PNHP's Don McCanne Comments on the RAND Study of How to Cover All Oregonians

By Don McCanne, M.D.

This study can be very helpful to those who are considering comprehensive health care reform on a state level. RAND has shown that a single payer system would cover everyone without increasing total health care spending; private health insurance for the nonelderly plus Medicare for seniors and the disabled would cover everyone but would increase total spending; and providing a state-run health plan (public option) would have only a negligible impact on coverage and spending.
Full article here.

Coordinated Care Organizations--How Are They Doing?

OPHA October 13, 2015Afternoon breakout session byMichael C. Huntington M.D.

In 30 years working with cancer patients I saw many patients with advanced and neglected cancers.  Some of these patients had avoided doctors for months or even years in spite of worrisome symptoms because they felt they could not afford care. Seeing this happen repeatedly was a very saddening experience for me.  I learned that it didn’t need to happen.  I began to realize that illness can be as much a result of politics as biology. The political question is, “By law, who will be allowed a good chance for a healthy life and good health care?” This talk is about how well CCOs are answering that question.

What is a Coordinated Care Organization (CCO)? 

 Health-care providers cooperate under a capitated budget,   communicate better, and deliver better care.

Unified care.  The care-delivery component of each CCO is the patient-centered primary medical home (PCPMH) in which primary care practitioners collaborate with a standardized array of other caregivers under a capitated budget to deliver better care at lower cost.

Each CCO board is advised by the leader of its community advisory council.  However, board meetings are closed to the public.

Sixteen CCOs have formed since August, 2012, each run by a board composed of local healthcare providers and community members. These boards are advised by a local community advisory council whose chair sits on the CCO board.  However, board meetings are closed to the public. More later about that as a frailty of CCOs. 

People churn in and out of Medicaid eligibilities because of varying incomes year to year.  Discontinuity of care.

Churning.  27% of patients who are initially eligible churn in and out of Medicaid eligibility because of varying incomes year to year. This leads to disruptions in continuity, therefore poor quality healthcare. A single eligibility pool would solve the churning problem. Yearly reapplication is required because of changes in eligibility. People forget, can’t find required documents, don't understand.  They unintentionally let coverage lapse and are surprised to discover they aren’t covered by Medicaid anymore. More churning.

So how are we doing?  
17 health care metrics:  Each June the Oregon Health Authority publishes its assessment of
performance by Oregon CCOs. Performance is based on 17 key healthcare metrics. Benchmarks:  unless stated otherwise are averages of the 2013 national Medicaid 75th percentiles for adults and children.
More Insured  95% of Oregonians now have some form of health insurance (84% in 2012).  The 2015 Robert Wood Johnson report says 83% (but is based on 2012 data) …but not better access:  Medicaid CCO cards say the holder is entitled to care but 16% of CCO patients still can’t find a doctor when they need one. The percentage of members (84%) who received appointments and care when they needed them has not improved. A home health nurse I know in Lincoln County frets over this underserved 16% of the CCO enrollees and all others who can’t access a primary care provider.  
 
Avoidable use of emergency departments was 14%, is now 7% (Lower is better). Criterion: Rate of patient visits to an emergency department for conditions that could have been more appropriately managed by or referred to a primary care provider in an office or clinic setting.  
 
Prenatal Care. Things are improving with 82% (up from 65%) of pregnant women receiving a prenatal care visit within the first trimester or within 42 days of enrollment in Medicaid. 50% of births in Oregon are covered by Medicaid. Good prenatal care leads to better health outcomes and cost savings.  

CCOs may be helping diabetics. The 78.2% control rate (HbA1c < 9.0%) compares favorably with the 66% rate of control before CCOs.
 
Outpatient control of congestive heart failure is better by 40%. Criterion: the rate of hospital stays because of congestive heart failure. Benchmark: 10% reduction from previous year's statewide rate. 2011 and 2013 data have been updated and may differ from earlier reports.  A PCPMH helped this man control his congestive heart failure. He had been in and out of the hospital many times before the CCO was available to him.

Satisfaction level among those who actually gained access to care has improved slightly since 2011 (84.5% vs 78%).  The several CCO patients and their doctors I have spoken with are pleased with the PCPMH process. Criterion: the percentage of members (adults and children) who received needed information or help and thought they were treated with courtesy and respect by provider staff.  
 
Hypertension Control. People have devastating strokes from undetected and uncontrolled hypertension. For some this happens because they can’t afford insurance or don’t qualify for Medicaid. I know of two such individuals. But only 65% of enrolled CCO hypertensive patients are getting their pressures under control.  Not so good.There are no earlier CCO data to compare with, but the US Medicaid 75thpercentile in 2013 was 64%.  

Childhood Immunization. Before and since the advent of CCOs only 2/3 of children received recommended vaccines before their third birthday.Vaccines are one of the safest, easiest and most effective ways to protect children from potentially serious diseases. 

Financial Problems. Even if Oregon limits Medicaid spending growth to 3.5%/yr as we are must do to keep all of our federal subsidy for the expanded Medicaid population, the subsidy drops from 100% to 94 % in 2017 and to 90 % in 2020. Oregon will have to come up with an extra $369 million per year from 2017 to 2020 and then $500 million/yr after that.  This is unsustainable.  Oregon’s current annual Medicaid budget is $6.8 billion.  
 
Solutions? Four options have been tried during Medicaid revenue shortfalls in the past.  
#1: Raise taxes without changing benefits
#2: Cut other state programs: police, fire and safety, schools, elderly, infrastructure, transportation
#3: Reduce Medicaid eligibility. This immediately reduces state spending — until neglected patients again fill our emergency rooms.  
#4: Cut benefits. same as #3 above.
None of these options are appealing. Stay tuned as your next speakers talk about how we might make health care and its financing sustainable.
 
Other problems.  Opaque or Transparent CCOs?  How will the public track the use of its public (Medicaid) money?  One of the 11 privately owned CCOs tripled its profits in 2013 after a large enrollment of Medicaid patients.  During the time this CCO was taking in its Medicaid payments of $300-$400 per member per month (pmpm), thousands of its patients ended up depending on safety net clinics because the CCO had too few primary care providers.  Safety net clinic workers I spoke with said that the CCO could have hired more providers but had turned down applications from qualified nurse practitioners and physician assistants.  This CCO was purchased last month by a Fortune 500 company. This is not what most of us had in mind when CCOs were conceived.  The main problem I see here is that the public should be the primary decision maker regarding use of public funds, not a private for-profit company.
 
I encourage you to Investigate. Find out who sits on your CCO board by going online to Oregon.gov/CCO governing boards and ask them for a clear accounting of where the money goes. Is it going for convincingly documented care of patients? How much is going to stockholders or into that mystical land of the reserves.  If your CCO doesn’t freely provide information you need, local journalists and your legislators may be willing to help.  
 
Tell legislators. I think we can say that Oregon's coordinated care organization experiment is starting to succeed and is based on sound principles of providing better care for more people at less cost. But we need major improvements in transparency, oversight, and incentives and we need a single risk pool and unified payer system if the ideals of the CCOs are to survive.
Tell legislators, media, Oregon Health Authority that we must:
1. Keep working on the CCO model of care delivery and capitated payments. This work is vital to success.
2. Stop determining who “deserves” care and who doesn’t with our complex eligibility schemes. The process is too costly and disruptive.  We must include everyone.
3. Fight for more public surveillance and power over how all public money, including Medicaid money, is used.   
4. Make our legislators create a system in which insurance is not just a card or promissory note but in fact allows access to health and health care.  
5. Make CCOs serve needs of the public rather than stockholders and the medical industry.
6. Create a unified coding and payment system with a single risk pool (everyone in).
 
These web sites listed below will help you gather and confirm the data you need if you want to help CCOs succeed. As we talk with others about health care reform I hope we can listen carefully, honor and allay their fears, and then pivot back to a mutually agreeable goal such as better care for everyone at lower cost. Help others see how achieving this goal will benefit them, their families, and their neighbors. It is pretty likely that they want all of those people to have access to good healthcare.
 
We have indeed come a long way in a very short time, but we have a long way to go.  Please investigate these organizations and websites, learn what you can about what’s going on, and rev up your activism for the public good and public health.  Here are two organizations that you can look in on and join to put your thoughts into action.

References

 Groups you can learn from and join

Transformation is slow difficult work - meaningful change takes time, like turning an ocean liner around when many of the crew members don't know how and a few don't want to. And of course powerful special interest tugboats keep pulling this healthcare ship toward their harbors.  

You can help MVHCA as we work for publicly funded universal health care like the rest of the developed world by donating, hosting 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.

InterCommunity Health Network Coordinated Care Organization Celebration

Join us as we celebrate 3 years of health care transformation. InterCommunity Health Network CCO provides care for over 60,000 Oregon Health Plan members in Benton, Lincoln and Linn counties.

Health care costs keep Oregon ex-pats in Canada

MVHCA, PNHP, and Mad As Hell Doctor member Mike Huntington wrote a great letter to the Corvallis Gazette-Times.

March 24, 2015 9:00 am

I spoke with my cousin Debbie at a recent family gathering. She and her husband grew up in the United States and then, long ago, moved to Canada for work. Both have dual citizenship. They love and miss Oregon. For years they have hoped to return permanently to Coos County.

But they don’t dare.

So long as they stay in Canada they have affordable tax-based healthcare insurance, Canadian Medicare, giving them access to good care that is free of US-style financial torment.

But if they come home to Oregon they have only unaffordable and troublesome options. They would have to pay $1,000 to $2,000 a month for a high deductible policy that provides no guaranteed access to care or protection from financial ruin.

They know that healthcare fees are the greatest cause of financial indebtedness in the United States and most families facing medical bankruptcy did indeed have insurance at the time they became ill or injured.

Debbie clings to hope. She knows that Oregon has a vibrant grassroots movement for legislation that will guarantee access to healthcare for all Oregonians without financial ruin or needless delay.

My cousin has a homesickness we can cure. She can return to Oregon without fear if we create a better and less expensive healthcare system that is based on need instead of the market.

Please tell your legislators it’s time to get well beyond the mixed benefits of Obamacare and Oregon’s Coordinated Care Organizations — with Health Care for All Oregon, mvhca.org.

Michael Huntington MD

Corvallis

Help MVHCA as we work for Improved Medicare for All by donating, hosting a house party, signing up for the newsletter, and attending our monthly meetings. Thank you.

Over 100 economists call on Vermont to move forward with universal health care

From the National Economic & Social Rights Initiative website.

Publication Date: February 26, 2015
Author: Healthcare Is a Human Right Campaign
Organization Title: NESRI and the Vermont Workers' Center

MONTPELIER, VT: A new health care financing plan and a letter signed by over 100 economists make the case for Vermont to establish what would be the first universal, publicly financed health care system in the United States. The plan and letter were delivered to lawmakers at the Vermont State House on Thursday by members of the Healthcare Is a Human Right Campaign.

The financing plan sets out a new, more equitable model for financing Vermont’s health care system that would expand access to care while lowering health care costs for low- and middle-income families. Adding to proposals released by Governor Peter Shumlin in December, the plan, which was published by the Vermont Workers’ Center and the National Economic and Social Rights Initiative (NESRI), provides data and models showing that Vermont could simultaneously guarantee health care access to all its residents, reign in the overall cost of health care, and finance the new health care system, Green Mountain Care, through progressive taxation.

The Healthcare Is a Human Right Campaign says that its financing plan not only shows that universal health care can be financed in Vermont, but that it can be financed far more equitably than the current market-based health care system.

“By moving from private, market-based insurance to public financing of universal care,” Anja Rudiger, NESRI, says, “we flip the way we pay for care: people contribute based on their ability, so that low- and middle-income people pay a smaller share of their income on health care than the wealthy – the opposite of the current system.”

Gerald Friedman, Professor of Economics at the University of Massachusetts Amherst, who advised the campaign, says, "Act 48 promised to establish in Vermont a system of universal health care that would improve the health of its people while shifting the financial burden from the poor and the sick to those able to pay. Building on the Governor’s Green Mountain Care report, the new Equitable Financing Plan shows how this promise can be realized so that Vermont can move forward to a fair and economically efficient health care system."

The financing plan was delivered to legislators along with an open letter from over 100 economists from across the country including Prof. Friedman as well as Dean Baker of the Center for Economic and Policy Research and Richard Wolff of The New School University, New York. Both the plan and the letter are responses to a sudden announcement in December by Governor Shumlin, who had long backed Green Mountain Care, that he would no longer recommend the legislature move forward with public financing.

“As economists,” the letter reads, “we understand that universal, publicly financed health care is not only economically feasible but highly preferable to a fragmented market-based insurance system. Health care is not a service that follows standard market rules; it should be provided as a public good.” The letter calls on Vermont lawmakers to “move forward with implementing a public financing plan for the universal health care system envisioned by state law.”

According to the plan, low- and middle-income families would pay much less in health care costs if Green Mountain Care was implemented. A family with an income of $50,000 per year, for example, would pay 40% less for health care costs on average under Green Mountain Care. The plan proposes taxing wealthier people’s unearned investment income in order to give a bigger break to low- and middle-income families. It also proposes implementing a graduated payroll tax that requires large employers and businesses with highly unequal salary structures to pay more than smaller and more wage-equitable businesses. The payroll tax takes into account the difference between the top 1% of wages and the bottom half of wages in each company, and lowers the tax rate for companies with more equitable wage structures.

Ellen Schwartz of the Healthcare Is a Human Right campaign says that the financing plan and letter make clear that the economics of universal health care are sound. “This plan shows that financing Green Mountain Care is not just doable, but hugely important for Vermont. It would finally guarantee access to health care for everyone in the state, and would also move us toward a much more equitable society in which we each support public systems according to our ability and each get what we need.”

The Healthcare Is a Human Right campaign is working with legislators to introduce a bill for public health care financing, building on the state’s law for universal healthcare, Act 48, which was passed in 2011 but did not include a financing plan.

Links:
Financing plan: http://www.nesri.org/resources/equitable-financing-plan-for-vermonts-universal-healthcare-system
Economists' letter: http://www.nesri.org/economists-support-universal-healthcare

Contact:
Keith Brunner: keith@workerscenter.org, (802) 363-9615
Anja Rudiger: anja@nesri.org, (212) 253-1710 ext. 305 or 917-455-9544

For a summary of Oregon's proposed single payer bill click

Help MVHCA on the road to true universal health care, by donating, hosting a house party, signing up for the newsletter, and attending our monthly meetings.

Governor Brown Supports Health Care for All Oregonians in First News Conference

Health care statement at about 13 minutes.

MVHCA Presence At the Wellness Fair at the First Alternative Co-ops

On Saturday Jan. 10 Mid-Valley Advocates Shelley Ries, Bobbi Hall, Jim Gore and Max Jones joined other vendors tabling in the Wellness Fair at the First Alternative Co-ops—at the north store in the morning and the south store in the afternoon. Talking to new people about the rally Feb. 11 and the need to provide healthcare for all is always educational, and among others we talked to:   a teacher who reported that over the last 20 years she has seen the health of her students decline sharply; a juggler who favors universal publicly funded health care and hopes to do some juggling at the rally; a vendor who at age 44 is "totally thrilled” because for the first time she has health insurance (under expanded Medicaid) and wishes for others to have it too; a shopper with Lyme disease who has received great care from her naturopath and is excited to have comprehensive health care for all that includes naturopaths as practitioners; a shopper who has seen his employer’s health insurance costs go up even as the deductibles have risen ever higher and cancelled out his annual raises. Let’s all talk to our neighbors about these important issues!
(Roberta Hall)

Help spread the word! Sign up to attend the February 11 rally here.  Share the event on Facebook as well!

THANK YOU!

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.

The HB 3260 Study Will Tell Us How to Provide Health Care for ALL Oregonians. Please Donate Now to Help Fund the Study.

We need your donation to make the study happen because the legislature did not fund it. HB 3260 authorizes the Oregon Health Authority to contract a third party to study Oregon’s health care financing options.

The bill stipulates the ideal health care system will:

• Provide universal access to comprehensive care at the appropriate time.

• Allow choice of provider.

• Reduce administrative costs.

• Use sufficient, fair, and sustainable financing.

• Ensure adequate compensation of providers.

• Include physical, dental, vision, and mental health care.

• Be affordable for individuals, families, businesses, and state and local governments.

The study will examine at least four options for financing health care:

1. Implementation of the Affordable Care Act including private health insurance exchanges and the Oregon Integrated and Coordinated Health Care Delivery System (Health Care Transformation process).

2. Implementation of the Affordable Care Act with the addition of a public option and including the basic health program of the Affordable Care Act.

3. Publicly financed, privately delivered single payer health care, decoupled from employment.

4. A plan selected by the OHA that makes available to every Oregonian essential health benefits, including preventive care and hospital services, using private insurance and privately delivered health care

Researchers must consider previous health care financing studies in Oregon and other states, the impact on Oregon’s Health Care Transformation process, and compliance with the Affordable Care Act, the Employee Retirement Income Security Act (ERISA), and other relevant federal law.

The study must consider the impact of each option on individuals, businesses, the economy of the state including employment, and budget impacts to state and local governments.

The final report must include a recommendation for the option that best satisfies the criteria specified in the bill.

More Information

DEADLINE SEPT. 30! PLEASE ACT NOW! Help the HCAO Education Fund Win $10,000!

The Health Care for ALL Oregon Education Fund helps educate people in Oregon about the need for universal publicly funded health care. Let's pitch in and help them earn this grant!  Thank you.

Please help nominate HCAO Education Fund for a $10,000 grant
 

Tom’s of Maine is accepting nominations for its 50 States of GoodTM annual sponsorship program. Tom’s will award $10,000 to one 501(c)(3) nonprofit organization in each state plus the District of Columbia—$510,000 in total.
 
With your help, HCAO-EF could be Oregon’s $10,000 winner. The nomination process is easy and relatively quick. You just need to fill out a simple on-line form. The deadline for nominations is September 30, 2014. 
 
YOUR STEP-BY-STEP GUIDE TO NOMINATING HCAO-EF
Access the nomination form here. After you land on the nomination page, verify your eligibility. Then select the category that best describes HCAO-EF’s overall mission from the pull down menu: Health & Wellness
   Then you will be asked to answer the following two questions. Share specific examples where possible.You only have 300 characters and spaces to answer each question.

1. How has this nonprofit made a difference in your life or the life of someone you know?

Note: We checked and you can talk about how HCAO-EF’s mission would make a difference if we achieve publicly funded health care for ALL.. 

1. What is the one thing you’d want the judges to know about this nonprofit that sets it apart?

Here are some things you might want to say. Use your own words, of course.  

• HCAO-EF’s mission is to educate Oregonians about publicly financed health care.
• Health care is NOT a commodity. It is a human right. HCAO-EF wants all Oregonians to have high quality, publicly funded health care. 
• HCAO-EF is training people to advocate for themselves.
• Have you attended an HCAO-EF educational event?. What did you learn? 
• Our Speaker’s Bureau is educating Oregonians and Oregon businesses about the differences between health care and health insurance and the need for publicly funded health care.
• Our support base is strong and growing: we have more than 12,000 volunteers and supporters with more added daily.
• HCAO-EF’s vision is a system of health care in Oregon that improves the health of all Oregon residents, improves the patient care experience (including quality & satisfaction), and reduces the per capita cost of health care.  
• HCAO-EF embraces health care as a basic human and social need, rather than a commodity. We believe that Oregonians need a health care system that is publicly financed, one that encompasses the principles of universality, equity, accountability, transparency, participation, and public good.

 
NONPROFIT INFORMATION
Name of organization:  Health Care for All Oregon Education Fund
URL of organization:  HCAOEF.org
Nonprofit contact name:  Linda Alband
Nonprofit contact email address:  development@hcao.org
Nonprofit contact phone number:  503-206-6709 (office) or 971-404-9224 (cell)
Select a state (pull down menu):  Oregon

Fill in your name, email address, and phone number in the appropriate places. 
Please contact Linda by phone 971-404-9224 or email if you have questions. 

The Health Care for ALL Oregon Education Fund

Post-Tour Q & A with Gerald Friedman

Mike Huntington relayed these questions to Gerald Friedman. Clarifications in red are Mike’s.

MODELS/STEPS

Q. What’s your opinion about the wisdom of individual states achieving single-payer healthcare rather than working politically to achieve a national single-payer system?
A. With our national government gridlock, states’ efforts are needed even though they may not achieve economies of scale and other benefits of national health insurance. We need to start with a few states in order to match the success of OECD countries in providing the best healthcare to the most people at the least cost.

Q. How can we handle the mechanics of single-payer at the state level? We don’t have the administrative machinery of Medicare to achieve a 2% overhead. (We can’t even build an exchange.)
A. A state single payer plan will be far simpler than the exchanges. Billing could be handled through phone terminals at each provider’s office and healthcare credit cards or smartcards.

Q. What changes should Oregon make for a state-level effort to achieve health care for all Oregon?
A. Get the feds on board regarding Medicare and Medicaid. Learn how the VA is negotiating prices for pharmaceuticals.

Q. Is the co-pay is less likely to prevent the patient from making an appointment and getting needed care than a deductible?
A. Dr. Friedman prefers neither although the co-pay could be administratively simple.

Q. Is there any movement by the people toward single-payer in Massachusetts since healthcare costs are not being controlled by Romney Care?
A. Yes! There is a strong movement for single-payer healthcare in Massachusetts. One third of the legislators (13/40 in the Senate) favors single-payer. Donald Berwick is running for governor, calling for single-payer.

Q. What do you think it will take to achieve a national single-payer system?
A. It will take determination by single-payer supporters. Right now it’s time for the ACA to play itself out.

Q. How can we get around the federal employee benefit plans, federal retirees, and other plans over which the state has no control?
A. We can ignore them if we offer the health plan to everyone in the state.

Q. Are you confident that the assumptions you made in HR 676 (Medicare study) are applicable at the state level?
A. No, they are not.

TAXES

Q. What kind of taxes would you recommend here in Oregon? (Remember we are one of the few states that does not have a sales tax and that depend heavily on personal income taxes to meet the state’s needs.)
A. A top rate would be 9% but this would be deductible from federal income tax assessment. The top federal tax would be 38% making the total 47%.

Q. What type of taxes might people accept?
A. Rich people will probably favor payroll tax, while businesses and corporations will favor an income tax.

Q. What lessons have we learned from Vermont? Do you think they are applicable to Oregon?
A. Vermont and each state will have to deal with the fact of imposing a very large tax. Vermont’s bill based on health care as a human right was passed but without funding explicitly outlined. Now Vermont is struggling to answer funding questions.

Q. You recommend payroll taxes as a part of the formula to finance a single payer plan but with different levels of tax at different income levels. Would the employers match the payroll tax paid by employees? Would large and small employers pay the same percentage?
A. Yes, but in reality both the employer contribution and the employee contribution come from the employee as part of the negotiated salary/benefits package. All payroll taxes are really from the employee. Any amount of payroll tax paid by the employer represents foregone wages negotiated away from employees. Workers wages have been relatively flat over the past twenty years as US business productivity and CEO incomes have dramatically risen. -- Mike Huntington.

Q. How would a single-payer system save money for a small business, that is, one with 50 or fewer employees?
A. A business owner would have personal savings because of reduced or eliminated insurance premiums. Business would increase because consumers would have more money. Employees would be healthier, more productive and reliable. There would be a decreased payroll tax. Recruiting employees would be easier. Even if a business does not qualify for or take advantage of a tax credit through the ACA or does not offer health insurance to its employees (the owner must offer health insurance to employees if the business pays for the owner’s policy) the owner as an individual will save money under a single payer system like everyone else. Everyone else will have more money to spend because they will be paying less for health care. -- Mike Huntington.

Q. What happens to the liability of corporations that have guaranteed future health insurance to retired employees?
A. Corporations (especially multistate corporations) will be relieved of their liability and should jump at the chance to do so.

Q. A tax on financial transactions (“Tobin tax”) should be supported by those who are concerned about stability in the economy. What are some of these groups, and are they actively seeking a Tobin tax right now?
A. National Nurses United and the progressive Caucus of Congress led by Keith Ellison of Minnesota support a Tobin tax. (In other words, liberals and labor.)

Q. Are there financial/cost studies available that a non-financial person can see and understand regarding how or whether universal healthcare payment is viable?
A. Yes. Go to the national PNHP website and enter Gerald Friedman in the search window. Also go to dollarsandsense.org for a two-page summary by Dr. Friedman.

OPPONENTS

Q. What is rent-seeking?
A. It is making a monopoly out of business to increase one’s profits. Examples are big Pharma’s ever-greening of drug patents; also hospitals and insurance companies buying up physician practices.

Q. Do you expect the pharmaceutical industry, hospitals, and medical equipment makers to argue against a single payer system? Are they going to do this right now, do you think?
A. Not now but later, yes, these companies will pour hundreds of thousands of dollars into a media campaign opposing any single-payer proposal that appears to pose a threat to them.

Gerald Friedman - Can We Afford Healthcare for All

Economist Dr. Gerald Friedman spoke in Corvallis on May 16 about how we can and should have publicly funded, universal health care for all.

Northwest Patients to Gain Easy Access to Clinicians’ Notes

Regional collaboration spurs first widespread adoption of the OpenNotes initiative
Portland, Ore. – A unique regional collaboration among nine prominent health systems and medical groups in the Northwest will provide more than one million patients in Oregon and Southwest Washington with electronic access to the notes their providers include in medical records. This marks the first time that OpenNotes, a national movement that urges health-related organizations to adopt open access to clinician notes as a standard of care, has been embraced simultaneously throughout an entire region.   
Spurred by the efforts of the nonprofit group, We Can Do Better, the health providers that have committed to practicing open notes, are Kaiser Permanente Northwest, Legacy Health, Oregon Health & Science University, Providence Medical Group Oregon, The Portland Clinic, The Vancouver Clinic, Portland VA Medical Center, OCHIN and Salem Health. Each of these groups is already practicing open notes in some form or intends to do so sometime in 2014 or 2015. 

Full press release here.