PNHP

California's lesson on promptness of corrective legislation

California's lesson on promptness of corrective legislation

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

Comment: 

By Don McCanne, MD

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’s lesson on promptness of corrective legislation

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

Comment: 

By Don McCanne, MD

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!

Health care hot issue on MLK Day

King's Chicago doctor says Congress' legislation falls short of satisfying civil rights hero's dream

By Abdon M. Pallasch, Political Reporter
Chicago Sun Times, January 19, 2010

At churches and schools, living rooms and nursing home parlors across the land Monday, people gathered to remember the Rev. Martin Luther King Jr. and to give their own takes on what his legacy means.

Is it racial harmony, African-American empowerment or about fighting for access to medical care?

Dr. Quentin Young, who dressed the head wound King received from a rock to the head in Marquette Park in 1966, told an audience of King’s contemporaries and fellow marchers — King would be 81 had he lived — at an Oak Park nursing home that King would want people to fight for health-care justice — and that means a single-payer system, Young said.

Earlier Monday at Northwestern University’s Law School, Sen. Dick Durbin invoked King’s memory to urge passage of the health-care plan as senators and congressmen try to iron out their differences over it.

Forty-four years ago, King told a Chicago audience, “Of all the forms of inequality, injustice in health care is the most shocking and most inhuman,” Durbin said.

Durbin pointed to a man in the audience who owes $100,000 in medical bills for treatment of his T-cell lymphoma and said, “Repeat that story 47 million times and tell me that it isn’t time for health-care reform in America. The critics of health-care reform tell us it’s too much government. . . . This bill we’re working on would increase the number of insured by 30 million. We would start to end the injustice … to make sure that the work of Martin Luther King is finally done.”

But the plan only orders everyone to buy insurance, profiting the drug companies, Young argued. Invoking the same quote Durbin used from King — Young was actually at the meeting where King said it –Young argued the current bill would not satisfy King’s dream.

“What’s coming out of the Congress is really bad. It’s rotten,” Young said. “It keeps the power in the insurance companies.”

Retired pediatrician Dr. Herbert Lerner gave Young a big hug when his fellow octogenarian entered Belmont Village of Oak Park. Lerner pointed to his wife, Ruth, and said when she marched with King through Marquette Park, “She was never so frightened in her life — and she was a Holocaust survivor.”

Lerner, Young and attorney Larry Hagen said the “tea party” protesters of today can’t match the “meanness” exhibited by the protesters who greeted King when he marched through Marquette Park.

Hagen said that as he marched with King through crowds of angry Southwest Side residents, “I passed by someone I work with every day. Neither of us ever spoke about that incident with each other.”

Durbin, Gov. Quinn, Mayor Daley and many other elected officials started the day with the Rev. Jesse Jackson at a Rainbow/PUSH Coalition breakfast downtown, then moved off to speak at events around the Chicago area throughout the day.

A Wake Up Call

By Robert Kuttner, Co-Founder and Co-Editor of The American Prospect
The Huffington Post, January 17, 2010

How could the health care issue have turned from a reform that was going to make Barack Obama ten feet tall into a poison pill for Democratic senators? Whether or not Martha Coakley squeaks through in Massachusetts on Tuesday, the health bill has already done incalculable political damage and will likely do more. Polls show that the public now opposes it by margins averaging ten to fifteen points, and widening. It is hard to know which will be the worse political defeat — losing the bill and looking weak, or passing it and leaving it as a piñata for Republicans to attack between now and November.

The measure is so unpopular that Republican State Senator Scott Brown has built his entire surge against Coakley around his promise to be the 41st senator to block the bill — this in Ted Kennedy’s Massachusetts. He must be pretty confident that the bill has become politically radioactive, and he’s right.

It has already brought down Senator Byron Dorgan of North Dakota, a fighter for health care and other reforms far more progressive than President Obama’s. Dorgan championed Americans’ right to re-import cheaper prescription drugs from Canada, a popular provision that the White House blocked. Dorgan, who is one of the Senate’s great populists, began the year more than twenty points ahead in the polls of his most likely challenger, North Dakota Governor John Hoeven. By the time he decided to call it a day, Dorgan was running more than twenty points behind. The difference was the health bill, which North Dakotans oppose by nearly two to one. The fact that Dorgan’s own views were much better than the Administration’s cut little ice. He was fatally associated with an unpopular bill.

So, how did Democrats get saddled with this bill? Begin with Rahm Emanuel. The White House chief of staff, who was once Bill Clinton’s political director, drew three lessons from the defeat of Clinton-care. All three were wrong. First, get it done early (Clinton’s task force had dithered.) Second, leave the details to Congress (Clinton had presented Congress with a fully-baked cake.) Third, don’t get on the wrong side of the insurance and drug industries (The insurers’ fictitious couple, Harry and Louise, had cleaned Clinton’s clock.)

But as I wrote in Obama’s Challenge, in August 2008, it would be a huge mistake to try to get health care done right out of the box. Obama first needed to get his sea-legs, and focus like a laser on economic recovery. If he got the economy back on track, he would then have earned the chops to undertake more difficult structural reforms like health care.

Deferring to the House and Senate was fine up to a point, but this was an issue where the president needed to lead as only presidents can — in order to frame the debate and define the stakes.

Cutting a deal with the insurers and drug companies, who are not exactly candidates to win popularity contests, associated Obama with profoundly resented interest groups. This was exactly the wrong framing. This battle should have been the president and the people versus the interests. Instead more and more voters concluded that it was the president and the interests versus the people.

As policy, the interest-group strategy made it impossible to put on the table more fundamental and popular reforms, such as using Federal bargaining power to negotiate cheaper drug prices, or having a true public option like Medicare-for-all. Instead, a bill that served the drug and insurance industries was almost guaranteed to have unpopular core elements.

The politics got horribly muddled. By embracing a deal that required the government to come up with a trillion dollars of subsidy for the insurance industry, Obama was forced to pursue policies that were justifiably unpopular — such as taxing premiums of people with decent insurance; or compelling people to buy policies that they often couldn’t afford, or diverting money from Medicare. He managed to scare silly the single most satisfied clientele of our one island of efficient single-payer health insurance — senior citizens — and to alienate one of his most loyal constituencies, trade unionists.

The bill helped about two-thirds of America’s uninsured, but did almost nothing for the 85 percent of Americans with insurance that is becoming more costly and unreliable by the day — except frighten them into believing that what little they have is at increased risk of being taken away.

All of this made things easier for the right, and left people to take seriously even preposterous allegations such as the nonsense about death panels. It got so ass-backwards that the other day Ben Nelson, who successfully held out for anti-abortion language and a sweetheart deal for Nebraska’s Medicaid as the price of his vote, found himself facing a wholesale voter backlash.

Nelson began running TV spots assuring Nebraska voters that the Obama health plan is “not run by the government.” That’s one hell of a slogan for a party that relies on democratically elected government to offset the insecurity, inequality and insanity generated by private commercial forces. If not-run-by-government is the Democrats’ credo, why bother?

So we went from a politics in which government is necessary to provide secure health insurance — because the private insurance industry skims off outrageous middlemen fees and discriminates against sick people — to a politics in which Democrats, as a matter of survival, feel they have to apologize for government. Thank you, Rahm Emanuel.

The budget-obsessives around Obama also insisted that most of the bill not take effect until 2013, so that all of the scary stuff gets three years to fester before most people see any benefit. Call it political malpractice.

Finally, the health insurance battle sucked out all the oxygen. When Obama made time to work the phones personally, it wasn’t to enact serious financial reform (this was left to the tender mercies of Tim Geithner) or to fight for a real jobs program (deficit hawks Peter Orszag and Larry Summers got to blunt that one). No — Obama got on the phone and met with legislators to round up the last vote or two for a sketchy health reform that crowded out far more urgent issues.

As a resident of Massachusetts, in the last two days I’ve gotten robo calls from Barack Obama, Joe Biden, Bill Clinton, Martha Coakley, and Angela Menino, the wife of Boston’s mayor — everyone but the sainted Ted Kennedy. In Obama’s call, he advised me that he needed Martha Coakley in the Senate, “because I’m fighting to curb the abuses of a health insurance industry that routinely denies care.” Let’s see, would that be the same insurance industry that Rahm was cutting inside deals with all spring and summer? The same insurance industry that spent tens of millions on TV spots backing Obama’s bill as sensible reform?

If voters are wondering which side this guy is on, he has given them good reason.

Looking forward, one can imagine several possibilities. Suppose Coakley loses. Obama and the House leadership may then decide that their one shot to salvage health reform after all this effort is for the House to just pass the Senate-approved bill and send it to the president’s desk. They can fix its deficiencies later. This is an easy parliamentary move. But the bill passed the House by only five votes; many House members are dead set against some of the more objectionable provisions of the Senate bill;
a Coakley loss would make the bill that much more politically toxic; there will be Republican catcalls that Congress is using dubious means to pass a bill that has just been politically repudiated; and the House votes just may not be there this time.

Alternatively, let’s say Coakley narrowly wins, the Democrats have a near death experience, and the House and Senate stop squabbling and pass the damned bill.

Either way, the Massachusetts surprise should be a wake-up call of the most fundamental kind. Obama needs to stop playing inside games with bankers and insurance lobbyists, and start being a fighter for regular Americans. Otherwise, he can kiss it all goodbye.

Robert Kuttner is co-editor of The American Prospect, a senior fellow at Demos, and author of Obama’s Challenge.

http://www.huffingtonpost.com/robert-kuttner/a-wake-up-call_b_426467.html

Interview with Patricia Reed on Single Payer and the Senate Health Plan

By Paul Post
The Saratogian (Saratoga Springs, N.Y.)
Sunday, January 17, 2010

Who are you?

I’m Patricia Reed of Saratoga Springs, a retired nurse practitioner. A nurse practitioner does 85 percent of the things a doctor does — evaluate, diagnose, treat, prescribe medication and order diagnostics. Plus, I did a lot of education and counseling.

What’s your opinion about proposed health care legislation?

I think it should be defeated in its current form. I belong to a group called Single Payer New York. We promote the concept, “Medicare for all.” Under proposed legislation, only half the people without insurance or the underinsured would actually be covered. The rest wouldn’t. We want access. Health care should be for everyone. Also, health care quality should be improved, based on evidence-based medicine, and it should be “portable.” People shouldn’t have to change insurance providers when they change employers. Sometimes there are gaps and waiting periods. God forbid you have a serious illness during one of those times.

We also think health care should be paid for with progressive taxation such as income tax instead of a regressive tax like property tax. Medicare is successful. Let’s expand it to everyone. It would save $400 billion.

When did Single Payer New York organize?

In September 2008. We’re a statewide organization composed of a cross-section of people — doctors, nurses, clergy, labor, the public. The term single-payer describes the kind of financing system in which one entity — in this case the government — handles all billing and payment for health care services. Right now, there are thousands upon thousands of payers — HMOs, PPOs, bill collection agencies. The sheer volume of paperwork required by our current system means that administrative waste accounts for about 31 percent of the money spent on health care. The single-payer system would eliminate waste and direct more dollars to providing care.

Where have you worked?

I spent 12 years with the Veterans Administration in Albany. I did home care, and in 1999 I set up and managed a primary care office in Clifton Park. Before that, I was executive vice president for nursing services at Albany Medical Center Hospital, in charge of all nursing services. I had a $75 million budget. I also led a program to help nurses earn bachelor’s degrees through non-traditional learning, such as distance learning.

Why did you leave Albany Medical Center for the Veterans Administration?

I really love patient care. I had a master’s degree in nursing administration and education, so I went back to become a nurse practitioner. I specialized in gerontology, caring for older people. That’s why I went to the VA. I wanted to do home care.

http://www.saratogian.com/articles/2010/01/17/life/doc4b5286d749517756271490.txt

Martin Luther King, Jr. – A Proper Sense of Priorities

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

Comment: 

By Don McCanne, MD

Yes… truly a proper sense of priorities… and especially apropos now for us and our friends and colleagues at PNHP.

Further comment on Martin Luther King, Jr.’s speech, “A Proper Sense of Priorities”

By Don McCanne, MD

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.

More (or Less) on Reform of Health Care

By Seth Sandronsky
truthout | Op-Ed
Friday, 15 January, 2010

Claudia Chaufan, MD, is an Argentine physician and assistant adjunct professor in the Institute for Health and Aging and Social and Behavioral Sciences at the University of California, San Francisco. She is also vice president of the California Chapter of Physicians for a National Health Program. According to its web site, PNHP supports “single-payer national health insurance – a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private.” Dr. Chaufan talks to, and writes for, lay and expert audiences on the social dimensions of the diabetes epidemic and on single-payer health care reform. This is a recent email interview with her.

Seth Sandronsky: What is at stake for minority groups in the upcoming reconciliation of the Senate and House version of health-care reform?

Claudia Chaufan: It is a bit hard to talk about what’s at stake for “minority groups” generally, but I can certainly tell you what is at stake according to people’s income and health status (whatever their ethnicity). The bill will make it a federal crime not to buy a policy – and there are no “public options” to choose among (that would not have been necessarily cheaper anyway), so for the first time in American history you have a legal obligation to buy a private product. So then the question becomes: is this good or bad for us? Will it eliminate financial barriers to medically necessary care and will it control costs so that the country can guarantee health care for all?

What’s the case against mandating Americans to buy private health-care insurance?

This private product is likely to be insufficient to eliminate financial barriers to health care, because what it counts as “acceptable” to be sold is very unclear. Policies will be allowed to have high deductibles and out-of-pocket expenses that many, including middle-income Americans, will not be able to afford. This is likely to affect minorities more, because the rates of disease are generally higher among them (again, one needs to discriminate within these groups, because the very rich will always be better off, whatever their ethnicity).

What about President Obama’s case for people being able to keep their health-insurance policies with his approach to health-care reform?

The reason offered by President Obama that this approach is good is because “it will allow you to keep your plan if you like it.” This is a very poor reason. The fact of the matter is you are very likely to lose your plan as soon as you lose your job, and the price of your plan is very likely to increase, so even if it is there you won’t be able to pay for it. And what is worse, even if you don’t like your plan, if it is offered by an employer you will have to keep it because it will be illegal for you not to do so, and you won’t have other alternatives.

How will the president’s reform affect the affordability of health-care insurance?

The presumed lifetime maximum in health care expenses is unclear as well, and at any rate will only be operative for whatever counts as “covered services.” Put another way, if your policy does not cover services x, y or z, and you happen to need them because they are otherwise medically necessary, paying for them is likely to bankrupt you, as it has up to now.

There will be a huge increase in public expenditures in health care (i.e., your taxes) going into financing the sale of a very bad product, i.e., private health care policies. This is because in both bills there is almost half a trillion dollars of public money going into subsidizing your buying these policies. This huge transfer of money from our pockets into the for-profit corporate sector is likely to increase the power – economic and political – of private health care interests for years to come, and get in the way of the only approach that can both control costs and guarantee real (not near) universal coverage of medically necessary services, i.e., improved and expanded Medicare for All (Senate Bill 810 in California).

The so-called “improvements” to control costs (e.g., electronic medical records, comparative effectiveness research, menu labels, wellness, etc) are worthless to that effect. They are absolutely unrelated to the policy principle of pooling risk in a single financing pool, which allows systems elsewhere (Canada, UK, etc.) to cut costs through reducing paper-pushing (administrative overhead), bulk purchases and cross-subsidizing.

The good things (e.g., Medicaid expansions) could have been implemented anyway without the grandiose title of “reform” and without implementing the individual mandate. Of course, the mandate was what industry has wanted all along, because it gives them, by law, millions of new customers (they still complain because they want to get rid of the very minor constraints they might be subject to).

What percent of people’s income will health care insurance cost under the current multiple-payer system after its House-Senate reform versus a single-payer system?

With a single-payer system, anywhere from four to eight percent of your paycheck in the form of a health tax (at any rate no more than 10 percent, depending on calculations) total, whether or not you are sick, old or young, etc. What matters is that this amount would be predictable.

With the House and Senate bills, God only knows…. Your taxes will go up to pay for subsidies, public program expansions, and new regulations of industry (we’re already paying around 10 percent of our income in public health care, covering the bad customers that industry does not want – very old, very poor or disabled).

To this, you will have to add an unspecified amount for private policies and out-of-pocket costs. To the ordinary American, it does not (or should not) matter what you call the money you spend in health care, whether taxes or out-of-pocket – money is money.

In sum, the current bills will make health care far more expensive that the reasonable alternative (a social insurance system, with no profit allowed for medically necessary services) would.

To make matters worse, they will also constrain your choices. The bills will force you to “choose” from within constrained lists of “preferred providers,” euphemisms for constrained choices. What social insurance, including single-payer systems allow for is the sort of choices that really matter: of doctors and medical establishments (like Canada, France, Switzerland, and even Taiwan, have).

http://www.truthout.org/article/more-or-less-reform-health-care

California's lesson on promptness of corrective legislation

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’s lesson on promptness of corrective legislation

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!

Martin Luther King, Jr. – A Proper Sense of Priorities

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.

Upcoming events with Dr. Oliver Fein, PNHP president

We invite you to join us at the at following events with Dr. Oliver Fein, president of PNHP, during his visit to Portland, Oregon.

Single-Payer Soiree
Fundraiser for Portland PNHP
The McMenamins Kennedy School
Sunday, January 31, 7-10 p.m.
5736 Northeast 33rd Ave, Portland

Keynote speaker: Oliver Fein, M.D., PNHP president

Entertainment provided by the Mad As Hell Doctors Tour in Review, OHSU medical student Project on the Uninsured, Bob Wickline, Al Bradbury, The Nurses Band and the Post Riders

Health Reform 2010:
Where do we go from here?
Providence Cancer Center, 4805 Northeast Glisan Street
Monday, February 1, 7-9 p.m.
A special event co-sponsored by Providence Portland Internal Medicine Residency Population Based Health Elective and City Club of Portland

Panelists include:
Robert Dannenhoffer, M.D., immediate past president of the Oregon Medical Association
Oliver Fein, M.D., president of Physicians for a National Health Program
Eric Fruits, Ph.D., Cascade Policy Institute
Rajiv Sharma, Ph.D., associate professor of economics, Portland State University

Moderated by Paul Gorman, M.D.

If you have any questions about either event, contact Dr. Peter Mahr at peter.n.mahr@gmail.com.

 Washington Politics and Single-Payer Health Care
Monday, Feb. 1, 12-1 p.m.
Doernbecher Children’s Hospital, Vey Auditorium (11th floor), 3181 Southwest Sam Jackson Park Road

Sponsored by OSHU PNHP

Click here for the flier

National Health Insurance in the U.S.: Real Health Care Reform
Monday, Feb. 1, 2:30-3:30 p.m.
Smith Memorial Student Union, Room 327 at Portland State University

Sponsored by Portland Pre-Health Society