California limits HMO wait times

By Duke Helfand
Los Angeles Times
January 19, 2010
Seeking to reduce the long waits many people endure to see a doctor, California regulators are implementing new rules that specify how quickly patients in health maintenance organizations must be seen.
The regulations by the California Department of Managed Health Care, in the works for much of the last decade, will require that patients be treated by HMO doctors within 10 business days of requesting an appointment, and by specialists within 15.
The managed healthcare department acted in response to a 2002 law that mandated more timely access to medical care. The law left it to state officials to work out the details, which became subject to protracted negotiations with HMOs, doctors, hospitals, consumer groups and other healthcare activists.
In all, it took seven years to finally reach agreement amid intensive talks, bureaucratic hurdles and a lengthy rule-writing process, participants said.
HMOs will be given until January 2011 to comply.
http://www.latimes.com/news/la-fi-health-access19-2010jan19,0,3456276,full.story

Remember the managed care revolution in the latter part of the last century? Remember how angry everyone became over the interventions designed to control spending by preventing patents from having timely access to care?
As a leader in managed care, California, very early on, began the process to enact corrective legislation to reduce some of the abuses. However it took them until 2002 to pass a law as simple as limiting the delays for appointments for medical care, and the law won’t even apply until 2011.
What have they done to correct other abuses such as the refusal to pay after bungled prior authorization requests, or the refusal to even authorize recommended care, or gouging made possible by tiering of benefits, or exposing patients to high out-of-pocket expenses through innovations in insurance product design, especially high deductibles, or, one of the worst, taking away patents’ choice of physicians and hospitals by limiting care within contracted networks of providers?
Our legislators initially jumped on the managed care bandwagon by enacting laws establishing the enabling regulatory framework that the managed care entities required. Those of us who raised alarms about the flawed policies were told that any problems could be fixed later. They never were fixed, and we’re still living with that mess.
And now we’re shouting as loud as we can that the policies contained the current legislation will leave too many uninsured, many more underinsured, and health care costs will keep increasing at intolerable rates. And what are we told now? Let’s pass this and we can fix the problems later.
We already know what the problems are, but they will not be officially acknowledged until many years after the program formally begins a few years from now. Then we will see many more years of fighting over tweaks to the system, but with no substantial reform.
Everyone understands the problems of managed care, and this reform theoretically should be replacing that flawed system with substantial reform. But what is this reform proposal? More managed care! And now with a mandate to purchase these plans or be assessed penalties.
Really. Think of what they would be doing many years from now to fix this system. Pass a federal law to specify the maximum number of days that can elapse before your provider must grant you an appointment? Come on!
This system can’t be fixed. It will have to be replaced with an improved Medicare for everyone. Why delay for maybe decades, prolonging the physical and financial suffering of those who need care now? We need to replace the system now – in 2010!

California limits HMO wait times

By Duke Helfand
Los Angeles Times
January 19, 2010

Seeking to reduce the long waits many people endure to see a doctor, California regulators are implementing new rules that specify how quickly patients in health maintenance organizations must be seen.

The regulations by the California Department of Managed Health Care, in the works for much of the last decade, will require that patients be treated by HMO doctors within 10 business days of requesting an appointment, and by specialists within 15.

The managed healthcare department acted in response to a 2002 law that mandated more timely access to medical care. The law left it to state officials to work out the details, which became subject to protracted negotiations with HMOs, doctors, hospitals, consumer groups and other healthcare activists.

In all, it took seven years to finally reach agreement amid intensive talks, bureaucratic hurdles and a lengthy rule-writing process, participants said.

HMOs will be given until January 2011 to comply.

http://www.latimes.com/news/la-fi-health-access19-2010jan19,0,3456276,full.story

Remember the managed care revolution in the latter part of the last century? Remember how angry everyone became over the interventions designed to control spending by preventing patents from having timely access to care?

As a leader in managed care, California, very early on, began the process to enact corrective legislation to reduce some of the abuses. However it took them until 2002 to pass a law as simple as limiting the delays for appointments for medical care, and the law won’t even apply until 2011.

What have they done to correct other abuses such as the refusal to pay after bungled prior authorization requests, or the refusal to even authorize recommended care, or gouging made possible by tiering of benefits, or exposing patients to high out-of-pocket expenses through innovations in insurance product design, especially high deductibles, or, one of the worst, taking away patents’ choice of physicians and hospitals by limiting care within contracted networks of providers?

Our legislators initially jumped on the managed care bandwagon by enacting laws establishing the enabling regulatory framework that the managed care entities required. Those of us who raised alarms about the flawed policies were told that any problems could be fixed later. They never were fixed, and we’re still living with that mess.

And now we’re shouting as loud as we can that the policies contained the current legislation will leave too many uninsured, many more underinsured, and health care costs will keep increasing at intolerable rates. And what are we told now? Let’s pass this and we can fix the problems later.

We already know what the problems are, but they will not be officially acknowledged until many years after the program formally begins a few years from now. Then we will see many more years of fighting over tweaks to the system, but with no substantial reform.

Everyone understands the problems of managed care, and this reform theoretically should be replacing that flawed system with substantial reform. But what is this reform proposal? More managed care! And now with a mandate to purchase these plans or be assessed penalties.

Really. Think of what they would be doing many years from now to fix this system. Pass a federal law to specify the maximum number of days that can elapse before your provider must grant you an appointment? Come on!

This system can’t be fixed. It will have to be replaced with an improved Medicare for everyone. Why delay for maybe decades, prolonging the physical and financial suffering of those who need care now? We need to replace the system now – in 2010!

A Proper Sense of Priorities

A speech by Martin Luther King, Jr.
Washington, D.C.
February 6, 1968
Closing remarks:
As we were marching today, some 5,000 strong, I thought about Selma because I could look around and see so many who have marched with us in Selma, and from Selma to Montgomery. And we are still marching and we are still moving. And I give you my commitment today that I plan to continue.
Someone said to me not long ago, it was a member of the press, “Dr. King, since you face so many criticisms and since you are going to hurt the budget of your organization, don’t you feel that you should kind of change and fall in line with the Administration’s policy. Aren’t you hurting the civil rights movement and people who once respected you may lose respect for you because you’re involved in this controversial issue in taking the stand against the war.”
And I had to look with a deep understanding of why he raised the question and with no bitterness in my heart and say to that man, “I’m sorry sir, but you don’t know me. I’m not a consensus leader. [Laughter – Applause] I don’t determine what is right and wrong by looking at the budget of the Southern Christian Leadership Conference or by taking….[Applause] Nor do I determine what is right and wrong by taking a Gallup poll of the majority opinion.” [Applause] Ultimately a genuine leader is not a searcher of consensus but a molder of consensus. [Applause]
On some positions cowardice asks the question, is it safe? Expediency asks the question, is it politic? Vanity asks the question, is it popular? But conscience asks the question, is it right? And there comes a time when one must take a position that is neither safe, nor politic, nor popular but he must take it because conscience tells him it is right. [Applause]
http://www.aavw.org/special_features/speeches_speech_king04.html

Yes… truly a proper sense of priorities… and especially apropos now for us and our friends and colleagues at PNHP.
The speech of Martin Luther King, Jr., “A Proper Sense of Priorities,” was, as the title states, a speech on the proper sense of priorities. As a central theme he expressed his opposition to the war in Vietnam.
For those who believe that it was a stretch to use a quote from an anti-war speech of Martin Luther King, Jr. to advance the cause of health care justice, the following excerpt from the same speech should clarify the intent of my message:
“I’m still convinced that the struggle for peace and the struggle for justice or the struggle for civil rights, we call it in America, can be tied together. These two issues….[Applause] They are tied together in many many ways. And I feel the people who are working for civil rights should be working for peace and I feel that those who are working for peace should be working for civil rights and justice.”
Justice in health care is what Physicians for a National Health Program is all about (and many of us incidentally are pacifists as well).
I apologize to those who perceived my communication to be deficient, though the stand-alone words of Martin Luther King, Jr. certainly require no clarification.

(Note: This event occurred earlier this week, before the tragic earthquake in Haiti.)

The future of healthcare reform came to Sacramento yesterday

by Shockwave
Daily Kos
January 12, 2010
I joined the California Health Professionals Students Alliance at the Embassy Suites about a mile from the Capitol building.
Students from every medical school in California came in buses the night before.  I was impressed by their enthusiastic support of SB 810 and their ability to explain the advantages of Single Payer and this pivotal legislation which will be re-introduced at the Senate floor next month.
We then marched about a mile toward the Capitol building.
Shockwave’s diary and a 3 minute video of the event:
http://www.dailykos.com/storyonly/2010/1/12/824274/-The-future-of-healthcare-reform-came-to-Sacramento-yesterday
California Health Professional Student Alliance
http://www.calauhc.org/

This week medical students and other health professional students and colleagues marched on Sacramento in support of Sen. Mark Leno’s SB 810, a reintroduction of Sen. Sheila Kuehl’s single payer bill that was passed and vetoed twice in prior legislative sessions.
Reading Shockwave’s diary and watching the brief video can give you renewal. California’s health professional students understand that Congress abandoned so many important policies that they are ending up with legislation that ostensibly achieves a political victory, but one that is reform in name only, while leaving most of our dysfunctional system in place.
These students know what real reform is. They hold our future in their hands. Thanks to them and to all of the rest of the single payer activists, the process will continue until every single one of us can have the health care that we need.

by Michael F. Cannon
Cato Institute
January 13, 2010

Executive Summary

House and Senate Democrats have produced health care legislation whose mandates, subsidies, tax penalties, and health insurance regulations would penalize work and reward Americans who refuse to purchase health insurance. As a result, the legislation could trap many Americans in low-wage jobs and cause even higher health-insurance premiums, government spending, and taxes than are envisioned in the legislation.

Those mandates and subsidies would impose effective marginal tax rates on low-wage workers that would average between 53 and 74 percent — and even reach as high as 82 percent — over broad ranges of earned income. By comparison, the wealthiest Americans would face tax rates no higher than 47.9 percent.

Over smaller ranges of earned income, the legislation would impose effective marginal tax rates that exceed 100 percent. Families of four would see effective marginal tax rates as high as 174 percent under the Senate bill and 159 percent under the House bill. Under the Senate bill, adults starting at $14,560 who earn an additional $560 would see their total income fall by $200 due to higher taxes and reduced subsidies. Under the House bill, families of four starting at $43,670 who earn an additional $1,100 would see their total income fall by $870.

In addition, middle-income workers could save as much as $8,000 per year by dropping coverage and purchasing health insurance only when sick. Indeed, the legislation effectively removes any penalty on such behavior by forcing insurers to sell health insurance to the uninsured at standard premiums when they fall ill. The legislation would thus encourage “adverse selection” — an unstable situation that would drive insurance premiums, government spending, and taxes even higher.

http://www.cato.org/pubs/pas/pa656.pdf

Comment: 

By Don McCanne, MD

Since the numbers and policy details in the final reform legislation have not yet been released, the results presented here by Michael Cannon of the Cato Institute may be modified, but unchanged will be the conclusion that the complex, jerry-rigged method of paying for health care premiums will not eliminate inequities.

It is almost impossible to get right the amount that each person or family should pay with so many variables moving in different directions: insurance premiums, actuarial values, premium subsidies, cost-sharing subsidies, income levels, family sizes, age rating, bracketed income cliffs of eligibility, and other factors. Financing health care by using a fixed premium for a given private insurance plan no longer works because premiums for adequate plans are no longer affordable for the majority. Trying to make health care affordable by applying corrections for the many variables increases the administrative complexity while falling short on equity.

Financing would be greatly simplified and much more equitable if we established a single risk pool that covered everyone and funded it through progressive taxes. (That likely would not be the conclusion of the libertarians at Cato, but they offered no alternative suggestions in this report, and we wouldn’t agree with them anyway.)

Obama’s Prescription for Low-Wage Workers: High Implicit Taxes, Higher Premiums

by Michael F. Cannon
Cato Institute
January 13, 2010
Executive Summary
House and Senate Democrats have produced health care legislation whose mandates, subsidies, tax penalties, and health insurance regulations would penalize work and reward Americans who refuse to purchase health insurance. As a result, the legislation could trap many Americans in low-wage jobs and cause even higher health-insurance premiums, government spending, and taxes than are envisioned in the legislation.
Those mandates and subsidies would impose effective marginal tax rates on low-wage workers that would average between 53 and 74 percent — and even reach as high as 82 percent — over broad ranges of earned income. By comparison, the wealthiest Americans would face tax rates no higher than 47.9 percent.
Over smaller ranges of earned income, the legislation would impose effective marginal tax rates that exceed 100 percent. Families of four would see effective marginal tax rates as high as 174 percent under the Senate bill and 159 percent under the House bill. Under the Senate bill, adults starting at $14,560 who earn an additional $560 would see their total income fall by $200 due to higher taxes and reduced subsidies. Under the House bill, families of four starting at $43,670 who earn an additional $1,100 would see their total income fall by $870.
In addition, middle-income workers could save as much as $8,000 per year by dropping coverage and purchasing health insurance only when sick. Indeed, the legislation effectively removes any penalty on such behavior by forcing insurers to sell health insurance to the uninsured at standard premiums when they fall ill. The legislation would thus encourage “adverse selection” — an unstable situation that would drive insurance premiums, government spending, and taxes even higher.
http://www.cato.org/pubs/pas/pa656.pdf

Since the numbers and policy details in the final reform legislation have not yet been released, the results presented here by Michael Cannon of the Cato Institute may be modified, but unchanged will be the conclusion that the complex, jerry-rigged method of paying for health care premiums will not eliminate inequities.
It is almost impossible to get right the amount that each person or family should pay with so many variables moving in different directions: insurance premiums, actuarial values, premium subsidies, cost-sharing subsidies, income levels, family sizes, age rating, bracketed income cliffs of eligibility, and other factors. Financing health care by using a fixed premium for a given private insurance plan no longer works because premiums for adequate plans are no longer affordable for the majority. Trying to make health care affordable by applying corrections for the many variables increases the administrative complexity while falling short on equity.
Financing would be greatly simplified and much more equitable if we established a single risk pool that covered everyone and funded it through progressive taxes. (That likely would not be the conclusion of the libertarians at Cato, but they offered no alternative suggestions in this report, and we wouldn’t agree with them anyway.)