waivers from the federal government so Vermont can innovate with its own model of reform,” he said. As of now, the federal Affordable Care Act prohibits states like Vermont from adopting their own models of reform until 2017. Shumlin, Sanders and others are trying to move that date up to 2014.

Adams continued: “Vermonters, like their counterparts across the United States, recognize that our current way of financing care – using wasteful, inefficient middlemen known as private health insurance companies – is broken and economically unsustainable. Many also understand that the new federal health law, while containing modest benefits, is an insufficient remedy, among other reasons because it retains a central role for these same greedy insurers.”

He noted that several other states, including California, are looking at variations of a single-payer model for reform.

Adams said while the Vermont law declares health care to be a “public good” and says the state has a responsibility to “ensure universal access to and coverage for high-quality, medically necessary health services for all Vermonters,” a praiseworthy objective, the actual provisions of the law fall considerably short of the single-payer reform needed to realize those goals.

A major problem, he said, is that the Vermont law will permit multiple private insurers to operate in the state indefinitely, setting the stage for multi-tiered care, rising costs and needless waste.

“Allowing multiple insurers in the system will deny Vermonters the enormous administrative savings they would otherwise get under a true single-payer plan,” Adams said. “Having multiple insurers also nullifies the potential bargaining power of a ‘single payer’ to negotiate reduced prices for pharmaceutical drugs and other goods and services.”

Dr. David Himmelstein, co-founder of Physicians for a National Health Program, said that the law’s emphasis on complying with the Affordable Care Act means that it will leave the door open for burdensome co-pays, deductibles and other out-of-pocket expenses that deter people from seeking timely care. Finally, to the extent the law permits large, for-profit institutional providers to allocate their profits as they see fit, it will deny the system the ability to do effective health planning.

“In this context, the continuing mobilization of Vermont’s broad-based movement for true single-payer reform will be essential,” Himmelstein said. “Such a mobilization can bolster the governor’s clear enthusiasm for the single-payer project and the courage of the Legislature as they face the inevitable onslaught of corporate opposition to deep-going health reform.”

“We remain hopeful that the rhetorical commitment to further reform will become a reality,” Himmelstein said. “Much more work, including continuing advocacy for a national solution – a single-payer system as embodied in legislation such as H.R. 676, the Expanded and Improved Medicare for All Act – will be needed in the years ahead to achieve Vermonters’ goal of universal access to high-quality, affordable care.”

******

Physicians for a National Health Program (www.pnhp.org) is an organization of 18,000 doctors who support single-payer national health insurance, an improved Medicare for all. To speak with a physician/spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.

Insurers are expensive middlemen

By Robert N. Shorin, A.C.S.W., B.C.D.
Newsday, Letters, May 24, 2011

Regarding “Insurer puts undue pressure on doctors” [Letters, May 19]: I am a clinical social worker, and I can tell you from hard experience that many private insurance companies are only out to make a profit, often at the direct expense of their own customers, and at the indirect expense of the government.

For example, private insurance companies often deny payment for medical treatment without justification to the agency providing service, making it time-consuming and burdensome for the understaffed and underfunded agency to protest. Since the agency cannot abandon its responsibility to provide service to a suicidal patient, for example, service is continued at the expense of the agency, with the financial support of the limited government funding we are granted. In effect, the private insurance company’s clients are paid for by the agency and the government, without costing the insurance company an extra penny.

Or, the private insurance company will raise its co-pay requirements, knowing full well that its customers cannot afford the increase. As a result, the agency again spends its own limited funds, or worse, the client prematurely drops out of treatment.

Expanding Medicare is the only fair way to go. It would cost less, without the need to make a profit and pay the private executive salaries. Nor would we need the insurance company itself to act as an unessential and parasitic middleman.

Robert N. Shorin, ACSW, BCD, resides in Syosset, N.Y.

Medicaid maintenance-of-effort

GOP Pushes To Let States Reduce Medicaid Rolls

By Mary Agnes Carey and Phil Galewitz
Kaiser Health News, May 23, 2011

Medicaid covers about 56 million Americans, with states sharing the costs with the federal government. States have been barred from cutting eligibility for the program since 2009 when economic stimulus legislation gave states billions to prop up their Medicaid program on the condition they didn’t tighten eligibility standards. The 2010 health law extended this requirement until 2014.

President Obama and congressional Democrats say eliminating the “maintenance-of-effort” provision would increase the challenge of expanding Medicaid in 2014; an additional 16 million people will qualify, with the federal government picking up most of the cost.

The House Energy and Commerce Health Subcommittee voted along party lines earlier this month to repeal the Medicaid “maintenance of effort” requirement. The legislation is expected to pass both the full Energy and Commerce panel and the GOP-controlled House. A vote on similar standalone legislation in the Democratic-controlled Senate is unlikely but the measure could end up in a debt-limit package.

But liberals have at times been disappointed by Obama’s concessions, including last year’s deal to extend the Bush-era tax cuts. They worry that the president will ultimately feel compelled to trade away the “maintenance-of-effort” requirements. The White House declined to comment.

http://www.kaiserhealthnews.org/Stories/2011/May/24/medicaid-maintenance-of-effort-republicans.aspx

Comment:

By Don McCanne, MD

As has been said many times in these messages, Medicaid is a welfare program, and our politicians will continue to approach it as such. It will remain underfunded and will always be vulnerable to budgetary decisions. Not only did the Affordable Care Act greatly expand coverage with the highly flawed private insurance plans, it also greatly expanded the highly flawed Medicaid program. It’s still not too late to eliminate these unsatisfactory programs and replace them with an improved Medicare that covers everyone.

Calif. health plan revived: Democrats re-introduce single payer

By Jim Steinberg and Mediha Fejzagic DiMartino, Staff Writers
Contra Costa Times, May 22, 2011

State Democrats have revived a bill that would create a single-payer health care system and provide access to doctors for everyone in the state, including illegal residents.

Senate Bill 810, the California Universal Health Care Act introduced earlier this month by Sen. Mark Leno, D-San Francisco, would replace President Barack Obama’s health care reform legislation with a more comprehensive system — one its advocates say would cost everyone no more than what they already pay.

But local Republican legislators emphatically deny that assertion.

“S.B. 810 is a job-killing measure that will end many insurance plans, lead to huge tax increases and health care rationing,” said Assemblyman Curt Hagman, R-Chino Hills. “S.B. 810’s socialized medicine makes the ruinous Obamacare look like small government.”

Supporters of the measure say it would create a public-private partnership to provide every state resident with medical, dental, vision, hospitalization and prescription drug benefits, while still allowing patients to choose their own doctors and hospitals.

This plan would set up a single-payer “Medicare for All” type of program by pooling the money that government, employers and individuals already pay and using that money more efficiently by cutting out the middle man — insurance companies.

State Sen. Bob Dutton said he understands that there needs to be some fixes within the health-care delivery system, but making it government-run is not the answer, said Larry Venus, Dutton’s spokesman.

“Sen. Dutton wants to make sure the cost is accounted for,” Venus said. “That you would be able to cover every single person without increasing cost, it’s not a reality. That cost has to be borne by somebody, generally the taxpayer.”

Assemblyman Tim Donnelly, R-Hesperia, said creating a single-payer health care system in California would impose a massive overgrowth of government that will be costly to both the state and the people at a time when the state is working to close a huge budget gap.

“It is unrealistic and disingenuous to promise what the author has promised in this bill,” Donnelly said. “It is impossible to offer coverage to every resident at a reasonable cost without engaging in rationing. S.B. 810 promises to destroy any semblance of consumer choice in health care left.

“Furthermore, the bill does nothing to address shortages in doctors and nurses and will only exacerbate the problem. Promises to provide greater access to health care are void without ensuring there is someone to provide that care.”

So how will the health care solution created by S.B. 810 not cost more than we are paying now?

Advocates say a big reason will be in the reduction of administrative expenses of health care by reducing the involvement of insurance companies — and trimming administrative expenses of doctors’ offices — and other medical providers — as they seek payment from insurers.

“There are some 6,000 health plans in California, and health care providers spend about one-third of their resources just getting paid,” Leno said.

And there will be other saving opportunities as well — in unprecedented bulk purchasing power for everything from pharmaceuticals to hearing aids, eyeglasses and the investment in primary and preventive care, Leno said.

The bill will not conflict with the federal health care reform legislation — it allows states to set up their own health care systems if their program does not obligate Uncle Sam to shell out more money.

“We applaud the president’s affordable-care program, but we know it leaves 3 million Californians without insurance,” Leno said.

In some areas the state version of health care reform seems more comprehensive.

S.B. 810 would provide dental care – something largely not addressed in the federal program.

The California proposal would also cover both legal and illegal residents.

“Infection and disease does not recognize immigration status,” Leno said.

S.B. 810 is estimated to save California about $20 billion its first year through reduced administrative costs, based on a study conducted in 2006, for an earlier go-around with this proposal.

The bill has passed through Senate Health Committee and is now in the Rules Committee.

Leno said the bill will not advance this year and that the 2006 study will be redone to bring up-to-date figures to a campaign for its approval next year.

Single-payer systems were passed twice by the Legislature in recent years, only to be vetoed each time by then-Gov. Arnold Schwarzenegger.

The proposal was tabled in 2009.

Leno reintroduced it in January, making this the fourth effort.

“We (were not) surprised,” Venus said. “There is never new bill ideas, just different people introducing it. Now they have a Democratic governor.”

Leno said he has not discussed the plan in detail with Gov. Jerry Brown, but noted that when Brown ran against former President Bill Clinton in the 1992 presidential primary, he said he favored a nationwide universal health care plan.

Leno said he hopes to have that in-depth conversation with Brown soon.

Patrick Johnston, the president and CEO of the California Association of Health Plans, said S.B. 810 “has no chance of becoming a law.”

The association represents 39 public and private organizations that provide health care coverage to more than 21 million Californians.

He said an analysis of the bill in a previous form determined there would be a shortfall of $45 billion three years after its implementation.

“There is not enough money in the system to provide services to everyone who shows up,” Johnston said, adding that private money to purchase new medical technology would dry up. “The president and Congress reviewed all the options and decided on the course of the affordable health care plan.

“Implementing that federal law is a huge task that state and federal health care officials are working on. The debate over this law is a diversion” from the work that needs to be done, he said.

One academic observer of health care policy said, “If you think the fight over affordable care was nasty, you haven’t seen anything yet.”

“This plan is going to gore a lot of oxen,” said Gerald F. Kominski, associate director for UCLA Center Health Policy Research. “No. 1 is the insurance industry. They are not about to see their business go up in smoke.”

Kominski said that the federal Patient Protection and Affordable Care Act “is a very moderate, middle-of-the-road approach to health care reform. It fills the gaps in the current system.”

On the other hand, he said the state proposal “is a fundamental reform.”

Asked if he thought S.B. 810 has a chance to become reality, Kominski said, “I’ve seen enough things happen to never say `never.’ I don’t know how the ongoing financial crises might change public opinion on health care to vote for a more fundamental change of health care delivery.”

http://www.contracostatimes.com/california/ci_18118630?nclick_check=1

Medicaid maintenance-of-effort

GOP Pushes To Let States Reduce Medicaid Rolls

By Mary Agnes Carey and Phil Galewitz
Kaiser Health News, May 23, 2011

Medicaid covers about 56 million Americans, with states sharing the costs with the federal government. States have been barred from cutting eligibility for the program since 2009 when economic stimulus legislation gave states billions to prop up their Medicaid program on the condition they didn’t tighten eligibility standards. The 2010 health law extended this requirement until 2014.

President Obama and congressional Democrats say eliminating the “maintenance-of-effort” provision would increase the challenge of expanding Medicaid in 2014; an additional 16 million people will qualify, with the federal government picking up most of the cost.

The House Energy and Commerce Health Subcommittee voted along party lines earlier this month to repeal the Medicaid “maintenance of effort” requirement. The legislation is expected to pass both the full Energy and Commerce panel and the GOP-controlled House. A vote on similar standalone legislation in the Democratic-controlled Senate is unlikely but the measure could end up in a debt-limit package.

But liberals have at times been disappointed by Obama’s concessions, including last year’s deal to extend the Bush-era tax cuts. They worry that the president will ultimately feel compelled to trade away the “maintenance-of-effort” requirements. The White House declined to comment.

http://www.kaiserhealthnews.org/Stories/2011/May/24/medicaid-maintenance-of-effort-republicans.aspx

Vermont Steps Closer To Single-Payer Health Care

By NPR Staff, All Things Considered
NPR, May 22, 2011

Vermont is about to accomplish something the federal government couldn’t.

Once Gov. Peter Shumlin signs a bill on May 26, the state will be on track to having a single-payer health care system.

“We’re actually trying to design the first single-payer health care system for America,” Shumlin told Guy Raz, host of weekends on All Things Considered.

“Basically what our system will do is treat health care as a right and not a privilege,” he says. “We want to design a system where health care will follow the individual, and not be a requirement of the employer, which we think will be a huge jobs creator.”

Most importantly, Shumlin says, it’ll be a publicly financed system. Everyone pays, and the state uses those “health care dollars to make us healthier, not to enrich insurance companies, inefficiency, waste, and the current fee-for-service system, which bills providers based on how much service they do.”

But don’t break out the Canada comparisons just yet.

Vermonters aren’t going to wake up to a single-payer system overnight. What’s being passed is more of a framework. They are using the Affordable Care Act, the hotly contested bill passed last year by Congress, as a bridge for the state to get there. When that bill becomes law in 2014, so will Vermont’s plan.

The basic outline looks like this: The federal government, Vermont’s state government and employers will all still pay in for health insurance. That money will then all flow through Green Mountain Care, Vermont’s official health insurance. To equalize the rates consumers pay, the state will ask the federal government for Medicaid waivers. The state government must also court national employers that do business in Vermont to put their employees on Green Mountain Care.

The bill doesn’t lay out hard specifics on how to pay for it all, which has critics nervous. A financial exploratory committee has the task of putting together a proposal due January 2013, but for now Shumlin isn’t worried. He says there are only a few different options to choose from in order to pay for a publicly financed system, like using Medicaid vouchers.

The logistics will come in time, he says. Right now, the cost of health care is swelling and Shumlin believes setting Vermont up on a single-payer system will create a more sustainable way to take care of everybody.

“We have a crisis,” he says. “What I find alarming is that so many of us are willing to pretend that everything is going to be OK if we stick with the current system. So we’re taking the bull by the horns up here in Vermont.”

If Vermont does get it right, it could see more businesses and jobs coming in. Shumlin sees this type of health insurance as a big financial ease for employers, especially small-business owners.

That’s a big economic incentive, but it wasn’t enough to save the single-payer provision of the Affordable Care Act from being axed by Congress last year. [PNHP note: the writer is almost certainly referring to the “public option,” since there was no “single-payer provision” in the draft federal legislation.] Yet Vermont might be the right size and the right political environment to be a sandbox for a single-payer system in America, and Shumlin believes it could serve as a model for other states.

“We want to figure this one out and get it right,” Shumlin says, “Then we hope that perhaps others might follow.”

http://www.npr.org/2011/05/22/136502764/vermont-steps-closer-to-single-payer-health-care

Vermont closing in on single payer

By Ezra Klein
The Washington Post, 05/09/2011

Kevin Outterson is an associate professor of health law, bioethics and human rights at Boston University, as well as a blogger at the Incidental Economist. He’s also been following the Vermont health-care reform process in some detail, and is one of fairly few people who has actually read the 141-page single-payer bill that the governor is poised to sign. Earlier this afternoon, he walked me through what he’s learned.

Ezra Klein: What is Vermont passing, exactly? My understanding is that they’re not going to sign this legislation and wake up with single-payer health care the next day. So what’s in this bill, and what does it do?

Kevin Outterson: This bill is more of a framework. For example, they left out all the financing. But it sets a planning process for a single-payer — or what they’re calling a “single-payment” — system. If you read the various reports and presentations they’ve released so far, you can get a sense of where that’s going. Their plan is to roll every payer they can into one system. It’s easy to do with state and municipal employees. They might be able to do it with the individual and small-group markets that they regulate under the terms of the Affordable Care Act. They are going to ask the Obama administration for waivers for Medicaid, so they’d get the Medicaid money and use it in this system, and they also want a waiver for Medicare, which I’m not sure anyone has ever done before. And the last group they’re trying to woo in are the large, national employers who are regulated by ERISA. Their plan is to tax these employers whether they pay in or not, and then these employers have to ask themselves, “We’re already paying this tax, why wouldn’t we just put our employees into Green Mountain Care?”

EK: So all these different players remain part of the health-care system. But now their payments run through the Vermont state government.

KO: Right. So employers would still be paying in, the Vermont state government would still pay in, the federal government would still be paying in, but all the money would then flow through Green Mountain Care, the single-payment system. And for all providers, there’d just be one contract. It’d equalize payment rates between private insurance and Medicare and Medicaid. It’ll dramatically reduce their paperwork. That’s why they’re supporting it. And Blue Cross/Blue Shield of Vermont, which is the biggest insurer in the state, supports it.

EK: Wait, Blue Cross/Blue Shield supports it? Why? Won’t this put them out of business?

KO: You would think. But this is one of those Blue Cross plans that never sold out to Anthem. They’re still nonprofit. And they’ve got 70 percent of the market in Vermont. So the theory is they would administer the payment system. But they’re not alone. The Vermont Medical Association and the Vermont hospitals are supporting this legislation. [PNHP correction: the Vermont Medical Society has taken a neutral stance on the bill.] The most vocal opponents are the state association of insurance agents, and the drug companies are about to descend in force, because there’s a lot in there the drug industry won’t like.

EK: How quickly could something like this be up and running in Vermont?

KO: They can do a single-payment system fairly quickly for the state and municipal employees and the individual and small-group exchange markets that they regulate under the ACA. So that’s the core. And it’s pretty substantial. And if they get Blue Cross in, then they get Blue Cross’s customers. Then there’s Medicaid and Medicare, which will be a long process going back-and-forth with the Center on Medicaid and Medicare Services. And then the discussion with the big employers is happening now, as Vermont can toss this tax into place pretty quickly, which will force those guys in.

EK: But there’s no financing mechanisms in the bill yet, right? That seems like a pretty big omission.

KO: Vermont has a study group that’s been working on financing for a while and that’s been negotiating with these big employers to join the party. And they need them there: If they don’t tax the big guys, they don’t have the money, and if they don’t get buy-in from the big guys and they move their offices to New Hampshire, Vermont has a problem. But let’s say you’re Wal-Mart. You might be willing to take a risk on paying a bit more in Vermont because if it works and spreads, this might fix your long-term problems nationally. If I was a national employer with 3 or 4 million lives in my care, I might be willing to invest a little money to see if Vermont can do this.

EK: That national question seems like the interesting one. In Canada, single payer began in a single province and then spread across the whole country. If Vermont pulls this off successfully, it seems like the sort of thing that, in 10 or 20 years, could lead to very large changes in America’s health-care system.

KO: The first thing I posted on was the incredible power of Vermont’s version of the Independent Payment Advisory Board to control costs. If they do this and they’re successful, there are a number of other states that will want to try it. It’s a 20-year time horizon, but if you think national single-payer is a political nonstarter, this is where the action is. But that’s the question: whether they can control costs. That’ll be everything.

http://www.washingtonpost.com/blogs/ezra-klein/post/vermont-closing-in-on-single-payer/2011/05/09/AFvtBmZG_blog.html

Single-payer system provides security

By Thomas P Clairmont, W. Jost Michelsen and Patricia A Locuratolo
Letters, Portsmouth (N.H.) Herald, May 22, 2011

We read with interest the article on the Leadership Seacoast event on health care costs (Herald, May 5, 2011).

Identifying smoking, drinking and inactivity as contributing factors to these costs is exactly right. Unfortunately, the state has diverted every penny of the tobacco settlement money to be used for education of children about the dangers of smoking. Now they want to reduce the price of cigarettes to encourage even more of this disease-causing habit. Closing public pools and gyms are on their list, too. And they wonder why costs are rising.

Then there was a discussion about seniors, a group which has 10,000 members turning 65 every day for the next 20 years. At the end there will be 76 million of us. Are we really going to cut Medicare benefits for those who served/saved our country in World War II? That is just not right.

Finally, there was a discussion about Accountable Care Organizations of which the Mayo Clinic said “they would not participate, because the rules as written are so onerous it would be nearly impossible for them to succeed.”

There was absolutely no mention, as usual, of a publicly financed but privately delivered approach — also called single-payer or Medicare for All. Dr. David Himmelstein of Physicians for a National Health Program said reducing administrative overhead to Canadian levels would save $400 billion annually, “more than enough to cover our uninsured.” This is what most other countries do and they cover all of their citizens at a cost of less than half of the United States.

No one mentioned our neighboring state of Vermont, where Harvard Professor William Hsiao said “our research and analysis shows a single-payer system can immediately reduce health care costs in Vermont by 8 to 12 percent and reduce health care costs by an additional 12 to 14 percent over time.” His plan would cover every Vermont citizen.

No one mentioned the work of Dr. Jack Wennberg of Dartmouth, who said “bringing health care costs down to the level of Minneapolis or Seattle would save up to 40 percent, more than enough to offset any increase in public spending that might result from extending insurance coverage to the uninsured.” It is unbelievable that cost-saving research like this goes nowhere and gets no press at all. In testimony to the Portsmouth City Council in February, we said that extrapolating the Vermont data to Portsmouth would result in savings to local taxpayers of more than $1.5 million every year.

Those of you who “don’t want the government involved in my health care” must prefer the only alternative, Wall Street Medicine. You must be especially pleased with the current results. The CEO of United Health Care made $101.96 million last year and has a net worth approaching $1 billion. All seven of the leading insurance companies had huge profits and shareholder earnings in the first three months of this year. Of course, this wasn’t enough.

The New York Times, in a feature article on New Hampshire, demonstrated increases in health care premiums for various businesses of 20 percent to 43 percent for this year. Keep in mind that inflation in 2010 was 1.6 percent.

More than 130,000 of our fellow New Hampshire citizens have no insurance.

So here is our plan for you and your children. Note that health care will not be free. For about 5 percent of your income, taken out of your paycheck or paid from your other income sources, you will get comprehensive coverage with choice of doctor and hospital, and no additional out-of-pocket costs. There will be no manuals to read, and you will never have to raise funds to cover your health care. No one will make those obscene amounts of money ever again. And you will sleep well, knowing you and your family are fully covered for life.

If this health security appeals to you and your family, then question the candidates about what they are going to do, and push them, like in every other country, toward a universal system that makes sense and will improve the health of all Americans.

Thomas P Clairmont, MD, W. Jost Michelsen, MD, and Patricia A Locuratolo, MD, are members of the Physicians for a National Health Program and practice in Portsmouth, N.H..

http://www.seacoastonline.com/articles/20110522-OPINION-105220317

The Self-Rationing of Medical Care

Letters, The New York Times, May 22, 2011

Re “Health Insurers Profit as Many Postpone Care” (front page, May 14): How more scathing an indictment could there be of the insurance industry’s commodification of the nation’s health? In a faltering economy, the health insurers have rung up record profits, rewarded shareholders with new dividends and are demanding double-digit premium increases for fear of possible higher costs.

Is health a commodity to be sold for profit, for bonuses and dividends, or is our nation’s health a responsibility of our government? Can we not now, or ever, see the need to replace this needless, costly, money-sucking, claim-denying middleman, this so-called health insurance industry, with a single-payer government-administered system?

HERBERT BENGELSDORF
Hastings-on-Hudson, N.Y., May 14, 2011

The writer is a retired psychiatrist.

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GOP Pushes To Let States Reduce Medicaid Rolls

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