PNHP

UnitedHealth usurping role of primary care provider

UnitedHealth usurping role of primary care provider

UnitedHealth to Pay Walgreens, YMCA, for Progress on Diabetes

By Katherine Hobson
The Wall Street Journal
Health Blog
UnitedHealth Group and Walgreens say they’re teaming up with the YMCA on a program that will reimburse pharmacists and lifestyle coaches to help insured patients prevent and control diabetes.
The program, which will be announced Wednesday at the CDC Diabetes Conference in Kansas City, Mo., will have two parts, says Tom Beauregard, executive vice president of UnitedHealth and executive director of the UnitedHealth Center for Health Reform and Modernization. The prevention arm will use UnitedHealth claims data and other demographic information to flag people at risk of developing diabetes and invite them to a free, 16-session exercise and nutrition class at a local YMCA. They’ll have monthly follow-up after the class is over, and instructors will be paid bonuses if participants meet certain modest weight-loss goals.
The control part of the program will be administered with Walgreens. Participants who already have diabetes will receive a 45-minute assessment and then other health-care coaching sessions, covering both medical and lifestyle management, says Colin Watts, chief innovation officer at Walgreens.
(Beauregard) said UnitedHealth would pay the YMCA around $300 for someone who completed the program and it could rise to $500 for someone who met weight-loss goals. Neither he nor Watts would disclose the reimbursements to Walgreens, but Watts says it includes a strong pay-for-performance element.
http://blogs.wsj.com/health/2010/04/13/unitedhealth-to-pay-walgreens-ymca-for-progress-on-diabetes/

One of the most important goals of health care reform was to reinforce the primary care infrastructure to provide for everyone a medical home that would ensure access to the highest quality care reasonably attainable.
That would have been easy through a universal publicly administered health care financing program such as an improved Medicare that included everyone. Instead reform was based on an expansion of a chronically underfunded welfare program – Medicaid – plus an infusion of taxpayer funds into an expansion of the private insurance industry.
Think about it. UnitedHealth is using its proprietary data bank to glean information about primary care patients, and then using that information to pull the patients out of their primary care homes and referring them on to the YMCA and Walgreens, effectively fragmenting their health care management. If the programs are appropriate, the decision to use them should be made in the primary care home, and not usurped by middlemen money managers.
With the need to demonstrate a medical loss ratio of 80 percent (individual and small groups) to 85 percent (large groups), we can anticipate that UnitedHealth, WellPoint and the other for-profit insurers will make every effort they can to establish other similar programs outside of the mainstream of health care that would satisfy their medical loss ratio requirements. Of course these programs will draw funds away from primary care professionals, hospitals and other health care providers.
We do need a much stronger primary care infrastructure, but we need to get UnitedHealth and the others out of the way so that we can do it right. A publicly-owned financing system would place patients first, ensuring that they would have the coordinated care that they need.

Healthcare overhaul won't stop premium increases

Healthcare overhaul won't stop premium increases

By Noam N. Levey
Los Angeles Times
April 13, 2010

Public outrage over double-digit rate hikes for health insurance may have helped push President Obama’s healthcare overhaul across the finish line, but the new law does not give regulators the power to block similar increases in the future.

And now, with some major companies already moving to boost premiums and others poised to follow suit, millions of Americans may feel an unexpected jolt in the pocketbook.

At least in the short term, regulators will be able to do little more than require insurers to publicly explain why they want to raise rates. Consumer advocates think that will not be an effective deterrent against premium increases such as the 39% hike that Anthem Blue Cross sent some California customers last year.

“It is a very big loophole in health reform,” Sen. Dianne Feinstein (D-Calif.) said. Feinstein and Rep. Jan Schakowsky (D-Ill.) are pushing legislation to expand federal and state authority to prevent insurance companies from boosting rates excessively.

But more intensive oversight would not begin until 2014, when states set up new regulated insurance markets, or exchanges, where consumers who do not get insurance at work would shop for coverage.

The healthcare bill allows regulators to ban insurers from the exchanges if their rates are deemed unjustified.

http://www.latimes.com/news/la-na-health-premiums13-2010apr13,0,3121779,full.story

Comment: 

By Don McCanne, MD

The health insurance overhaul that is now law does not include significant regulatory control of private insurance premiums. At most, plans can be excluded from the state insurance exchanges if their premiums are considered to be excessive. Thus the call for more legislation to increase oversight of premium increases. But would this really address the problem?

Actually the bill does require that 75 to 85 percent of premium dollars must be spent on health care. As long as the insurers demonstrate that they are complying with that requirement, the premium increases are not deemed to be excessive as far as excluding them from the exchanges. Of course they will be excessive, but that is because health care costs will continue to rise at excessive rates.

There are two questions we should be asking. One is why we should consider 15 to 25 percent of the premium to be a reasonable share for the private insurers to consume for their own intrinsic purposes, especially when they place an administrative burden of another 12 percent or so on the providers of health care, amounting to an administrative cost of 27 to 37 percent of the insurance premiums. You would think that this would be a prime target in our efforts to improve health care spending.

The other question we should be asking is why we should finance health care using using a market model that has a half century track record proving that it is ineffective in controlling costs, when we could be using a public insurance model that would use proven economic tools that can actually slow health care increases to sustainable rates.

Regardless of the hoopla, we didn’t reform health care financing, we only expanded our existing dysfunctional system. We don’t have to accept this. We can still do it right.

Healthcare overhaul won’t stop premium increases

Healthcare overhaul won’t stop premium increases

By Noam N. Levey
Los Angeles Times
April 13, 2010

Public outrage over double-digit rate hikes for health insurance may have helped push President Obama’s healthcare overhaul across the finish line, but the new law does not give regulators the power to block similar increases in the future.

And now, with some major companies already moving to boost premiums and others poised to follow suit, millions of Americans may feel an unexpected jolt in the pocketbook.

At least in the short term, regulators will be able to do little more than require insurers to publicly explain why they want to raise rates. Consumer advocates think that will not be an effective deterrent against premium increases such as the 39% hike that Anthem Blue Cross sent some California customers last year.

“It is a very big loophole in health reform,” Sen. Dianne Feinstein (D-Calif.) said. Feinstein and Rep. Jan Schakowsky (D-Ill.) are pushing legislation to expand federal and state authority to prevent insurance companies from boosting rates excessively.

But more intensive oversight would not begin until 2014, when states set up new regulated insurance markets, or exchanges, where consumers who do not get insurance at work would shop for coverage.

The healthcare bill allows regulators to ban insurers from the exchanges if their rates are deemed unjustified.

http://www.latimes.com/news/la-na-health-premiums13-2010apr13,0,3121779,full.story

Comment: 

By Don McCanne, MD

The health insurance overhaul that is now law does not include significant regulatory control of private insurance premiums. At most, plans can be excluded from the state insurance exchanges if their premiums are considered to be excessive. Thus the call for more legislation to increase oversight of premium increases. But would this really address the problem?

Actually the bill does require that 75 to 85 percent of premium dollars must be spent on health care. As long as the insurers demonstrate that they are complying with that requirement, the premium increases are not deemed to be excessive as far as excluding them from the exchanges. Of course they will be excessive, but that is because health care costs will continue to rise at excessive rates.

There are two questions we should be asking. One is why we should consider 15 to 25 percent of the premium to be a reasonable share for the private insurers to consume for their own intrinsic purposes, especially when they place an administrative burden of another 12 percent or so on the providers of health care, amounting to an administrative cost of 27 to 37 percent of the insurance premiums. You would think that this would be a prime target in our efforts to improve health care spending.

The other question we should be asking is why we should finance health care using using a market model that has a half century track record proving that it is ineffective in controlling costs, when we could be using a public insurance model that would use proven economic tools that can actually slow health care increases to sustainable rates.

Regardless of the hoopla, we didn’t reform health care financing, we only expanded our existing dysfunctional system. We don’t have to accept this. We can still do it right.

Finding Good Migraine Care a Headache for the Uninsured

They are twice as likely to resort to ERs for help rather than a doctor's office, study finds

By Amanda Gardner, HealthDay Reporter
U.S. News and World Report, April 12, 2010

MONDAY, April 12 (HealthDay News) — People who are uninsured or who are on Medicaid are much less likely to receive adequate care for their migraines than people who have private coverage.

In fact, more than 5.5 million Americans may be at risk of receiving inadequate care for their migraines because of their insurance status, a new study suggests.

“Left untreated or undertreated, as a result of being uninsured, will cause millions of Americans with migraine to suffer needlessly and place them at greater risk for developing more frequent migraine headaches,” said Dr. Brian M. Grosberg, director of the Inpatient Headache Program at Montefiore Medical Center and assistant professor of neurology at Albert Einstein College of Medicine in New York City. He was not involved in the study.

The lag in care may stem from the fact that the uninsured tend to seek care at hospital emergency rooms rather than a doctors’ office, according to findings published in the April 13 issue of Neurology.

“This study is really about the need to improve the healthcare system so everybody has access to a physician in an office so they don’t have to go to an emergency department — where we know they’re not going to get the best treatment,” added the study’s senior author, Dr. Rachel Nardin, chair of neurology at Cambridge Health Alliance and assistant professor of neurology at Harvard Medical School in Boston.

“It’s a sad situation because we actually have pretty good treatments that can help a lot of people, but what we don’t have is a functioning healthcare system that allows us to get treatment to people who need it,” continued Nardin, who is also chair of the Massachusetts chapter of Physicians for a National Health Program.

According to background information in the article, some 18 percent of women and 6 percent of men suffer from migraines.

“Migraines are a whole-system disease. People with migraines are really out of commission,” Nardin said. “They have to lie down and sleep for several hours. People with migraines lose an average of four days of work a year, and that doesn’t include the toll it takes on them as productive members of their family or church.”

Meanwhile, more than 45 million Americans have no health insurance at all, and an additional 58 million are underinsured, according to the latest federal data from the National Center for Health Statistics.

In the study, researchers looked at results from two surveys on visits to doctors’ offices, hospital outpatient visits and trips to the emergency room over a period of 11 years.

They estimated a total of 68.6 million such visits nationally during that time period for migraine complaints.

People with no insurance were twice as likely to receive inadequate therapy, either to treat or prevent migraines, as those with private coverage. Those with Medicaid were 50 percent more likely.

If migraine care was received in an emergency room, uninsured and Medicaid patients were almost five times more likely to receive inadequate care for their migraine.

“Migraine can be treated very effectively in a physician’s office,” Nardin said. “We all suffer when people need to use the emergency room because it then becomes less available for true emergencies. Migraines are a great example of where the system is not set up to get the right care in the right place at the right time. If we could do that, we would all benefit.”

http://www.usnews.com/health/family-health/brain-and-behavior/articles/2010/04/12/finding-good-migraine-care-a-headache-for-the-uninsured.html

Healthcare overhaul won't stop premium increases

Healthcare overhaul won’t stop premium increases

By Noam N. Levey
Los Angeles Times
April 13, 2010
Public outrage over double-digit rate hikes for health insurance may have helped push President Obama’s healthcare overhaul across the finish line, but the new law does not give regulators the power to block similar increases in the future.
And now, with some major companies already moving to boost premiums and others poised to follow suit, millions of Americans may feel an unexpected jolt in the pocketbook.
At least in the short term, regulators will be able to do little more than require insurers to publicly explain why they want to raise rates. Consumer advocates think that will not be an effective deterrent against premium increases such as the 39% hike that Anthem Blue Cross sent some California customers last year.
“It is a very big loophole in health reform,” Sen. Dianne Feinstein (D-Calif.) said. Feinstein and Rep. Jan Schakowsky (D-Ill.) are pushing legislation to expand federal and state authority to prevent insurance companies from boosting rates excessively.
But more intensive oversight would not begin until 2014, when states set up new regulated insurance markets, or exchanges, where consumers who do not get insurance at work would shop for coverage.
The healthcare bill allows regulators to ban insurers from the exchanges if their rates are deemed unjustified.
http://www.latimes.com/news/la-na-health-premiums13-2010apr13,0,3121779,full.story

The health insurance overhaul that is now law does not include significant regulatory control of private insurance premiums. At most, plans can be excluded from the state insurance exchanges if their premiums are considered to be excessive. Thus the call for more legislation to increase oversight of premium increases. But would this really address the problem?
Actually the bill does require that 75 to 85 percent of premium dollars must be spent on health care. As long as the insurers demonstrate that they are complying with that requirement, the premium increases are not deemed to be excessive as far as excluding them from the exchanges. Of course they will be excessive, but that is because health care costs will continue to rise at excessive rates.
There are two questions we should be asking. One is why we should consider 15 to 25 percent of the premium to be a reasonable share for the private insurers to consume for their own intrinsic purposes, especially when they place an administrative burden of another 12 percent or so on the providers of health care, amounting to an administrative cost of 27 to 37 percent of the insurance premiums. You would think that this would be a prime target in our efforts to improve health care spending.
The other question we should be asking is why we should finance health care using using a market model that has a half century track record proving that it is ineffective in controlling costs, when we could be using a public insurance model that would use proven economic tools that can actually slow health care increases to sustainable rates.
Regardless of the hoopla, we didn’t reform health care financing, we only expanded our existing dysfunctional system. We don’t have to accept this. We can still do it right.

Healthcare overhaul won’t stop premium increases

Healthcare overhaul won’t stop premium increases

By Noam N. Levey
Los Angeles Times
April 13, 2010

Public outrage over double-digit rate hikes for health insurance may have helped push President Obama’s healthcare overhaul across the finish line, but the new law does not give regulators the power to block similar increases in the future.

And now, with some major companies already moving to boost premiums and others poised to follow suit, millions of Americans may feel an unexpected jolt in the pocketbook.

At least in the short term, regulators will be able to do little more than require insurers to publicly explain why they want to raise rates. Consumer advocates think that will not be an effective deterrent against premium increases such as the 39% hike that Anthem Blue Cross sent some California customers last year.

“It is a very big loophole in health reform,” Sen. Dianne Feinstein (D-Calif.) said. Feinstein and Rep. Jan Schakowsky (D-Ill.) are pushing legislation to expand federal and state authority to prevent insurance companies from boosting rates excessively.

But more intensive oversight would not begin until 2014, when states set up new regulated insurance markets, or exchanges, where consumers who do not get insurance at work would shop for coverage.

The healthcare bill allows regulators to ban insurers from the exchanges if their rates are deemed unjustified.

http://www.latimes.com/news/la-na-health-premiums13-2010apr13,0,3121779,full.story

The health insurance overhaul that is now law does not include significant regulatory control of private insurance premiums. At most, plans can be excluded from the state insurance exchanges if their premiums are considered to be excessive. Thus the call for more legislation to increase oversight of premium increases. But would this really address the problem?

Actually the bill does require that 75 to 85 percent of premium dollars must be spent on health care. As long as the insurers demonstrate that they are complying with that requirement, the premium increases are not deemed to be excessive as far as excluding them from the exchanges. Of course they will be excessive, but that is because health care costs will continue to rise at excessive rates.

There are two questions we should be asking. One is why we should consider 15 to 25 percent of the premium to be a reasonable share for the private insurers to consume for their own intrinsic purposes, especially when they place an administrative burden of another 12 percent or so on the providers of health care, amounting to an administrative cost of 27 to 37 percent of the insurance premiums. You would think that this would be a prime target in our efforts to improve health care spending.

The other question we should be asking is why we should finance health care using using a market model that has a half century track record proving that it is ineffective in controlling costs, when we could be using a public insurance model that would use proven economic tools that can actually slow health care increases to sustainable rates.

Regardless of the hoopla, we didn’t reform health care financing, we only expanded our existing dysfunctional system. We don’t have to accept this. We can still do it right.

Uninsured get poor care for migraine: Harvard study

U.S. health system causes headaches in more ways than one, researchers say

EMBARGOED until     
Monday, April 12, 2010

Contacts:
Rachel Nardin, M.D.
Andrew P. Wilper, M.D., M.P.H
Steffie Woolhandler, M.D., M.P.H.
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org

Migraines, often characterized by excruciating headache and nausea, are much worse for the uninsured, a new Harvard Medical School study shows.

Researchers say migraine sufferers who lack private health insurance get poor care for their condition. They are about twice as likely to get inadequate treatment for their headaches as their privately insured counterparts. People with Medicaid also get substandard care.

Because migraine is common in the United States, affecting about 18 percent of women and 6 percent of men, and because so many Americans lack health insurance, a startling 5.5 million people are at risk of getting substandard care for their often painful and disabling headaches, the researchers say.

The study, titled “The impact of insurance status on migraine care in the United States: a population based study,” was published today [Tuesday, April 13] in Neurology, the world’s leading clinical neurology journal.

Study senior author Dr. Rachel Nardin, assistant professor of neurology at Harvard and chief of neurology at the Cambridge Health Alliance in Massachusetts, said: “The tragedy is that we know how to treat this disabling condition. But because they are uninsured or inadequately insured, millions of Americans suffer needlessly.

“Unfortunately,” she said, “the new health law doesn’t fully address this problem. At least 23 million people will remain uninsured nine years out.

“Optimizing migraine care requires improvement in our health care systems as well as educating physicians to prescribe the best available drug and behavioral treatments.”

The researchers analyzed data from two federal surveys, the National Hospital Ambulatory Medical Care Survey and the National Ambulatory Medical Care Survey, which together provide a nationally representative sample of all U.S. visits to doctors’ offices, hospital clinics and emergency rooms. They analyzed the 6,814 visits for migraine between 1997 and 2007, representing 68.6 million visits nationwide.

Neurologists recommend two types of drugs when a moderate-to-severe migraine strikes: “triptans” (such as sumatriptan) or dihydroergotamine (DHE). For the majority of migraine sufferers whose headaches are frequent or severe, neurologists also recommend a daily dose of one of several preventive medications.

The researchers used these recommendations from the American Academy of Neurology to define standard migraine treatment and found that the uninsured were nearly twice as likely as the privately insured to receive substandard treatment.

Medicaid enrollees were 50 percent more likely to receive substandard treatment, suggesting that “access to some forms of insurance is not the same as access to adequate care,” the researchers wrote.

Care in doctors’ offices was substantially better than in emergency departments. The fact that the uninsured are less likely to get care in doctors’ offices explained some, though not all, of their substandard care.

Most people with migraine are impaired by their headaches and the accompanying nausea, and lose an average of four to six days of work annually.

Dr. Steffie Woolhandler, professor of medicine at Harvard and study co-author, said: “Lack of insurance clearly takes a heavy toll on our patients and the economy. Regrettably, the health bill just signed into law will leave tens of millions of Americans uninsured or poorly insured and thus unable to get the care they need.”

Dr. Andrew Wilper, lead author of the study, said: “We showed that the uninsured have a higher risk of death when compared to those with insurance. Lack of insurance also puts patients with migraine at risk for needless suffering due to lack of access to standard medical therapy.”

****

“The Impact of Insurance Status on Migraine Care in the United States: A Population Based Study,” Andrew P. Wilper, M.D., M.P.H., Steffie Woolhandler, M.D., M.P.H., David U. Himmelstein, M.D. and Rachel Nardin, M.D. Neurology, April 13, 2010.

A limited number of patient stories are available upon request from Mark Almberg, (312) 782-6006, mark@pnhp.org.

Physicians for a National Health Program (www.pnhp.org) is an organization of 17,000 doctors who support single-payer national health insurance. To speak with a physician/spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.

Mutual fund managers are relieved

Health Care Overhaul May Help a Fund Sector

By Geraldine Fabrikant
The New York Times
April 9, 2010

Now that President Obama has finally gotten his sweeping health overhaul passed, mutual fund managers can breathe a sign of relief. Finally, there is some certainty about the changes, and most of them appear to be beneficial for health care stocks.

“There does not seem to be any onerous cost control,” said Les Funtleyder, a heath care analyst at Miller Tabak, an insititutional brokerage firm and asset manager.

In the wake of the new bill, the only negative he sees is a potential problem for insurance companies, like WellPoint, the UnitedHealthGroup and Aetna, because at some point they will have to cover all potential clients. “Then the question is, will they price these things so that they can avoid losing money?” he asked.

http://www.nytimes.com/2010/04/11/business/mutfund/11health.html?hpw

Comment: 

By Don McCanne, MD

For those of us who continue to express concerns about the failure of the reform legislation to adequately control the excess growth in health care spending, this news is no surprise. Mutual fund managers are relieved that there are no onerous cost controls, allowing them to continue to include health care stocks as an important part of their portfolios. The only concern they’ve expressed is that health insurers now are going to have pay for health care for high-cost patients that they’ve been successful in excluding from their plans.

Expanding our expensive dysfunctional health care financing system works well for Wall Street, but it doesn’t work for the rest of us. It is absolutely inevitable that we will have to adopt a program of social insurance, preferably an improved Medicare for all.  The sooner, the better.

Bill to design new health care model approved

By DANIEL BARLOW
Times Argus (Vt.), April 8, 2010

MONTPELIER – Senators voted 28-2 Wednesday to hire consultants to design a new health care model for Vermont, one of which would include a single-payer system.

Approval of the bill is a victory for Sen. Doug Racine, D-Chittenden, the chair of the Senate Health and Welfare Committee, who made it his goal this year to set Vermont on a path to a new health care system.

Racine, a gubernatorial candidate, said the state’s health care spending is on an unsustainable path and is now expected to hit almost $6 billion by the year 2012. His proposal would fully design several new options for the state.

“This is an essential next step for the state of Vermont,” Racine told his colleagues on the Senate floor Wednesday afternoon. “We need to get our costs under control and provide what we have promised … that all Vermonters have access to high-quality and affordable health care.”

Racine said his goal with the bill was to move the discussion over the future of health care beyond the abstract and instead begin looking at the specific details of various proposals. His bill allocates about $300,000 to a newly-revamped Health Care Reform Commission to hire consultants and fully design up to three new health care models.

The bill states that at least one of those models must be a single-payer system, one where all Vermonters are included in a single pool run by the state government. That has some advocates – such as Burlington’s Vermont Workers’ Center – cheering Racine on.

“We know that this bill has changed a little since when it was first introduced, but we’re still strongly supporting it,” said James Haslam, the director of the Center. “It puts Vermont on the right path.”

Racine conceded that he preferred his original bill, which envisioned setting up a new independent committee to study health care and help design the new systems. Under changes made to the bill by the Senate Appropriations Committee, that format was scrapped and the plans handed to the Reform Commission, a body of legislators and citizens who debate health care policy.

“The commission can still do the work,” Racine said.

Racine’s bill changed in other ways too. The Senate Appropriations Committee also successfully added an amendment to the bill – in a 21-9 vote on the floor – language that would give the Vermont government more authority over regulating hospital budgets.

That provision, sponsored by Sen. Susan Bartlett, D-Lamoille, the Appropriations Committee chairwoman and another gubernatorial candidate, places a 4 percent statewide cap on hospital budget increases over the next two years. There are provisions in the bill for certain financial exemptions from that cap.

Several senators worried that their hospitals would be shortchanged. Sen. Kevin Mullin, R-Rutland, said his county’s main hospital would be hurt more than others because 72 percent of the patients they see are on Medicaid or Medicare. The 4 percent cap would effectively be a 1 percent cap, he said.

“I want to be on record supporting my local hospital,” Mullin said.

Bartlett responded that the state government and school districts have been making tough budget decisions. She said “this isn’t even the beginning of the hard stuff” when it comes to bring budgets in line.

“They should be scared,” Bartlett said. “We’re almost out of money. But there are protections in here. There are plenty of outs for a hospital that is in an extreme financial situation.”

Only two senators – Sen. Randy Brock, R-Franklin, and Sen. Margaret “Peg” Flory, R-Rutland, voted against Racine’s health care bill. Brock said he was worried that a single-payer system in Vermont would be a “magnet for those from elsewhere.” Flory said the commission’s mission would cost too much in a tight budget year.

“We’re talking about a quarter million to a half million here,” she said. “This is just another proposal that we probably wouldn’t be able to do anything with for six more years.”

Daniel.Barlow@timesargus.com

http://www.timesargus.com/article/20100408/NEWS01/4080374/1002/NEWS01

Mutual fund managers are relieved

Health Care Overhaul May Help a Fund Sector

By Geraldine Fabrikant
The New York Times
April 9, 2010
Now that President Obama has finally gotten his sweeping health overhaul passed, mutual fund managers can breathe a sign of relief. Finally, there is some certainty about the changes, and most of them appear to be beneficial for health care stocks.
“There does not seem to be any onerous cost control,” said Les Funtleyder, a heath care analyst at Miller Tabak, an insititutional brokerage firm and asset manager.
In the wake of the new bill, the only negative he sees is a potential problem for insurance companies, like WellPoint, the UnitedHealthGroup and Aetna, because at some point they will have to cover all potential clients. “Then the question is, will they price these things so that they can avoid losing money?” he asked.
http://www.nytimes.com/2010/04/11/business/mutfund/11health.html?hpw

For those of us who continue to express concerns about the failure of the reform legislation to adequately control the excess growth in health care spending, this news is no surprise. Mutual fund managers are relieved that there are no onerous cost controls, allowing them to continue to include health care stocks as an important part of their portfolios. The only concern they’ve expressed is that health insurers now are going to have pay for health care for high-cost patients that they’ve been successful in excluding from their plans.
Expanding our expensive dysfunctional health care financing system works well for Wall Street, but it doesn’t work for the rest of us. It is absolutely inevitable that we will have to adopt a program of social insurance, preferably an improved Medicare for all.  The sooner, the better.

Healthcare Reform Not Found: Abort, Retry, Ignore?

By Eric LaMotte, Contributing Writer
Synapse, The UCSF Student Newspaper
April 8, 2010

Despite the intense efforts of a vocal minority, healthcare reform was enacted this year by congressional Democrats who claimed to place the needs of American citizens over those of corporations. Unfortunately, they chose to enact policies that will continue to allow a costly, complex, fragmented, for-profit insurance system to inflict damage on the rest of our healthcare system. Now, living in a post-reform world, we must decide where to go from here, and I am reminded of the error prompt that every frustrated computer user has had to answer at one point or another: Abort, Retry, Ignore?

Republicans are clamoring to repeal the law after November’s midterm elections. They want us to “Abort” our efforts for reform.

Congressional Democrats, the White House and the press want us to play dumb and pretend that the law is a “sweeping measure of reform” that is going to bring meaningful change to patient’s lives, and that we should wait ten years to see how the reform goes before tackling the subject again. They want us to “Ignore” the deficiencies of the new law, despite the fact that Massachusetts, our model for national reform, is already retracting the expansion of insurance coverage it enacted in 2006 and cutting payments to safety net hospitals in order to sustain a fiscally irresponsible model of reform. Massachusetts has the most expensive healthcare system in the world, and yet we are emulating this system in an effort to address rising costs.

Unfortunately, neither “Aborting” nor “Ignoring” are going to lower the $2.4 trillion dollars that we currently spend on healthcare, or get us significantly more healthcare for that pricetag. Neither option will decrease the 31% of healthcare costs that we spend pushing paper to figure out who’s going to pay for care. Neither option will prevent a middle-class family from going bankrupt when a parent gets very ill, has to temporarily miss work and is still on the line for paying her premiums, deductibles, 30% co-payments and full costs for out-of-network charges and uncovered benefits. This political triumph for Democrats is a policy disaster, shifting problems around rather than fixing them.

Instead, we must click “Retry” and quickly. Before HR3962/4872, the thing our country needed most from Congress was universal healthcare. After reform, it’s still universal healthcare.

Democrats could have improved Medicare and expanded it to cover all Americans, giving them full coverage for a comprehensive array of benefits (including dental, drug and mental health coverage) with no co-payments or deductibles: a 100% actuarial value plan. American residents would be guaranteed coverage from birth to death, without having to sign up year after year or worry about transferring insurance and providers with changes in employment. Patients would have full choice of doctor, without limitation to “networks,” and decisions about medical care would be restored to patients and providers. Private insurance would be allowed for any services not covered in the universal benefits package, such as cosmetic surgery. This is what is called a single payer system, since one organization is paying every part of every bill for every patient. The plan would be paid for by taxes that would replace the current mix of taxes, premiums, copayments, and deductibles, and would cost the same amount we pay now by eliminating $400 billion in bureaucratic waste from the system. In essence, Congress could have enacted a law that obviously and successfully prevents patients from going broke when they get sick.

Instead, Congress enacted a law that prevents patients from going broke in some ways – for example, by being rescinded from their plan – but leaves other ways of going broke wide open. You can bet that insurance companies will quickly adapt. As just one example, they could lower payments to providers, which would also cause providers to drop off the plan, making it harder to find a doctor who is “in-network” and raising the likelihood of out-of-network, uncovered charges.

Many progressives see these adaptations as a reason to trash corporations, and especially executives of private insurance companies. I think this reaction is ineffective and counterproductive, as it can turn off moderates and conservatives. Insurance companies are businesses, and they’re supposed to make the biggest profit they can within the boundaries of the law. We shouldn’t expect them to do anything else. The problem is not that they are evil, but rather that they are amoral, and yet we decide to put them in charge of access to a service with moral value. The fault is with us. If we are going to routinely consider the actions that we should naturally expect insurance companies to take to be abusive, then perhaps we shouldn’t put them in that position in the first place. Democrats, including President Obama, pretended to be outraged when Anthem Blue Cross threatened to raise premiums 39% in California, yet Democrats are unwilling to even allow the idea into the public debate that it might make sense to cut the private insurance industry out of the game altogether. They need to learn the meaning of the Ice T lyric, “don’t hate the player, hate the game.”

Amidst the already loud voices in support of “Abort” and “Ignore,” we need to raise a new and thundering voice for “Retry.” The national single payer bill described above is already written: HR 676. It’s thirty pages long, and written in plain English. It’s deficit neutral. It’s fiscally responsible. It guarantees access to healthcare as a right for all Americans. It has 88 co-sponsors, many of whom are “progressive” democrats who violated public promises to constituents by voting for a bill without a public option and are now in need of appealing to their base. Democrats have shown that they can pass something without the help of a single Republican.

Although San Francisco’s congresswomen are unlikely to work towards a new healthcare bill this year, we can make that their fault, not our own. Currently, neither Rep. Jackie Speier nor Speaker Nancy Pelosi are among the 88 cosponsors of the bill. If I know one thing, it’s that we won’t get single payer until we give our representatives no choice but to vote for it, by making our voices heard loud and clear. Don’t just call them today – keep them on your speed dial.

In California, we will have our own shot at enacting a statewide single payer system with SB 810. The bill passed the State Senate in January by a vote of 22-14. But it’s a long way from being enacted, and California’s idiosyncratic political system makes it unlikely that California will be the first state to enact a single payer plan. You can support real reform by joining efforts with PNHP/CaPA, CaHPSA, AMSA, CNA, or California OneCare.

http://synapse.ucsf.edu/articles/2010/April/8/opinion.html

Senate wants 3 plans that ensure health care for all Vermonters

Experts to provide options for universal coverage

By Nancy Remsen
Burlington (Vt.) Free Press
Thursday, April 8, 2010 

MONTPELIER — Dr. Deb Richter is accustomed to the slow pace of progress toward the health reform she favors, but she comes back to the Statehouse again and again to push for change. She was on hand Wednesday when senators took another small step.

The Senate voted 28-2 to give preliminary approval to a bill that directs the Legislature’s Health Care Reform Commission to hire experts to write three sets of plans that would implement a universal health care system in Vermont beginning in July 2012. One of the options must be a government-administered, publicly financed health benefits system.

“It is a good bill. It will get the ball rolling,” said Richter, an advocate of a single-payer system she sometimes describes as “Medicare for all.” Medicare is a federal health insurance program that covers all Americans over age 65. Richter is sure the design for a single-payer system will show it to be “the most fiscally conservative way to cover everybody.”

The Senate’s health reform bill wouldn’t commit the state to change, said Senate Health and Welfare Committee Chairman Doug Racine, D- Chittenden. Rather, it would give next year’s Legislature and new governor detailed information to help them make decisions about the next steps they could take to achieve universal access and better affordability.

Racine said the design process “is a necessary step to make change.”

The bill senators endorsed Wednesday was a political compromise among three Democratic gubernatorial candidates. Racine, Senate Appropriations Chairwoman Susan Bartlett and Senate President Pro Tempore Peter Shumlin are among five Democrats running for governor. Initially, they disagreed about who should coordinate the planning called for in the bill.

“I believe now we are one big happy family,” Racine reported as he asked senators to substitute the compromise bill for his committee’s original version. Rather than create a new board to oversee the planning process, the bill calls for using an existing commission. The panel’s membership would change to include two more nonlegislative members and two fewer lawmakers.

Another change proved more controversial — although not among the gubernatorial candidates. It would cap growth in the collective rate increase for the state’s 14 hospitals at 4 percent for each of the next two years.

http://www.burlingtonfreepress.com/article/20100408/NEWS03/100407029/-1/RSS