Health Care Around the World - Video by T.R. Reid

Published on Apr 7, 2012 on YouTube

Fans of U.S. health care reform point out that many other countries provide coverage for all their citizens, and no one files for bankruptcy due to medical bills. But how exactly do these countries do it? January Series guest & journalist T.R. Reid, author of The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, tells of his travels comparing systems around the world. Shirley Hoogstra hosts.

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.

Video: This Won't Hurt a Bit

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

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

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

This U.S. doctor is moving to Canada. Find out why.

This story of a U.S physician, Emily Queenan, moving to Canada so that she could care for patients without spending most of her time fighting with private insurance gives the flip side of the argument that if a universal publicly funded system is adopted in Oregon the physicians will flee to other states. Many physicians want to care for their patients without fighting insurance.

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.

Here's the story as published in the blog of Kevin Pho MD:

I’m a U.S. family physician who has decided to relocate to Canada. The hassles of working in the dysfunctional health care “system” in the U.S. have simply become too intense.

I’m not alone. According to a physician recruiter in Windsor, Ont., over the past decade more than 100 U.S. doctors have relocated to her city alone. More generally, the Canadian Institute for Health Information reports that Canada has been gaining more physicians from international migration than it’s been losing.

Like many of my U.S. counterparts, I’m moving to Canada because I’m tired of doing daily battle with the same adversary that my patients face – the private health insurance industry, with its frequent errors in processing claims (the American Medical Association reports that one of every 14 claims submitted to commercial insurers are paid incorrectly); outright denials of payment (about one to five percent); and costly paperwork that consumes about 16 percent of physicians’ working time, according to a recent journal study.

I’ve also witnessed the painful and continual shifting of medical costs onto my patients’ shoulders through rising co-payments, deductibles, and other out-of-pocket expenses. According to a survey conducted by the Commonwealth Fund, 66 million — 36 percent of Americans — reported delaying or forgoing needed medical care in 2014 due to cost.

My story is relatively brief. Six years ago, shortly after completing my residency in Rochester, New York, I opened a solo family medicine practice in what had become my adopted hometown.

I had a vision of cultivating a practice where patients felt heard and cared for, and where I could provide full-spectrum family medicine care, including obstetrical care. My practice embraced the principles of patient-centered collaborative care. It employed the latest in 21st-century technology.

I loved my work and my patients. But after five years of constant fighting with multiple private insurance companies in order to get paid, I ultimately made the heart-wrenching decision to close my practice down. The emotional stress was too great.

My spirit was being crushed. It broke my heart to have to pressure my patients to pay the bills their insurance companies said they owed. Private insurance never covers the whole bill and doesn’t kick in until patients have first paid down the deductible. For some, this means paying thousands of dollars out-of-pocket before insurance ever pays a penny. But because I had my own business to keep solvent, I was forced to pursue the balance owed.

Doctors deal with this conundrum in different ways. A recent New York Times article described how an increasing number of physicians are turning away from independent practice to join large employer groups (often owned by hospital systems) in order to be shielded from this side of our system. About 60 percent of family physicians are now salaried employees rather than independent practitioners.

That was a temptation for me, too. But too often I’ve seen in these large, corporate physician practices that the personal relationship between doctor and patient gets lost. Both are reduced to mere cogs in the machine of what the late Dr. Arnold Relman, former editor of The New England Journal of Medicine, called the medical-industrial complex in the U.S.

So I looked for alternatives. I spoke with other physicians, both inside and outside my specialty. We invariably ended up talking about the tumultuous time that the U.S. health care system is in — and the challenges physicians face in trying to achieve the twin goals of improved medical outcomes and reduced cost.

The rub, of course, is that we’re working in a fragmented, broken system where powerful, moneyed corporate interests thrive on this fragmentation, finding it easy to drive up costs and outmaneuver patients and doctors alike. And having multiple payers, each with their own rules, also drives up unnecessary administrative costs — about $375 billion in waste annually, according to another recent journal study.

I knew that Canada had largely resolved the problem of delivering affordable, universal care by establishing a publicly financed single-payer system. I also knew that Canada’s system operates much more efficiently than the U.S. system, as outlined in a landmark paper in The New England Journal of Medicine. So I decided to look at Canadian health care more closely.

I liked what I saw. I realized that I did not have to sacrifice my family medicine career because of the dysfunctional system on our side of the border.

In conversations with my husband, we decided we’d be willing to relocate our family so I could pursue the career in medicine that I love. I’ll be starting and growing my own practice in Penetanguishene on the tip of Georgian Bay this autumn.

I’m excited about resuming my practice, this time in a context that is not subject to the vagaries of backroom deals between moneyed, vested interests. I’m looking forward to being part of a larger system that values caring for the health of individuals, families and communities as a common good — where health care is valued as a human right.

I hope the U.S. will get there some day. I believe it will. Perhaps our neighbor to the north will help us find our way.

Emily S. Queenan is a family physician. This article originally appeared in Evidence Network.

Tea Party Patriot May Vote For Hillary

From Rawstory:

A conservative video blogger with over a million views on YouTube said this week that he would likely vote for Democratic presidential candidate Hillary Clinton because he was terrified that a Republican president would take away his affordable health insurance.

James Webb, a 51-year-old YouTube celebrity who devotes his “Hot Lead” channel to topics like his love of guns and ranting about gay men kissing on The Walking Dead, may have shocked his viewers on Monday when he revealed that he was torn over which party to vote for in the 2016 election.

“And I’m serious because I asked myself, ‘Which party has helped me out the most in the last, I don’t know, 15 years, 20?’ And it was the Democrat [SIC] Party,” Webb lamented. “If it wasn’t for Obama and that Obamacare, I would still be working.”

“With Obamacare, I got to retire at age 50 because if it wasn’t for Obamacare, I would have had to work until I was 65 and get on Medicare because health insurance is expensive when you’ve got medical problems,” he continued.

Webb said that he hoped to lose some weight and get in shape by taking advantage of a gym membership that was covered by his health insurance.

“But you know, the Republican Party, they haven’t done nothing for me, man. Nothing,” he remarked. “So, I’m leaning toward voting for Hillary unless something major comes up. I don’t trust the Republicans anymore because they’re wanting to repeal the Obamacare. And I don’t want them to do that, man, because then I’ll have to go to work again. My life’s already planned out.”

“Just a tough decision,” Webb sighed. “I voted for Republicans for 32 years, I’m a charter member of my Tea Party Patriots chapter. I’m also a veteran of the U.S. Army under Reagan, when Reagan was in. That was great when Reagan was in there.”

“Things have changed. So unless the Republicans change with it, I’m probably going to have to swing my vote over toward Hillary.”

Watch the video below from the Hot Lead YouTube channel.

The lesson -- once people get health care, they don't want to give it up. Publicly funded universal health care would cover more people for less money. Help us spread the word by joining MVHCA!


Photos of the February 11 Rally in Salem

We had a large and enthusiastic turnout for the Health Care for ALL rally on  February 11 at the  capitol in Salem. Thanks to all who attended and helped out.

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

Thank you to Mina Carson, Sandra Bean, and Amy Roy for their photos. Mina's full album of rally photos can be found here.

Health care costs keep Oregon ex-pats in Canada

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

March 24, 2015 9:00 am

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

But they don’t dare.

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

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

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

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

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

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

Michael Huntington MD

Corvallis

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

 

MVHCA at Corvallis Sustainability Fair

At the Mar. 12 Sustainability Fair MVHCA was asked to have interactive features so we made lots of photo petitions—25 in the two hours we had! On the right panel of our display board was an actual photo petition and a note inviting people to tell their legislators their advocacy for universal health care—and this made it easy to describe to people what we asked them to do. Thanks to Don Hall for processing them to send to HCAO for their website. In 2 hours we made 25 photos!

Don Hall made the diagrams for our board. Shelley Ries, Maxine Eckes, Jim Gore, and Bobbi Hall were the regular volunteers. and MVHCA Chair, Ron Green, stopped by and gave our hard-working volunteers some time off to get food at the fair. A busy and successful time! Thank you to all our dedicated volunteers!

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.

 

FEBRUARY 11 RALLY INFORMATION!

Information about the rally program available here.

Rally bus information:

Please show up to ride the early bus to Salem:
St. Mary's (25th St. side, north parking lot) at 8:30
Unitarian Fellowship (2945 Northwest Circle Boulevard) at 8:40
Albany (Former K-mart parking lot, 3100 Pacific Blvd) at 9:10

For the 10:00 buses please be at any of these locations by 9:45:
South Co-op (north parking lot, Chapman Pl side)
St. Mary's (25th St. side, north parking lot)
Albany (Former K-mart parking lot, 3100 Pacific Blvd) at
Unitarian Fellowship (2945 Northwest Circle Boulevard)
The bus from the UU will go straight to Salem. The bus starting at the South Co-op will proceed to
St. Mary's and then Albany.

Rally day suggested social media messages

                    "I'm _____________ from ____________.
I'm here in solidarity with Health Care for All
members who are in Salem today urging
you to support universal, publicly funded
healthcare for all Oregon."
                    "I'm _____________, a small business
owner from _________. I support universal,
publicly funded health care for all Oregon
and hope you will support bringing
affordable health care to small businesses."
                    "I'm ___________ from ___________. I
support universal, publicly funded health
care for all Oregon. Everybody in, nobody
out!"
                    "I'm ______________ from ___________.
I'm looking forward to meeting with you
today to encourage your support for
universal, publicly funded health care for all
Oregon."   

           
          Rally Chants:
What do we want?
Healthcare for All!
When do we want it?
NOW!

Everybody in and Nobody out
That’s what healthcare is all about!


Health Care, Yes!
Denials, No!
Pro-fi-teers have got to go!



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!

2015 HCAO Rally on the Capitol Steps!

Join 2,500 other Oregonians carrying signs & banners supporting universal, publicly funded (single payer) healthcare in Oregon! There will be great music & inspiring speakers.

"Everybody in & nobody out! Why? Because we believe health care is a basic human right!"  
 
Mark your calendar and join us and Health Care for ALL Oregon on the Capitol steps in Salem, February 11th from 11AM to 1PM. We expect 2,500 people carrying signs and banners while they listen to a program of great music and inspiring speakers.

Buses to Salem from Albany and Corvallis ($15 suggested donation).
 

There will also be the opportunity to join a group to meet with legislators. Don’t wait – start your plans to RIDE THE BUS AND RALLY WITH US and spend the day in Salem Rallying with HCAO Supporters and telling Oregon Legislators that we want health care for all people!

Please share this post.

Save your seat and register for the Rally today.


2015 HCAO Rally on the Capitol!

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

Harvard’s Health Benefits Unfairness

The Harvard Crimson, November 12, 2014

(Excerpts)

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

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

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

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

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

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

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

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

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

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

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

****

Harvard Ideas on Health Care Hit Home, Hard

By Robert Pear

The New York Times, January 5, 2015

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

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

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

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

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

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

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

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

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

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

****

Comment:

By Don McCanne, MD

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

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

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

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

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

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

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.