Thursday, December 31, 2015
Wednesday, December 30, 2015
Tuesday, December 29, 2015
Monday, December 28, 2015
Sunday, December 27, 2015
Saturday, December 26, 2015
Friday, December 25, 2015
Sanders on Single Payer
http://readersupportednews.org/opinion2/277-75/34235-focus-single-payer-health-care
want to talk with you about one of the very real differences between Secretary Clinton and me that surfaced during last weekend's debate, and that is our approach to health care in this country.
Single Payer Health Care
By Bernie Sanders,
Reader Supported News
24 December 2015
want to talk with you about one of the very real differences between Secretary Clinton and me that surfaced during last weekend's debate, and that is our approach to health care in this country.I was, and all progressives should be, deeply disappointed in some of her attacks on a Medicare-for-all, single-payer health care system. The health insurance lobbyists and big pharmaceutical companies try to make "national health care" sound scary. It is not.
In fact, a large single-payer system already exists in the United States. It's called Medicare and the people enrolled give it high marks. More importantly, it has succeeded in providing near-universal coverage to Americans over age 65 in a very cost-effective manner.
So I want to go over some facts with you and ask that you take action on this important issue:
Right now, because of the gains made under the Affordable Care Act, 17 million people have health care who did not before the law was passed. This is a good start, and something we should be proud of. But we can do better.
The truth is, it is a national disgrace that the United States is the only major country that does not guarantee health care to all people as a right. Today, 29 million of our sisters and brothers are without care. Not only are deductibles rising, but the cost of prescription drugs is skyrocketing as well. There is a major crisis in primary health care in the United States.
So I start my approach to health care from two very simple premises:
- Health care must be recognized as a right, not a privilege -- every man, woman and child in our country should be able to access quality care regardless of their income.
- We must create a national system to provide care for every single American in the most cost-effective way possible.
I expected to take some heat on these fundamental beliefs during a general election, but since it is already happening in the Democratic primary, I want to address some of the critiques made by Secretary Clinton and Rupert Murdoch's Wall Street Journaldirectly:
Under my plan, we will lower the cost of health care for the average family making $50,000 a year by nearly $5,000 a year. It is unfair to say simply how much more a program will cost without letting people know we are doing away with the cost of private insurance and that the middle class will be paying substantially less for health care under a single-payer system than Hillary Clinton's program. Attacking the cost of the plan without acknowledging the bottom-line savings is the way Republicans have attacked this idea for decades. Taking that approach in a Democratic Primary undermines the hard work of so many who have fought to guarantee health care as a right in this country, and it hurts our prospects for achieving that goal in the near future. I hope that it stops.
Let me also be clear that a Medicare-for-all, single-payer health care system will expand employment by lifting a major financial weight off of the businesses burdened by employee health expenses. And for the millions of Americans who are currently in jobs they don't like but must stay put because of health care access, they would be free to explore more productive opportunities as they desire.
So, what is stopping us from guaranteeing free, quality health care as a basic fundamental right for all Americans? I believe the answer ties into campaign finance reform.
The truth is, the insurance companies and the drug companies are bribing the United States Congress.
I want to make health care a right for every American. The health care industry doesn't like that very much, so they're flooding my opponents with cash. Fight back against those who want to stop a Medicare-for-all, single-payer system with a contribution to our campaign.
Now, I don't go around asking millionaires and billionaires for money. You know that. I don't think I'm going to get a whole lot of contributions from the health care and pharmaceutical industries. I don't like to kick a man when he is down, but when some bad actors have tried to contribute to our campaign, like the pharmaceutical CEO Martin Shkreli who jacked up the price of a life saving drug for AIDS patients, I donated his contribution to an AIDS clinic in Washington, D.C.
Secretary Clinton, on the other hand, has received millions of dollars from the health care and pharmaceutical industries, a number that is sure to rise as time goes on. Since 1998, there are no industries that have spent more money to influence legislators than these two. Billions of dollars! An absolutely obscene amount of money. And in this election cycle alone, Secretary Clinton has raised more money from the health care industry than did the top 3 Republicans -- combined.
Now, and let's not be naive about this, maybe they are dumb and don't know what they are going to get? But I don't think that's the case, and I don't believe you do either.
So, what can we do about it?
Changing the health care laws in this country in such a way that guarantees health care as a right and not a privilege will require nothing short of a political revolution. That's what this campaign is about and it is work we must continue long after I am elected the next President of the United States.
And because of the success we have enjoyed so far, I am more convinced today than ever before that universal quality health care as a right for all Americans will eventually become the law of the land.
It is the only way forward.
Thank you for standing with me on this important issue.
Thursday, December 24, 2015
Wednesday, December 23, 2015
High Deductibles and Narrow Networks: The Achilles Heel of the ACA'S Health Insurance | John Geyman
High Deductibles and Narrow Networks: The Achilles Heel of the ACA'S Health Insurance | John Geyman
"It is time to replace it with a more accountable system with universal access, cost containment, lower administrative overhead, and a service-oriented culture--single-payer national health insurance (NHI)."
"It is time to replace it with a more accountable system with universal access, cost containment, lower administrative overhead, and a service-oriented culture--single-payer national health insurance (NHI)."
Tuesday, December 22, 2015
Monday, December 21, 2015
Sunday, December 20, 2015
Supporting single-payer, universal health care
Supporting single-payer, universal health care
"Many of the false arguments used against universal health care absolutely apply to our current system of relying on private insurance. Reliance on private insurance has proven to be bad for individuals, for business, for health-care providers, for the economy and our society. Still there are those who will claim socialized medicine is bad for our country. I suspect that if we could find the original sources of these claims, they would have very familiar-sounding names from the health insurance industry."
"Many of the false arguments used against universal health care absolutely apply to our current system of relying on private insurance. Reliance on private insurance has proven to be bad for individuals, for business, for health-care providers, for the economy and our society. Still there are those who will claim socialized medicine is bad for our country. I suspect that if we could find the original sources of these claims, they would have very familiar-sounding names from the health insurance industry."
The Fate of Obamacare - The New York Times
The Fate of Obamacare - The New York Times
Coment from PNHP:
Coment from PNHP:
ACO
Proponents
Submitted
to the Health Care Financing Task Force by the Board of Directors of
the Minnesota Chapter of Physicians for a National Health Program
December
18, 2015
MN PNHP’s last letter to the Task Force presented evidence indicating ACOs do not cut health care expenditures, and may in fact raise them when the costs required to set up and run ACOs are taken into account. In this letter we call your attention to an article that ran on the front page of the New York Times on December 15. That article reinforced our conclusion that the task force should not recommend any policies that will encourage the spread of ACOs.
The Times article presented evidence indicating the endorsement of ACOs by President Obama and the Affordable Care Act has encouraged mergers among hospitals and clinics, and that this has in turn driven up health care costs. What makes the article particularly interesting is that it contradicts research authored by Elliot Fisher, the man who invented the phrase “accountable care organization” along with Glenn Hackbarth (former chair of the Medicare Payment Advisory Commission) in 2006.
The online version of the Times article http://www.nytimes.com/interactive/2015/12/15/upshot/the-best-places-for-better-cheaper-health-care-arent-what-experts-thought.html is entitled, “The Experts Were Wrong About the Best Places for Better and Cheaper Health Care.” The “experts” referred to in the title include Elliot Fisher and other scholars at Dartmouth who produce the Dartmouth Atlas, and other experts who relied on the Dartmouth Atlas, including Atul Gawande, author of the famous 2009 New Yorker article that influenced President Obama’s thinking about cost containment.
The Dartmouth Atlas divides the country into 306 “hospital referral regions” and compares per capita Medicare spending among regions. For the last two decades, Fisher and many others have claimed that the low Medicare costs in places like Grand Junction, CO and Rochester, MN were not only reflective of total per capita costs in those areas, but were due to the presence of large hospital-clinic systems in those areas. Both claims were dubious when they were made. Now it appears both claims are wrong.
According to the Times’ article, many of the areas shown to be low-cost by Medicare data alone are high-cost areas when measured by expenditures by insurance companies. Moreover, it appears that the large “integrated systems” that Fisher et al. are so passionate about, now called ACOs, are raising costs because they are so big they can force even large insurers like UnitedHealthCare to pay them high rates.
The New York Times article is about a paper published by the National Bureau of Economic Research. The paper was written by Zack Cooper, an economist at Yale, and three others http://www.healthcarepricingproject.org/sites/default/files/pricing_variation_manuscript_0.pdf
Cooper et al. examined the cost of health care spending for three large insurance companies by “hospital referral region.” The Times article begins by placing two maps of the country side by side. One shows high- and low-cost regions according to the Dartmouth Atlas, and one shows high- and low-cost regions according to Cooper et al.’s data. There is some overlap but not much.
Here is the Times’ summary of the findings by Cooper et al.
Health care researchers who have seen the new findings say they are likely to force a rethinking of some conventional wisdom about health care. In particular, they cast doubt on the wisdom of encouraging mergers among hospitals, as parts of the 2010 health care law did.
Larger, integrated hospital systems – like those in Grand Junction – can often spend less money in Medicare, by avoiding duplicative treatments. But those systems also tend to set higher prices in private markets, because they face relatively little local competition.
“Price has been ignored in public policy,” said Dr. Robert Berenson, ... former vice chairman of the Medicare Payment Advisory Commission, which recommends policies to Congress. “That has been counterproductive.”
We agree with Dr. Berenson’s remark. Public policy, in Minnesota and across the country, has followed conventional wisdom since the early 1970s. It has encouraged reducing volume of medical services by herding doctors into larger organizations – HMOs beginning in the 1970s, now ACOs – so that they can bear insurance risk. This policy has ignored the impact of higher administrative costs and consolidation (in both the provider and insurer sectors) on price.
We urge task force members to focus on price, not volume. After a half century of experimenting with HMOs, PPOs etc., it is clear that pushing doctors into “integrated systems,” whether we call them HMOs or ACOs, cannot cut costs, and that the agglomeration of providers into these large entities is creating serious side effects, including concentrated market power.
Saturday, December 19, 2015
Friday, December 18, 2015
The Magical World of ACA Funding | THCB
The Magical World of ACA Funding | THCB
"Revenue was to be generated (in large part) by a series of taxes on a variety of different sources. These taxes did not fare so well in the current budget."
"Revenue was to be generated (in large part) by a series of taxes on a variety of different sources. These taxes did not fare so well in the current budget."
The problem of Obamacare's large knowledge gap
The problem of Obamacare's large knowledge gap
"Not only do most uninsured Americans not know when the deadline is, but many may be mistaken in the belief that they can't afford coverage — apparently, many people with moderate incomes are unaware of available financial aid that can significantly cut the price of their monthly premiums. Separately, some of the uninsured don't know they could qualify for Medicaid, the government program for the poor, which would cost them little or no money."
"Not only do most uninsured Americans not know when the deadline is, but many may be mistaken in the belief that they can't afford coverage — apparently, many people with moderate incomes are unaware of available financial aid that can significantly cut the price of their monthly premiums. Separately, some of the uninsured don't know they could qualify for Medicaid, the government program for the poor, which would cost them little or no money."
Medicaid Privatization Gets Messy in Iowa - Bloomberg Business
Medicaid Privatization Gets Messy in Iowa - Bloomberg Business
"Nationally, the shift to Medicaid managed care hasn’t been proved to save money, and the approach has a mixed record on how patients fare.."
"Nationally, the shift to Medicaid managed care hasn’t been proved to save money, and the approach has a mixed record on how patients fare.."
Thursday, December 17, 2015
Tuesday, December 15, 2015
The Experts Were Wrong About the Best Places for Better and Cheaper Health Care - The New York Times
The Experts Were Wrong About the Best Places for Better and Cheaper Health Care - The New York Times
Comment from Kip Sullivan: This morning's NY Times has a delicious article on the front page
debunking the ACA's theory of cost-containment, namely, overuse is
what's causing US health care costs to skyrocket, and the solution is to
push doctors into ACOs so they can bear insurance risk. In fact, the
paper provides evidence indicating that precisely BECAUSE the ACA
encourages consolidation of hospitals and clinics into ACOs, costs are
going up.
PNHP has been trying to communicate this fact to the
Health Care Financing Task Force: Overuse and the fee-for-service system
are not the problem, and cramming doctors into HMOs/ACOs so that they
can bear more insurance risk is not the solution. I hope task force
members read this article.
The article is based on a
soon-to-be-published paper by the National Bureau of Economic Research.
The paper shows that the overuse mavens who publish the Dartmouth Atlas
got it all wrong. They became very excited in the early 1990s about
Medicare data as computers made it possible to compare Medicare spending
region by region. By becoming obsessed with Medicare data and ignoring
data from the private sector, they convinced themselves of the wrong
solution. This is a great illustration of why drunks never find their
keys: They only look under the streetlight because that's where the
light is good.
Comment from Kip Sullivan: This morning's NY Times has a delicious article on the front page
debunking the ACA's theory of cost-containment, namely, overuse is
what's causing US health care costs to skyrocket, and the solution is to
push doctors into ACOs so they can bear insurance risk. In fact, the
paper provides evidence indicating that precisely BECAUSE the ACA
encourages consolidation of hospitals and clinics into ACOs, costs are
going up.
PNHP has been trying to communicate this fact to the
Health Care Financing Task Force: Overuse and the fee-for-service system
are not the problem, and cramming doctors into HMOs/ACOs so that they
can bear more insurance risk is not the solution. I hope task force
members read this article.
The article is based on a
soon-to-be-published paper by the National Bureau of Economic Research.
The paper shows that the overuse mavens who publish the Dartmouth Atlas
got it all wrong. They became very excited in the early 1990s about
Medicare data as computers made it possible to compare Medicare spending
region by region. By becoming obsessed with Medicare data and ignoring
data from the private sector, they convinced themselves of the wrong
solution. This is a great illustration of why drunks never find their
keys: They only look under the streetlight because that's where the
light is good.
Monday, December 14, 2015
Sunday, December 13, 2015
Saturday, December 12, 2015
Friday, December 11, 2015
Lone profitable ACA insurance co-op losing millions - Yahoo Finance
Lone profitable ACA insurance co-op losing millions - Yahoo Finance
I'm guessing the devils in the political details. Killing the public option was a big deal for the insurance companies and this co-op ideas was a compromise. But, as with county based purchasing in MN, I assume the non-profit co-ops got short changed in terms of money and red tape requirements.
I'm guessing the devils in the political details. Killing the public option was a big deal for the insurance companies and this co-op ideas was a compromise. But, as with county based purchasing in MN, I assume the non-profit co-ops got short changed in terms of money and red tape requirements.
Wednesday, December 9, 2015
Tuesday, December 8, 2015
More Former Inmates Getting Medicaid Under Obamacare, Study Finds - US News
More Former Inmates Getting Medicaid Under Obamacare, Study Finds - US News
Getting coverage upon release needs to become a mandatory part of our criminal justice system. Mental health and chemical abuse are major contributing factors to criminal behavior and access to treatment is essential.
Getting coverage upon release needs to become a mandatory part of our criminal justice system. Mental health and chemical abuse are major contributing factors to criminal behavior and access to treatment is essential.
This Could Be the Obamacare Outcome We've All Been Waiting For -- The Motley Fool
This Could Be the Obamacare Outcome We've All Been Waiting For -- The Motley Fool
"In exchange for spending more money on
their members up front, it's possible that chronic and serious diseases
that are the primary expense culprit for insurance companies can be
caught before they become a serious issue. Thus, while health benefit
providers may be spending more now than they would like to, their
long-term outlook is also looking brighter presuming the current
generation of members is now going to be healthier than the last
generation given expanded access to medical care."
"In exchange for spending more money on
their members up front, it's possible that chronic and serious diseases
that are the primary expense culprit for insurance companies can be
caught before they become a serious issue. Thus, while health benefit
providers may be spending more now than they would like to, their
long-term outlook is also looking brighter presuming the current
generation of members is now going to be healthier than the last
generation given expanded access to medical care."
Needed: Domestic Disarmament, Not 'Gun Control' | Amitai Etzioni
Needed: Domestic Disarmament, Not 'Gun Control' | Amitai Etzioni
This could be a major public health effort.
This could be a major public health effort.
Monday, December 7, 2015
Sunday, December 6, 2015
Sunday, November 29, 2015
Saturday, November 28, 2015
Friday, November 27, 2015
Patrick Watson: Obamacare Collapsing Ahead of Schedule
Patrick Watson: Obamacare Collapsing Ahead of Schedule
Medicare for All single payer universal medical coverage for all
citizens is the only way we can save enough money to do what is right.
Profit should NOT be in our health care and insurance companies are an
experiment in health care that has failed miserably. I don't want
insurance execs making millions by denying me access to health care. I
don't want my coverage / access to health care dependent upon where I
work - it should not be job related. Hospitals should be put on a
budget and not have all that detailed billing for every little thing
they do or give you. Hospitals should be treated like public utilities
like electric companies in terms of what they can do and how much they
charge. Our country has the worst health care outcomes of all
developed nations and it has by far the most costly health care system
in the world. You can not change that by continuing to treat health
care as a commodity and me as a consumer. My local fire department and
police department and road and bridge department are not considered as
providing a commodity and I am not their consumer. Same needs to happen
for health care. And, I am not saying I want all my health care
providers to work for the government.
If you believe health care
should be denied to those you believe to be unworthy for whatever your
personal reasons may be, you are the problem. Our country needs to
change its view of health care to be considered as a right, not as a
privilege
Medicare for All single payer universal medical coverage for all
citizens is the only way we can save enough money to do what is right.
Profit should NOT be in our health care and insurance companies are an
experiment in health care that has failed miserably. I don't want
insurance execs making millions by denying me access to health care. I
don't want my coverage / access to health care dependent upon where I
work - it should not be job related. Hospitals should be put on a
budget and not have all that detailed billing for every little thing
they do or give you. Hospitals should be treated like public utilities
like electric companies in terms of what they can do and how much they
charge. Our country has the worst health care outcomes of all
developed nations and it has by far the most costly health care system
in the world. You can not change that by continuing to treat health
care as a commodity and me as a consumer. My local fire department and
police department and road and bridge department are not considered as
providing a commodity and I am not their consumer. Same needs to happen
for health care. And, I am not saying I want all my health care
providers to work for the government.
If you believe health care
should be denied to those you believe to be unworthy for whatever your
personal reasons may be, you are the problem. Our country needs to
change its view of health care to be considered as a right, not as a
privilege
Thursday, November 26, 2015
Wednesday, November 25, 2015
Monday, November 23, 2015
Sunday, November 22, 2015
Saturday, November 21, 2015
Medicare hopes bundled payments will lead to better care, lower costs
Medicare hopes bundled payments will lead to better care, lower costs
hope this is a move toward putting hospitals on a budget as how they get reimbursed.
hope this is a move toward putting hospitals on a budget as how they get reimbursed.
Friday, November 20, 2015
Obamacare's Fate May Rest on Patience of Insurers Aetna, Anthem - Bloomberg Business
Obamacare's Fate May Rest on Patience of Insurers Aetna, Anthem - Bloomberg Business
Yet another money based view. What this points out to me is just how consolidated the insurance companies have become and are becoming. We are close to a "for-profit" single payer system now. We need a Medicare for All system without the profit motive. Health care is a right, not a commodity. I am a patient, not a consumer shopping around.
Get ready for that TOO BIG TO FAIL crap applied to health insurance companies.
Yet another money based view. What this points out to me is just how consolidated the insurance companies have become and are becoming. We are close to a "for-profit" single payer system now. We need a Medicare for All system without the profit motive. Health care is a right, not a commodity. I am a patient, not a consumer shopping around.
Get ready for that TOO BIG TO FAIL crap applied to health insurance companies.
UnitedHealth Warning Creates Huge Spillover, With Big Implications Ahead - UnitedHealth Group (NYSE:UNH) - 24/7 Wall St.
UnitedHealth Warning Creates Huge Spillover, With Big Implications Ahead - UnitedHealth Group (NYSE:UNH) - 24/7 Wall St.
We really need to get the for-profit insurance companies out of our health care. So much of the recent hype in the news has been about profits and shareholders and NOT about health care quality or access.
More on this: http://www.cnbc.com/2015/11/19/big-bad-day-for-obamacare-as-unitedhealth-considers-exit.html
We really need to get the for-profit insurance companies out of our health care. So much of the recent hype in the news has been about profits and shareholders and NOT about health care quality or access.
More on this: http://www.cnbc.com/2015/11/19/big-bad-day-for-obamacare-as-unitedhealth-considers-exit.html
Thursday, November 19, 2015
Many Say High Deductibles Make Their Health Law Insurance All but Useless - The New York Times
Many Say High Deductibles Make Their Health Law Insurance All but Useless - The New York Times
Comment by Don McCanne
The deductibles are
out of control. The anecdotes in the full article (link above)
demonstrate that many people find that their insurance is “all but
useless” simply because they cannot afford to pay the deductibles.
Anecdotes do not constitute a scientifically valid study, but they
certainly do tell us what is happening to individuals out in the real
world.
out of control. The anecdotes in the full article (link above)
demonstrate that many people find that their insurance is “all but
useless” simply because they cannot afford to pay the deductibles.
Anecdotes do not constitute a scientifically valid study, but they
certainly do tell us what is happening to individuals out in the real
world.
Insurers needed to keep premiums
affordable in order to maintain a viable market of private plans. They
do that by shifting costs to patients through ever higher deductibles.
This was inevitable through the reform model selected for the misnamed
Patent Protection and Affordable Care Act. Because of the large
deductibles, actual health care is not affordable for individuals with
modest incomes and thus patients do not have the protection that they
need.
affordable in order to maintain a viable market of private plans. They
do that by shifting costs to patients through ever higher deductibles.
This was inevitable through the reform model selected for the misnamed
Patent Protection and Affordable Care Act. Because of the large
deductibles, actual health care is not affordable for individuals with
modest incomes and thus patients do not have the protection that they
need.
The three trillion dollars that we are
already spending on health care is enough to provide all essential
health care services for everyone. With a properly designed financing
system there is no need to erect financial barriers to care since cost
containment can be achieved through patient-friendly policies such as
those of a single payer national health program.
already spending on health care is enough to provide all essential
health care services for everyone. With a properly designed financing
system there is no need to erect financial barriers to care since cost
containment can be achieved through patient-friendly policies such as
those of a single payer national health program.
Without
proper reform, “degradation of health insurance” will progress. People
will face greater financial hardship because of medical bills. People
will suffer more because of forgone health care. People will die.
proper reform, “degradation of health insurance” will progress. People
will face greater financial hardship because of medical bills. People
will suffer more because of forgone health care. People will die.
This isn’t right. We need an improved Medicare that includes everyone.
The Future of Public Health — NEJM
The Future of Public Health — NEJM
Comment by Don McCanne
A century ago life
expectancy was 54. Today it is 79. Public health has played a much
greater role in realizing this gain than has clinical medicine. Although
most health funds are being directed to clinical services, public
health services will need support to continue and to expand the gains
that have been more important to society as a whole.
expectancy was 54. Today it is 79. Public health has played a much
greater role in realizing this gain than has clinical medicine. Although
most health funds are being directed to clinical services, public
health services will need support to continue and to expand the gains
that have been more important to society as a whole.
Government
must remain responsive to the nation’s health needs. Recognizing that,
Congress included in the Affordable Care Act a $15 billion boost in
public health funding. However, that was reduced in 2012 legislation by
$6.25 billion, and then further reduced by sequestration. Public health
appropriations for 2015 are less than half of the $2 billion budgeted.
must remain responsive to the nation’s health needs. Recognizing that,
Congress included in the Affordable Care Act a $15 billion boost in
public health funding. However, that was reduced in 2012 legislation by
$6.25 billion, and then further reduced by sequestration. Public health
appropriations for 2015 are less than half of the $2 billion budgeted.
How
can these reductions be justified? The need for austerity? Not based on
the billions of dollars being fed into the coffers of the wealthiest
amongst us. Less need for government public health services? Not unless
we are willing to accept a surge in preventable disease epidemics and
injuries from public hazards. Can we justify these reductions based on
the ideological principle that the responsibility for health should be
shifted from the government to the individual? Even ideologues can
suffer or die from uncontrolled epidemics, from uncorrected public
hazards, or because of a lack of beneficial interventions that were not
implemented.
can these reductions be justified? The need for austerity? Not based on
the billions of dollars being fed into the coffers of the wealthiest
amongst us. Less need for government public health services? Not unless
we are willing to accept a surge in preventable disease epidemics and
injuries from public hazards. Can we justify these reductions based on
the ideological principle that the responsibility for health should be
shifted from the government to the individual? Even ideologues can
suffer or die from uncontrolled epidemics, from uncorrected public
hazards, or because of a lack of beneficial interventions that were not
implemented.
In addition to these important
public health actions, we would also benefit by adopting a
government-run health care financing system - a single payer national
health program. The failure to act makes our Congress one of the
greatest public health hazards that we face. Electing the right people
to Congress may be the most important single measure that we could take
to maintain and improve the health of our nation.
public health actions, we would also benefit by adopting a
government-run health care financing system - a single payer national
health program. The failure to act makes our Congress one of the
greatest public health hazards that we face. Electing the right people
to Congress may be the most important single measure that we could take
to maintain and improve the health of our nation.
Tuesday, November 17, 2015
Assembly approves self-insurance oversight bill | State and Regional News | host.madison.com
Assembly approves self-insurance oversight bill | State and Regional News | host.madison.com
Hard to believe this. Here's the email I sent to my Senator:
---------- Forwarded message ----------
Hard to believe this. Here's the email I sent to my Senator:
---------- Forwarded message ----------
Senator Vinehout
Can
you help me understand what this will really mean. I can't believe the
current leadership in the Legislature and the Governor want to take
business away from private insurance/HMO companies. Are they just going
to shift from buying "insurance" to paying those same companies to do
all the work?
you help me understand what this will really mean. I can't believe the
current leadership in the Legislature and the Governor want to take
business away from private insurance/HMO companies. Are they just going
to shift from buying "insurance" to paying those same companies to do
all the work?
What is this really going to mean in terms of who is paid to do what for employee covereage?
And, if this really is "Under
self-insurance, the state would pay benefits directly instead of buying
insurance from 18 HMOs.", then why isn't it a good idea for WI to do so
for ALL publiclly funded health care programs?
self-insurance, the state would pay benefits directly instead of buying
insurance from 18 HMOs.", then why isn't it a good idea for WI to do so
for ALL publiclly funded health care programs?
Again, I find it hard to believe this is REALLY a move to have "the state would pay benefits directly".
Please help me understand what this Self Insurance Oversight Bill really will do.
Monday, November 16, 2015
Saturday, November 14, 2015
Saturday, November 7, 2015
Why You Might Be Choosing the Wrong Obamacare Plan | The Fiscal Times
Why You Might Be Choosing the Wrong Obamacare Plan | The Fiscal Times
$ up front for premiums versus $ later via tax subsidies....Maybe folks don't trust the government....maybe we need a simpler way to make it affordable.
$ up front for premiums versus $ later via tax subsidies....Maybe folks don't trust the government....maybe we need a simpler way to make it affordable.
Thursday, November 5, 2015
PNHP: This is why we need single-payer – Medicare for all
http://singlepayerhealthcarenow.com/2015/09/20/pnhp-this-is-why-we-need-single-payer-medicare-for-all/?GD_NONCE=8d7a0dd105
Open Enrollment - note from Grassroots North Shore in Milwaukee
It's healthcare
enrollment season again. Remember: everyone is required to carry
health insurance or pay a special tax surcharge. If you're covered by
your employer, you probably know what to do. If you're over 65,
Medicare is likely to be your primary health insurance plan. The
budget deal President Obama signed yesterday finally determined what
premiums for Medicare in 2016 will be. Here's the account from Forbes
(but you should receive some kind of official notification from the
government in the near future):
The Part B
payment for all those who’ll turn 65 next year and join the
program, as well as some upper-income people (incomes over $85,000 or
$170,000 for married couples filing jointly) and poor people whose
premiums are paid by state governments, ... will increase 15% to $123
a month ($120 plus a $3 surcharge).... Higher-income beneficiaries
will likely owe premiums of $168 to $384 plus the surcharge....
Similar, the
annual Part B deductible — the amount in doctor bills you have to
pay each year before full coverage begins — will increase to $167,
from $147 this year. This will avoid the planned deductible boost to
$223.
For most
Medicare beneficiaries, the Part B premium in 2016 will be unchanged,
at $104.90 a month, and the deductible will stay at $147.
If you aren't
covered through your workplace or by Medicare, you will shop in the
individual market (that's Obamacare). To make sure you're getting the
best possible deal, don't just stick with the plan you bought for
2015. It will pay for you to look at the competing plans in your
area.
You can search by
zip code to see what plans, companies, prices and more are available
in your county. You don't need to log in or create a username and
password; just provide an age and estimate annual income to see what
is available.
For coverage that
begins on Jan 1, 2016, you will need to be enrolled by December 15,
but you can sign up until Jan 31, 2016 — as long as you don't mind
risking exposure for the first couple of months in 2016. Just don't
slip on any ice or throw your back out shoveling snow before your
coverage takes effect!
In terms of
competition among plans and pricing, there's some good news and some
bad. Some areas of WI have new insurance options; others have lost
some plans. And while insurance premiums generally have not
skyrocketed, they are still very expensive. Wisconsin has been one of
the most expensive states in the nation for health insurance, and
even a 4% increase means a large dollar amount.
What is most
concerning are the deductibles and out of pocket costs. Citizen
Action's comparison of major metro areas of the state show that for
the most commonly available plan, deductibles increased 40% on
average. More and more insurance companies are pushing more of the
burden on consumers. And both Walker's Insurance Commissioner and the
State Legislature seem to have no desire to fight for more affordable
coverage for you and me.
Important Topics to
Remember:
Open Enrollment
starts on November 1st and goes until January 31st
Insurance
companies are pushing more and more of the cost of healthcare onto
consumers, meaning hundreds even thousands more in costs when someone
gets sick or injured.
The Walker
Administration has made no effort to challenge these higher prices
and costs for consumers. The state needs to act to challenge these
insurance companies and guarantee quality affordable healthcare!
Other states are
not seeing the same rise in deductibles that we are, and if Wisconsin
doesn't act we will fall behind. Wisconsin is already one of the most
expensive state in the country for health insurance.
It is important,
even if you are currently covered, to go back and compare new
options. There are new options, new plans, new rates and different
tax credits. Be sure to visit Healthcare.gov
today!
If you or someone
you know needs assistance navigating the Obamacare landscape,
Grassroots North Shore has prepared a document :
Wednesday, November 4, 2015
The hidden risk of high-deductible health plans
The hidden risk of high-deductible health plans
"...they’re just skipping the care they need altogether"
"...they’re just skipping the care they need altogether"
Tuesday, November 3, 2015
Saturday, October 31, 2015
Friday, October 30, 2015
Thursday, October 29, 2015
Wednesday, October 28, 2015
Tuesday, October 27, 2015
Minnesota achieves the near impossible: 95 percent of residents insured
Minnesota achieves the near impossible: 95 percent of residents insured
Congrats MN
Don't give in to the political and profit motive pressures to go backwards. You will lead others in the right direction toward single payer if you continue to get better.
Congrats MN
Don't give in to the political and profit motive pressures to go backwards. You will lead others in the right direction toward single payer if you continue to get better.
Saturday, October 24, 2015
Thursday, October 22, 2015
Tuesday, October 13, 2015
Friday, October 9, 2015
U.S. Health Care from a Global Perspective: Spending, Use of Services, Prices, and Health in 13 Countries - The Commonwealth Fund
U.S. Health Care from a Global Perspective: Spending, Use of Services, Prices, and Health in 13 Countries - The Commonwealth Fund
We do need to improve the way we spend our health care dollars so that
Comment by Don McCanne
"This update, comparing us with 13 high-income countries, confirms that we
still spend far more than any other nation on health care, partly
because of our very high prices, even though we are not using more
health care. Worse, in spite of our high levels of spending, our
population health remains relatively poor.
still spend far more than any other nation on health care, partly
because of our very high prices, even though we are not using more
health care. Worse, in spite of our high levels of spending, our
population health remains relatively poor.
One exhibit in this report shows that our combined spending on health care
and on social care (retirement and disability benefits, employment
programs, and supportive housing) is about average (see Exhibit 8,
above). Considering that our health care spending is so high, it may be
that the comparatively low spending on social services is a significant
contributor to our poor population health.
and on social care (retirement and disability benefits, employment
programs, and supportive housing) is about average (see Exhibit 8,
above). Considering that our health care spending is so high, it may be
that the comparatively low spending on social services is a significant
contributor to our poor population health.
everyone has affordable access to high quality care, and a single payer
system would do that. However, since we are a very wealthy nation, we
should be able to increase spending on social services as well. The
progressive taxes required to do that would also help to address our
crisis in income inequality."
system would do that. However, since we are a very wealthy nation, we
should be able to increase spending on social services as well. The
progressive taxes required to do that would also help to address our
crisis in income inequality."
Thursday, October 8, 2015
Risk Selection Threatens Quality Of Care For Certain Patients: Lessons From Europe’s Health Insurance Exchanges
Risk Selection Threatens Quality Of Care For Certain Patients: Lessons From Europe’s Health Insurance Exchanges
Comment by Don McCanne
Comment by Don McCanne
"This report, supported by the Commonwealth Fund and published in Health
Affairs, looks at European nations that use variations of market
exchanges of private insurance plans (Belgium, Germany, Ireland,
Switzerland and, especially, the Netherlands) to see what lessons on
risk selection they may have for the United States. But are these the
right lessons for us?
Affairs, looks at European nations that use variations of market
exchanges of private insurance plans (Belgium, Germany, Ireland,
Switzerland and, especially, the Netherlands) to see what lessons on
risk selection they may have for the United States. But are these the
right lessons for us?
Private insurers in the United States have long been masters at figuring out ways of insuring
the healthy, with their relatively low health care costs, while avoiding
insuring individuals with greater health care needs. Although the
Affordable Care Act prohibits insurers from refusing to cover
individuals anticipated to have higher health care costs, we are seeing
insurance innovations in gaming risk selection that substitute for
medical underwriting, which sometimes still prevents patients from
receiving the care that they should have.
the healthy, with their relatively low health care costs, while avoiding
insuring individuals with greater health care needs. Although the
Affordable Care Act prohibits insurers from refusing to cover
individuals anticipated to have higher health care costs, we are seeing
insurance innovations in gaming risk selection that substitute for
medical underwriting, which sometimes still prevents patients from
receiving the care that they should have.
The multi-payer system in the United States is infamous for the very high
costs of the wasteful administrative excesses in our health care
financing. In fact, some of these excesses are for the very purpose of
ensuring the business success of the private insurers. So what
efficiencies do the European systems that use marketplace exchanges of
private plans have that might help the United States avoid the
perversities of favorable risk selection on the part of the insurers?
costs of the wasteful administrative excesses in our health care
financing. In fact, some of these excesses are for the very purpose of
ensuring the business success of the private insurers. So what
efficiencies do the European systems that use marketplace exchanges of
private plans have that might help the United States avoid the
perversities of favorable risk selection on the part of the insurers?
The authors suggest the introduction of additional risk adjusters (more
administration), systems to collect yet more data (more administration),
introduction of risk-sharing strategies such as mandatory
community-rated reinsurance or risk sharing between the regulator and
the insurers (more administration), allowing insurers to charge their
enrollees, within a band or range of acceptable charges, risk-adjusted
health insurance premium rates (more administration), and balancing
trade-offs of quality-skimping selection, efficiency, and affordability
(more administration).
administration), systems to collect yet more data (more administration),
introduction of risk-sharing strategies such as mandatory
community-rated reinsurance or risk sharing between the regulator and
the insurers (more administration), allowing insurers to charge their
enrollees, within a band or range of acceptable charges, risk-adjusted
health insurance premium rates (more administration), and balancing
trade-offs of quality-skimping selection, efficiency, and affordability
(more administration).
Not only would these “lessons” expand the administrative excesses of our system, but because
of the trade-offs involved, further compromises in quality and equity
would result. No matter what strategies are used, the private insurers
will always find a way around them. That is inherent in their
business-model DNA.
of the trade-offs involved, further compromises in quality and equity
would result. No matter what strategies are used, the private insurers
will always find a way around them. That is inherent in their
business-model DNA.
Instead of us looking for lessons in the European private insurance markets, it seems that these
European nations should be looking for lessons from our neighbor to the
North: Canada and its single payer model of health care financing. We
would do well to do the same."
European nations should be looking for lessons from our neighbor to the
North: Canada and its single payer model of health care financing. We
would do well to do the same."
Obamacare mandated better mental health-care coverage. It hasn’t happened. - The Washington Post
Obamacare mandated better mental health-care coverage. It hasn’t happened. - The Washington Post
"The Affordable Care Act has boosted the number of Americans with health insurance coverage but has not resolved the disparate way in which many insurers treat the costs of mental and physical health care, according to an April report released by the National Alliance on Mental Illness. "
"The Affordable Care Act has boosted the number of Americans with health insurance coverage but has not resolved the disparate way in which many insurers treat the costs of mental and physical health care, according to an April report released by the National Alliance on Mental Illness. "
Reimagining Health Care
Conversations on Health Care presents:
Reimagining Health Care
A panel of speakers from Canada, the UK, and Germany
will share their experience with universal health care. The
current state of the US health care system will be
presented for comparison. The presentation will be
followed by small and large group discussion.
Saturday, November 21, 2015
9 to 11 a.m.
St. Joan of Arc Catholic Community
Hospitality Hall
Join us - Be a part of the discussion
Be a part of the solution
Refreshments served
4537 Third Avenue South, Minneapolis, MN 55419
Reimagining Health Care
A panel of speakers from Canada, the UK, and Germany
will share their experience with universal health care. The
current state of the US health care system will be
presented for comparison. The presentation will be
followed by small and large group discussion.
Saturday, November 21, 2015
9 to 11 a.m.
St. Joan of Arc Catholic Community
Hospitality Hall
Join us - Be a part of the discussion
Be a part of the solution
Refreshments served
4537 Third Avenue South, Minneapolis, MN 55419
Wednesday, October 7, 2015
The world’s best, and worst, places to die ranked - The Washington Post
The world’s best, and worst, places to die ranked - The Washington Post
This has much about how the U.S. ranks in health care for the rapidly increasing number of us older folks. Includes some good arguments for universal health care.
This has much about how the U.S. ranks in health care for the rapidly increasing number of us older folks. Includes some good arguments for universal health care.
Tuesday, October 6, 2015
Monday, October 5, 2015
Sunday, October 4, 2015
More from Kip-Evidence DHS is peddling faith-based health policy
These comments by Kip are important nationwide as we see the corporations taking more and more control of the system at the expense of our health and our pocketbooks.
Oct. 4, 2015
Oct. 4, 2015
I want to drive more stakes into the heart of DHS's belief that
pushing Minnesotans into ACOs and "medical homes" will save money. I'll
do that in this email by discussing two documents in the New England
Journal of Medicine -- a paper in the current edition and a letter to
the editor that I co-authored that I'm told will appear in the Oct 15 edition of NEJM.
The paper I'm referring to is by Jonathan Oberlander, an expert who teaches a the U of NC, and Miriam Laugeson, who teaches at Columbia. Oberlander is a prolific and highly respected writer. I don't know anything about Laugeson. The title of their paper is "Leap of faith -- Medicare's new physician payment system." http://www.nejm.org/doi/full/
Oberlander and Lauger essentially say two things: Other countries spend a lot less than we do on health care even though they rely on the fee-for-service method of payment and do not rely on ACOs etc; there is no evidence to support CMS's claims for ACOs, "medical homes," and similar entities designed to shift insurance risk onto clinics and hospitals. Congress and CMS have only faith in the rightness of their opinions.
The other document I want to call your attention to is a letter to the editor of NEJM that I co-authored with Ted Marmor, the professor at Yale who invited me to speak with him at the Yale conference on Medicare and Medicaid last November. The NEJM asst editor I'm dealing with told me recently this letter will appear in the Oct 15 edition of NEJM.
The letter is very short (you only get 175 words). It criticizes the authors of a paper published in the June 18, 2015 edition of NEJM by David Blumenthal, currently the head of the Commonwealth Fund and formerly a member of the Obama administration, and two colleagues. This paper appeared in the June 18 NEJM. It purported to assess the progress of the ACA five years after its enactment.http://www.nejm.org/
They claimed that one of CMS's ACO programs (the Medicare Shared Savings Program (MSSP)) cut Medicare costs and one of CMS's three "home" programs cut Medicare costs. Neither statement was true. And here's the crazy thing: The two studies Blumenthal et al. cited proved them wrong. I don't know what to call the error Blumenthal et al made. How do you make a false statement and then cite a paper that demonstrates you made a false statement? Was it a lie? Was it laziness? Was it seeing the world through hallucinations induced by HMO Kool-Aid?
Here's what happened. The two papers Blumenthal et al relied on highlighted the reduced claims costs Medicare enjoyed as a result of the MSSP and "home" programs, but downplayed the cost of the bonuses CMS paid out to ACOs and "homes" that succeeded in cutting Medicare's claims costs. The latter costs were right there in the reports for anyone to see who didn't rely on CMS's press releases about the reports. Unfortunately for Blumenthal and all ACO and home buffs, the cost of the bonuses CMS paid out were HIGHER than the reductions in claims costs, for a net increase in costs to CMS of both programs.
What you should find especially troubling about Blumenthal et al's mistake is that they chose what they thought was the best research proving their point that ACOs and homes save money. They didn't have the space to do a literature review, so they cited what they thought were two of the most credible and up to date reports. But they got both reports wrong. The reports disproved their thesis.
So, if someone as smart as Blumenthal et al. couldn't find any literature to support their claims, what are the odds that DHS staff are going to find anything supporting their obsession with "value based purchasing" and ACOs?
Letters to NEJM rarely have replies. NEJM hasn't told me Blumenthal et al. were given a chance to reply and did or did not write a response. I don't know how you respond to our letter other than to say, "Thank you for catching our error."
I did give Blumenthal two chances to explain his behavior to me before I approached Ted about writing NEJM. I sent him and his Commonwealth Fund colleague Stu Guterman the email below. Guterman replied but dodged the question I directed at Blumenthal as to why he misrepresented the papers he cited. I replied to both men again and noted Guterman had dodged my question to Blumenthal. Neither man answered.
Ted and I then wrote the editor at NEJM who managed the article by Blumenthal et al. and politely demanded she print a correction, with or without Blumenthal's permission. She replied she would allow us to write a letter to the editor even though the three-week deadline for letters (they have to arrive at NEJM within three weeks of the publication of the article being criticized). So that's what we did.
So what is the probability that anyone at DHS can produce evidence for ACOs and "value based purchasing" that Blumenthal et al. couldn't think of? Answer: Zero.
Kip
==
From: kiprs [mailto:kiprs@usinternet.com]
Sent: Friday, June 26, 2015 8:04 AM
To: Stuart Guterman; David Blumenthal
Subject: Two questions about ACO research
....
Dear Mr. Guterman and Dr. Blumenthal,
I'm writing you to call your attention to a defect in the ACO model, and to an inexplicable tendency among health policy analysts to report the gross savings allegedly achieved by ACOs rather than the net savings. I urge you and other Commonwealth Fund officers and staff to use your influence to correct these problems.
I have pasted in below two comments I posted recently on the blog of Physicians for a National Health Program on these issues.
The first comment opens with a statement you made, Mr. Guterman, to Modern Healthcare about how difficult it is to make sense of the findings reported by L&M Policy Research, and by Nyweide et al. in their paper in JAMA based on the L&M report, on the first two years of the Medicare Pioneer ACO program. If Modern Healthcare had called and asked for a comment about the final evaluation of the five-year Physician Group Practice Demonstration (an earlier test of the ACO concept), you would have been forced to make the same comment -- it's hard to know who did what to whom to save the grand total of three-tenths of a percent that the PGP demo saved Medicare (net of CMS's bonus payments).
Can we agree that financing ACO experiments that tell us almost nothing about why ACOs saved or lost money is not a good use of taxpayer dollars? If so, I urge you to use your influence to induce ACO proponents (starting perhaps with your own board and Medpac) to demand that CMS and private promoters of ACOs define the mechanisms ACOs are supposed to use precisely enough to test them -- to operationalize them. That's not possible now given the extraordinarily vague, aspirational definition of "ACO."
The second comment I'm sending along addresses CMS's habit of reporting gross savings to Medicare and either ignoring the cost to CMS of its bonus payments to ACOs, the administrative costs associated with running the ACO programs, and the cost to ACOs of hiring the extra staff and buying equipment necessary to start and maintain an ACO, or burying them in a separate document. (The second comment also addresses another but less common problem -- simulating ACOs and reporting the results as if they were for a real program. If you care to comment on that issue, please do, but I'm more interested in the two issues I've described above.)
Dr. Blumenthal, your comment about the L&M/Nyweide et al. reports in your paper for NEJM, "The Affordable Care Act at 5 Years," illustrates the second problem -- the habit among analysts of repeating CMS's gross savings estimates and not calling readers' attention to the fact that the figures don't take account of CMS's costs, including the bonus payments they make to ACOs. In your NEJM paper, you cited CMS's claim that Pioneer ACOs have cut Medicare's costs by $385 million, but you neglected to tell readers that number was a gross number, not a net. According to a May report put out by CMS, the Pioneer program saved only two-tenths of a percent in 2012 and five-tenths in 2013 when CMS payments are taken into account (see page four here http://www.cms.gov/Research-
Similarly, CMS says the MSSP ACOs have RAISED Medicare costs (see the same document above), but you claimed in your NEJM paper savings of $700 million (with no citation).
http://pnhp.org/blog/2015/06/
http://pnhp.org/blog/2015/06/
I'd appreciate hearing any comments you have in response to this email, especially if you feel inclined to support the health policy community's current policy of defining ACOs so vaguely they can't be tested, and CMS's and the health policy community's emerging habit of pretending there are no costs to administering the ACO programs and, therefore, all savings are pure gravy.
Thank you.
Kip Sullivan
The paper I'm referring to is by Jonathan Oberlander, an expert who teaches a the U of NC, and Miriam Laugeson, who teaches at Columbia. Oberlander is a prolific and highly respected writer. I don't know anything about Laugeson. The title of their paper is "Leap of faith -- Medicare's new physician payment system." http://www.nejm.org/doi/full/
Oberlander and Lauger essentially say two things: Other countries spend a lot less than we do on health care even though they rely on the fee-for-service method of payment and do not rely on ACOs etc; there is no evidence to support CMS's claims for ACOs, "medical homes," and similar entities designed to shift insurance risk onto clinics and hospitals. Congress and CMS have only faith in the rightness of their opinions.
The other document I want to call your attention to is a letter to the editor of NEJM that I co-authored with Ted Marmor, the professor at Yale who invited me to speak with him at the Yale conference on Medicare and Medicaid last November. The NEJM asst editor I'm dealing with told me recently this letter will appear in the Oct 15 edition of NEJM.
The letter is very short (you only get 175 words). It criticizes the authors of a paper published in the June 18, 2015 edition of NEJM by David Blumenthal, currently the head of the Commonwealth Fund and formerly a member of the Obama administration, and two colleagues. This paper appeared in the June 18 NEJM. It purported to assess the progress of the ACA five years after its enactment.http://www.nejm.org/
They claimed that one of CMS's ACO programs (the Medicare Shared Savings Program (MSSP)) cut Medicare costs and one of CMS's three "home" programs cut Medicare costs. Neither statement was true. And here's the crazy thing: The two studies Blumenthal et al. cited proved them wrong. I don't know what to call the error Blumenthal et al made. How do you make a false statement and then cite a paper that demonstrates you made a false statement? Was it a lie? Was it laziness? Was it seeing the world through hallucinations induced by HMO Kool-Aid?
Here's what happened. The two papers Blumenthal et al relied on highlighted the reduced claims costs Medicare enjoyed as a result of the MSSP and "home" programs, but downplayed the cost of the bonuses CMS paid out to ACOs and "homes" that succeeded in cutting Medicare's claims costs. The latter costs were right there in the reports for anyone to see who didn't rely on CMS's press releases about the reports. Unfortunately for Blumenthal and all ACO and home buffs, the cost of the bonuses CMS paid out were HIGHER than the reductions in claims costs, for a net increase in costs to CMS of both programs.
What you should find especially troubling about Blumenthal et al's mistake is that they chose what they thought was the best research proving their point that ACOs and homes save money. They didn't have the space to do a literature review, so they cited what they thought were two of the most credible and up to date reports. But they got both reports wrong. The reports disproved their thesis.
So, if someone as smart as Blumenthal et al. couldn't find any literature to support their claims, what are the odds that DHS staff are going to find anything supporting their obsession with "value based purchasing" and ACOs?
Letters to NEJM rarely have replies. NEJM hasn't told me Blumenthal et al. were given a chance to reply and did or did not write a response. I don't know how you respond to our letter other than to say, "Thank you for catching our error."
I did give Blumenthal two chances to explain his behavior to me before I approached Ted about writing NEJM. I sent him and his Commonwealth Fund colleague Stu Guterman the email below. Guterman replied but dodged the question I directed at Blumenthal as to why he misrepresented the papers he cited. I replied to both men again and noted Guterman had dodged my question to Blumenthal. Neither man answered.
Ted and I then wrote the editor at NEJM who managed the article by Blumenthal et al. and politely demanded she print a correction, with or without Blumenthal's permission. She replied she would allow us to write a letter to the editor even though the three-week deadline for letters (they have to arrive at NEJM within three weeks of the publication of the article being criticized). So that's what we did.
So what is the probability that anyone at DHS can produce evidence for ACOs and "value based purchasing" that Blumenthal et al. couldn't think of? Answer: Zero.
Kip
==
From: kiprs [mailto:kiprs@usinternet.com]
Sent: Friday, June 26, 2015 8:04 AM
To: Stuart Guterman; David Blumenthal
Subject: Two questions about ACO research
....
Dear Mr. Guterman and Dr. Blumenthal,
I'm writing you to call your attention to a defect in the ACO model, and to an inexplicable tendency among health policy analysts to report the gross savings allegedly achieved by ACOs rather than the net savings. I urge you and other Commonwealth Fund officers and staff to use your influence to correct these problems.
I have pasted in below two comments I posted recently on the blog of Physicians for a National Health Program on these issues.
The first comment opens with a statement you made, Mr. Guterman, to Modern Healthcare about how difficult it is to make sense of the findings reported by L&M Policy Research, and by Nyweide et al. in their paper in JAMA based on the L&M report, on the first two years of the Medicare Pioneer ACO program. If Modern Healthcare had called and asked for a comment about the final evaluation of the five-year Physician Group Practice Demonstration (an earlier test of the ACO concept), you would have been forced to make the same comment -- it's hard to know who did what to whom to save the grand total of three-tenths of a percent that the PGP demo saved Medicare (net of CMS's bonus payments).
Can we agree that financing ACO experiments that tell us almost nothing about why ACOs saved or lost money is not a good use of taxpayer dollars? If so, I urge you to use your influence to induce ACO proponents (starting perhaps with your own board and Medpac) to demand that CMS and private promoters of ACOs define the mechanisms ACOs are supposed to use precisely enough to test them -- to operationalize them. That's not possible now given the extraordinarily vague, aspirational definition of "ACO."
The second comment I'm sending along addresses CMS's habit of reporting gross savings to Medicare and either ignoring the cost to CMS of its bonus payments to ACOs, the administrative costs associated with running the ACO programs, and the cost to ACOs of hiring the extra staff and buying equipment necessary to start and maintain an ACO, or burying them in a separate document. (The second comment also addresses another but less common problem -- simulating ACOs and reporting the results as if they were for a real program. If you care to comment on that issue, please do, but I'm more interested in the two issues I've described above.)
Dr. Blumenthal, your comment about the L&M/Nyweide et al. reports in your paper for NEJM, "The Affordable Care Act at 5 Years," illustrates the second problem -- the habit among analysts of repeating CMS's gross savings estimates and not calling readers' attention to the fact that the figures don't take account of CMS's costs, including the bonus payments they make to ACOs. In your NEJM paper, you cited CMS's claim that Pioneer ACOs have cut Medicare's costs by $385 million, but you neglected to tell readers that number was a gross number, not a net. According to a May report put out by CMS, the Pioneer program saved only two-tenths of a percent in 2012 and five-tenths in 2013 when CMS payments are taken into account (see page four here http://www.cms.gov/Research-
Similarly, CMS says the MSSP ACOs have RAISED Medicare costs (see the same document above), but you claimed in your NEJM paper savings of $700 million (with no citation).
http://pnhp.org/blog/2015/06/
http://pnhp.org/blog/2015/06/
I'd appreciate hearing any comments you have in response to this email, especially if you feel inclined to support the health policy community's current policy of defining ACOs so vaguely they can't be tested, and CMS's and the health policy community's emerging habit of pretending there are no costs to administering the ACO programs and, therefore, all savings are pure gravy.
Thank you.
Kip Sullivan
Long but important comments by an expert - Kip Sullivan
Oct 3, 2015
Posted by: kiprs <kiprs@usinternet.com>
Yesterday DHS staff made a Powerpoint presentation to the
Delivery Design and Sustainability work group (one of three work groups
within the Health Care Financing task force). This presentation made it
even clearer what DHS wants from the task force: They want the task
force to recommend policies that expand ACOs to all Minnesotans.
True to form, DHS spoke in a language that sounds remarkably like English but actually isn't English when you ask yourself, What did I just hear? I will do my best to translate.
The presentation included 31 slides. It was entitled "Integrated Care Models and Value-based Purchasing in Minnesota." I know you understand what "in Minnesota" means. Let me translate the rest:
* "Integrated care" means medical care delivered by large corporations that own clinics, hospitals, pharmacies, and nursing homes. You see, providers can only communicate clearly with one another if they have the same corporate logo on their doors. Otherwise, communication is impossible. Email doesn't work, phones don't work, faxes don't work. If you don't have a corporate logo on your door, you provide "fragmented care" and, worse, "uncoordinated care."
"Value-based purchasing" is something insurers (public and private) do. "Value," as you know, is a combination of cost and quality. You might fear that letting DHS or BCBS define "value" is a recipe for disaster, but you'd be wrong, according to DHS. DHS knows we're on the brink of being able to measure not just cost per patient accurately, but the quality of care given to that patient as well. Moreover, DHS knows that some IT nerds somewhere are about to invent a computer program will that will combine an accurate score for cost with an accurate score for quality into a single "value" score. And then, DHS can rank all HMOs or all ACOs with a single value score, and award contracts on the basis of this score. Ditto for BCBS. It can rank all doctors and hospitals in the state and decide which ones to include in their ACO.
The first two-thirds of the Powerpoint slides are devoted to explaining ACOs that DHS has already set up within the Medicaid program. The first few slides use the phrase "integrated care model" (ICM) but gradually that label is displaced by the phrase "accountable care organization."
DHS warns us in slide 5 that we're never going to know what an ICM or an ACO actually does. Slide 5, entitled "MN approach to Medicaid ICM," says: "Define 'what' we want, rather than the 'how,'" and "Allow for local flexibility and innovation...." Slide 5 says what we "want" is "accountability for total cost of care," "robust quality measurement," and "models that drive rapidly toward increasing levels of integration."
See what I mean? The words are all words all have an obviously Anglo-Saxon origin, but when you stop and ask, What the hell did DHS just tell me, you realize you have no idea what they said.
The problem is that DHS won't state clearly what their end game is -- to identify the corporations they have in mind that will rule our system, and the tactics these corporations will use to control physician-patient decision-making. DHS's goal is to cram all Minnesotans into a few enormous insurance companies that will be nothing more than HMOs on steroids, but will be called ACOs. The Big Three insurers and a half-dozen dominant hospital-clinic chains (Allina, Mayo, Sanford, etc) will run these ACOs.
The Big Three and the hospital-clinic chains know precisely what DHS is up to. The rest of us don't. This is dog-whistle health policy. It's profoundly undemocratic.
Slides 24-28 describe DHS's attempt to determine how widespread ACOs are already in MN. This attempt was apparently conducted around the time MN received the SIM grant. I infer that from the title of slide 24, "SIM ACO baseline: What we hoped to learn." This note appears (after the name "Karen") at the bottom of the slide: "We wanted to learn about ACO and ACO-like practices in the health care delivery system and we wanted to know the strengths, weaknesses and barriers experienced by providers and payers, with the ultimate goal engaging our stakeholders in a broader discussion around statewide goals and SIM priorities."
The phrase "our stakeholders" appears to refer to insurance companies and hospitals. According to slide 26, DHS interviewed five insurance companies, five medical groups, and two community service workers for this "SIM ACO baseline" study.
Slide 27, entitled "ACOs are spreading," informs us that 40 percent of fully insured businesses (as opposed to self-insured) are "in ACOs," although there's no indication of whether the businesses know they're in an ACO. (I've never heard of an ACO definition which defines ACOs by the businesses that are "in" them. This is a definition peculiar to DHS.) We learn that about half of all providers (individual docs, clinics and hospitals) are in "organizations" that are in ACOs (note the convoluted progression from provider to organization to ACO).
Slide 28 informs us that, regrettably, the amount of insurance risk (presumably meaning risk borne by ACOs) is "low," defined as less than 10 percent of their revenues. But, and here's the good news, "many anticipate growth in % in next five years." You see, it won't be long before insurance companies have shifted all risk over to ACOs.
Not one of the slides in this presentation presents evidence that ACOs function as claimed -- that they reduce costs or improve quality. There is a good reason for that: Existing research shows ACOs either save no money or are raising costs, and that ACOs do improve their scores and the tiny handful of quality measures that are imposed on them, which of course tells us nothing about what happened to the patients whose care was not measured.
Not one of these slides discussed the evidence that "value based purchasing" harms poor people (because cost and quality cannot be measured accurately, that is, in a manner that measures only factors under physician or hospital control). This even though the entire task force has agreed they will examine every recommendation they make for its impact on health disparities.
Despite the evidence, and despite the threat that ACO mania will rapidly increase consolidation and worsen disparities and raise costs, the last slide, slide 31, recommends that we mash the ACO button even harder and spread ACOs across the land.
I have attached the slides that I have discussed here.
True to form, DHS spoke in a language that sounds remarkably like English but actually isn't English when you ask yourself, What did I just hear? I will do my best to translate.
The presentation included 31 slides. It was entitled "Integrated Care Models and Value-based Purchasing in Minnesota." I know you understand what "in Minnesota" means. Let me translate the rest:
* "Integrated care" means medical care delivered by large corporations that own clinics, hospitals, pharmacies, and nursing homes. You see, providers can only communicate clearly with one another if they have the same corporate logo on their doors. Otherwise, communication is impossible. Email doesn't work, phones don't work, faxes don't work. If you don't have a corporate logo on your door, you provide "fragmented care" and, worse, "uncoordinated care."
"Value-based purchasing" is something insurers (public and private) do. "Value," as you know, is a combination of cost and quality. You might fear that letting DHS or BCBS define "value" is a recipe for disaster, but you'd be wrong, according to DHS. DHS knows we're on the brink of being able to measure not just cost per patient accurately, but the quality of care given to that patient as well. Moreover, DHS knows that some IT nerds somewhere are about to invent a computer program will that will combine an accurate score for cost with an accurate score for quality into a single "value" score. And then, DHS can rank all HMOs or all ACOs with a single value score, and award contracts on the basis of this score. Ditto for BCBS. It can rank all doctors and hospitals in the state and decide which ones to include in their ACO.
The first two-thirds of the Powerpoint slides are devoted to explaining ACOs that DHS has already set up within the Medicaid program. The first few slides use the phrase "integrated care model" (ICM) but gradually that label is displaced by the phrase "accountable care organization."
DHS warns us in slide 5 that we're never going to know what an ICM or an ACO actually does. Slide 5, entitled "MN approach to Medicaid ICM," says: "Define 'what' we want, rather than the 'how,'" and "Allow for local flexibility and innovation...." Slide 5 says what we "want" is "accountability for total cost of care," "robust quality measurement," and "models that drive rapidly toward increasing levels of integration."
See what I mean? The words are all words all have an obviously Anglo-Saxon origin, but when you stop and ask, What the hell did DHS just tell me, you realize you have no idea what they said.
The problem is that DHS won't state clearly what their end game is -- to identify the corporations they have in mind that will rule our system, and the tactics these corporations will use to control physician-patient decision-making. DHS's goal is to cram all Minnesotans into a few enormous insurance companies that will be nothing more than HMOs on steroids, but will be called ACOs. The Big Three insurers and a half-dozen dominant hospital-clinic chains (Allina, Mayo, Sanford, etc) will run these ACOs.
The Big Three and the hospital-clinic chains know precisely what DHS is up to. The rest of us don't. This is dog-whistle health policy. It's profoundly undemocratic.
Slides 24-28 describe DHS's attempt to determine how widespread ACOs are already in MN. This attempt was apparently conducted around the time MN received the SIM grant. I infer that from the title of slide 24, "SIM ACO baseline: What we hoped to learn." This note appears (after the name "Karen") at the bottom of the slide: "We wanted to learn about ACO and ACO-like practices in the health care delivery system and we wanted to know the strengths, weaknesses and barriers experienced by providers and payers, with the ultimate goal engaging our stakeholders in a broader discussion around statewide goals and SIM priorities."
The phrase "our stakeholders" appears to refer to insurance companies and hospitals. According to slide 26, DHS interviewed five insurance companies, five medical groups, and two community service workers for this "SIM ACO baseline" study.
Slide 27, entitled "ACOs are spreading," informs us that 40 percent of fully insured businesses (as opposed to self-insured) are "in ACOs," although there's no indication of whether the businesses know they're in an ACO. (I've never heard of an ACO definition which defines ACOs by the businesses that are "in" them. This is a definition peculiar to DHS.) We learn that about half of all providers (individual docs, clinics and hospitals) are in "organizations" that are in ACOs (note the convoluted progression from provider to organization to ACO).
Slide 28 informs us that, regrettably, the amount of insurance risk (presumably meaning risk borne by ACOs) is "low," defined as less than 10 percent of their revenues. But, and here's the good news, "many anticipate growth in % in next five years." You see, it won't be long before insurance companies have shifted all risk over to ACOs.
Not one of the slides in this presentation presents evidence that ACOs function as claimed -- that they reduce costs or improve quality. There is a good reason for that: Existing research shows ACOs either save no money or are raising costs, and that ACOs do improve their scores and the tiny handful of quality measures that are imposed on them, which of course tells us nothing about what happened to the patients whose care was not measured.
Not one of these slides discussed the evidence that "value based purchasing" harms poor people (because cost and quality cannot be measured accurately, that is, in a manner that measures only factors under physician or hospital control). This even though the entire task force has agreed they will examine every recommendation they make for its impact on health disparities.
Despite the evidence, and despite the threat that ACO mania will rapidly increase consolidation and worsen disparities and raise costs, the last slide, slide 31, recommends that we mash the ACO button even harder and spread ACOs across the land.
I have attached the slides that I have discussed here.
__._,_.___
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