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.

Dr. Samuel Metz Protests the AMA's Endorsement of Price for HHS Secretary

Below is a letter to the AMA by Dr. Samuel Metz of Physicians for a National Health Program (PNHP) and Health Care for All Oregon (HCAO) about his opposition to the AMA's endorsement of Donald Trump's nomination of Dr. tom Price for Secretary of Health and Human Services.

Dear Oregon physicians,
 The nomination of Dr. Tom Price as Donald Trump’s Secretary of Health and Human Services was endorsed by the American Medical Association. https://wire.ama-assn.org/ama-news/why-we-support-dr-price-lead-hhs
 I was not happy with this choice. Below is a letter sent to the AMA office listing my objections. Following it are two responses from the AMA.
 Other physicians were even more unhappy with this choice. Nationally, many took action:
 https://medium.com/@ClinicianAction/the-ama-does-not-speak-for-us-d697511267d5#.rwy2o6f3i
 
http://www.bizjournals.com/portland/news/2016/12/15/not-all-oregon-doctors-like-trumps-choice-for-hhs.html
 The first link allows more physicians to join as signatories. Please consider doing so.
 Please also consider contacting the AMA office with your opinion.

Samuel Metz, MD

 
-----Original Message-----
From: Samuel Metz [mailto:s@samuelmetz.com]
Sent: Wednesday, November 30, 2016 10:17 AM
To: Medical Association American (Jack.Deutsch@ama-assn.org)
 
Mr. Deutsch,
I am deeply disappointed with the AMA’s enthusiastic endorsement of Dr. Tom Price for Secretary of Health and Human Services.
As the AMA endorsement states, Dr. Price is an experienced physician, administrator, and legislator. He understands how to achieve policy goals.
It is his specific policy goals that concern me. Dr. Price’s highest priorities are protecting physician Medicare revenue and reducing federal Medicaid spending.
 In contrast, my highest priority is increasing every patient’s access to healthcare regardless of ability to pay at time of need. Dr. Price’s priorities conflict with mine.
 I am a private practice anesthesiologist who enjoys my highly paid medical specialty. All my patients receive excellent care, or so I hope. My greater concern, and the concern the AMA should adopt, is getting care to patients who currently get none, and suffer or die for that lack of care. One third of Americans, insured or not, delay or defer care because of inability to pay. The US is unique among industrialized nations in rationing care on the basis of individual wealth.
 Dr. Price’s policies improve my income and reduce my taxes. They do not correct America’s wretched system of denying care.
 The AMA has always put my professional financial needs first. That should change. Compared to other nations, American patients (including mine) suffer the worst outcomes from chronic diseases and die more frequently of treatable diseases because of inability to pay for treatment. This also should change. I want the AMA to advocate for patients. I am willing to sacrifice portions of my income to bring better care to more patients.
 The AMA endorsement of Dr. Price creates a moral dilemma. Do I remain a member of a professional organization that places my financial interests above the interests of patients too poor to afford care, even care from me?
 The AMA public image, rightly or wrongly, as a “physicians first – patients second” organization is corroborated by this endorsement. I urge the AMA leadership to consider the credibility damage to the AMA generated by associating with Dr. Price’s policies. My fear is that the AMA will lose current members, lose public trust, and lose the next generation of physicians whose professional commitment places patient access above personal financial success.
 Please reconsider the AMA endorsement of Dr. Price.
 Samuel Metz, MD
 

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.

Our Nation Needs This Balm as Single-Payer Action Surges Forward

Published on Monday, November 02, 2015 by Common Dreams

Rally for healthcare justice at Chicago's "Bean." (Photo: Donna Smith)

Rally for healthcare justice at Chicago's "Bean." (Photo: Donna Smith)

Over the past few days, more than 700 people from all over the country came together for the annual single-payer strategy conference.  This year, we were in Chicago, my hometown,  Of course we shared ideas, successes, concerns, and knowledge about the kind of healthcare reform that might truly give us the best healthcare system in the world through an improved Medicare for all for life model.

The convening groups represented Healthcare-NOW, the Labor Campaign for Single-Payer Health Care, One Payer States, and Physicians for a National Health Program.

Leaders from this movement get precious little time to gather face-to-face during the year.  There were scores of nurses from all over the country -- New York, Massachusetts, Illinois, Texas, California, Minnesota, Pennsylvania and beyond.  There were doctors from all over the place.  And there were those of us who are patients who have been injured (or might be injured) by our aggressively greedy healthcare system.  Labor leaders brought the hopes of their rank and file membership that someday we will actually allow contract bargaining to surround much more than healthcare benefits and costs that have squeezed out other issues like wages, vacation and other leave benefits and so on.

The conference opened with a joint protest at the Blue Cross/Blue Shield building in Chicago.  One of the great moments for me was seeing the medical students passionately calling for changes to their chosen profession.  It gave me hope for the future and the potential for real change.

But the highlight of the conference for me came in something much less quantifiable but much more powerful -- the balm of knowing that this wonderful nation is filled with compassionate, decent people who believe in the promise of our Declaration of Independence in which we read that all men are endowed by their creator of certain unalienable rights, and that among these rights are life, liberty and the pursuit of happiness.  There can be none of those dearly held rights for Americans when our healthcare system snuffs out any chance for equality and the opportunity to live life to its fullest extent.

We are not enemies of our neighbors, our business owners or our fellow Americans who may hold very different political positions.  When it comes to our unalienable rights, we are one.

On Sunday morning when we convened for the final session, John Lozier of the National Health Care for the Homeless Council called us together.  John reminded us that after Halloween comes the Day of the Dead, and he asked that we silence ourselves -- not an easy task for this many opinionated, wonderful social justice warriors -- and the room grew quiet.  John asked us to remember all of those who have lost the struggle to stay alive in the midst of a cloud of inhumanity that has emboldened those who profit from the pain of others.  I cannot say that it was silent.  Although there was an absence of noise, the energy of compassion swelled in the air.

In those few moments of collective remembrance, the room was filled with a palpable sense of belonging to something greater than ourselves that drives us onward to the day when our healthcare system unites us around healing and health rather than profits and wealth.  I tried to turn my thoughts away to gather myself for the morning's work, but the wonder, comfort and compassion washed over me in waves.  I tried not to weep.  I fought back my tears.  And all at once, I knew why it is not only possible but probable that we will secure the rights we all need to be as free and healthy as our neighbors.  I felt what it might be like to rest in that security and compassion.  And let me say, it was one of my life's "ah ha" moments.  Imagine a society that healed instead of arming itself for the next gun assault our streets.

So, going forward to do the work we envisioned is so much more important than our focus on the healthcare system or other progressive struggles.  It is about who we are as human beings and how we make sure that we can live up to the elegance of the words written in the Declaration and so oft cited by those who would tear us apart for personal gain.  All men, all women, all children are created equal.

Finally, just moments before we needed to part, a dear friend and brilliant woman professor, Lindy Hern, handed me a gift she brought me from her home state of Hawaii.  It is a beautiful little jar of ginger-guava lip balm.  Indeed.  Another balm.  I march on.  We march on.  We will achieve our goal, and soon we will gather in joyous celebration that the years of struggle when we worried about the path forward will wash away, and we will leave our children the promise we hold dear -- a nation that lives up to its earliest bargaining agreement that brought us together almost 240 years ago to believe we are indeed not only deserving of equal rights but endowed with those rights.

Won't you be a part of creating this kind of nation and this kind of world?  Join us.  A better society is coming.  Everybody in, nobody out.  Our battle cry sounds an awful lot like that long ago declaration, and it calls us to action.

This work is licensed under a Creative Commons Attribution-Share Alike 3.0 License

Donna Smith is the Executive Director of Health Care for All Colorado and the Health Care for All Colorado Foundation. 

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.

Why Canadian Hospitals Outperform U.S. Hospitals

From the Huffington Post:

by Co-founder, Physicians for a National Health Program, Professor, Public Health, CUNY, advisor, EvidenceNetwork.ca, and David Himmelstein Co-founder, Physicians for National Health Program, Professor Public Health, CUNY, advisor, EvidenceNetwork.ca

In many countries, bereaved families get condolence cards and flowers. In the U.S., they are also deluged with hospital bills and insurance paperwork.

That paperwork isn't merely an insult. It costs U.S. society a fortune. Take hospitals, for instance. According to research we recently published in Health Affairs, U.S. hospitals spent $215 billion in 2011 on billing and administration, a striking 1.43 per cent of GDP.

Put another way, about $1 of every $4 of U.S. hospital spending goes to bureaucracy rather than patient care.

Other countries manage modern, first-rate hospital systems for far less. While administration devoured $667 per capita annually in the U.S., we found that Canada spent only $158, Scotland $164, England $225 and the Netherlands $325.

If U.S. hospitals ran as efficiently as Canada's, the average U.S. family of four would save $2,000 annually on health care.

Moreover, U.S. hospital paperwork costs have risen sharply since 2000, even after adjusting for inflation. In contrast, administration's share of hospital budgets in Canada has actually fallen since 1999.

A generation ago, it took just one or two managers to run a U.S. hospital. Now, the CEO has been joined by "chief officers" for operations, finance, compliance, information, quality management, and more.

Each chief commands his/her own legions - hundreds of billing and registration clerks, referral managers, upcoding specialists (to translate doctors' diagnoses into the most profitable billing codes), and massive IT departments whose first commandment is "get the bill right."

Why are U.S. hospitals so inefficient? Our multiple-payer insurance system forces every hospital to negotiate rates with dozens of insurance plans, each with its own coverage rules, billing procedures and documentation requirements. And each hospital must collect deductibles, co-payments and co-insurance from tens of thousands of patients.

In contrast, Canada and Scotland -- where bureaucratic costs are lowest -- have single-payer systems that reject this kind of red tape and the need to bill for every Band-Aid. They pay hospitals simple lump-sum budgets, the way we fund local fire stations. And like fire departments, their hospitals don't need to collect from each victim of misfortune.

But the complexity of hospital billing isn't the only thing driving bureaucracy. Hospitals have been forced to add layers of business expertise in order to survive in our market-driven system.

A hospital that doesn't show an operating profit can't fund essential new investments in new equipment and cutting-edge services, or modern buildings. That means administrators have to devote resources to financial gaming like marketing lucrative services (e.g. sports medicine); billing units to squeeze every penny from insurers and patients; and strategies to recruit profitable (well-insured) patients, and avoid unprofitable (e.g. uninsured) ones.

The dismal record of for-profit hospitals illustrates the problem with running hospitals as businesses. The for-profits have higher death rates and employ fewer clinical personnel like nurses than their non-profit counterparts. But care at for-profits actually costs more, and they spend much more on the bureaucracy, a reflection of the high cost of implementing shrewd financial strategies.

Canadian and Scottish hospital administrators don't have to play financial games to assure their survival. Government grants -- rather than operating profits -- pay for new buildings and equipment. Even in France and Germany, where hospitals bill multiple payers, bureaucratic costs are modest because government directly funds most hospital investments.

England and the Netherlands provide unfortunate counter-examples. Pro-market reforms initiated during the Thatcher era have driven English hospital administrative costs sharply higher. And only U.S. hospitals have higher administrative costs than those in the Netherlands, where radical market-oriented reforms now pressure hospitals to show a profit.

Economics textbooks hold that subjecting medicine to market forces will stimulate efficiency and root out waste. But reality stubbornly refuses to obey. In health care, market-oriented policies encourage hospitals to shift resources to business strategies that boost the bottom line, but contribute nothing to care.

Dr. Steffie Woolhandler is an advisor with EvidenceNetwork.ca and co-founder of Physicians for a National Health Program. She is professor of public health at the City University of New York and lecturer in medicine at Harvard Medical School. She is also an internist at the Montefiore Medical Center in New York.

Dr. David Himmelstein is an advisor with EvidenceNetwork.ca and co-founder of Physicians for a National Health Program. He is professor of public health at the City University of New York and lecturer in medicine at Harvard Medical School. He is also an internist at the Montefiore Medical Center in New York.

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.

PNHP - What Single Payer Advocates Can Learn From Australia

Australian Health Care — The Challenge of Reform in a Fragmented System

By Jane Hall, Ph.D.
The New England Journal of Medicine, August 6, 2015

The Australian health care system appears remarkably successful in delivering good health outcomes with reasonable cost control. Australians enjoy one of the longest life expectancies and a long healthy life expectancy, while costs as a proportion of the gross domestic product remain around the median among countries in the Organization for Economic Cooperation and Development (OECD). Universal, tax-financed comprehensive health insurance, Australian Medicare, has been largely stable for three decades. Yet this performance has been achieved through, or despite, the interplay of public and private financing, public and private service provision, and a division of responsibilities between the federal and state governments. The main political parties clash over the role of government and whether national health insurance in its current form should continue.

Australian Medicare was established in 1984, after a period of tumultuous change. Australia has moved through numerous approaches to health care financing: private insurance with public subsidies (pre-1974), publicly financed national universal health insurance (Medibank, 1974–1976), predominantly private insurance with public subsidies (1976–1984), publicly financed national universal health insurance (Medicare, 1984–1996), publicly financed national universal health insurance with publicly subsidized private health insurance (1996–2013), and publicly financed national universal health insurance with means testing for private insurance subsidies (2013 to present). The rationale for government subsidies for private insurers alongside a public universal insurance scheme has never seemed clear; perhaps it is best seen as the compromise between the “strife of interests masquerading as a conflict of principles” that, according to health planner Sidney Sax, characterizes the Australian system. full text here

Comment:

By Don McCanne, MD

Probably the greatest problem with government financed and government administered health care systems is that, whenever conservatives gain control of the government, they attempt to privatize the systems, believing that markets work better than the government. Currently we are seeing such efforts in England, Canada and Australia.

As today’s message demonstrates, Australia serves as a prime example of how the health care systems suffer under continuing shifts in political ideology, with the most damage being done under conservative rule. As their government leadership changes periodically, “Australia has moved through numerous approaches to health care financing.” 

Jane Hall, the author of the NEJM article above, writes, “The rationale for government subsidies for private insurers alongside a public universal insurance scheme has never seemed clear; perhaps it is best seen as the compromise between the ‘strife of interests masquerading as a conflict of principles’ that, according to health planner Sidney Sax, characterizes the Australian system.”

Thus Australia has ended up with a highly fragmented system, though shifting political winds make it likely that they have not seen the last change. (More information is available in the white paper produced by the current conservative Australian government - link above.)

One interesting observation in the NEJM article (which is available for free at the link above) is the contrast between the public and private sectors in delivering health care. An example is that “42% of private deliveries (unadjusted for risk factors) are caesareans, versus 29% of public deliveries.” Their private sector seems to have much in common with our medical-industrial complex.

Many single payer supporters in the United States continue to advocate for a “public option” - a government-run insurance that competes with the private plans - as an incremental step towards a universal single payer system. Australia’s Medibank began as such a program in 1975. The Wikipedia chronicle (above) of the history of Medibank reveals that it has transformed into the largest, private, shareholder owned insurance company in their nation. Although our efforts at establishing a public option never got off the ground, before the effort was abandoned, the concept had already evolved away from an expansion of Medicare into simply another player in the private insurance market, government in name only.

Our health care politics have much in common with Australia, and we both have fragmented health systems as a result. Our public Medicare program has already been partially privatized by using overpayments of taxpayer dollars to lure Medicare beneficiaries into the private Medicare Advantage plans. The conservatives are not through in that they want to shift the entire program into the private sector by use of “premium support” vouchers. Of course, the expansion of private insurance plans also perpetuates fragmentation, though currently efforts are being made to convert the insurers into private oligopolies - perhaps the worst model of health care reform that we could have.

So who ultimately controls the ideological complexion of the government? The voters, of course. That is why it is crucial that we continue to educate the public on single payer - an improved Medicare for all - contrasting it with the more dysfunctional models, with our present system being a prime example of dysfunction. The people can have a much better health care system, but they are going to have to understand what that is so that they will demand it of our politicians.

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.

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.

Price Gouging by Drug Manufacturers

Don McCanne of PNHP comments here on the article in the Boston Globe about why the cost of naloxone, which is used to reverse heroin overdoses, has skyrocketed since former governor Deval Patrick declared a public health emergency a year ago.

Comment by Don McCanne

Drug manufacturers recently have been engaged in outrageous pricing
practices for essential drugs that they produce - the hepatitis C drugs
being an egregious example.

Narcan - a crucial life saving drug that reverses narcotic overdoses - now
has much wider distribution since it has become available to first
responders. The manufacturer - Amphastar Pharmaceuticals - in what has to
be more than a mere coincidence, chose this time to sharply increase the
price of this drug.

When the market is dysfunctional, it is the responsibility of government to
intervene. The United States has shirked its responsibility. We need to
revise our approach.

A single payer national health program functions as a monopsony - a single
purchaser of products and services. In private markets, monopsonistic
pricing can be as evil as monopolistic pricing like the example of Narcan.
The difference with a government monopsony is that it gets pricing right -
an adequate price to be sure that products and services remain available,
yet at a price that does not gouge the taxpayers who fund the system.

 

 

 

Single-Payer Health Care Support Growing

From The Corvallis Advocate:

By Kirsten Allen

Ron Green first learned of the woes of providing health care to employers in the 70s when he was running a bike shop in Texas. Green, a disabled veteran, receives free health care through the VA. When his bike shop began to expand, he looked to hire workers that were either young and still covered by their parents’ insurance, or old enough to receive Medicare, to keep costs down and earn profit.

“In the late 1960s, we had 5% of our GDP devoted to health care. Now, that’s 18%, and it’s going up. That’s just not sustainable, we can’t afford to keep doing that. Those that do have coverage often go bankrupt either providing it or paying medical bills, and those who don’t are constantly worried about the consequences of not having it,” said Green.

It is for this reason, as well as several others, that Green agreed to chair the Mid-Valley Health Care Advocates (MVHCA). MVHCA is a grassroots organization founded in the early 90s, with the goal to bring quality health care to everybody. Along with their ally, Health Care for All-Oregon, (HCAO) a coalition of over 100 organizations, MVHCA is working “to create a comprehensive, equitable, affordable, publicly funded, high quality, universal health care system serving everyone in Oregon and the United States.”

Medical bills are the number one reason Americans are in debt. The US is paying more toward health care than the entire GDP of France, and yet we are ranked 31st in the world. Green, along with volunteers of MVHCA, is trying to change this using the method of single-payer health care.

Also referred to as universal health care, single-payer health care is a system where the state government provides free health care to everybody. Funded by a progressive income and employer payroll tax, single-payer would provide quality health care free of premiums, deductibles, and co-payments.

Green again: “The fact is, it’s going to cost a lot of money. It’s not politically easy to sell to people the idea that we’re going to have to raise so much money from taxes to pay for it. The other half of that, of course, is you subtract from that all the health insurance company premiums, all the co-pays and deductibles. The intent of the plan is to cover all services previously covered by Oregon Educators Benefit Board (OEBB), Public Employees Benefit Board (PEBB), Medicare, Medicaid and Medicare Advantage Plans.”

HB 2922 was brought to the Oregon legislature in 2013, outlining the implementation of the plan. Though the bill didn’t go to General Assembly for a vote, it had 24 sponsors, up from 12 in 2011. This year, Green expects that number to increase to 36. The health care plan was supplemented by HB 3260, which proposed a study of four different health care systems in attempt to discern which system would best fit Oregon. The study is estimated to cost $200,000, a drop in the bucket considering the amount of money the state has spent before. The bill passed, overwhelmingly in fact, but was later struck down because a source of funding hadn’t been identified. The bill is expected to pass in the next legislative session, and Green suspects the results of the study will be in favor of a single-payer system.

Although HB2922 didn’t pass, sponsorship in the legislature nearly doubled since the previous vote, and is expected to continue growing. Though a promising sign, ahead lie many obstacles waiting to slap the bill down. Perhaps the most challenging obstacle is the profit-driven system we are involuntarily thrust into. This system has many stakeholders (medical device manufacturers, pharmaceutical companies, insurance companies, etc.) whose profits would take a hit and who would squeal the loudest when this plan creates enough steam to capture more widespread interest and support.

Another obstacle Green expects to encounter lies at the heart of what the single-payer plan is all about: health care for everybody, including undocumented migrant workers. After the failure of Measure 88, Green suspects this to be a considerable point of contention. However, no matter the amount of resistance this matter is likely to receive, it will remain non-negotiable.

The governance of the plan is also expected to draw opposition. Typically citizens are wary of health care when the government is involved (think of the infamous “death panels” that accompanied the rolling out of Affordable Care Act). However, Green believes this is a taboo society must overcome. The plan will be governed by a board of directors containing nine voting members appointed by the governor and approved by the Senate. The board will include two licensed health care providers, two persons with significant education and experience in public health, two with demonstrated experience in health or consumer advocacy, and one each from labor and business. Having a state-regulated health care system would allow for better allocation of resources, cut wasteful spending, and reduce expensive overhead.

Among single-payer’s many advocates, Physicians for a National Health Care System has been boisterously supportive. Dr. Carol Paris, a psychiatrist and member of PNHCS, states the cost of dealing with insurance companies to an average primary care physician is somewhere around $68,000. These costs result in an increase in price and decrease of face time for patients, because doctors need to see a larger volume of patients to make enough money to pay their insurance clerks and have enough money left over to support themselves.

Now that you know the who, the why, and the what, get ready to embrace the when, the where, and the how. MVHCA are teaming up with HCAO to rally at the capitol in Salem on Wednesday, Feb. 11 from 11 a.m. to 1 p.m. Buses will run from Corvallis and Albany to transport red shirt-wearing, banner-carrying folks wanting to express their desire for health care for all. The rally will feature live music, inspiring speakers, and a chance to join a group to meet with legislators. Being that this is an issue universal to all colors, ages, and occupations, it would be fantastic to have more than the typical old white protestor. The rally is expected to draw 2,500 people, so don’t wait to reserve your bus seat! For more information or to reserve your seat, visit www.mvhca.org. For more info, visit www.pnhp.org/facts/single-payer-faq.

Sign up to ride the bus! Join us in a LIve-Tweet!

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...

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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...

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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.

Doctors Actually Want Single Payer Healthcare

Doctor Carol Paris, psychiatrist and member of Physicians for a National Health Program, joins us to discuss why a single payer national healthcare system would be preferable to the current system. Become a member & Support TDPS: http://www.davidpakman.com/membership If you liked this clip of The David Pakman Show, please do us a big favor and share it with your friends...

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Two Memes that Undercut Medicare-for-All: Managed Care and Competition

From our friends at PNHP-

By Don McCanne, MD

The dream of expanding Medicare to cover all of us has failed to materialize in a large part because of the nation’s obsession with marketplace concepts of health care financing. On the supply side, health care providers are responding to financial incentives that maximize their revenue. On the demand side, patient-consumers are responding to financial incentives that minimize their out-of-pocket spending. In both instances, health care access is compromised - in managed care by erecting structural barriers to care (“managing” the care), and in competition by erecting financial barriers to care (buying competitively-priced plans with lower premiums that have higher deductibles and other cost sharing).

Where did this obsession come from? Gilens and Page have shown that the very wealthy and large business interests have control over major legislation. These interests benefit from marketplace approaches to health care through investments in for-profit insurance companies and in health care delivery organizations, including for-profit hospitals. In contrast, their tax burden in publicly-financed health programs is greater when taxes are progressive. Also many other important government programs are financed through progressive taxes, so the moneyed interests benefit by privatizing government functions to the maximum extent possible.

These interests, along with ideologues, have made a meme of the concept that private markets are always more efficient than massive government bureaucracies, when the evidence is almost always to the contrary. Unfortunately, much of the media have accepted this meme as a given. Since everyone “knows,” based on a lifetime of exposure to these memes, that the private sector can always do it better, they are quite willing to support private solutions to problems such as the financing of health care.

Whenever proposals such as expanding Medicare come up, the insurance industry pulls the puppet strings in Congress, and the public is reminded how well UnitedHealth and the other for-profit insurers are doing in creating private products that have lower out-of-pocket costs than Medicare (not mentioning that they are doing that with one-third of the overpayments they receive while keeping the other two thirds for profits and to pay for the excessive administrative services that they are selling us - a bad deal for taxpayers).

So those who support the intrusive managed care organizations and who support shifting more costs directly to patients under the false banner of marketplace competition (see Kenneth Arrow) have been effective in suppressing any serious consideration of improving Medicare and expanding it to cover everyone. As long as the public continues to buy their meme, there is little likelihood of change.

We need to continue to inform the public on the legitimate findings of health policy science (national health programs that include everyone while providing higher quality at a lower cost), but that is a daunting task considering how difficult it is to communicate complex policies to a population blunted by unfounded memes.

Medicaid improving access for the homeless, but…

Below are the comments by Dr. McCanne of PNHP about the article

Early Impacts of the Medicaid Expansion for the Homeless Population
By Barbara DiPietro, Samantha Artiga and Alexandra Gates

Kaiser Family Foundation, November 13, 2014

Comment: By Don McCanne, MD

The experience of the homeless population under the Affordable Care Act (ACA) demonstrates both the benefits of reform under ACA and the flaws of ACA that call for replacement with a single payer system. ACA was better than nothing, but we can have so much more through enactment of a single payer system.

The primary ACA benefit for the homeless is that most of them in expansion states qualify for Medicaid and thus have improved access to health care without financial barriers. Some of the homeless who access health care have been noted to have an increased ability to work and to maintain stable housing. Financial stress is reduced and some have gained access to appropriate disability benefits. These benefits to the homeless are more reasons why calls for simple repeal of ACA are bad policy, devoid of compassion.

Yet the last paragraph from the excerpts above explains why Medicaid managed care is often a poor choice for the homeless (and many other lower-income individuals as well). Homeless patients often are unable to see the health care professionals who would be most accessible and appropriate for them. Transportation concerns are more likely. Essential specialized services may not be available. Managed care intrusions such as prior authorization requirements, limitations and changes in formularies, or other perverse managed care innovations may impair access to important health care services or products. Further, those states that refuse to expand Medicaid are leaving most of the homeless without any coverage and therefore reliant on often inadequately funded safety-net institutions.

There are those who believe that we should merely proceed with implementation of ACA and try to obtain legislative and administrative patches along the way. Compared to the deficiencies in our dysfunctional system, patches have only minimal beneficial impact while increasing the administrative complexity that already overburdens our system. Patches fall way too short of what we need.

We should not repeal ACA since it does provide some temporary benefit until we can implement a single payer system. But we should not let ACA implementation divert us from instituting what we really need - a single payer national health program. Not only would that benefit the homeless, it would benefit all of the rest of us as well.

Read the full post here.  Consider joining MVHCA and attending our Feb. 11 Rally.