Friday, June 30, 2017

Why US health care costs defy common sense (opinion) - CNN.com

Why US health care costs defy common sense (opinion) - CNN.com

Medicare for All

The Economist/YouGov Poll
April 2-4, 2017

81. Do you favor or oppose expanding Medicare to provide health insurance to every American?

60% Favor strongly or favor somewhat

23% Oppose strongly or oppose somewhat

https://d25d2506sfb94s.cloudfront.net/cumulus_uploads/document/divhts7l9t/econTabReport.pdf

==

The Economist/YouGov Poll
June 25-27, 2017

61. Do you favor or oppose creating a single-payer health care system, in which all Americans would get their health insurance from one government plan that is financed by taxes?

44% Favor strongly or favor somewhat

31% Oppose strongly or oppose somewhat

https://d25d2506sfb94s.cloudfront.net/cumulus_uploads/document/p97ezf7wcq/econTabReport.pdf

===


Comment by Don McCanne

During a time when there is a crescendo of support for single payer/Medicare for All, the Economist/YouGov polls suggest that support declined during the past couple of months. There is a lesson here, but it is not that single payer support is fading.

The single payer policy community would recognize these two questions as being essentially the same from a policy perspective. But the layman hears the first question as being the expansion of Medicare to cover everyone (Medicare for All), whereas the second question is about single payer, government, and taxes (single payer). The first is about a popular insurance program which we have all earned and eventually participate in, and would it be that everyone could be included. The second is about government taking over health care and us being taxed for it when the insurance benefit at work seems to be working just fine, and the boss is already paying for most of it anyway. At least that’s often the perception.

We already knew this. “Medicare for all” polls better than does “single payer.” What is reassuring is that people are beginning to understand the single payer concept well enough such that there is more support than opposition, even if it is a government program for which we will be taxed. The term “single payer” is out there and will be used by friend and foe alike, so people have to understand that it refers to an improved version of Medicare in which everyone gets to participate.


The lesson? We should not only continue with but we should expand our education and advocacy activities through coalitions and grassroots efforts. The people are getting the word. Support is burgeoning. Soon the public will be immunized against the soundbites of the opponents.

Wednesday, June 28, 2017

Robert Reich: This Is the Message Democrats Have Been Searching For | Alternet

Robert Reich: This Is the Message Democrats Have Been Searching For | Alternet

Some states see opportunity for single-payer health care

Some states see opportunity for single-payer health care

Elizabeth Warren: ‘The next step is single-payer’ health care | The Seattle Times

Elizabeth Warren: ‘The next step is single-payer’ health care | The Seattle Times

Warren Buffett Makes The Case For Single-Payer Health Care | HuffPost

Warren Buffett Makes The Case For Single-Payer Health Care | HuffPost

How Did Health Care Get to Be Such a Mess? - The New York Times

How Did Health Care Get to Be Such a Mess? - The New York Times

Medicare Advantage: “The Average Person Is Probably Appalled by This”

Drugs, Crime, Medicare, Nixon - Nygaard Notes
"Young people may not know that there is a “private option” for seniors to choose when they become old enough to qualify for Medicare. If a senior does not want to participate in the traditional fee-for-service Medicare program, they can choose “Medicare Advantage.” I’ll let the Center for Medicare Advocacy explain what we’re talking about: “Traditional Medicare is administered and run by the federal government. Traditional Medicare includes both Part A which covers hospital care and Part B which covers medical insurance. Part C is an alternative to traditional Medicare that allows private health insurance companies to provide Medicare benefits. The private health plans are known as Medicare Advantage plans.”

The Medicare Advantage program—that is, the partial privatization of Medicare—was sold to the public with the traditional pitch that “increased competition” in the “marketplace” would result in better care for less money. This doesn’t appear to be the case, and just this month reports are coming out that offer details about a fairly huge scam that’s been going on for a very long time. In fact, the original complaint about the scam was filed in 2011, but the record was just unsealed in February of this year, and the details are now coming to light as the Justice Department has decided to sue UnitedHealth on the basis of the recently-revealed claims.

The New York Timesreports in its May 16th edition that “now a whistle-blower, a former well-placed official at UnitedHealth Group, asserts that the big insurance companies have been systematically bilking Medicare Advantage for years, reaping billions of taxpayer dollars from the program by gaming the payment system.”

Adds the Times, “The amounts in question industrywide are mind-boggling: Some analysts estimate improper Medicare Advantage payments at $10 billion a year or more.”

“In the first interview since his allegations were made public, the whistle-blower, Benjamin Poehling of Bloomington, Minn. [just minutes from Nygaard Notes HQ!], described in detail how his company and others like it—in his view—gamed the system: Finance directors like him monitored projects that UnitedHealth had designed to make patients look sicker than they were, by scouring patients’ health records electronically and finding ways to goose the diagnosis codes. The sicker the patient, the more UnitedHealth was paid by Medicare Advantage—and the bigger the bonuses people earned, including Mr. Poehling.”

“There were bonuses when Mr. Poehling and his team hit their revenue targets, Mr. Poehling said, but no bonuses for better health outcomes or for more accurate patients’ charts. ‘You or I or the average person is probably appalled by this,’ Mr. Poehling said. ‘But the scheme here was not about delivering better care to members—the thing you would expect from a health care company. It was about increasing the bottom line.’”

I have no doubt that “the average person” believes that the primary concern of a private health care company is to provide better care. That’s the basis upon which Medicare Advantage—in fact, the entire private health care sector in the United States—is sold to the public. The sales pitch goes like this: “Public” programs are rife with waste, fraud, and abuse, while “private” corporations that follow the laws of the market are run like well-oiled machines.

That second part is correct: There is a well-oiled machine at work. The Times quotes Poehling as saying “They’ve set up a perfect scheme here. It was rigged so there was no way they could lose.” But UnitedHealth, and the others, are profit-generating machines, not health-generating machines. And, well-oiled though they are, whistle-blowers like Benjamin Poehling are throwing sand into the gears.

Buried deep in the article, the Times succinctly sums it up the meaning of all of this: “Mr. Poehling’s allegations, if true, could help explain why insurers are staying in the Medicare Advantage program even as they pull out of the Affordable Care Act exchanges in some states: Medicare Advantage offers a way to get extra money from the federal government.”

Almost all of the reporting about Medicare—about health care policy in general—appears in the Business pages. That’s a powerful message in itself (telling us as it does that health care is a “business”), but it also means that most citizens remain ignorant about these developments, as most people do not regularly read the business press. Despite the long-standing advice from Nygaard Notes to do so.

Who knows where the President stands on the issue, but privatizing Medicare is certainly a high priority for House Speaker Paul Ryan and also for Tom Price, the new head of the Department of Health and Human Services. And the sales pitch, as always, will be the promise that a privatized system will deliver better health care for less money. The Benjamin Poehling whistle-blower suit tells a different story, and it’s up to us to talk about this story and to help make the real goal of privatization—increased profits for Wall Street, not better health care—clear for all to see."

Sunday, June 25, 2017

Dipesh Navsaria: Privately insured? What happens to Medicaid affects you too | Column | host.madison.com

Dipesh Navsaria: Privately insured? What happens to Medicaid affects you too | Column | host.madison.com

RECOMMENDATION: HMO exemption in state single-payer legislation must be specific and narrow | Physicians for a National Health Program

RECOMMENDATION: HMO exemption in state single-payer legislation must be specific and narrow | Physicians for a National Health Program

From Kip Sullivan:

SB 562, the so-called "single payer" bill introduced in the CA
legislature earlier this year, has been tabled for now, and will
apparently not be heard again in 2017. This may or may not be good
news.

As you know, I think the bill in its current form is a multiple-HMO bill because it
contains a huge loophole for Kaiser Permanente, a loophole so large
any insurance company calling itself an "integrated delivery
system" will walk through. SB 562 in its current form will at
best mislead the public about what a single-payer is and do a
relatively ineffective job of keeping costs under control, and at
worst will recreate the ACA mess -- costs won't be contained,
coverage will be stingy or much less than promised, taxes will go up
by more than they need to, and single-payer and universal coverage
and "government" will all get a bad name. Or maybe it will
recreate the Vermont-Governor-Shumlin mess: The researchers and
agencies that have to estimate the cost of SB 562 will see through
the "single payer" charade and score it for what it is -- a
multiple-HMO bill -- and Democrats will be forced to abandon it
because it costs too much.

But messages I have gotten from several people in CA suggest that real single-payer
advocates were working on amendments to SB 562 to shrink the Kaiser
loophole. Why these amendments weren't offered in the Senate I don't
know. From everything I've read, SB 562 was introduced in a hurry and
many issues, ranging from funding to the Kaiser loophole, hadn't been
resolved. I suspect SB 562 was written and introduced in a hurry
because the authors didn't anticipate Trump's election and, after his
election, realized Obamacare was in trouble and now was a good time
to push a solution that goes beyond the ACA.

I have also heard that the opportunity to amend in the Assembly wouldn't have arrived
till late July. If that's the case, then there was still time for
real single-payer advocates to prepare and lobby for an amendment
that would shrink the Kaiser loophole. Now that SB 562 is tabled, it
isn't clear (to me at least) what's going to happen to the loophole
language.

If in fact what I just told you is true, that would explain why some PNHP docs are
referring to SB 562 as a single-payer. They didn't have a chance to
influence the writing of the original SB 562 because it was written
so quickly, but they anticipated shrinking the Kaiser loophole later
in the process and didn't want to stir up a fuss saying it's not a
single-payer. If the Kaiser loophole was going to be shrunk to the
size of the HMO loophole in HR 676, then the indefinite tabling of SB
562 is not good news.

Here is a description of the HMO loophole in HR 676 taken from a 2010 article
http://www.pnhp.org/news/2010/july/recommendation-hmo-exemption-in-state-single-payer-legislation-must-be-specific-and-n
I wrote with David Himmelstein and Steffie Woolhandler, the
founders of PNHP, in 2010:

==
Specifically,
participating plans must:

(1) be nonprofit;
(2) "actually deliver care in their own facilities" through salaried physicians who are
employees (not contractors) of the HMO;
(3) not use their capitation or budget payments to cover hospital services (hospital
services would be paid for through a global budget paid directly to the hospital); and
(4) not offer financial incentives based on utilization.

Very few HMOs will qualify under this definition.
==
Not one of those four criteria are mentioned by the Kaiser-loophole provisions
currently in SB 562.


Kip

Monday, June 19, 2017

Every Democrat in America Should Support Medicare for All | By Shaun King | Common Dreams

Every Democrat in America Should Support Medicare for All | By Shaun King | Common Dreams

Letter: Single-payer is way to go for health care - Opinion - recordonline.com - Middletown, NY

Letter: Single-payer is way to go for health care - Opinion - recordonline.com - Middletown, NY

Love the simplicity of this LTE:

Letter: Single-payer
is way to go for health care
Posted Jun 18, 2017

Since WWII we Americans have been trying to pound a square peg into a round hole. I
am referring to the health care vs. health insurance dilemma we struggle with. Health care is the round hole; free-market health insurance is the square peg.
Health care is patient-driven and includes preventative measures to help people
remain healthy and supplies a standard of care when needed. People
are treated before small problems accelerate into huge ones that can
send them to the emergency room, the most expensive health care
“system.“Free-market health insurance, the square peg, is a
fee-for-service system that offers various and often very limited
services. We all know the loopholes: no pre-existing conditions
coverage; very limited availability or affordability; and surprises
when you find that this test or that procedure are not covered.
Premiums are up to 30 percent higher because doctors are motivated to
overly prescribe and test, and need additional staff to deal with
insurance companies.
No wonder we find ourselves at a road block; as the president exclaimed a few days into
office, “who knew health care was so complicated?” I suggest that
we eliminate “complicated” and slip a round peg into the round
hole by switching to a single-payer, universal health-care system.
Throw away the insurance square peg. We could join all other
developed democracies in the world. Everyone wins except the
insurance companies and the politicians who accept their money.

Sunday, June 11, 2017

5 reasons all advisers should pay attention to the single-payer debate | Employee Benefit Adviser

5 reasons all advisers should pay attention to the single-payer debate | Employee Benefit Adviser

See comment.  Re-training is needed for these poor insurance company workers.  But, not for the CEOs.

Is a single-payer system the solution? Universal health care | NWADG

Is a single-payer system the solution? Universal health care | NWADG

This NY Times piece is in a NW Arkansas paper! The country IS changing.

This uses the term "government health care". This is an example of language shaping the issue. There are many, including elected officials, who actually believe single payer universal health care is only the original British model where providers of health care would be employees of the government. The government needs to guarantee access to health care for all. Private insurance (the whole concept of insurance) was installed here between me and my doctor/provider of health care. I don't have private insurance for my local police protection, my local fire department, my local street repair & plowing, my local public school, our military, etc. etc. I don't want all our providers of service to become government employees (BTW - most who are do a great job). I do want private insurance as a part of our health care system to become a failed experiment of the past. It has done nothing to improve my access to health care and it has only succeeded in lining the pockets of very rich CEOs and shareholders. The US has the most expensive health care in the world with the worst outcomes. It is time to turn that around.

Friday, June 2, 2017

Want to know what Trumpcare would do to the country? Look at the implosion in Iowa. - The Washington Post

Want to know what Trumpcare would do to the country? Look at the implosion in Iowa. - The Washington Post

Fixing healthcare: Which single-payer system would be best for California? - LA Times

Fixing healthcare: Which single-payer system would be best for California? - LA Times
Comment by Kip Sullivan:
"This article in the Los Angeles Times http://www.latimes.com/business/lazarus/la-fi-lazarus-single-payer-california-choices-20170307-story.html uses "single payer" to describe the German health care system and Medicare Advantage (the privatized portion of Medicare). It's easy to see why a reporter without much knowledge of health policy would make that mistake, especially now that "single payer" advocates in CA are calling SB 562, a German-style and Medicare Advantage-style bill, a "single payer" bill.

The reporter, David Lazurus, interviews several experts and concludes the German system is the best one for CA because it would allow Kaiser Permanente and other private insurers to continue to function. One expert tells Lazurus the "German-style approach ...would make it easier to incorporate Kaiser." That's accurate. The German system would leave the insurance industry in place; SB 562 leaves some of the existing CA insurance industry in place and will create new insurance companies by shifting total insurance risk onto them.

As I have noted here before, SB 562 contains an enormous loophole for Kaiser. The loophole doesn't refer to Kaiser, but instead to "integrated delivery systems" that would bear all insurance risk just as Kaiser does now -- in other words, Kaiser is still the same old gigantic HMO under 562 it's always been. SB 562 proponents, however, have long made it clear Kaiser is what the authors of SB 562 have in mind when they wrote the words "integrated delivery system."

Under a single-payer system, all insurance risk stays with the government (as it does, for example, in the fee-for-service Medicare program and in Canada). Under single-payer systems, insurance risk is NOT palmed off onto private-sector entities like Kaiser and some of the enormous hospital-clinic chains calling themselves "integrated delivery systems." When private-sector entities bear insurance risk, they incur all the costs insurance companies incur (with one or two exceptions, notably the cost of collecting premiums), and they have all the incentives to screw patients that insurance companies have now.

That doesn't mean that a German system in CA can't cost less than the crazy system CA and the rest of the country suffers now. (This is especially true of the German system prior to about 1995.) Multiple-payer systems like Germany's cut costs as single-payers do with one obvious exception -- the savings in administrative costs that come with one payer paying doctors and hospitals directly.

A recently released study of SB 562 http://www.healthycaliforniaact.org/wp-content/uploads/Pollin-Economic-Analysis-SB-562.pdf concludes it would insure all Californians and yet reduce CA's total spending by 8 percent. I have only scanned the summary of this study. I get the impression the study treats CA as if it were a German system even while calling it a single-payer system. Since I haven't read the study, I can't say how the study arrives at its conclusion that total spending will fall by 8 percent. I do think a German-style system could easily cut spending in an American state by 8 percent.

But a huge caveat is in order. The system that SB 562 will create will be unlike any seen anywhere on the planet. The distinguishing feature of the CA system under 562 will be enormous aggregations of hospitals, clinics, pharmacies, nursing homes, ambulance services, equipment suppliers, and God knows what else, with an insurance department on top of all that to manage risk. No other nation -- not Germany, Holland, Switzerland -- with multiple-payer systems has allowed or encouraged the formation of such gigantic fiefdoms. SB 562 not only allows horizontal and vertical merging of all players, it encourages it.

So as we contemplate whether a German-style system could work in CA or MN, we have to ask whether we're talking about the German system or the SB 562 version of the German system. If we mean the latter, then we have to think about more than a projected 8 percent cut in total spending. We have to ask whether it's politically possible to control the merger madness SB 562 will encourage, and whether it's politically feasible to audit and otherwise hold accountable corporations as big as Kaiser as well as the monster corporations that will gobble up every thing in sight in order to compete with Kaiser."   

What would California's proposed single-payer healthcare system mean for me? - LA Times

What would California's proposed single-payer healthcare system mean for me? - LA Times

Study: Single-payer plan would save California $37 billion per year

Study: Single-payer plan would save California $37 billion per year