Doctors Group Welcomes National Debate on ‘Medicare for All’

Doctors group welcomes national debate on ‘Medicare for All’

Nonpartisan physicians group calls single-payer reform ‘the only effective remedy’ for nation’s continuing health care woes and urges focus on facts, not rhetoric

FOR IMMEDIATE RELEASE, January 22, 2016
Contact: Mark Almberg, PNHP communications director, (312) 782-6006, mark@pnhp.org

Physicians for a National Health Program, a nonprofit, nonpartisan organization of 20,000 doctors who support single-payer national health insurance, released the following statement today by its president, Dr. Robert Zarr, a Washington, D.C., pediatrician.

The national debate on single-payer health reform, or "Medicare for All," that has emerged in the course of the presidential primaries is a welcome development. But unfortunately a number of misrepresentations about single-payer national health insurance – and the prospects for its attainment – have crept into the dialogue and are potentially misleading the public.

Most of these misrepresentations, or myths, have been decisively refuted by peer-reviewed research. They include the following:

Myth: A single-payer system would impose an unacceptable financial burden on U.S. households. Reality: Single payer is the only health reform that pays for itself. By replacing hundreds of insurers and thousands of different private health plans, each with their own marketing, enrollment, billing, utilization review, actuary and other departments, with a single, streamlined, tax-financed nonprofit program, more than $400 billion in health spending would be freed up to guarantee coverage to all of the 30 million people who are currently uninsured and to upgrade the coverage of everyone else, including the tens of millions who are underinsured. Co-pays and deductibles, which have been rapidly rising under the Affordable Care Act, would be eliminated. Further, the single-payer system’s bargaining clout would rein in rising costs for drugs and medical supplies. Lump-sum budgets for hospitals and capital planning would control costs even more.

A recent study shows 95 percent of U.S. households would come out financially ahead under an improved version of Medicare for all. The graduated, progressively structured tax burden would be based on ability to pay, and the heavy cost to average U.S. households of private insurance premiums, co-pays, deductibles, and many currently uncovered services would be eliminated. Patients could go to the doctor or hospital of their choice, and would no longer be restricted to proprietary networks. Multiple studies over a period of several decades, including by the General Accountability Office and the Congressional Budget Office, show that a single-payer system would provide universal coverage at a much lower cost, per capita, than we are spending now. International experience confirms it. Even our traditional Medicare program, which falls short of a true single-payer system, has much lower overhead than private insurance, and shows that publicly financed programs can deliver affordable, reliable care.

A single-payer system would also greatly diminish the administrative burden on our nation’s physicians and hospitals, freeing up physicians, in particular, to concentrate on doing what they know best: caring for patients.

Covering everyone for all medically necessary care is affordable; keeping the current private-insurance-based system intact is not.

Myth: The U.S. has a privately financed health care system. Reality: About 64 percent of U.S. health spending is currently financed by taxpayers. (Estimates that are lower than this exclude two large sources of taxpayer-funded care: health insurance for government employees and tax subsidies to employers and individuals for purchasing private health plans.) On a per capita basis, the amount of government-funded health care in the U.S. exceeds the health spending of nations with universal health systems, e.g. Canada. We are paying for a national health program, but not getting it.

Myth: A single-payer system would overturn the gains won under the Affordable Care Act and provide inferior coverage to what people have today. Reality: A single-payer system would go far beyond the modest improvements that the ACA made around the edges of our current private-insurance-based system and ensure truly universal care, affordability and health security. For example, H.R. 676, the Expanded and Improved Medicare for All Act, would guarantee coverage for all necessary medical care, including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care and correction, hearing services including hearing aids, chiropractic, durable medical equipment, palliative care, podiatric care, and long-term care. It would eliminate financial barriers to care like co-pays and deductibles and eliminate restrictive networks. It would end the steady erosion of job-based coverage under our current arrangements and disconnect insurance coverage from employment. H.R. 676 currently has 61 sponsors.

Myth: The American people don’t support single payer. Reality: Surveys have repeatedly shown that an improved Medicare for All is the remedy preferred by about two-thirds of the population. A recent Kaiser Family Foundation survey yielded similar results, showing 58 percent of Americans support Medicare for All. A solid majority of the medical profession favors such an approach, as well, as do more than 600 labor organizations, and many civic and faith-based groups.

Myth: The goal of establishing a single-payer system in the U.S. is unrealistic, or “politically infeasible.” Reality: It’s true that single-payer health reform faces formidable opposition, especially from the private insurance industry, Big Pharma, and other for-profit interests in health care, along with their allies in government. This prompts some people to conclude that single payer is out of reach and therefore not worth fighting for. While such moneyed opposition should not be underestimated, there is no reason why a well-informed and organized public, including the medical profession, cannot prevail over these vested interests. We should not sell the American people short. At earlier points in U.S. history, the abolition of slavery and the attainment of women’s suffrage were considered unrealistic, and yet the movements to achieve these goals were ultimately victorious and we now wonder how those injustices were allowed to stand for so long.

What is truly “unrealistic” is believing that we can provide universal and affordable health care, and control costs, in a system dominated by private insurers and Big Pharma.

We call upon our nation’s lawmakers and the political leaders of all political parties to heed public opinion and to do the right thing by acting swiftly to bring about the only equitable, financially responsible and humane cure for our health care ills: single-payer national health insurance, an expanded and improved Medicare for all.

Physicians for a National Health Program (www.pnhp.org) has been advocating for single-payer national health insurance for three decades. It neither supports nor opposes any candidates for public office.

You can help MVHCA as we work for publicly funded universal health care like the rest of the developed world by donatinghosting a house party, signing up for the newsletter, and attending our monthly meetings. You can also Like us on Facebook, and Follow us on Twitter. Thank you.

Letter: A Health Care Opportunity

Here's a Letter to the Editor to the Corvallis Gazette-Times by MVHCA Vice-Chair Tim Roach

December 01, 2015 5:00 am

Our nation's largest health insurer — UnitedHealth — is seriously considering pulling out of Obamacare as early as 2017 (BloombergBusiness, Nov. 19). The insurer has lost millions and anticipates losses of $500 million in 2016. The word is Anthem and Aetna are in a similar circumstance.

What happened? Insurers agreed to cover 10 categories of health care benefits; accept higher cost individuals; limit excess administrative costs and profits, and submit premium increases to insurance regulators for public scrutiny.

Thus the Affordable Care Act was crafted to keep premiums down and require greater cost sharing by patients. Government subsidies were provided to assist lower-income individuals. And when that was still not enough, insurers leveraged narrow provider networks to contract for cheaper medical services, and increased deductibles, shifting more of the costs to patients.

Guess what? It isn’t working — for insurers or patients! Congress created an administratively complex system that has made it almost impossible for insurers to offer a product that meets the required basic plan and has affordable premiums. Additionally, the combination of premiums and deductibles are pricing many patients out of health care. So now insurers are beginning to back out!

Well, that’s fine, because it offers the opportunity of replacing for-profit insurers with a financing plan designed for patient care, as is the case in almost all other developed countries around the world. A well-designed, publicly funded health care program would restore choices and make health care available to everyone. Health Care for ALL!


You can help MVHCA as we work for publicly funded universal health care like the rest of the developed world by donatinghosting a house party, signing up for the newsletter, and attending our monthly meetings. You can also Like us on Facebook, and Follow us on Twitter. Thank you.

Updates on the Oregon Health Insurance Marketplace

From the Community Partner Outreach Team Community Partner Newsletter.

Cancelling Marketplace Coverage
When consumers cancel their Marketplace health insurance plan, coverage doesn't end immediately. Cancellation takes effect no sooner than 14 days after the consumer notifies HealthCare.gov that they want to end their coverage and HealthCare.gov will collect premiums until the coverage ends. If a consumer gets other coverage, such as job-based coverage, Medicare, Medicaid, or CHIP, it's important that they contact HealthCare.gov online or by phone as soon as they know the start date of their other coverage. More information about cancelling Marketplace coverage can be found online.

Special Enrollment Period for Marketplace Coverage
HealthCare.gov now has a permanent special enrollment period for victims of domestic abuse and spousal abandonment outside of the regular open enrollment period. Eligible individuals will have 60 days after submitting a request to HealthCare.gov to sign up him or herself and his or her dependents for health insurance through HealthCare.gov. More information about Guidance on Victims of Domestic Abuse and Spousal Abandonment is available online.

Open Enrollment Events
During open enrollment (November 1, 2015 - January 31, 2016), the Marketplace doesn't plan to host its own, separate enrollment events. Instead, the Marketplace will support enrollment events planned and hosted by OHA community partners. The Marketplace can help by providing staff, materials, and health insurance agent contacts. Community partners interested in receiving Marketplace support should reach out to their OHA Regional Outreach Coordinator.

OregonHealthCare.gov

We will continue to gradually improve OregonHeatlhCare.gov leading up to open enrollment. This will include improving the screening questions to make sure customers get sent to the right application process, and we will begin to post resources for agents, insurers, and community partners on the partner resources pages http://www.oregonhealthcare.gov/partner-resources.html.
Longer term, we would also like to look at redesigning the website to make it easier to view on mobile devices and provide an improved experience for customers who speak languages other than English. For questions about the website, please contact joel.c.metlen@oregon.gov

Advisory Committee
Applications for appointments to the Oregon Health Insurance Marketplace Advisory Committee are now available online.
The Advisory Committee will provide feedback on issues affecting the Marketplace such as outreach, customer feedback, and insurance plan affordability. It will consist of 13 members appointed by the Governor and confirmed by the Oregon Senate, representing insurers, insurance producers, navigators, health care providers, businesses, consumer advocacy groups, enrollees in health plans, and medical assistance agencies. The Department of Consumer and Business Services director and Oregon Health Authority director will be ex-officio members.
In addition to providing feedback on the marketplace, the committee will hold open meetings that provide a forum for public discussion.

Marketplace Marketing
DCBS has signed a contract with Grady Britton (gradybritton.com), a local marketing firm that is teaming up with Metropolitan Group (metgroup.com) to provide outreach and marketing services to both the Marketplace and the Oregon Insurance Division. Grady Britton, Metropolitan Group, and DCBS are currently working on creating and finalizing an outreach and marketing plan for open enrollment by the end of August.

Outreach Materials
OHA and Marketplace staff will meet this month to discuss developing outreach materials for community partners and agents. The Marketplace's new marketing company will help produce a couple of items. Others will be developed in-house and made available for download from OregonHealthCare.gov. We expect to have materials developed by October to have them ready for open enrollment in November.

Grants for QHP Outreach and Application Assistance
DCBS and OHA are currently evaluating proposals received in response to the recent Request for Grant Proposals issued by OHA for two $100,000 grants for qualified health plan (QHP) outreach and application assistance. We expect to award the grants sometime this fall before open enrollment.

Small Business Health Options Program
DCBS is continuing to develop a plan to implement the Small Business Health Options Program (SHOP). We intend to release an RFP in the next few months. In the meantime, information about SHOP can be found at http://www.oregonhealthcare.gov/small-business-2.html.

OREGON ELIGIBILITY (ONE) Progress update for ONE

ONE System Access
As mentioned previously, the Oregon Eligibility (ONE) worker portal will go live in December 2015. This part of the system is where staff will enter and manage eligibility information.
The ONE applicant portal will go live in February 2016. This is where community partners and the public will submit applications and report changes.

First users
Several internal OHA units have been identified to obtain access to ONE's worker portal once launched in December 2015. These units were identified based on how directly their work impacts the delivery of medical benefits and the need to give access in phases following the rate at which training can be provided.
OHA Regional Outreach Coordinators and certified application assisters will be granted access to ONE's applicant portal when it is launched in February 2016.

Training Plan
A training plan is being finalized for the rollout of system access to these first user units. The project team is also working in conjunction with identified staff from each unit to develop training material and arrange for training this fall.

Change Agents
Key individuals have been identified and engaged from the "first-user" units to serve as local experts in their work units. These change agents provide input on the project as well as help delivering project information to the units they represent.

Current Events
Limited modifications to Kentucky's KYNECT system for the initial rollout of ONE have been decided upon and are under development

  • System testing by users will begin in the fall, and planning for that process has begun
  • Internal training is currently being developed for initial system users, and it will begin in the fall





Video: This Won't Hurt a Bit

Watch this informative/funny/tragic video by Mary Harron from the We The Economy channel on YouTube. It packs a lot of information into an entertaining video. Please share with your friends, neighbors, family, co-workers, and anyone else you can think of!

THIS WON'T HURT A BIT! | Mary Harron CHECK US OUT: http://www.wetheeconomy.com Why is healthcare so expensive? "This Won't Hurt a Bit" is a short film that tells the all too familiar tale of American healthcare. A patient enters a hospital with a migraine headache, unaware of the costs his visit will incur on the path to a diagnosis.

You can help MVHCA as we work for publicly funded universal health care like the rest of the developed world by donatinghosting a house party, signing up for the newsletter, and attending our monthly meetings. You can also Like us on Facebook, and Follow us on Twitter. Thank you.

Supreme Court upholds Obamacare's tax subsidies

See the Oregonian for the full article,

WASHINGTON — The Supreme Court on Thursday upheld the nationwide tax subsidies under President Barack Obama's health care overhaul, in a ruling that preserves health insurance for millions of Americans.

The justices said in a 6-3 ruling that the subsidies that 8.7 million people currently receive to make insurance affordable do not depend on where they live, under the 2010 health care law.

 

Oregon stood on sidelines of Obamacare case

Oregon had less at stake than most states in the U.S. Supreme Court's ruling in King v. Burwell.
The suit targeted subsidies issued by the federal health insurance exchange. Oregon used the federal exchange website to enroll Oregonians in health coverage this year after state officials shelved the homegrown Cover Oregon technology project.
Still, because Oregon had passed a law, insurance tax and regulations to set up a state-based exchange, state officials argued that it should not be considered a federal exchange state. Legal briefs filed by both sides in the case agreed, considering Oregon one of 16 state-based exchanges in addition to that of Washington, D.C..
The Supreme Court majority agreed as well, writing that "At this point, 16 States and the District of Colum­bia have established their own Exchanges; the other 34 States have elected to have (the federal government) do so."
Oregon stood on sidelines of Obamacare caseOregon had less at stake than most states in the U.S. Supreme Court's ruling in King v. Burwell.
The suit targeted subsidies issued by the federal health insurance exchange. Oregon used the federal exchange website to enroll Oregonians in health coverage this year after state officials shelved the homegrown Cover Oregon technology project.
Still, because Oregon had passed a law, insurance tax and regulations to set up a state-based exchange, state officials argued that it should not be considered a federal exchange state. Legal briefs filed by both sides in the case agreed, considering Oregon one of 16 state-based exchanges in addition to that of Washington, D.C..
The Supreme Court majority agreed as well, writing that "At this point, 16 States and the District of Colum­bia have established their own Exchanges; the other 34 States have elected to have (the federal government) do so."

--Nick Budnick

As we breath a sigh of relief for all the people who are able to keep their insurance as a result of this ruling, let's also work to update the ACA so that we have true universal, publicly funded health care!

You can help MVHCA as we work for single payer health care by donatinghosting a house party, signing up for the newsletter, and attending our monthly meetings. You can also Like us on Facebook, and Follow us on Twitter. Thank you.

Share This Video Explaining Medicare for All

Robert Reich says, "You may have heard that Medicare is running out of money and needs to be pared back. Wrong. Medicare isn't the problem. In fact, Medicare is more efficient than private health insurance. It's the solution.

Here is the piece Robert Reich wrote in the Huffington Post to introduce his video:

Again and again the upcoming election you'll hear conservatives claim that Medicare -- the health insurance program for America's seniors -- is running out of money and must be pared back.

Baloney. Medicare isn't the problem. In fact, Medicare is more efficient than private health insurance.The real problem is that the costs of health care are expected to rise steeply.

Medicare could be the solution -- the logical next step after the Affordable Care Act toward a single-payer system.

Please see the accompanying video -- #11 in our series on ideas to make the economy work for the many rather than for the few. And please share.

Some background: Medicare faces financial problems in future years because of two underlying trends that will affect all health care in coming years, regardless of what happens to Medicare:

The first is that healthcare costs are rising overall -- not as fast as they were rising before the Affordable Care Act went into effect, but still rising too quickly.

The second is that the giant post­war baby boom is heading toward retirement and older age. Which means more elderly people will need more health care, adding to the rising costs.

So how should we deal with these two costly trends? By making Medicare available to all Americans, not just the elderly.

Remember, Medicare is more efficient than private health insurers ­­ whose administrative costs and advertising and marketing expenses are eating up billions of dollars each year.

If more Americans were allowed to join Medicare, it could become more efficient by using its growing bargaining power to get lower drug prices, lower hospital bills, and healthier people.

Allowing all Americans to join Medicare is the best way to control future healthcare costs while also meeting the needs of the baby boomer and other Americans.

Everyone should be able to sign up for Medicare on the healthcare exchanges set up under the Affordable Care Act.This would begin to move America away from its reliance on expensive private health insurance, and toward Medicare for all - a single­ payer system.

Medicare isn't a problem. It's part of the solution.

ROBERT B. REICH's film "Inequality for All" is now available on DVD and blu-ray, and on Netflix. Watch the trailer below:

You can help MVHCA as we work for single payer health care by donatinghosting a house party, signing up for the newsletter, and attending our monthly meetings. You can also Like us on Facebook, and Follow us on Twitter. Thank you.

Families USA: Forgoing health care because of high out-of-pocket costs

 Families USA recently produced a report showing that many families were forgoing health care because even though they had insurance, the health care was still not affordable. The full report is available here.  These are the main points:

  • Just over one-quarter (25.2 percent) of adults who were insured for a full year went without needed medical care because they could not afford it.
  • Adults with lower to middle incomes were the most likely to forgo needed medical care.
  • Adults with high deductibles were more likely to forgo needed medical care.
  • In 2014, half (50.6 percent) of adults had high deductibles of $1,500 or more, and 30 percent had exceedingly high deductibles of $3,000 or more.

Why are people still struggling with out-of-pocket costs?

  • Premium tax credits are tied to silver plans, which often have cost-sharing that is too high for many consumers to be able to afford.
  • Only a portion of the lower-income consumers who are eligible for subsidies to reduce cost- sharing in silver plans receive substantial help to also reduce their deductibles.
  • Insurers are choosing to design silver plans with upfront cost-sharing that is too high for lower- and middle-income consumers to afford.

Policy Recommendations

  • Health insurers should offer more plans at the silver level that have low or no cost-sharing for primary care, other outpatient services, and prescription drugs.
  • Policymakers at the state and federal levels should require health insurers to sell silver plans with lower cost-sharing for primary care, other outpatient services, and prescription drugs.
  • At the federal level, Congress should: Provide cost-sharing reduction subsidies to middle-income consumers (above 250% FPL) and increase the generosity of this help.
  • At the state level, lawmakers can also strengthen financial assistance.

Don McCanne MD, of Physicians for a National Health Program, comments on this report:

Today Families USA released their report that confirms, once again, that many adults insured with high-deductible health plans are likely to forgo needed medical care, especially if they have lower to middle incomes. So what are their recommendations?

In order to remove financial barriers to care, they recommend that more plans offered at the silver level - the benchmark plans -  have lower or no cost-sharing for primary care, other outpatient services, and prescription drugs. This has the advantage of increasing access to primary care services, which most agree would significantly improve the performance of our health care system.

The problem is that the barely affordable silver plans must have an actuarial value of 70 percent (the patient pays 30 percent of health care costs, up to a given maximum). Higher deductibles are used in most of these plans in order to meet this actuarial value. But in a report that Families USA released last year, they explain that if the deductibles and copayments were reduced to more affordable levels, then the required 30 percent of out-of-pocket costs must be shifted to more expensive services.

So this scheme would help the majority who simply need primary care services, but it would make care less affordable, even catastrophic, for those who have greater health care needs. As long as our benchmark plans are set at an actuarial value of 70 percent, this trade-off cannot be avoided.

Families USA also suggests the obvious. We should increase federal and/or state subsidies for both the purchase of plans and for cost sharing for low and middle income individuals and families.

But if you are going to make care affordable for everyone, why continue with this highly inefficient, administratively complex system that wastes so many of our health care dollars. Surely by now Families USA should acknowledge that our dysfunctional system should be replaced by a much more efficient single payer national health program - an improved Medicare for all. We’ve experimented extensively with their preferred model, and it didn’t work.

You can help MVHCA as we work for single payer health care by donatinghosting a house party, signing up for the newsletter, and attending our monthly meetings. You can also Like us on Facebook, and Follow us on Twitter. Thank you.

March 2015 Cover Oregon Consumer Advisory Committee Report

Cover Oregon and the current Oregon Healthcare Exchange under the Affordable Care Act

by CAC member Roberta Hall

On Friday, Feb. 27, Cover Oregon’s Consumer Advisory Committee (CAC) met for the last time. The place was the Durham headquarters of Cover Oregon, soon to be dissolved, though the space will be used for several more months. The exchange is not by any means abolished, however, as its activities will continue under the Department of Consumer and Business Services, the state’s largest regulatory agency. (This transfer occurred about a week later.) The important points that the public should know appear to be these:
1. Cover Oregon costs have been reduced significantly. In 2014 the budget was 90 million dollars, of which 80 million were spent, whereas this year the budget is 15 million. Last year, the average cost per enrollee was $48, and this year it is $10. Last year, enrollment was done with both paper and online techniques developed under contract to the state of Oregon, whereas 2015 enrollees used technology developed by the federal government (HealthCare.gov).
2. The King v. Burwell case, heard in the Supreme Court on Wed., March 4, is a legal challenge to federal tax credits offered in the 2010 Affordable Care Act (ACA). It applies to states that did not set up their own exchange; however, Oregon is one of 16 that did. Oregon continues to run its own exchange, albeit using technology developed by the federal government. Still, if the plaintiffs win, and tax credits are not provided in the other states, it would change the ACA’s impacts dramatically.  Regardless of the outcome (expected in June of this year), the extension of Medicaid to persons with incomes less than 138% of the federal poverty level is not affected by the suit. Oregon’s Medicaid system, OHP, is now administered by the Oregon Health Authority (OHA).
3. Once again, at the 11th hour, the OHA extended the deadline for OHP fast-track enrollees to renew their coverage; “fast-track” refers to automatic enrollment because of prior income-certification through the food-stamp program. The previous deadline was 2/28, but that has been extended to March 31. It was estimated that the remaining fast-track population who need to act before the 3/31 deadline is about 32,000. There has been a backlog, but the OHA has announced that it is hiring more call center staff to address that serious problem.
4. One of the obligations Cover Oregon staff are working on, in addition to clearing up problems that the technology collapse caused earlier, is getting the small business healthcare insurance program (SHOP) online. Right now, there is a manual process in place until a permanent solution is found.  You can find out more here. Employers with 1-50 employees face no penalty for not providing insurance, but it is my understanding that they can use the program if they wish, and some have been using it.  Starting in 2016, employers with 51-99 employees will be required to provide insurance.  Employers with 100+ employees are supposed to offer coverage to 70% of their employees this year, 2015.
Ten members of Cover Oregon’s CAC attended the Feb. 27 meeting, seven in person, and three online. Much of the meeting was given to a report and Q and A with Director Aaron Patnode.  Alicia Blevins discussed income tax forms pertaining to the individual insurance obligation and Qualified Health Plans (1095-A); next year a tax form (1095-B) will also be sent to people enrolled in a government-sponsored plan like OHP.  Joel Melton and D’Anne Gilmore from the Department of Consumer and Business Services, together with Director Patnode gave an update on the apparently amicable transition process. Cover Oregon staff members Rachael Oh, Kelly Harms, and Cherie Miller ran the meeting and performed recording and online activities. CAC members thanked them and Director Patnode for their work, and expressed regret that these employees had in effect been held accountable for problems that they had no control over.
Please note that Cover Oregon employees are not state employees, so they will not be transferred to other state jobs, nor do they have PERS. The director of the agency where the exchange is now housed did not keep director Patnode on staff after the take-over, and the agency is laying off about 50 more in March; several current Cover Oregon staff will continue, perhaps through June. I, for one, appreciate their service and believe that the successes the exchange has had in extending healthcare coverage to many more Oregonians – perhaps approaching half a million – are due to their efforts and dedication.
Advocacy groups such as Mid-Valley Health Care Advocates need to follow these changes as they unfold in order to advise people correctly as well as to learn more about the complexities of making changes in the structure of the state’s healthcare-related programs.


Roberta Hall, member, Cover Oregon CAC, March, 2015



Harvard professors’ crusade against health care injustice, with comment by Dr. Don McCanne of PNHP

Harvard’s Health Benefits Unfairness

The Harvard Crimson, November 12, 2014

(Excerpts)

Last week, the Faculty of Arts and Sciences voted unanimously in favor of a motion asking the President and Fellows to suspend changes to the health benefits offered faculty and non-union staff for 2015. In justifying the benefits changes, the University offered four main explanations for its addition of deductibles and co-insurance: (1) the cost of benefits relative to the overall budget; (2) parity with peer institutions; (3) social science on containing health care costs and (4) the future financial health of the University. In advancing these explanations, the University has offered information that is incomplete, incorrect, deeply misleading, and ethically troubling.

The second argument offered in favor of the health benefits changes has been that we need to remain in line with our peers. We contend that the only peer pressure Harvard should heed is that which makes us a better research university. Increasing salaries and benefits might do this if it allowed Harvard to recruit and retain the brightest minds in our fields of research and teaching, as well as the post-doctoral fellows and staff needed to support these research and teaching endeavors.

Perhaps the most distressing argument advanced in favor of the changes, however, has been one that draws on a social science experiment from the 1970s to suggest that a co-insurance system, where the insured must pay a percentage of after-deductible costs, is the best way to contain health-care costs. At the November FAS meeting, Provost Alan M. Garber ’76 and members of the University Benefits Committee asserted that because the RAND Health Insurance Experiment, or HIE, demonstrated a reduction in healthcare utilization without decreasing overall well-being, the new Harvard plan will do likewise.

We assert that, on the contrary, the HIE is irrelevant to the present benefits proposal before us.

The HIE randomized individuals into different insurance plans (some received health insurance free of charge, while others faced a range of co-insurance options). It found that those paying a higher percentage of costs visited primary care physicians less frequently and reduced their health-care expenditures as a result.  But copays for regular physician visits have long been standard and are already part of Harvard’s plan. What Harvard now proposes is further extending cost-sharing to hospitalizations, surgery, and diagnostic testing via co-insurance.

The HIE’s measurement of outcomes is also irrelevant to the matters that concern all of us. The study looked at indicators of general health such as blood pressure, visual acuity, and propensity to smoke. The relevant question for today’s Harvard is not whether going to one’s primary care doctor more often makes one smoke less, but whether a diagnostic test ordered by that doctor could save one’s life, or detect an illness in time to allow for a less invasive, and perhaps in the long run, less expensive treatment.

Co-insurance is not only of questionable utility in the 21st century—at a time when diagnostic testing is much more effective at influencing outcomes than it was in the 1970s—it also unethically transfers risk and expense to the most vulnerable in our community.

We often hear that Harvard is the apex of academic research and teaching institutions, and that part of its success is due to its sense of community. The University ignored that community when it embarked on a secret and non-consultative planning process and disregarded the strong concerns that faculty have about their own health and that of less well-paid members of our community.

The result is a plan that imposes a serious financial burden on those with chronic illness or who face medical emergencies for themselves or their families. This plan is based on a flawed process, on a misguided charge to the University Benefits Committee, on misinformation about our peers, and on outdated research that is not relevant to the current situation. It is unfair to the most vulnerable members of our community, and not worthy of our great university.

Jerry R. Green, John Leverett Professor in the University and David A. Wells Professor of Political Economy
Alison F. Johnson, Professor of History
Marc W. Kirschner, John Franklin Enders University Professor of Systems Biology
Mark Kisin, Professor of Mathematics
Charles H. Langmuir ’72, Professor of Geochemistry
Mary D. Lewis, Professor of History
James J. McCarthy, Alexander Agassiz Professor of Biological Oceanography
Lisa M. McGirr, Professor of History
Richard F. Thomas, George Martin Lane Professor of the Classics
Mary C. Waters, M.E. Zuckerman Professor of Sociology
Christopher Winship, Diker-Tishman Professor of Sociology

http://www.thecrimson.com/article/2014/11/12/harvards-health-benefits-un...

****

Harvard Ideas on Health Care Hit Home, Hard

By Robert Pear

The New York Times, January 5, 2015

For years, Harvard’s experts on health economics and policy have advised presidents and Congress on how to provide health benefits to the nation at a reasonable cost. But those remedies will now be applied to the Harvard faculty, and the professors are in an uproar.

Members of the Faculty of Arts and Sciences, the heart of the 378-year-old university, voted overwhelmingly in November to oppose changes that would require them and thousands of other Harvard employees to pay more for health care. The university says the increases are in part a result of the Obama administration’s Affordable Care Act, which many Harvard professors championed.

“Harvard is a microcosm of what’s happening in health care in the country,” said David M. Cutler, a health economist at the university who was an adviser to President Obama’s 2008 campaign. But only up to a point: Professors at Harvard have until now generally avoided the higher expenses that other employers have been passing on to employees. That makes the outrage among the faculty remarkable, Mr. Cutler said, because “Harvard was and remains a very generous employer.”

Richard F. Thomas, a Harvard professor of classics and one of the world’s leading authorities on Virgil, called the changes “deplorable, deeply regressive, a sign of the corporatization of the university.”

Mary D. Lewis, a professor who specializes in the history of modern France and has led opposition to the benefit changes, said they were tantamount to a pay cut. “Moreover,” she said, “this pay cut will be timed to come at precisely the moment when you are sick, stressed or facing the challenges of being a new parent.”

The university is adopting standard features of most employer-sponsored health plans: Employees will now pay deductibles and a share of the costs, known as coinsurance, for hospitalization, surgery and certain advanced diagnostic tests. The plan has an annual deductible of $250 per individual and $750 for a family. For a doctor’s office visit, the charge is $20. For most other services, patients will pay 10 percent of the cost until they reach the out-of-pocket limit of $1,500 for an individual and $4,500 for a family.

Harvard’s new plan is far more generous than plans sold on public insurance exchanges under the Affordable Care Act. Harvard says its plan pays 91 percent of the cost of services for the covered population, while the most popular plans on the exchanges, known as silver plans, pay 70 percent, on average, reflecting their "actuarial value.”

Michael E. Chernew, a health economist and the chairman of the university benefits committee, which recommended the new approach, acknowledged that “with these changes, employees will often pay more for care at the point of service.” In part, he said, “that is intended because patient cost-sharing is proven to reduce overall spending.”

“It seems that Harvard is trying to save money by shifting costs to sick people,” said Mary C. Waters, a professor of sociology. “I don’t understand why a university with Harvard’s incredible resources would do this. What is the crisis?”

http://www.nytimes.com/2015/01/06/us/health-care-fixes-backed-by-harvard...

****

Comment:

By Don McCanne, MD

Peering into Harvard’s academic cocoon, there are two lessons we can take home. One has to do with the insularity of the Harvard academic staff as they consider their own health benefit program, but the more important lesson has to do with the insularity of the health policy academics at Harvard and other institutions regarding the design of optimal systems of health care financing.

When we have a new national standard for health insurance that has an actuarial value of 70 percent (patients pay an average of 30 percent of their health care costs) based on the benchmark silver plans offered in the insurance exchanges established by the Affordable Care Act, it is astonishing to hear the outrage expressed by the Harvard academic community over the reduction of the actuarial value of their plans to the almost unheard of level of 91 percent! They would pay on average only 9 percent of their health care costs.

That said, they are right. They should be able to receive all essential health care services without paying anything out-of-pocket at the time they receive care. Other nations have proven that you can provide first dollar coverage at a per capita cost that averages half of what we spend in the United States. Placing financial barriers in the way of health care access is not only unnecessary, it is frequently harmful.

The first lesson here is that the insularity of these academics did not allow them to think beyond the needs of themselves and the needs of the “less well-paid members of our community” - the Harvard community, that is. It is difficult to watch the expression of their outrage over their comparatively modest reduction in benefits, leaving them with platinum-level plans, when they remain silent on the deficient plans that most of the nation has to deal with. From their academic towers, they have the luxury of being able to sound off about the health care injustices that so many in the nation face. But they didn’t do it. They merely whined about the injustices of their own solid-platinum insurance.

But then there is the academic health policy community. They are still fixated on the misinterpretations and extrapolations of the RAND Health Insurance Experiment (see the Harvard Crimson excerpts above). They continue to insist that when patients have health care needs, they must buy a ticket to enter the health care arena, partially invalidating their prepayment arrangements (i.e., health insurance). That there are better ways to improve value without erecting financial barriers to care seems to be lost not only behind the blinders that these health policy academics are wearing, but also behind the earplugs that they must be wearing as well. They see and hear no evil, but they sure do speak evil!

When are those of us outside of the moat protecting Harvard’s insular compound finally going to take over the policy reins? Soon, I hope.

What Happened in Vermont: Implications of the Pullback from Single Payer (Part 2)

 Commentary by Steffie Woolhandler, M.D., M.P.H., and David U. Himmelstein, M.D. of PNHP:

Gov. Peter Shumlin’s Dec. 17, 2014, announcement that he would not press forward with Vermont’s Green Mountain Care (GMC) reform arose from political calculus rather than fiscal necessity. GMC had veered away from a true single payer design over the past three years, forfeiting some potential cost savings. Yet even the diluted plan on the table before Shumlin’s announcement would probably have lowered total health spending in Vermont, while covering all of the state’s uninsured.

Background

Decades of exemplary grassroots organizing (and strong labor union support) in Vermont put single payer on the agenda. During Shumlin’s 2010 gubernatorial campaign, he promised to implement a single payer reform, which was a factor in the Progressive Party’s decision not to field a candidate. But the details of Shumlin’s plan weren’t fleshed out during the campaign.
 
After his victory, Shumlin and the legislature commissioned economist William Hsiao to study options for health reform in Vermont, including single payer. Rejecting a fully public single-payer plan, Hsiao instead proposed a “public-private hybrid” model and projected $580 million in savings, including large administrative cost savings, in the program’s first year.

Spurred by Hsiao’s positive projections, in 2011 the legislature passed a health reform law that laid out plans for implementing the Affordable Care Act in the short term, and called for a later transition to a single payer GMC plan. But while the law gave a detailed prescription for implementing the ACA (including construction of an exchange whose final cost was about $250 million), the sections on single payer were vague, and punted decisions on critical issues to the GMC Board to be appointed by the governor. That board would determine whether critical services like long-term care would be covered; the amount of copayments; how hospitals and doctors would be paid; and whether capital funds would be folded into operating budgets or allocated through separate capital grant (the sine qua non of effective health planning). Critically, the bill included no plan for funding the single payer program.

An early signal of trouble was Shumlin’s appointment of Anya Rader Wallack to chair the new GMC board. Wallack had deep ties to the private insurance industry, having held key positions (including the presidency) at the Blue Cross Blue Shield of Massachusetts Foundation. That foundation played a central role in designing and pushing for Massachusetts’ 2006 Romneycare reform, and subsequently issued a series of glowing evaluations of Romneycare that helped buttress the case for replicating its structure in the ACA.

From the outset, Shumlin and the GMC Board embraced an Accountable Care Organization payment strategy that would enroll most Vermonters in large hospital-based, HMO-like organizations that would be overseen by a “designated entity” – presumably Blue Cross. To-date, ACOs have shown little or no overall cost savings, have increased administrative costs, and have driven hospitals to merge and gobble up physician practices. The consolidation of ownership triggered by ACO incentives has raised concern that regionally dominant ACOs will use their market power to drive up costs. In Vermont, Dartmouth Hitchcock and the University of Vermont’s Fletcher Allen system dominate the market, and have initiated a for-profit, joint venture ACO.
 
The GMC Board’s design incorporated several other features that increased the administrative complexity, and hence administrative costs of the proposed reform. The plan never envisioned including all Vermonters in a single plan, instead retaining multiple payers. Hence, hospitals, physicians’ offices, and nursing homes would still have had to contend with multiple payers, forcing them to maintain the complex cost-tracking and billing apparatus that drives up providers’ administrative costs. It proposed continuing to pay hospitals and other institutional providers on a per-patient basis, rather than through global budgets, similarly perpetuating the expensive billing apparatus that siphons funds from care. And hospitals would have continued to rely on surpluses from day-to-day operations as their main source of capital funds for modernization and expansion. This undermines health planning and raises bureaucratic costs by forcing hospital administrators to undertake the additional work needed to identify and pursue profit opportunities.

Some of this complexity was forced on Vermont by federal statutes that may preclude folding Medicare and the military’s Tricare program into a state single payer plan, and restrict states’ ability to outlaw private employer-provided coverage that duplicates the public plan. But the decisions to abandon lump-sum hospital payment, and separate grants for capital were the GMC Board’s choices.

The End Game of Vermont’s Reform

Vermont’s November 2014 gubernatorial election had very low voter turnout, a circumstance that generally favors the right. Gov. Shumlin – who had hedged on health reform during the campaign – eked out a narrow plurality, leaving the state legislature to decide between him and the Republican candidate and greatly weakening Shumlin’s position. A month later, while awaiting the legislature’s decision (they elected him to a third term on January 9), Shumlin announced his pullback from reform.

Shortly thereafter, he released the GMC Board’s detailed cost projections which he said had convinced him not to go ahead. The Board estimated zero administrative savings from its proposed plan. It also projected zero savings on drugs and medical devices, tacitly acknowledging that GMC wouldn’t use bargaining clout to rein in prices, and ignoring the fact that Quebec, its neighbor to the North, has gotten big discounts.

The Board’s cost estimates also incorporated an old (too high) estimate of the number of uninsured Vermonters, inflating the projected increase in utilization and cost. Finally, it assumed that doctors would expand their work hours (and incomes) to care for the newly insured, rather than maintaining their current work hours by seeing their other patients a little less frequently – as happened with the implementation of single payer coverage in Quebec.

But even the GMC Board’s inflated cost estimates indicate that universal coverage under its quasi-single payer plan would cost somewhat less overall than the current system. The voluminous Board report includes detailed tabulations of new costs to the state treasury under the proposed reform. But the report scrupulously avoids providing any figures for the impact of reform on the total cost of health care (public and private) in the state. Economist Gerald Friedman has estimated these overall impacts using the report’s data, previous estimates of health expenditures in Vermont, and CMS figures on Medicare spending and expected health care inflation under the ACA. He estimates that even the diluted reform proposed by the GMC Board would cut overall health spending in Vermont by about $500 million annually.

So why did Gov. Shumlin declare the reform unaffordable? Many have noted that the $2.5 billion in new state expenditures required under the reform would nearly double the state’s previous budget. But these numbers are meaningless absent an accounting of the savings Vermont households would realize by avoiding private insurance premiums and out-of-pocket costs. As detailed above, these savings would more than offset the new taxes.

But although the total costs of care would have fallen even under the GMC plan, some – mostly higher-income, healthy Vermonters whose taxes would go up the most – would have paid more. Although the GMC tax plan was far from progressive, it was far less regressive than the current pattern of health care funding in the state. The GMC Board estimated that most of the 340,214 families earning less than $150,000 annually would have gained, while most of the 24,102 families above that income level would have lost. Overall, employers’ costs would have risen by $109 million – with many small businesses experiencing cost increases, a political sore point.

Conclusion

It’s a misnomer to label Vermont’s Green Mountain Care plan “single payer.” It was hemmed in by federal restrictions that precluded including 100 percent of Vermonters in one plan, and its designers further compromised on features needed to maximize administrative savings and bargaining clout with drug firms, and improve health planning.

But even the watered-down plan that emerged could have covered the uninsured, improved coverage for many who currently face high out-of-pocket costs, and actually reduced total health spending in the state – albeit far less than under a true single payer plan. A true single payer plan would have made covering long-term care affordable, and allowed the elimination of all copayments and deductibles.

Vermont’s experience holds important lessons for single payer advocates.

1. Effective grassroots organizing makes a difference. It got real health care reform on the political radar screen in Vermont, and can get it back on the radar there and elsewhere. Indeed, single payer forces in Vermont are already rallying to reverse Shumlin’s decision. The virtues, value, and simplicity of a single payer approach have broad popular appeal.

2. Federal restrictions impose significant compromises on state-level single payer plans. For this, as well as other reasons, organizing for single-payer state plans and organizing for national legislation are not competing strategies, but complementary ones. The ultimate goal for both is a single, inclusive program for the entire nation.

3. As single payer work advances, we need to anticipate that corporate opposition will mobilize – often behind the scenes. The only effective antidote is continued grassroots mobilization. Delayed implementation and punting key decision to the future opens the door for corporate influence and smear campaigns.

4. Beware of “experts” with a track record unsympathetic to single payer. Economic projections are always based on assumptions, which are often highly political.

5. Even when we don’t get the whole pie, demanding it often yields a significant piece. Although a major single payer effort was stymied in Vermont, it achieved substantial progress. It’s no accident that Vermont’s uninsurance rate has come down to 3 percent; that virtually all children in that state are covered; that its Medicaid program is among the best; that its hospitals have come under tighter fiscal regulation; and that single payer remains in the limelight there. Even as he backed off from single payer for now, the governor promised to press for future health reform.

Dr. Steffie Woolhandler and Dr. David U. Himmelstein are internists, professors at the City University of New York’s School of Public Health at Hunter College, and lecturers at Harvard Medical School. They co-founded Physicians for a National Health Program.

Get involved today with the Oregon campaign for publicly funded universal health care.  Attend our the Rally on the Capitol Steps on February 11, and attend our monthly meetings.

Why Vermont Failed to Enact Single Payer? (Part 1)

Guest Opinion by Dr. Samuel Metz on the Lund Report:

Its collapse was a legislative failure, according to this author, which Oregon legislators deserve support so the same problem doesn't befall us.

Drawing unwanted national attention to his tiny state, Governor Peter Shumlin pronounced Vermont’s quest for universal health care Dead On Arrival. This statement broke the hearts of activists who previously cheered passage by the 2011 Vermont legislature of Act 48, the first step toward America’s first statewide universal care plan.

But this collapse was no ordinary failure. It was not a failure of universal care, or of single payer, or even of Gov. Shumlin himself. This was a spectacular failure of a very different nature, and one with valuable lessons for Oregon. But we must learn the right lessons, not the wrong ones.

The Wall Street Journal called this a failure of universal care to reduce costs. Not true. Not only was the universal plan never implemented, all predictions in Vermont’s universal care study, prepared at the request of the legislature by Dr. William Hsiao, remain valid. Regardless of costs, universal care in Vermont would still provide better care to more people for less money. Dr. Hsiao’s conclusions are corroborated by more than two dozen other studies in 14 states that come to the same conclusion.

Megan McArdle of Bloomberg View called this a single payer failure. But this was not a single payer failure because Vermont did not enact single payer. Vermont made a valiant effort to provide universal health despite many federal laws, including Medicare, ERISA, and the Affordable Care Act, that make single payer impossible in any state. Instead, Vermont created a work-around in which Green Mountain Care, the proposed state health care program, would have included less than 60% of its population; Vermont’s proposal included multiple payers, not just the state single payer.

James Haslam, executive director of the Vermont Workers' Center and a respected leader in Vermont’s campaign for universal care, labeled this as Gov. Shumlin’s failure. But as tempting as it is to blame the messenger, this failure was not Gov. Shumlin’s. Governors do not enact legislation; legislatures enact legislation. Vermont’s 2011 legislature dared to establish a universal care plan, but it left enactment of the taxes to fund that care to the 2012 legislature. The 2012 legislature left the task to the 2013 legislature. The 2013 legislature left the task to the 2014 legislature. When the 2014 legislature left the task for the 2015 legislature, Gov. Shumlin did not need a Hebrew prophet to read the writing on that wall. He simply stated the obvious: No Vermont legislature in the foreseeable future would take that responsibility. He pronounced the death; he did not kill the patient.

The collapse of the Vermont plan was a legislative failure, clear and simple.

For the record, Gov. Shumlin and the majority of legislators were Democrats.

No matter how expensive health care becomes, private insurance costs more than single payer. In every population – the poor, the sick, the elderly, employees of large businesses who self-fund, our veterans – single payer costs less.

But Vermont legislators did not believe they could vote for replacing insurance premiums with single payer taxes and still get re-elected. Neither did Gov. Shumlin.

Gov. Shumlin attributed the death of Vermont’s universal care plan to runaway healthcare costs and the increased taxes needed to pay those costs. Both are true: Vermont’s healthcare costs are rising (like every other state) and higher taxes would be necessary to match them. But universal care does not generate higher healthcare costs. It converts what we currently pay privately (i.e., employer premiums, family premiums, deductibles, co-pays, out of network payments, and excluded medication costs) into taxes. Premiums, out of pocket payments, taxes – it’s all our money, just different labels.

And while the efficiency of single payer reduces total healthcare costs (not dramatically – most studies, including Dr. Hsiao’s, suggest a modest 5-10% reduction), the primary advantage of single payer is guaranteed access to healthcare that costs less, that removes fear of bankruptcy, and that does not depend upon employers.

What is Vermont’s lesson for Oregon?

Our legislators need our unequivocal support before they will make bold decisions: not just to enact universal healthcare (like Vermont), but to create the tax plan to fund it (unlike Vermont).

Legislators will not respond to our need for universal healthcare unless we tell them. Legislators will not vote for new taxes to fund universal healthcare unless they know they have our vote if they do. Enabling our legislators to avoid the debacle of Vermont requires us to take our message directly to their offices: We want universal care. We want them to make it happen. And we will vote for them if they do.

We must give our legislators courage (and our votes) to do the right thing. That’s Vermont’s lesson for Oregon.

Samuel Metz, MD, is a private practice anesthesiologist in Portland. He has collaborated with Oregon State Sen. Michael Dembrow on passing the HB 3260 study of financing options for universal health care in Oregon. Dr. Metz can be reached at S@SamuelMetz.com. More information about the HB 3260 can be found at www.OregonStudy.org.

Jan 8 2015

Get involved today with the Oregon campaign for publicly funded universal health care.  Attend our the Rally on the Capitol Steps on February 11, and attend our monthly meetings.

Why Did Swiss Voters Reject Single-Payer Health Care?

Supporters of a single-payer, Medicare-for-all health care system in the U.S. were puzzled September 27 when Swiss voters rejected a reform proposal by 62 percent.

The new law would have replaced the current system, where about 60 insurance companies offer mandatory health coverage, with a single insurer, the government. It would have offered all medically necessary care, paid for by taxes adjusted to each person’s ability to pay.

To Americans who’ve worked for such a system here, nationally and state by state, it was a blow. What’s not to like about single payer?

Swiss and American media, academia, and business sectors rushed to interpret the results. Virtually all crowed that the Swiss people had rejected government-run national health insurance because they preferred private insurers.

But these convenient interpretations rely on false assumptions to justify a model of health insurance that is unraveling—less conspicuously in Switzerland, but dramatically in the U.S.

Let’s look at what’s wrong with these pro-business interpretations, and see what lessons the Swiss referendum has for single-payer advocates here.

Mainstream Answers

Washington Post “policy wonk” Jason Millman wrote that the Swiss rejection shows that single-payer has little chance of gaining popular support in the U.S.

He notes that in 1996, the Swiss voted for an individual mandate that compels everyone to buy a basic package of health services. That law eliminated discrimination for pre-existing conditions, meaning companies have to sell equal plans at equal prices to all customers. The government subsidizes low-income people. In Millman’s view, the resulting Swiss system is very much like Obamacare.

Another policy reporter, Avi Roy from Forbes, asserted that Obamacare (and Romneycare before it) was modeled on the Swiss system: people shopping among competing private plans with little government interference.

Roy says the referendum demonstrates the “political popularity” of universal coverage via private insurance. He concludes that because the Swiss have rejected single payer, there’s good reason to believe Americans will reject it, too.

What’s Wrong with the ‘Official View’?

These interpretations are based more on ideology than on facts. Why?

First, Swiss health care is not a version of Obamacare. The differences are critical to understanding the implications of the Swiss referendum for health care reform here.

Second, Swiss health care, though far superior to ours in terms of access, quality, and equity, has critical problems that threaten the system. Those problems illustrate why, four years after Obama signed the Affordable Care Act into law, health care access, quality, and equity are increasingly threatened here too. The Swiss is a model to reject, not to embrace.

Third, the referendum does not prove that the Swiss don’t want government involvement in health care, nor that they like private insurance companies. Quite the opposite.

Indeed, an analysis of a series of referendums over several years shows that, like the U.S. population, the Swiss are increasingly unhappy with treating health care as a business, rather than a social good.

1) Obamacare is not a version of the Swiss system.

The current National Health Care Law, known as LaMal, requires that everybody living and working in Switzerland carry health insurance—we call this an “individual mandate.” So the Swiss are required to purchase insurance for a uniform, comprehensive package of medical services.

But the national government operates at every level to make everything run smoothly. To more than 50 percent of the population, the government offers full or partial subsidies to purchase insurance. So more than 99 percent of the population is covered.

The government also compels insurers to sell policies to everybody at the same price, irrespective of health status, medical history, gender, age, or location (within each canton, the administrative equivalent of a U.S. state). A 25-year-old and an 80-year-old pay exactly the same premium for the same plan. The only exception: those under 25 pay substantially less.

If your income changes, or job changes, or marital status changes, your doctor need not change.

The government also enforces a “basic” package that is very comprehensive—in the U.S., some call it “Cadillac,” as if only spoilt Americans would dare demand it! Thus basic insurance, Swiss-style, includes outpatient care—essentially whatever a doctor prescribes—hospital care, mental health, all pharmaceuticals on the government’s list, some rehabilitation services, some dental care, some herbal medicine, and acupuncture.

Importantly, the government forbids insurers to make a profit from the sale of the mandatory package, and it compels them to contract with every single health care provider in Switzerland.

The government also imposes a system of risk equalization. It compensates companies that enroll individuals with more expensive medical needs, taking the money from companies that enroll healthier users.

The government also compels mechanisms to deal with prices. Within each canton, prices must be negotiated between associations of providers and insurers, and everybody must abide by them. So providers within a canton are paid equal amounts for equal services, regardless of which plan the patient has.

Finally, the state also enforces limited deductibles (about $300 U.S.) in all plans, and a maximum out-of-pocket cost of about $700.

Users can choose to purchase cheaper policies as a trade-off for higher deductibles (up to 2,500 Swiss francs, or about $2,500 U.S., for adults, and 600 francs, or about $600 U.S., for children). They can also choose policies with restricted provider networks, though few do.

As you can see, this looks nothing like “no government interference.”

Obamacare: A Reality Check

Nor does it look like a version of Obamacare. A few comparative points:

  • Obamacare does not cover 100 percent of the population. In fact, more than 30 million people living in the U.S., the majority of them citizens or legal residents, will remain uninsured by 2024, according to the Congressional Budget Office.
  • Obamacare does not guarantee a homogeneous, generous basic package of services.
  • It does not guarantee equal prices for equal services—hence all these calls for greater transparency of prices so “consumers” can shop more productively! Prices vary according to age—older people pay up to three times as much—geographical location (over 18 different ones only in California!), even gender composition of the workforce insured.
  • Providers under Obamacare are paid differently depending on the patient’s plan—which is unheard of, and would be scandalous, in Switzerland.
  • Obamacare does not guarantee access to every provider in your state—only to providers in your plan, and only as long as your plan does not change.
  • As to maximum out-of-pocket, we’re not even close to the Swiss.
  • As to the celebrated choice of plans, it hardly applies to the 160 million Americans with employer-sponsored coverage (now 60 percent of the non-elderly population; it was close to 70 percent back in 2000), who are stuck with whatever “choices” their employers offer (assuming they offer any).
  • Last and not least, insurers in the U.S. can and do make a profit for selling you insurance for medically necessary care. Which is the only reason they are in the business of selling insurance!

So the belief that Swiss health care and U.S. health care after the ACA are “more or less the same” is quite misguided.

At the center of the ACA is a well-oiled money-making machinery for the medical-industrial complex: insurance companies, Big Pharma, and for-profit (and many non-profit) medical establishments.

2) Over the last decade corporate interests have hijacked the Swiss system, despite the strong government oversight.

This has led to increasing overall and out-of-pocket costs, making the Swiss system the third most expensive in the world.

To control costs, the Swiss government has promoted managed-care options and encouraged users to comparison-shop. So in addition to the classic comprehensive plans, insurers are offering narrower provider networks and higher deductibles and co-pays, and users are prompted to choose plans annually.

However, the Swiss appear not to like all these “new choices” after all, because in a 2012 referendum more than 70 percent voted against a dramatic expansion of managed care, proposed as a key mechanism to “control costs and improve the system.” And only a very small minority chooses to change plans every year.

Last, a growing number find health care unaffordable and are failing to pay their premiums.

Simply put, all the problems the Swiss are grappling with are rooted in the for-profit nature of the companies that participate in the system. As these companies become more financially successful, and hence more powerful, they get harder to tame—and their influence on the politicians who decide health policies grows stronger and stronger.

Clearly, even in the best-case scenario—the highly regulated environment of Swiss private insurers—entrusting them with the provision of health care is assigning a fox to guard the henhouse. The attempt to achieve justice in health care via competing private insurers is a pipe dream.

3) The defeat of the single-payer referendum does not mean the Swiss people reject a government-run system and support private insurance.

The Swiss have rejected almost all referendums since 1891—only 20 out of 191 have succeeded, even when issues were popular.

Critically, one successful referendum was LaMal, the 1996 health insurance law that banned profit from the sale of medically necessary care. It also allowed the government to pass on money from companies spending less on patient care, to those spending more—certainly not an indicator that the Swiss shun “government interference” on behalf of ordinary people, nor that they trust private insurance to do well by them without supervision.

Also worth noting: in 2007 single payer was rejected by 71 percent, but the figure fell to 62 percent in 2014. Maybe the Swiss are beginning to cut through the anti-single-payer propaganda?

Further Reading

For a detailed comparison of the U.S. and Swiss systems, see my article “Is the Swiss Health Care System a Model for the United States?”

For a thorough, albeit ideological (i.e. supportive of “market forces”) review of the current state of the Swiss system, see the 2011 OECD report.

For a full “reality check” of the Affordable Care Act, see “Why do Americans still need single-payer health care after major health reform?”

To understand the single-payer movement’s recent setback in Vermont, and what comes next, read “Vermont Governor Backs Away from Health Care for All.”

Lessons Learned

Why, then, was single payer defeated? What can we learn?

In this article from Labor Notes, Claudia Chaufan  discusses the recent rejection of a single payer referendum in Switzerland and how it relates to the ACA and the campaign for universal coverage in the United States..

First, we need to grant that the state of Swiss health care may be of concern for the Swiss (they seem to have lower tolerance than we do!), but it is still not as bad as in the U.S. People who experience the greatest barriers to care in Switzerland are the most politically disenfranchised—the young, poor, women, immigrants, much like here—so the problem has yet to affect the so-called middle class enough to pass a referendum.

Second, we can see the extraordinary power of corporate propaganda. The scare tactics deployed by corporate interests in Switzerland were quite extraordinary, both in 2007 and this year. Likewise, their interpretation of the results was designed to discourage supporters of public health care—to make us think we’re more alone than we really are.

The Swiss referendum teaches us that:

  • We need to sharpen our understanding of what the ACA is really about, who our enemies are, and what our alternatives could be.
  • We must increase our outreach to the disenfranchised, to those who don’t think their voices make a difference.
  • And we must work on improving our political education of those we wish to reach—rather than watering it down to sound bites that fit within the boundaries of the “politically feasible.”

Claudia Chaufan, MD, PhD, is an associate professor at the University of California San Francisco and a member of Single Payer Now and of Physicians for a National Health Program.

- See more at: http://labornotes.org/blogs/2014/12/why-did-swiss-voters-reject-single-payer-health-care#sthash.xIHxPSzh.rZrJLPE8.dpuf

PNHP Comments about the Wall Street Journal Article on Vermont's Single Payer Effort

The Wall Street Journal
December 22, 2014
Vermont’s Single Payer Washout

Last week, in a reversal that deserves more attention, Democratic Governor
Peter Shumlin announced that Vermont would no longer create America’s first
statewide single-payer health system.
Single payer is the polite term for socialized medicine and the ultimategoal of the political left.
At least the Governor deserves credit for admitting failure. His ideological comrades are rarely dissuaded by the prospect of economic damage, as ObamaCare proves. But Mr. Shumlin has succeeded in making Vermont a national model: By admitting that single payer will make health care both more expensive and less efficient, he has shown other states what not to do.

Vermont
H.202
Bill as Passed by the House and Senate, 2011

“An act relating to a single-payer and unified health system”
changed to
“An act relating to a universal and unified health system”

(H.202 is a 213 page bill. The first 135 pages were deleted and the
remaining pages are a rewrite of the entire bill.)

Sec.2(a)(6):

The director, in collaboration with the agency of human services, shall
obtain waivers, exemptions, agreements, legislation, or a combination
thereof to ensure that, to the extent possible under federal law, all
federal payments provided within the state for health services are paid
directly to Green Mountain Care. Green Mountain Care shall assume
responsibility for the benefits and services previously paid for by the
federal programs, including Medicaid, Medicare, and, after implementation,
the Vermont health benefit exchange.

***

Comment by Don McCanne of PNHP

As was fully expected, the conservative and libertarian pundits are
inundating the Internet and other media vehicles with celebratory
commentaries on the theme that Vermont Gov. Peter Shumlin’s withdrawal of
his single payer proposal is proof that single payer is more expensive and
less efficient than other health care financing systems. The Wall Street
Journal editorial excerpt above is selected as a leading example of these
right-wing responses. The problem with these comments is that H.202, the
Vermont reform legislation, IS NOT A SINGLE PAYER PROPOSAL.

Even many single payer supporters have it wrong. They claim that Gov.
Shumlin gave up for political reasons, and, if he had persevered, he would
have been successful in establishing the first state-level single payer
system in the U.S. Again, the problem is that H.202, the Vermont reform
legislation, IS NOT A SINGLE PAYER PROPOSAL.

Posted above is a link to H.202. During the legislative process, the bill
was renamed, deleting “single-payer” from its title. If you check the
document at the link, you will see that the original bill was red-lined
out, and the bill was entirely rewritten. All references to “single-payer”
were removed.

The crucial phrase in the except above regarding waivers and agreements is
“to the extent possible under federal law.” It was known at the time the
revisions were being made that Sec 1332 ACA waivers, Sec 1115 Medicaid
waivers, the narrowly defined Medicare demonstration waivers, and the ERISA
limitations on employer-sponsored plans were so limited that it would be
impossible to establish a bona fide single payer system through unilateral
state action alone, nor through a cooperative effort with the Obama
administration. Comprehensive federal legislation would have been required,
and that clearly was not forthcoming from this or the next Congress.
Legislating a wish list does not equate with clearing all of the hurdles
that only Congress can effectuate.

The reason that this message is being reemphasized again today is that
there has not been a loud enough voice in unison emphatically rejecting the
claim that Vermont’s experience is proof that single payer cannot work.
Single payer never had a chance, considering the inertia in Congress. This
was not a single payer failure. Do not remain silent when that claim is
made. Single payer has been proven to work well in many other nations.