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.

MVHCA Annual Picnic Celebration!

INSTEAD of having a business meeting on the fourth Monday of August we will be celebrating a very busy 2014-5 year — rally, hearing, meetings with legislators, 50th Medicare birthday, TR Reid-visit and much hard work! So it is time for a picnic-potluck.

Bring food you'd like to share: a casserole, a salad, a main dish or dessert—whatever you like and enough for a few others too. If you have plastic or metal plates, and silver and napkins, bring them along! and we’ll have some recyclable ware if you do not; we’ll take home what’s leftover and compost what waste we produce. If you have a large cloth tablecloth, bring it along and don’t forget it when you go home. We can relax and refresh, and get prepared to enjoy a provocative play (called “Mercy Killers”) on Sept. 19, 7 p.m., at Takena Hall at LBCC (tickets available at the potluck and at Grassroots Books too).

We’ll have food and conversation and a short program including a visit from the Health Care for All Oregon’s Outreach board member Nancy Sullivan who will very briefly describe strategies that HCAO is considering. We’ll also introduce a few other distinguished guests and make a few announcements, but mainly we’ll enjoy the evening. You can take a minute to have a photo petition made to show your legislators you favor health care for all, too.

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.

UPDATE: T.R. Reid at LBCC -- Report, Photos, and Recordings

MVHCA Chair Roberta Hall made recordings of T.R. Reid's talks in Salem and Albany. They are available for streaming and downloading here. She also interviewed him and that conversation is available here.

By MVHCA Chair Roberta Hall:

TR Reid, author of The Healing of America, made a whirlwind tour of Oregon over the last weekend in July, making numerous appearances before packed public audiences such as the 250-plus crowd at LBCC’s Takena Hall the evening of July 25. The venue worked well and will be the site Sept. 19 of the play MERCY KILLERS.  TR in addition to public talks also met with smaller groups of health care reform leaders such as members of Physicians for a National Health Program in Portland and the board of Health Care for All Oregon in Corvallis. On the 25th, Mike Huntington, Bruce Thompson, Sandi Bean and Bobbi Hall took him from Portland to Salem for a noon talk in front of a large crowd at the Salem City Club, then to Corvallis to meet with the HCAO board, and then to LBCC to give a talk, followed by personal conversations with attendees, at LBCC.

The talk in Salem compared what the Affordable Care Act has done to advance health care with what needs to be done to extent care to everyone and also outlined what the Colorado plan will offer. To see a video of it go to the Club’s website:   salemcityclub.com    An audio podcast of the evening talk will be posted on the Mid-Valley website mvhca.org; and an interview with TR Reid made by Bobbi Hall will be aired on KBOO.fm (90.7 in Portland, 104.3 in the Corvallis area), and will be posted as a podcast on mvhca.org.

TR had questions for the HCAO board, and it had questions for him. As TR Reid chairs the Colorado Foundation for Universal Health Care, which is preparing an initiative petition to advance universal health care coverage, and the HCAO board is considering its next move, both organizations learned from each other’s experiences. He gave his Oregon colleagues much to chew on. We in the mid-valley owe much to several of our members for making large donations that brought our speaker and paid for theater rental at LBCC. Clearly, this event showed that we need more donations as well as more volunteers to meet our goals, and we all can add something.

bobbi hall

Tim Roach, representing HCAO and MVHCA encourages the crowd to join in the movement for publicly funded, universal health care.

Tim Roach, representing HCAO and MVHCA encourages the crowd to join in the movement for publicly funded, universal health care.

T.R. Reid speaking at Linn Benton Community College

T.R. Reid speaking at Linn Benton Community College

A large and supportive crowd at LBCC

A large and supportive crowd at LBCC

MVHCA members and benefactors at LBCC

MVHCA members and benefactors at LBCC

T.R. Reid speaks with Health Care for ALL Oregon Board

T.R. Reid speaks with Health Care for ALL Oregon Board

HCAO Board in discussion with T.R. Reid

HCAO Board in discussion with T.R. Reid

T.R. Reid with Mike Huntington taking notes

T.R. Reid with Mike Huntington taking notes

Thank you to all who helped, donated and attended.

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.

One-Man Play: Mercy Killers

More on our Upcoming Events Page.  Invite your friends through Facebook

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.

Universal Healthcare Expert to Visit Oregon, Tout Single Payer Plan

T.R. Reid's Oregon tour is featured in the Lund Report:

Efforts are underway in Colorado and Oregon for universal healthcare.

By Shelby Sebens

T.R Reid is hoping that Colorado is the first state in the nation to provide a healthcare system that covers everyone. But he’d still be happy if Oregon got there first.

“Some state has to get this going and prove that it will work and then it will spread,” Reid said.

An author and chairman of the Colorado Foundation for Universal Health Care, Reid will be in Oregon this weekend touting healthcare for all. Advocates in Colorado will put a measure on the 2016 ballot. Though the Affordable Care Act, better known as Obamacare, was intended to get every American insured, the Congressional Budget Office predicts 31 million people will still be uninsured as of 2025.

“The Obamacare solution doesn’t get us there,” said Reid, who has traveled the world studying universal healthcare in other countries. “It’s a national disgrace that we would have 31 million people uninsured in the world’s richest country.”

Reid said he thinks the way to universal coverage in the United States is through state initiatives.

“Congress can’t do this. This is a proven route to universal coverage,” he said of states adopting it first.

Efforts have been underway toward universal healthcare in Oregon for years and advocates say it’s gaining momentum though most universal healthcare bills that have made their way to hearings in the legislature have yet to pass.

“Each time that the state single payer bill is submitted to the legislature it gets more attention, more support and it becomes more viable,” said Dr. Samuel Metz, a member of Oregon Physicians for a National Health Program.

A bill on its way to Governor Kate Brown’s desk would fund a study that will look at methods for financing universal healthcare, Metz said. “The study in Oregon is necessary but not sufficient. It’s a first step but it doesn’t guarantee that the legislature will take action.”

Colorado’s Purple Plan

Reid thinks universal healthcare has a good shot in Colorado because of the state’s political Make up, divided evenly between Democrats and Republicans. He intends to appeal to Democrats as a way to insure everyone and save money and to Republicans as a way to get out of Obamacare. An opt out clause in the Affordable Care Act allows states to get out of the federal mandates while still receiving Medicaid dollars if they can insure people another way, Reid said.

“That’s why I think we can pass it,” said Reid who expects a fight from insurance companies. He argues the private market can still offer supplemental insurance as well as private insurance for those that don’t want a state run plan similar to parents paying to send their children to private schools.

The Colorado plan would add a 3.3 percent state income tax. Employers would also have to pay into the plan. Reid said studies showed Colorado families typically pay 8 percent of their salaries on healthcare.

Oregon’s efforts

Metz thinks Oregon is uniquely poised to push forward on universal healthcare because many insurance companies are non-profit and might benefit under a universal healthcare plan.

“They would thrive in this new business environment. We don’t see this in other states.”

Reid said Colorado is a little more ahead of the game, with its universal healthcare study completed and a ballot measure ready to go.

“We beat you to marijuana and we’ll beat you to universal healthcare,” he quipped.

Here are the events featuring T.R. Reid:

  • July 24th, Friday Noon, Collaborative Life Sciences Building, OHSU, 2730 SW Moody, South Waterfront, Portland. Open to PSU and OHSU students.
  • July 24th, Friday 6:00 pm in Portland: Health Care for All Oregon fundraiser with Mr. Reid as the featured guest. Please contact Terry Rogers at (503) 756-4273 or ibuterry@gmail.com for more details.
  • July 25th, Saturday 12:00 pm in Salem: “Obamacare: Is it the answer?” Presentation by Mr. Reid to the Salem City Club followed by discussion. Creekside Room, Building D, Salem Hospital Campus, 890 Oak Street SE, Salem. Details will be available at http://salemcityclub.com/page-953771
  • July 25th, Saturday 7:00 pm at the Russell Tripp Theater, Linn-Benton Community College, Albany: Presentation by Mr. Reid followed by discussion: “Our Costly and Troubled Sick Care System: U.S. Health Care, What to Do About It.”
  • July 27th, Monday 6:00 pm at the Multnomah County Building, 501 SE Hawthorne, Portland, Board meeting room: Presentation by Mr. Reid followed by discussion: “Universal Health Care: Why Oregon Won't Be First.” No charge. Registration is encouraged (http://www.pdxcityclub.org/calendar_day.asp?date=7/27/2015&event=294). This event is hosted by the City Club of Portland, Health Care Member-Led Forum. Mr. Reid will be introduced by Mike Marshall, executive director of the Portland City Club.

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.

HB 2828 Health Care Study Bill Signed into Law by Governor Brown

Thank you to all who worked hard at educating your elected officials about the importance of this bill in identifying the most cost effective way of providing health care to all Oregonians.

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.

Medicare Birthday Celebration Photos

Thanks to all who helped make this event such a great success! Photos courtesy of John G. Booker, Jr., Dr. Mike Huntington, and Amy Roy

Thank you also to Norbert DuBois for the photos below.

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.

2015 LEGISLATIVE SESSION UPDATES

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

Health Care for ALL Oregon (HCAO) posted this information about health care bills in the Oregon Legislature:

The 2015 Health Care for All Oregon Act previously LC 2548 is now SB 631 with its formal introduction in the Senate occurring on February 11th. The bill has been assigned to the Senate Health Care committee which is chaired by Senator Laurie Monnes-Anderson a supporter of our bill. A hearing is expected in early March.

Our priority bill in the 2015 legislative session is the extension and full funding of the Health Care Study HB 2828.  Passage will commission a rigorous study, the results of which will be a recommendation to the legislature as to the best method of funding comprehensive health care in Oregon. HB 2828 will be heard by the House Health Care committee on Monday February 16th at 1pm. Testifying on behalf of the bill will be Senator Michael Dembrow chief sponsor, Representative Smith Warner Co-sponsor and Sam Metz a physician allied with HCAO and key player in the passage of HB 3260 the predecessor to HB 2828. The bill is expect to pass out of the committee and move on to the House Ways and Means committee where it should be funded at the end of the 2015 session.

At the February 11th HCAO Capitol Rally HCAO activists from across the state met with their legislators to discuss our bills and ask their legislators' support.  From the report outs both oral and written our bills and especially HB 2828 received strong support. Some fiscally conservative are waiting to see the results of HB 2828 study before weighing in on SB 631.

Our goal in the 2015 session remains 36 sponsors and co-sponsors for our bills. As of the Rally on February 11th the number of sponsors for HB 2828 was 27 and rising. Having just been introduced SB 631 is only beginning to gain sponsors and cosponsors. We do expect as a results of our many legislative visits on the 11th and ongoing efforts we will see sponsorship continue to grow. Thanks go to all who came to Salem for the rally and lobbied their legislators.

Information on the SB 631 hearing will be made available as we receive it. We are presently preparing our panel of experts for the hearing. If you would like to testify at the hearing please contact me by clicking on my name below.

Information regarding our bills will continue to be available on this site.

Mark Kellenbeck, Chair, HCAO Legislative Committee

Summary of Our Bills:

 2 pages: Summary of The Health Care for All Oregon Act – SB 631.  
     This is HCAO’s publically funded universal health care bill.
     Full Bill text
1 page: Summary of The Health Care Study Bill – HB 2828. 
     The is HCAO’s must past bill in 2015.
     Full Bill Text

Recap of Voting History:

3 pages: The Oregon Health Care Study Bill - 2013 Passage Voting Census. 
     This recaps 2013 voting in the House and Senate. We are counting on these votes and desirous of new supporters (especially Republican) in 2015. 

Recap of Bill Sponsorship:

1 page: The Health Care for All Oregon Act – 2013 Legislative Sponsors.  
      This recaps all sponsors in the House and Senate in 2013, we are working to increase sponsorship to 36 (12 new sponsors in 2015).

Talking Points for Single Payer and HCAO Legislation:

2 pages: HCAO Talking Points
2 pages: Talking Points for the Health Care for All Oregon Act SB 631. 
      This provides strong single payer arguments and explanation of HCAO’s bill as well.
1 page: Key Talking Points for the Oregon Health Care Study Bill
      The provides a summary of the bill and strong points supporting the value and passage of the bill in 2015.

Video of Salem Rally

Filmed in Salem Oregon on 2.11.15 on the steps of the State Capital Health Care For All Oregon This is the complete rally and speeches video More info here: www.HCAO.org

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.

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.

 

Senate Bill 631 (Health Care for ALL Oregon) Summary

Summary of SB 631
 

Purpose of the Act: The purpose of the Act is to ensure access to comprehensive, quality, patient-centered, affordable, and publicly funded health care for all Oregonians, to improve population health, and to control the cost of health care for the benefit of individuals, families, business, and society.

Who is covered: All persons residing or working in Oregon.

Covered services: Services that are medically necessary, and/or appropriate for the maintenance or rehabilitation of health or the prevention or diagnosis of health problems, excluding elective cosmetic surgery, and including: Primary and preventive care, including health education; Specialty care; Inpatient care; Outpatient care; Emergency care; Home health; Prescription drugs; Durable medical equipment; Mental health services; Substance abuse treatment; Dental services; Women's health services; Chiropractic, Acupuncture, and Naturopathic services; Ophthalmic services, as well as basic vision and vision correction; Diagnostic imaging, laboratory services, and other diagnostic and evaluation services; Inpatient and outpatient rehabilitative services; Emergency transportation; Language interpretation and translation services; Palliative and hospice care; Podiatry; Dialysis; and telemedicine as it becomes available and effective. In 2019, The Board shall submit a plan to the Legislative Assembly to include Long Term Care in the Plan. (The Board will determine which services will be covered under each of the above categories.)

The Plan will cover all services previously covered by Oregon Educators Benefit Board (OEBB), Public Employees Benefit Board (PEBB), Medicare, Medicaid and Medicare Advantage Plans unless strong medical evidence indicates such services should be discontinued.

Choice: Participants are free to choose any state licensed health care providers practicing within the scope of their licenses.

Affordability: No co-payments and deductibles. Providers must accept payments from the Plan as payments in full and may not bill participants for services covered by the Plan.

Financing the Plan: In lieu of premiums, co-payments, co-insurance, and deductibles, the Health Care for All Oregon Plan will be funded primarily by a progressive income tax and a progressive employer payroll tax, which will be collected by the Oregon Department of Revenue and deposited in the "Health Care for All Oregon Fund." The intent is that:  

• The revenue raised by the progressive income tax will be approximately equal to the total currently paid by Oregonians for co-payments, co-insurance, and deductibles, with no new income tax on those below about 150% to 200% of the poverty level. (details TBD)
•  The revenue raised by the employer payroll tax on public payrolls will be smaller than what is currently paid for employee health insurance. (details TBD)
•  The revenue raised by the employer payroll tax on private sector payrolls will be less than the average currently paid for employee health insurance by firms of similar size. (details TBD)

Following arrangements for necessary waivers, exemptions, and agreements, the Legislative Assembly shall enact legislation necessary to assure that all payments for health care services provided to participants from federal, state, county, and local government sources will be paid directly to the "Health Care for All Oregon Fund."  
 
Fund for displaced workers: The Board will provide in the budget funds for up to two years of training and extended unemployment benefits, if necessary, of workers displaced as a result of this Act for the first four years that the Plan is operational.

Health Care for All Oregon Fund: All money in the Fund shall be used only for payments to health care providers, administrative costs, approved "capital expenditures for major facilities and equipment, independent Ombudsman offices for both health care providers and Plan participants, training for workers displaced by the Plan, extended unemployment benefits to workers displaced by the Plan if needed, and incentives/training to ensure an adequate number of health care providers in Oregon.

Governance: The Plan will be governed by a Board of Directors of nine voting members, appointed by the Governor and confirmed by the Senate. Two of the appointed members shall be licensed health care providers, at least one of whom is other than an MD or DO, two shall have significant education and experience in public health, two shall have extensive demonstrated experience in health or
consumer advocacy, and one each shall be from labor and business. There shall be at least one board member from each of Oregon*s congressional districts.

Responsibilities of the Board: The Board is responsible for the development and implementation of the Plan and oversight of Plan management, including, but not limited to: Seeking all waivers, exemptions, and agreements from federal, state, and local government sources that are necessary to provide funding for the Plan; Determining policies and adopting administrative rules; Adopting a biennial budget; Determining the specific benefits package; Overseeing management of the HCAO Fund; Ensuring that health services reimbursed by the Plan are evidence-based and cost-effective; Ensuring access to quality health services; Emphasizing disease prevention and health promotion; Establishing a process to evaluate proposed capital expenditures for major facilities, equipment and services to ensure equitable distribution of facilities and services; Partnering with public health agencies to improve population health; Submitting the Plan budget to the Oregon Legislature; Ensuring that implementation of the Act is equitable for Plan participants, regardless of health status, age, disability, gender, employment or income; Reporting at least annually to the Legislature and the public on the performance of the Plan; Recommending needed amendments to this Act and related legislation; Establishing cost containment mechanisms; Ensuring that Oregon's health care workforce is sufficient in numbers and adequately trained to meet the increasing demands of health care expansion and transformation, possibly using funds to attract or train providers if necessary; Working with Oregon's congressional delegation to change federal legislation or policy to support Oregon's health care expansion and transformation.

Advisory Committees: The Board shall apportion the state into regions for advice and planning purposes with at least one such region in each congressional district. Each region will have a Regional Advisory Committees to solicit input, receive complaints, conduct public hearings, facilitate accountability, and assist the Board. Each region shall also have a Regional Planning Board to identify health care facility and service needs in order to achieve optimum population health and equitable distribution of health services throughout Oregon. The Regional Planning Boards will review both privately and publicly funded major capital projects, and may recommend capital expenditures by the Plan towards health care facilities or equipment.

Oregon Health Authority: The Oregon Health Authority shall implement and administer the Health Care for All Oregon Plan under the general direction, policies, and oversight of the Board. This Act repeals the Oregon Health Insurance Exchange, Oregon Medical Insurance Pool Board, Oregon Medical Insurance Pool, Office of Private Health Partnerships, Family Health Insurance Assistance Program, and the private health option under Health Care for All Oregon Children program when the Plan becomes operational.

Thank you Roberta Hall for this summary.

To follow the progress of this or any other bill, or to read the entire text, click here

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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.

Gazette-Times LTE Isn't it time to make the change to universal health care?

In the December 30, 2014 issue of the Corvallis Gazette-Times, MVHCA's Roger Blaine refers to the opinion in the Chicago Tribune Ebola didn't have to kill my uncle, Thomas Eric Duncan. He makes some great points about the need for universal health care.

An article in the Chicago Tribune (Oct. 16) states that Thomas Eric Duncan, the first person on American soil to die from the Ebola virus, was turned away from the hospital on his first ER visit because, as a visitor to this country, he had no health insurance. This failure to treat put Mr. Duncan’s family and the whole of their community at risk of the disease. Indeed, it quite possibly led to Mr. Duncan’s death.
This lack of treatment for those without medical insurance is another example of the costs that a for-profit health care system puts on the well-being of some patients and the health of the community.
The Affordable Care Act does not prevent this situation. Only a universal health care system where everyone is in and no one is out will address it. Here in Oregon such a system goes by Health Care for All, Universal Medicare, and Single Payer Health Care. Universal health care implements the moral concept that health care is a human right, endorsed by the United Nations and World Health Organization and is the medical standard of most of the developed world. Our repeated failure to pass a single-payer health care plan is one of the reasons why we place 37th globally in health care outcomes, a Third-World ranking, all the while paying more than twice as much for healthcare than any other country. Universal health care will reduce the overall cost of medical care and improve its availability. Isn’t it time to make this change?

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