PNHP

Health study accurate [on 45,000 deaths annually], had no assumptions

Health study accurate [on 45,000 deaths annually], had no assumptions

Letter to the Editor
Orlando Sentinel
November 28, 2009

Congressman Cliff Stearns in his My Word column Tuesday (“Use facts in health-care debate”) repeats misinformation spread by a conservative think-tank about our study that found that nearly 45,000 Americans die annually because they lack health insurance.

The study was based on a survey conducted by the National Center for Health Statistics (not by us, as Stearns claims) of more than 9,000 people. They were interviewed, examined by a doctor and given blood tests. They were then followed for up to 12 years to see who lived and who died.

After taking into account many factors, including age, race and baseline health status, we found that the uninsured had 40 percent higher odds of dying.

Contrary to Stearns’ statements, our analytic approach requires no assumptions about health coverage in the intervening years, although we know that being uninsured one year predicts being uninsured the next.

The study’s methods have previously been accepted by the Institute of Medicine of the National Academy of Sciences. The article underwent extensive review by other scientists and was published in the world’s leading public-health journal.

Like the other 17,000 doctors who are members of Physicians for a National Health Program, we believe that every sick person deserves our care.

We also believe the private health-insurance industry cannot control costs or provide Americans with the coverage they need; hence, we support a single-payer, Medicare-for-all approach to health reform.

Unfortunately, U.S. Rep. Alan Grayson has not endorsed this approach.

He did, however, cite our findings accurately in his My Word column on Nov. 18.

Steffie Woolhandler, Professor of medicine, Harvard University Medical School
David U. Himmelstein, Associate professor of medicine, Harvard University Medical School

MedPAC on variation in service use

Report to the Congress: Measuring Regional Variation in Service Use

MedPAC (Medicare Payment Advisory Commission)
December 2009

In this paper, we present data on the difference between regional variation in Medicare spending and regional variation in the use of Medicare-covered services. Regional variation in Medicare spending per beneficiary reflects many factors, including differences in beneficiaries’ health status, Medicare payment rates, service volume (number of services), and service intensity (e.g., MRI versus simple X-ray). In contrast, regional variation in the use of Medicare services reflects only differences in the volume and intensity of services that beneficiaries with comparable health status receive.

… raw per capita spending is 55 percent higher for beneficiaries in the area at the 90th percentile than for beneficiaries in the area at the 10th percentile.

Service use in higher use areas (90th percentile) is about 30 percent greater than in lower use areas (10th percentile).

… the correlation between rate of growth in adjusted spending from 2000 to 2006 and the level of service use in an MSA is slightly negative.

Regional variation in service use is not equivalent to regional variation in Medicare spending. The two should not be confused.

http://www.medpac.gov/documents/Dec09_RegionalVariation_report.pdf

Comment:

By Don McCanne, MD

This paper is an important addition to the work of John Wennberg and his colleagues at Dartmouth on regional variation in spending in the Medicare program. It separates the variation in use of services by individuals with comparable health status from other factors that influence spending, especially Medicare payment policies.

The differences are important because they lead to different policy solutions. Policies to ensure adequate but not excessive volume and intensity of services are separate from, though must be integrated with, policies that establish proper levels of spending for services that Medicare beneficiaries should be receiving.

The complexities of these interdependent policies that would improve spending can be mastered only with a concerted effort by public agencies. The private insurance industry has no capability to create and apply the essential policies that would transform our health care delivery system into the efficient, affordable system that we desperately need.

MedPAC, the Medicare Payment Advisory Commission, currently provides advice to Congress on proposals to improve spending policies in the Medicare program. Congress is free to reject that advice and often does, more for political reasons than for reasons based on sound policy.

The health care reform proposal before Congress includes provisions to reduce the often perverse politics of Medicare financing by creating a commission, sometimes referred to as MedPAC-on-steroids, with much greater power to enforce its recommendations on spending.

The problem with the proposal is that the recommendations would be limited to the Medicare program alone. Unless the revisions applied to the other five-sixths of our population, it would be difficult to establish policies that would improve the overall use of health care services. Although reform of our financing system is essential, we may not get very far if we don’t have policies that would improve the structure of the health care delivery system.

We really do need an improved Medicare for all. We need to jettison the wasteful, ineffectual private insurers and get on with reform that will use our health care dollars to pay for an efficient health care system that serves all of us well.

MedPAC on variation in service use

Report to the Congress: Measuring Regional Variation in Service Use

MedPAC (Medicare Payment Advisory Commission)
December 2009
In this paper, we present data on the difference between regional variation in Medicare spending and regional variation in the use of Medicare-covered services. Regional variation in Medicare spending per beneficiary reflects many factors, including differences in beneficiaries’ health status, Medicare payment rates, service volume (number of services), and service intensity (e.g., MRI versus simple X-ray). In contrast, regional variation in the use of Medicare services reflects only differences in the volume and intensity of services that beneficiaries with comparable health status receive.
… raw per capita spending is 55 percent higher for beneficiaries in the area at the 90th percentile than for beneficiaries in the area at the 10th percentile.
Service use in higher use areas (90th percentile) is about 30 percent greater than in lower use areas (10th percentile).
… the correlation between rate of growth in adjusted spending from 2000 to 2006 and the level of service use in an MSA is slightly negative.
Regional variation in service use is not equivalent to regional variation in Medicare spending. The two should not be confused.
http://www.medpac.gov/documents/Dec09_RegionalVariation_report.pdf

This paper is an important addition to the work of John Wennberg and his colleagues at Dartmouth on regional variation in spending in the Medicare program. It separates the variation in use of services by individuals with comparable health status from other factors that influence spending, especially Medicare payment policies.
The differences are important because they lead to different policy solutions. Policies to ensure adequate but not excessive volume and intensity of services are separate from, though must be integrated with, policies that establish proper levels of spending for services that Medicare beneficiaries should be receiving.
The complexities of these interdependent policies that would improve spending can be mastered only with a concerted effort by public agencies. The private insurance industry has no capability to create and apply the essential policies that would transform our health care delivery system into the efficient, affordable system that we desperately need.
MedPAC, the Medicare Payment Advisory Commission, currently provides advice to Congress on proposals to improve spending policies in the Medicare program. Congress is free to reject that advice and often does, more for political reasons than for reasons based on sound policy.
The health care reform proposal before Congress includes provisions to reduce the often perverse politics of Medicare financing by creating a commission, sometimes referred to as MedPAC-on-steroids, with much greater power to enforce its recommendations on spending.
The problem with the proposal is that the recommendations would be limited to the Medicare program alone. Unless the revisions applied to the other five-sixths of our population, it would be difficult to establish policies that would improve the overall use of health care services. Although reform of our financing system is essential, we may not get very far if we don’t have policies that would improve the structure of the health care delivery system.
We really do need an improved Medicare for all. We need to jettison the wasteful, ineffectual private insurers and get on with reform that will use our health care dollars to pay for an efficient health care system that serves all of us well.

Boston University Medical Student Iyah Romm's Testimony in Support of Single Payer

Massachusetts Joint Comittee on Public Health
October 20, 2009
Boston, MA

Thank you, Madame Chair and Members of the Committee for the opportunity to testify this morning. My name is Iyah Romm, and I am a medical student at Boston University School of Medicine. I also serve as a national leader of the American Medical Student Association (AMSA), where I am the New England Regional Director and Co-Chair of the Health Care for All Steering Committee.

In my capacity as a medical student and AMSA leader, I am here today to offer the perspective of a large cohort of physicians-in-training regarding the broken health care system in which we are training, and which we will inherit. With respect to this system, AMSA believes the following:

1. Health care is a fundamental human right and is the single greatest moral imperative for our generation. We, even in the Commonwealth, are woefully failing to ensure quality, affordable, health care to all of our residents.

2. Medicine and the entire health care sector must serve the public good over private industry profits.

3. The best solution to our health care crisis is a single-payer system of publicly funded, publicly accountable, privately delivered, quality, affordable health care for all.

With 62,000 members, AMSA is the oldest and largest independent association of physicians-intraining in the US and has a rich history of advocacy on issues affecting our current and future patients. In fact, AMSA was borne from a seminal moment in the history of our health care system – the establishment of America’s own single payer system, Medicare. As an organization of future physicians, AMSA is committed to advancing a legislative agenda that reflects this history and basic principles.

While Chapter 58 reform has resulted in modest improvements in health insurance coverage, health care costs are spiraling out of control – even in Massachusetts.1 Despite a health insurance market dominated by not-for-profit insurers, premiums are expected to increase by 7-12 percent next year. In 2008, Massachusetts had the highest family coverage premiums in the country – $13,788 on average. These costs are being deflected onto the residents of the Commonwealth and are overwhelming state, municipal, family, and individual budgets and livelihoods. Public services are being slashed resulting in difficult choices and erosions of coverage.2 The long-term sustainability of “universal coverage” in Massachusetts is in peril. Clearly we cannot allow this trend of misprojection to continue at the expense of our patients and our friends, our neighbors, our sisters, and our fathers.

The individual mandate is a unique element of Chapter 58; many other components have been implemented previously in other states on differing scales. As we have seen in those other states, including but not limited to Maine, Minnesota, and Oregon, coverage has increased following reform. But these expansions in coverage have fallen short of the elusive goal of universality and true access for all3 – each time sabotaged by lack of financial sustainability. The culprit? Continued reliance upon commercial insurance markets as the gateway to care and the false hope of competition as a means of “bending the cost curve.”

By definition, incremental reforms explicitly limit access if not decrease the quality of coverage through many ‘crowd-out’ mechanisms to prevent the collapse of the private insurance sector – a necessary sequela of universal health care. Three years after implementation of Chapter 58, we have yet to see anticipated significant gains in coverage or affordability. In 1987, 7% of Massachusetts residents were uninsured – today, the sum is 3%, at best. Moreover, many Bay State residents struggle with skyrocketing premiums seemingly unhindered by the enhanced “competition” fostered by Chapter 58 and the Connector. And without comprehensive reform, the number of uninsured – and number of individuals qualifying for hardship exemption – will continue to rise unchecked. If I were to lose my university-provided insurance, I would be forced to spend exorbitant sums for minimal coverage.

Incremental reforms have focused on the crisis of uninsurance rather than the ultimate goal of ensuring access to quality, affordable health care. Expansions in health insurance coverage do not guarantee concurrent expansions in access. Through high deductibles and other cost-sharing mechanisms, commercial insurers continue to erect financial barriers to care. Indeed, despite purported universal coverage, one in six Massachusetts residents was unable to pay his or her medical bills last year. The result? Many Commonwealth residents are still forced to forego medically necessary care. Such practices by private insurance companies render expansions in coverage meaningless – and ultimately more costly. These are the patients that my peers and I do not see on our primary care rotations; rather, they still present unnecessarily in the Emergency Department with preventable conditions.

Recent funding cuts have torn gaping holes in our ‘safety net,’ with those clinics and hospitals committed to the underserved suffering under massive budget shortfalls – including Boston Medical Center where I study. In the hospital, I see how these shortfalls have resulted in staff reductions that ultimately threaten the quality and availability of care. And we have begun down the slippery slope of tiering coverage with, for example, the recent benefit restrictions imposed on legal immigrants.

Single payer is the only responsible health care reform option. The vast majority of our seniors are satisfied with Medicare; in fact, many patients anxiously await Medicare eligibility because of the program’s guarantee of both coverage and access. Labor unions and advocacy organizations across the Commonwealth support a single payer system, as do the majority of health care providers.4 These groups — these constituencies — recognize that single payer is the best system in which to guarantee quality, affordable, health care for all. Across the country, politicians, policy-makers, and citizens are looking to Massachusetts as a beacon of hope on health care reform. The private insurance industry has had eight decades to lead change, to shift from a world predicated upon a race to the bottom to culture of innovation and care. But their time has passed. Your Committee has the opportunity to truly provide that light. I hope you will offer the leadership necessary to reform our system and to address one of our greatest moral failures of the last fifty years. Only a single payer system can provide the change we need – simplifying payment, eliminating unnecessary bureaucracy, and investing the subsequent savings into a solitary goal, providing care to all. The math is simple, the morality pure, and the passion indefatigable. As a future physician, this is the type of system in which I aspire to practice medicine.

Thank you very much for the opportunity to share this perspective.

1. Steinbrook, R. Health Care Reform in Massachusetts — Expanding Coverage, Escalating Costs. N Engl J Med 2008 358: 2757-2760
2. Sack K. Massachussetts Faces Costs of Big Health Care Plan. NYT, 2009.
3. Long S, Masi P. An update on health reform in Massachusetts, fall 2008. Health Aff (Millwood). 2009;28(4):w578–87
4. McCormick D et al. Single-Payer National Health Insurance: Physicians’ Views Arch Intern Med. 2004;164(3):300-304.

Boston University Medical Student Iyah Romm’s Testimony in Support of Single Payer

Massachusetts Joint Comittee on Public Health
October 20, 2009
Boston, MA

Thank you, Madame Chair and Members of the Committee for the opportunity to testify this morning. My name is Iyah Romm, and I am a medical student at Boston University School of Medicine. I also serve as a national leader of the American Medical Student Association (AMSA), where I am the New England Regional Director and Co-Chair of the Health Care for All Steering Committee.

In my capacity as a medical student and AMSA leader, I am here today to offer the perspective of a large cohort of physicians-in-training regarding the broken health care system in which we are training, and which we will inherit. With respect to this system, AMSA believes the following:

1. Health care is a fundamental human right and is the single greatest moral imperative for our generation. We, even in the Commonwealth, are woefully failing to ensure quality, affordable, health care to all of our residents.

2. Medicine and the entire health care sector must serve the public good over private industry profits.

3. The best solution to our health care crisis is a single-payer system of publicly funded, publicly accountable, privately delivered, quality, affordable health care for all.

With 62,000 members, AMSA is the oldest and largest independent association of physicians-intraining in the US and has a rich history of advocacy on issues affecting our current and future patients. In fact, AMSA was borne from a seminal moment in the history of our health care system – the establishment of America’s own single payer system, Medicare. As an organization of future physicians, AMSA is committed to advancing a legislative agenda that reflects this history and basic principles.

While Chapter 58 reform has resulted in modest improvements in health insurance coverage, health care costs are spiraling out of control – even in Massachusetts.1 Despite a health insurance market dominated by not-for-profit insurers, premiums are expected to increase by 7-12 percent next year. In 2008, Massachusetts had the highest family coverage premiums in the country – $13,788 on average. These costs are being deflected onto the residents of the Commonwealth and are overwhelming state, municipal, family, and individual budgets and livelihoods. Public services are being slashed resulting in difficult choices and erosions of coverage.2 The long-term sustainability of “universal coverage” in Massachusetts is in peril. Clearly we cannot allow this trend of misprojection to continue at the expense of our patients and our friends, our neighbors, our sisters, and our fathers.

The individual mandate is a unique element of Chapter 58; many other components have been implemented previously in other states on differing scales. As we have seen in those other states, including but not limited to Maine, Minnesota, and Oregon, coverage has increased following reform. But these expansions in coverage have fallen short of the elusive goal of universality and true access for all3 – each time sabotaged by lack of financial sustainability. The culprit? Continued reliance upon commercial insurance markets as the gateway to care and the false hope of competition as a means of “bending the cost curve.”

By definition, incremental reforms explicitly limit access if not decrease the quality of coverage through many ‘crowd-out’ mechanisms to prevent the collapse of the private insurance sector – a necessary sequela of universal health care. Three years after implementation of Chapter 58, we have yet to see anticipated significant gains in coverage or affordability. In 1987, 7% of Massachusetts residents were uninsured – today, the sum is 3%, at best. Moreover, many Bay State residents struggle with skyrocketing premiums seemingly unhindered by the enhanced “competition” fostered by Chapter 58 and the Connector. And without comprehensive reform, the number of uninsured – and number of individuals qualifying for hardship exemption – will continue to rise unchecked. If I were to lose my university-provided insurance, I would be forced to spend exorbitant sums for minimal coverage.

Incremental reforms have focused on the crisis of uninsurance rather than the ultimate goal of ensuring access to quality, affordable health care. Expansions in health insurance coverage do not guarantee concurrent expansions in access. Through high deductibles and other cost-sharing mechanisms, commercial insurers continue to erect financial barriers to care. Indeed, despite purported universal coverage, one in six Massachusetts residents was unable to pay his or her medical bills last year. The result? Many Commonwealth residents are still forced to forego medically necessary care. Such practices by private insurance companies render expansions in coverage meaningless – and ultimately more costly. These are the patients that my peers and I do not see on our primary care rotations; rather, they still present unnecessarily in the Emergency Department with preventable conditions.

Recent funding cuts have torn gaping holes in our ‘safety net,’ with those clinics and hospitals committed to the underserved suffering under massive budget shortfalls – including Boston Medical Center where I study. In the hospital, I see how these shortfalls have resulted in staff reductions that ultimately threaten the quality and availability of care. And we have begun down the slippery slope of tiering coverage with, for example, the recent benefit restrictions imposed on legal immigrants.

Single payer is the only responsible health care reform option. The vast majority of our seniors are satisfied with Medicare; in fact, many patients anxiously await Medicare eligibility because of the program’s guarantee of both coverage and access. Labor unions and advocacy organizations across the Commonwealth support a single payer system, as do the majority of health care providers.4 These groups — these constituencies — recognize that single payer is the best system in which to guarantee quality, affordable, health care for all. Across the country, politicians, policy-makers, and citizens are looking to Massachusetts as a beacon of hope on health care reform. The private insurance industry has had eight decades to lead change, to shift from a world predicated upon a race to the bottom to culture of innovation and care. But their time has passed. Your Committee has the opportunity to truly provide that light. I hope you will offer the leadership necessary to reform our system and to address one of our greatest moral failures of the last fifty years. Only a single payer system can provide the change we need – simplifying payment, eliminating unnecessary bureaucracy, and investing the subsequent savings into a solitary goal, providing care to all. The math is simple, the morality pure, and the passion indefatigable. As a future physician, this is the type of system in which I aspire to practice medicine.

Thank you very much for the opportunity to share this perspective.

1. Steinbrook, R. Health Care Reform in Massachusetts — Expanding Coverage, Escalating Costs. N Engl J Med 2008 358: 2757-2760
2. Sack K. Massachussetts Faces Costs of Big Health Care Plan. NYT, 2009.
3. Long S, Masi P. An update on health reform in Massachusetts, fall 2008. Health Aff (Millwood). 2009;28(4):w578–87
4. McCormick D et al. Single-Payer National Health Insurance: Physicians’ Views Arch Intern Med. 2004;164(3):300-304.

CBO report on premiums

An Analysis of Health Insurance Premiums Under the Patient Protection and Affordable Care Act

Congressional Budget Office
November 30, 2009

The analysis looks separately at the effects on premiums for coverage purchased individually, coverage purchased by small employers, and coverage provided by large employers.

Nongroup Policies

Average premiums per policy in the nongroup market in 2016 would be roughly $5,800 for single policies and $15,200 for family policies under the proposal, compared with roughly $5,500 for single policies and $13,100 for family policies under current law.

The majority of nongroup enrollees (about 57 percent) would receive subsidies via the new insurance exchanges, and those subsidies, on average, would cover nearly two-thirds of the total premium, CBO and JCT estimate.

Employment-Based Coverage

By CBO and JCT’s estimate, the average premium per policy in the small group market would be in the vicinity of $7,800 for single policies and $19,200 for family policies under the proposal, compared with about $7,800 and $19,300 under current law. In the large group market, average premiums would be roughly $7,300 for single policies and $20,100 for family policies under the proposal, compared with about $7,400 and $20,300 under current law.

Those figures do not include the effects of the small business tax credit on the cost of purchasing insurance. A relatively small share (about 12 percent) of people with coverage in the small group market would benefit from that credit in 2016. For those people, the cost of insurance under the proposal would be about 8 percent to 11 percent lower, on average, compared with that cost under current law.

http://www.cbo.gov/ftpdocs/107xx/doc10781/11-30-Premiums.pdf

Comment:

By Don McCanne, MD

For most individuals and families, the Senate health care reform bill will have very little impact on the premiums to be paid for health plans. There are three important exceptions:

* Premiums in the individual market will increase significantly because the plans will be required to provide an actuarial value of 60 percent, higher than the average value in the current individual market.

* About 57 percent of individuals eligible for coverage in the exchange will receive subsidies which will more than offset the premium increases. Note that most individuals are not eligible for coverage in the exchange and would not receive these subsidies.

* Although there will be little change in premiums for small group plans, about 12 percent of people in the small group market will benefit from a small business tax credit designed to encourage small business owners to offer coverage to their employees.

The really bad news in this report is that, on average, premiums for group plans will continue to increase at the same intolerable rates that they would have if we did nothing. This CBO analysis demonstrates that, in 2016, the family premium alone for employer-sponsored coverage, not including deductibles and other out-of-pocket costs, would be over $20,000 for a large group plan, whether or not the proposed legislation is enacted. That is quite a hit for a hard-working family with a $60,000 income.

The only hope for premium relief is for innovative insurance products that would reduce costs for those who don’t need health care, but would increase even more the costs for those who do. This demonstrates why focusing on premium relief has been a misguided endeavor. We have been diverted from the the much more important goal of relieving the financial burden of those who actually need health care.

We can achieve that goal by improving Medicare, funding it equitably, and using its monopsonistic powers to provide us with greater value in our health care purchasing. Had we done that when the Clintons were proposing their flawed model of reform, our national health expenditures would be about 20 percent less than they currently are.

It’s tragic that we would be starting from an inflated baseline, but we can still achieve that level of efficiency in the future if we dumped the highly flawed proposal before Congress and adopted the much more humane system of an improved Medicare for all.

Obama's Privatized Health Care Propaganda Tour.

Public's Favorite Option, Single Payer, Wasn't on Baucus or Kennedy's

Allison Kilkenny
The Huffington Post, June 11, 2009 

The public finally got a look at Senator Kennedy’s behemoth 615-page health care bill, a document so gargantuan that Huffington Post put out an SOS to readers to help the editors read it. During the lead-up to the health care war, Kennedy promised Americans that the conversation about their health industry would be a national one, unlike the debacle the first time when the Clintons tried to take on private health care. No more secrecy, Teddy promised. Except, this time the negotiations are — once again — happening behind closed doors, and the public’s favorite option, single-payer, isn’t represented at the table.

Kennedy has depicted this secret operation as essential to negotiations, but the popular single-payer option has been almost entirely shut out of the debate (59% of Americans believe the government should provide national health insurance). Meanwhile, according to The New York Times, lobbyists from “AARP, Aetna, the A.F.L.-C.I.O., the American Cancer Society, the American Medical Association, America’s Health Insurance Plans, the Business Roundtable, Easter Seals, the National Federation of Independent Business, the Pharmaceutical Research and Manufacturers of America, and the United States Chamber of Commerce,” are all present at the Kennedy meetings.

You’d think single-payer advocate House Judiciary Chair John Conyers has the plague these days from the way his associates on the hill are dodging him. Conyers has been criticizing his fellow politicians for sabotaging the single-payer option.

“There is some notion that universal single-payer healthcare is off the table. Well, that raises a very important question. If you take the most popular healthcare reform measure and take it off the table, heaven knows what it is, I guess, you think you’re left with. This is the most popular form, and it would be very unlike the party in the majority now to determine that the most popular system would not even be examined. I am asking for a hearing in every committee, every committee, and if they will let us into the Senate, as well.”

Conyers, who — once again represents what the majority of Americans actually want — has been forced to chase the back of the health care bus like a crazed dog ever since March when he was not invited to President Obama’s Health Care Summit. Ultimately, Obama invited him when Conyers threatened to take his case to the president himself.

Why does one of the only politicians truly representing a populist desire need to grovel, beg, and holler to be included in the Kennedy-Obama closed-door meetings?

One reason may be that men like Max Baucus are permitted to aid in health care reform. Baucus is a human version of a NASCAR race car except all his corporate logos advertise pharmaceutical companies. Great Falls Tribute reports that Baucus “received more campaign contributions from the pharmaceutical and health insurance industries than any other sitting Democrat in the House or Senate, receiving $183,750 from health insurance companies and $229,020 from drug companies during that period.” It’s self-explanatory why a man who makes a living sucking from the teat of private health care wouldn’t be the most enthusiastic advocate of single-payer representatives being included in negotiations.

Others, like President Obama argue that the single-payer option isn’t (his favorite word) “pragmatic.”

“If I were starting a system from scratch, then I think that the idea of moving towards a single-payer system could very well make sense…We don’t want a huge disruption as we go into health care reform where suddenly we’re trying to completely reinvent one-sixth of the economy.”

But now is precisely the moment when the system needs to be reinvented and purged of pharmaceutical and health insurance lobbyists. America’s health care system is already a global embarrassment. The World Health Organization (WHO) reports the U.S. health care system rates 37th in the world in terms of quality and fairness. WHO Director-General Dr. Gro Harlem Brundtland says: “The main message from this report is that the health and well- being of people around the world depend critically on the performance of the health systems that serve them. Yet there is wide variation in performance, even among countries with similar levels of income and health expenditure. It is essential for decision- makers to understand the underlying reasons so that system performance, and hence the health of populations, can be improved.”

Dr. Julio Frenk, Executive Director for Evidence and Information for Policy at WHO says: “It is especially beneficial to make sure that as large a percentage as possible of the poorest people in each country can get insurance…Insurance protects people against the catastrophic effects of poor health. What we are seeing is that in many countries, the poor pay a higher percentage of their income on health care than the rich.”

The message seems lost on the US government. Secret meetings with healthcare lobbyists, a 600+ page, dense bill offered without a summary cover page, killing the popular single-payer option? Kennedy’s bill appears to be extremely undemocratic.

President Obama has promised to bring his message to the people soon. Starting in the Midwest, he’ll try to convince the American people that his public-private hybrid health care is best for the nation. The single-payer option seems to already be a thing of the past. Instead of listening to what the majority of Americans want, Obama and associates are trying to convince the American people that a partially privatized system is best for them. This is the opposite of democracy. It’s a privatized health care propaganda tour.

Cross-posted from Allison Kilkenny’s blog, this article ran under the title “Density and Secrecy Will Defeat Democracy in Kennedy’s Health Care Bill” on Huffington Post

http://www.huffingtonpost.com/allison-kilkenny/density-and-secrecy-will_b_214292.html

Obama’s Privatized Health Care Propaganda Tour.

Public’s Favorite Option, Single Payer, Wasn’t on Baucus or Kennedy’s

Allison Kilkenny
The Huffington Post, June 11, 2009 

The public finally got a look at Senator Kennedy’s behemoth 615-page health care bill, a document so gargantuan that Huffington Post put out an SOS to readers to help the editors read it. During the lead-up to the health care war, Kennedy promised Americans that the conversation about their health industry would be a national one, unlike the debacle the first time when the Clintons tried to take on private health care. No more secrecy, Teddy promised. Except, this time the negotiations are — once again — happening behind closed doors, and the public’s favorite option, single-payer, isn’t represented at the table.

Kennedy has depicted this secret operation as essential to negotiations, but the popular single-payer option has been almost entirely shut out of the debate (59% of Americans believe the government should provide national health insurance). Meanwhile, according to The New York Times, lobbyists from “AARP, Aetna, the A.F.L.-C.I.O., the American Cancer Society, the American Medical Association, America’s Health Insurance Plans, the Business Roundtable, Easter Seals, the National Federation of Independent Business, the Pharmaceutical Research and Manufacturers of America, and the United States Chamber of Commerce,” are all present at the Kennedy meetings.

You’d think single-payer advocate House Judiciary Chair John Conyers has the plague these days from the way his associates on the hill are dodging him. Conyers has been criticizing his fellow politicians for sabotaging the single-payer option.

“There is some notion that universal single-payer healthcare is off the table. Well, that raises a very important question. If you take the most popular healthcare reform measure and take it off the table, heaven knows what it is, I guess, you think you’re left with. This is the most popular form, and it would be very unlike the party in the majority now to determine that the most popular system would not even be examined. I am asking for a hearing in every committee, every committee, and if they will let us into the Senate, as well.”

Conyers, who — once again represents what the majority of Americans actually want — has been forced to chase the back of the health care bus like a crazed dog ever since March when he was not invited to President Obama’s Health Care Summit. Ultimately, Obama invited him when Conyers threatened to take his case to the president himself.

Why does one of the only politicians truly representing a populist desire need to grovel, beg, and holler to be included in the Kennedy-Obama closed-door meetings?

One reason may be that men like Max Baucus are permitted to aid in health care reform. Baucus is a human version of a NASCAR race car except all his corporate logos advertise pharmaceutical companies. Great Falls Tribute reports that Baucus “received more campaign contributions from the pharmaceutical and health insurance industries than any other sitting Democrat in the House or Senate, receiving $183,750 from health insurance companies and $229,020 from drug companies during that period.” It’s self-explanatory why a man who makes a living sucking from the teat of private health care wouldn’t be the most enthusiastic advocate of single-payer representatives being included in negotiations.

Others, like President Obama argue that the single-payer option isn’t (his favorite word) “pragmatic.”

“If I were starting a system from scratch, then I think that the idea of moving towards a single-payer system could very well make sense…We don’t want a huge disruption as we go into health care reform where suddenly we’re trying to completely reinvent one-sixth of the economy.”

But now is precisely the moment when the system needs to be reinvented and purged of pharmaceutical and health insurance lobbyists. America’s health care system is already a global embarrassment. The World Health Organization (WHO) reports the U.S. health care system rates 37th in the world in terms of quality and fairness. WHO Director-General Dr. Gro Harlem Brundtland says: “The main message from this report is that the health and well- being of people around the world depend critically on the performance of the health systems that serve them. Yet there is wide variation in performance, even among countries with similar levels of income and health expenditure. It is essential for decision- makers to understand the underlying reasons so that system performance, and hence the health of populations, can be improved.”

Dr. Julio Frenk, Executive Director for Evidence and Information for Policy at WHO says: “It is especially beneficial to make sure that as large a percentage as possible of the poorest people in each country can get insurance…Insurance protects people against the catastrophic effects of poor health. What we are seeing is that in many countries, the poor pay a higher percentage of their income on health care than the rich.”

The message seems lost on the US government. Secret meetings with healthcare lobbyists, a 600+ page, dense bill offered without a summary cover page, killing the popular single-payer option? Kennedy’s bill appears to be extremely undemocratic.

President Obama has promised to bring his message to the people soon. Starting in the Midwest, he’ll try to convince the American people that his public-private hybrid health care is best for the nation. The single-payer option seems to already be a thing of the past. Instead of listening to what the majority of Americans want, Obama and associates are trying to convince the American people that a partially privatized system is best for them. This is the opposite of democracy. It’s a privatized health care propaganda tour.

Cross-posted from Allison Kilkenny’s blog, this article ran under the title “Density and Secrecy Will Defeat Democracy in Kennedy’s Health Care Bill” on Huffington Post

http://www.huffingtonpost.com/allison-kilkenny/density-and-secrecy-will_b_214292.html

CBO report on premiums

An Analysis of Health Insurance Premiums Under the Patient Protection and Affordable Care Act

Congressional Budget Office
November 30, 2009
The analysis looks separately at the effects on premiums for coverage purchased individually, coverage purchased by small employers, and coverage provided by large employers.
Nongroup Policies
Average premiums per policy in the nongroup market in 2016 would be roughly $5,800 for single policies and $15,200 for family policies under the proposal, compared with roughly $5,500 for single policies and $13,100 for family policies under current law.
The majority of nongroup enrollees (about 57 percent) would receive subsidies via the new insurance exchanges, and those subsidies, on average, would cover nearly two-thirds of the total premium, CBO and JCT estimate.
Employment-Based Coverage
By CBO and JCT’s estimate, the average premium per policy in the small group market would be in the vicinity of $7,800 for single policies and $19,200 for family policies under the proposal, compared with about $7,800 and $19,300 under current law. In the large group market, average premiums would be roughly $7,300 for single policies and $20,100 for family policies under the proposal, compared with about $7,400 and $20,300 under current law.
Those figures do not include the effects of the small business tax credit on the cost of purchasing insurance. A relatively small share (about 12 percent) of people with coverage in the small group market would benefit from that credit in 2016. For those people, the cost of insurance under the proposal would be about 8 percent to 11 percent lower, on average, compared with that cost under current law.
http://www.cbo.gov/ftpdocs/107xx/doc10781/11-30-Premiums.pdf

For most individuals and families, the Senate health care reform bill will have very little impact on the premiums to be paid for health plans. There are three important exceptions:
* Premiums in the individual market will increase significantly because the plans will be required to provide an actuarial value of 60 percent, higher than the average value in the current individual market.
* About 57 percent of individuals eligible for coverage in the exchange will receive subsidies which will more than offset the premium increases. Note that most individuals are not eligible for coverage in the exchange and would not receive these subsidies.
* Although there will be little change in premiums for small group plans, about 12 percent of people in the small group market will benefit from a small business tax credit designed to encourage small business owners to offer coverage to their employees.
The really bad news in this report is that, on average, premiums for group plans will continue to increase at the same intolerable rates that they would have if we did nothing. This CBO analysis demonstrates that, in 2016, the family premium alone for employer-sponsored coverage, not including deductibles and other out-of-pocket costs, would be over $20,000 for a large group plan, whether or not the proposed legislation is enacted. That is quite a hit for a hard-working family with a $60,000 income.
The only hope for premium relief is for innovative insurance products that would reduce costs for those who don’t need health care, but would increase even more the costs for those who do. This demonstrates why focusing on premium relief has been a misguided endeavor. We have been diverted from the the much more important goal of relieving the financial burden of those who actually need health care.
We can achieve that goal by improving Medicare, funding it equitably, and using its monopsonistic powers to provide us with greater value in our health care purchasing. Had we done that when the Clintons were proposing their flawed model of reform, our national health expenditures would be about 20 percent less than they currently are.
It’s tragic that we would be starting from an inflated baseline, but we can still achieve that level of efficiency in the future if we dumped the highly flawed proposal before Congress and adopted the much more humane system of an improved Medicare for all.

Aetna to dump 600,000 members

Aetna prepares for loss of 600,000 members as it raises 2010 prices

By Emily Berry
American Medical News
November 30, 2009

Back when it was the largest private health plan in the country, Aetna downsized its membership by millions but boosted profits during an overhaul of its business several years ago.

Now it looks to be making a similar — but smaller — move with a planned price increase for many of its customers in 2010.

The company figures it will lose between 600,000 and 650,000 members next year because of the price hikes.

In a conference call with investment analysts to discuss the company’s third-quarter earnings, Chair and CEO Ron Williams told analysts, “The pricing we put in place for 2009 turned out to not really be what we needed to achieve the results and margins that we had historically been delivering.”

Aetna President Mark Bertolini laid out how the company planned to raise prices to improve the company’s profit margin. He said the firm had “implemented a combination of underwriting enhancements, pricing actions and plan design changes, intended to ensure that each customer is priced to an appropriate margin.”

Laying out specific expected membership losses is “pretty candid,” said David Gibbs, a retired health insurance industry consultant from San Luis Obispo, Calif. He worked for and consulted with health insurers, including Aetna, for 25 years.

He said Aetna’s decision comes from a system that encourages insurers to drive away sicker members — a strategy not unique to one insurer. “They’re running a business, and their obligation is a very singular one: to increase shareholder profits.”

Gibbs said simply raising prices probably would not get Aetna what it wants. That actually tends to result in sick people who are more “desperate” for coverage to keep it, and healthier groups to drop it. Instead, Aetna might change benefit designs, scaling back prescription drug coverage, for example, which sicker populations tend to value but healthier ones don’t notice as much.

http://www.ama-assn.org/amednews/2009/11/30/bisb1130.htm

Comment:

By Don McCanne, MD

This act by Aetna indicates the level of sincerity the insurance industry has in its alleged new effort to cooperate in ensuring that everyone has the health care coverage that they need. Aetna is redesigning and repricing its products in order to dump over 600,000 of its less profitable members. They need to be sure that “each customer is priced to an appropriate margin.” And, above all, they owe it to their shareholders “to drive away sicker members.”

But that’s one of the ways that markets work – improve profits by cutting losses. We keep hearing that markets improve quality while reducing costs, yet in a bit of irony, for those healthier populations that remain with the Aetna, the insurer is reducing quality through product redesign, and increasing costs through higher premiums.

Once Aetna dumps these members, what private insurer is going to jump in to capture this higher cost population? None you say? And under reform? The higher cost individuals buy into the weak public option driving premiums up through adverse selection to even more unaffordable levels?

Try to imagine Medicare dumping over 600,000 patients because they need more medical care. That is unthinkable and would be reprehensible in a public social insurance program such as Medicare. Yet for the private insurance industry, it’s business as usual. And President Obama and Congress want to keep these marketeers in charge? Talk about reprehensible!

Filibustering the Public

Editorial
The Nation, Nov. 24, 2009

This is not what democracy looks like. When Americans vote, by overwhelming majorities, to place control of the executive and legislative branches in the hands of a party that has promised fundamental change, they are supposed to get that change. They are not supposed to watch as a handful of self-interested and special-interested senators prevent progress by exploiting the arcane rules of the less representative of our two legislative chambers–rules requiring that not a majority but a supermajority be attained in order even to discuss necessary reforms, and that a similar supermajority be in place to thwart a filibuster.

Yet this is where America, a nation often inclined to tell other nations how to practice democracy, finds itself as the debate about healthcare reform reaches its critical stage. We have a president who is prepared to sign legislation to expand access to healthcare while establishing at least some controls against profiteering by insurers. We have a House of Representatives in which a majority has voted for imperfect but real reform. We have a Senate in which a majority is ready to vote for what could be even better reform. Unfortunately, that majority is sidelined as a few wavering senators game the system.

Unless Harry Reid and his colleagues implement majority rule–by abolishing rules that allow two-fifths of the chamber’s members (as few as forty-one senators) to prevent passage of that legislation–the character and quality of any “reform” will be dictated by a tiny minority from some of the nation’s least populous states.

The Nation has argued for years that the filibuster is antidemocratic. We long ago rejected the notion that rules preventing the majority of senators from implementing the will of the people must be maintained as a bow to tradition. The filibuster is not constitutionally mandated. It was established by rules that have been repeatedly altered over the years. Besides, as Thomas Geoghegan recently noted (see “The Case for Busting the Filibuster,” August 31/September 7), the proper reply to the history buffs is, “Yes, well, slavery and segregation are also part of our history, and that’s what the filibuster was used to defend. I’m all in favor of history and tradition, but I see no reason to go on cherishing either the filibuster or the Confederate flag.”

The healthcare debate highlights everything that’s wrong with the filibuster. Polling shows that more than 75 percent of Americans favor a public option, yet it could be eliminated–not to gain majority support in the Senate but to gain supermajority support. That’s absurd, and citizens know it. That’s why tens of thousands have signed petitions circulated by the Progressive Change Campaign Committee, Florida Congressman Alan Grayson and Firedoglake demanding alteration of the filibuster rule.

Reid should listen to the outcry. This is about more than healthcare. At stake is the promise of democratic governance and the credibility of Congress. A great lie of politics is that all legislators are “bought” by special-interest donors. In fact, most senators are not bought by insurance-industry contributions. Think of Bernie Sanders and Tom Harkin, who have stood so forthrightly for robust reform, and Jay Rockefeller, who battled another senior Democrat, Max Baucus, on behalf of the public option.

But as long as antidemocratic rules remain, the deliberations will be guided not by Sanders, Harkin or Rockefeller but by the likes of Ben Nelson, who from 2003 to 2008 banked more than $600,000 in insurance-industry donations, and Blanche Lincoln, another collector of industry cash, who is so worried about potential 2010 election challenges that she cannot think straight. Nelson and Lincoln are not holding out for a better deal for their constituents; they are watching out for special interests and perceived political self-interest. And they are not even doing a good job of that, especially Lincoln, who has resisted backing a public option even though polls show a clear majority of her constituents favor this approach. It’s even worse with supposedly moderate Republicans like Olympia Snowe and Susan Collins, who want to be seen as reformers but won’t back real reform.

Compromise with these senators compromises democracy. It warps the will of the people. And it creates bad policy–don’t forget that Reid’s decision earlier this year to cut funding for job creation in the stimulus bill in order to get three GOP votes limited the government’s ability to address rising unemployment.

Reid should take a stand for majority rule. He has decided against the budget reconciliation process, which would allow a simple majority to pass legislation with a robust public option. That’s understandable, as this procedure is arduous. But that decision must not become an excuse for making the compromises demanded by a corrupt or self-absorbed minority. No matter where the healthcare debate takes us, Reid and Senate Democrats should commit to getting rid of rules that stifle debate and prevent action, and they should eliminate the filibuster and implement majority rule. That, after all, is what democracy is supposed to look like.

This article appeared in the December 14, 2009 edition of The Nation.

Dr. John Shearer

By Lori A. Carter
Press-Democrat, Santa Rosa, Calif., Nov. 27, 2009

John Shearer, a Petaluma physician for more than 40 years and outspoken advocate for health care, died Nov. 18 only a few weeks after being diagnosed with pancreatic cancer. He was 77.

Services are pending.

Shearer began his career making house calls to patients, providing obstetric care and delivering hundreds of babies to Petaluma mothers.

Over the past two decades, he became concerned with the number of residents who were either denied medical coverage or couldn’t afford it, said his wife of 32 years, Donna Brasset Shearer of Petaluma.

“He actually had been working on health care reform for almost 20 years,” she said. “He was really a pioneer. Before and after he retired, he never stopped working for health care reform. He was always speaking at conferences and working on panels.

“In his practice, he knew many people who couldn’t afford health care and he saw them suffer. He saw quite a few tragedies because of people’s lack of coverage. It became personal for him.”

Shearer retired earlier than he could have after becoming disillusioned by the insurance industry’s control over medical care, she said.

Shearer was born in Kokomo, Ind., and later moved to Detroit with his family, where he met his first wife, Mary Diedrich, in 1955. Shearer earned his medical degree in family practice in 1962 from Wayne State University, where he graduated among the top in his class in medical school.

Two years later, he moved to Petaluma and joined the El Rose Medical Group with three other physicians. He served as president of the medical staffs of Hillcrest Hospital in 1974 and at Petaluma Valley Hospital in 1986-87. He was the chair of the Ethics Committee at Petaluma Valley for several years until 2005.

He served on a variety of local health care boards, including the California Physician’s Alliance, a chapter of Physicians for a National Health Program, an organization that advocates for a single-payer, national health insurance.

He also worked locally for children’s health care. He helped create the Children’s Healthcare Access Coalition, which led to a program that provides health insurance for every child in Sonoma County.

He also volunteered his medical services at the Jewish Community Free Clinic in Rohnert Park, serving as its medical director for two years.

“Beyond being thoroughly kind and warm-hearted, he was also the least judgmental, least critical person I’ve ever known,” his wife said. “My life with him was a song.”

As the cancer worsened, Shearer became philosophical about the end of life.

“He said he was the luckiest person, he was surrounded by people he loved and who loved him,” she said. “He had a sense of accomplishment about his life. He was happy that he did it the way he wanted to.”

As recently as a month ago, he was walking 18 to 20 miles a week, she said. He died in the hospital, surrounded by his wife and family.

In addition to his wife, he is survived by his daughter, Annette Moussa of Petaluma; son David Shearer of Gig Harbor, Wash.; sisters Marianna Shearer of Woodland and Linda Rook of Arizona; and three grandchildren.

In lieu of flowers, the family prefers written reminiscences that can be sent to dosdocs2@hotmail.com or a donation to California Physicians Alliance, 2344 Sixth St., Berkeley, CA, 94710.

http://www.pressdemocrat.com/article/20091127/ARTICLES/911279933?Title=Dr-John-Shearer