Friday, March 31, 2017
California’s single payer bill - full text of bill released
Bill Text - SB-562 The Healthy California Act.
Comment by Don McCanne
Now we have the
full text of California’s new single payer bill - SB 562. It calls for
comprehensive health care coverage for all residents of California with
no premium, copayment, coinsurance, deductible, nor any other form of
cost sharing, for all covered benefits. “Resident” means an individual
whose primary place of abode is in the state, without regard to the
individual’s immigration status. It’s the real thing.
full text of California’s new single payer bill - SB 562. It calls for
comprehensive health care coverage for all residents of California with
no premium, copayment, coinsurance, deductible, nor any other form of
cost sharing, for all covered benefits. “Resident” means an individual
whose primary place of abode is in the state, without regard to the
individual’s immigration status. It’s the real thing.
Last
week, Gov. Jerry Brown seemed to dismiss the idea of a single payer
system with this response to reporters, “Where do you get the extra
money? This is the whole question.”
week, Gov. Jerry Brown seemed to dismiss the idea of a single payer
system with this response to reporters, “Where do you get the extra
money? This is the whole question.”
Of course,
the money is already there and being spent on health care. Current
government and private spending combined is enough to pay for a
comprehensive system for all residents wherein the administrative
savings and other efficiencies frees up enough funds to pay for those
currently uninsured and underinsured.
the money is already there and being spent on health care. Current
government and private spending combined is enough to pay for a
comprehensive system for all residents wherein the administrative
savings and other efficiencies frees up enough funds to pay for those
currently uninsured and underinsured.
There are
two issues that may have prompted the governor’s response: transferring
current federal health care funds to the state, and establishing a
state tax system to replace current private spending.
two issues that may have prompted the governor’s response: transferring
current federal health care funds to the state, and establishing a
state tax system to replace current private spending.
The
excerpts from SB 562 posted above indicate that it is the “intent” to
obtain “waivers and other approvals” that would enable the federal
government to transfer to the state funds from Medicare, Medicaid, Chip,
ACA, and other federal programs. The problem is that current waiver
programs are inadequate to fully accomplish that, and new federal
legislation would be required. Considering the composition of the
current Congress, that could be a difficult task (a comment that does
not require a mastery of understatement).
excerpts from SB 562 posted above indicate that it is the “intent” to
obtain “waivers and other approvals” that would enable the federal
government to transfer to the state funds from Medicare, Medicaid, Chip,
ACA, and other federal programs. The problem is that current waiver
programs are inadequate to fully accomplish that, and new federal
legislation would be required. Considering the composition of the
current Congress, that could be a difficult task (a comment that does
not require a mastery of understatement).
Health
care spending through the private sector is relatively inefficient
compared to spending in government programs such as Medicare. Yet when
the taxes that would replace private spending are spelled out
specifically, they seem overwhelming to the average individual with an
aversion to taxes in general. It is difficult for them to see what they
are already paying for our health care system that is not particularly
transparent such as the component of employer-sponsored health plans
that are only nominally paid by the employer, the tremendous tax
expenditures for employer-sponsored plans that go disproportionately to
higher income individuals, the huge spending for government employee
health plans on the federal, state, and local level, and the costs of
health care built into the prices of services and products to pay for
employee coverage, worker’s comp, liability coverage, and the like. When
that spending goes away and is replaced by government spending, the
taxes to pay for that can look formidable. Just ask former Gov. Peter
Shumlin of Vermont. Then try to sell that to the residents of
California. When you try to explain to them that the tax system would be
more equitable and efficient, and most would actually pay less overall,
they are already blinded by the proposed tax increases that they do see
(but are not yet spelled out in SB 562).
care spending through the private sector is relatively inefficient
compared to spending in government programs such as Medicare. Yet when
the taxes that would replace private spending are spelled out
specifically, they seem overwhelming to the average individual with an
aversion to taxes in general. It is difficult for them to see what they
are already paying for our health care system that is not particularly
transparent such as the component of employer-sponsored health plans
that are only nominally paid by the employer, the tremendous tax
expenditures for employer-sponsored plans that go disproportionately to
higher income individuals, the huge spending for government employee
health plans on the federal, state, and local level, and the costs of
health care built into the prices of services and products to pay for
employee coverage, worker’s comp, liability coverage, and the like. When
that spending goes away and is replaced by government spending, the
taxes to pay for that can look formidable. Just ask former Gov. Peter
Shumlin of Vermont. Then try to sell that to the residents of
California. When you try to explain to them that the tax system would be
more equitable and efficient, and most would actually pay less overall,
they are already blinded by the proposed tax increases that they do see
(but are not yet spelled out in SB 562).
What
we need is a well designed, national single payer health program. We
should continue to pull all stops toward that goal, though it is
difficult to see when we will reach the political threshold that will
make that possible. Until then we should also support state efforts to
relieve the physical suffering and financial hardship that is being
wrought on our people by our dysfunctional health care financing system.
we need is a well designed, national single payer health program. We
should continue to pull all stops toward that goal, though it is
difficult to see when we will reach the political threshold that will
make that possible. Until then we should also support state efforts to
relieve the physical suffering and financial hardship that is being
wrought on our people by our dysfunctional health care financing system.
Thus
we should strongly support SB 562. We should make every effort to
obtain “waivers and other approvals,” as difficult as that will be. We
should increase our efforts to educate the public on what a really good
deal this would be for them, otherwise our efforts could be sunk by a
few soundbites from the industries that profit excessively from our sick
system (as they were in prior ballot measures in California, Oregon and
Colorado).
we should strongly support SB 562. We should make every effort to
obtain “waivers and other approvals,” as difficult as that will be. We
should increase our efforts to educate the public on what a really good
deal this would be for them, otherwise our efforts could be sunk by a
few soundbites from the industries that profit excessively from our sick
system (as they were in prior ballot measures in California, Oregon and
Colorado).
But while we do this, we cannot let
up the least in our advocacy for a national health program. Our
brothers and sisters in other states desperately need our help.
http://www.latimes.com/politics/essential/la-pol-ca-essential-politics-updates-what-would-single-payer-look-like-in-1490888709-htmlstory.html
up the least in our advocacy for a national health program. Our
brothers and sisters in other states desperately need our help.
http://www.latimes.com/politics/essential/la-pol-ca-essential-politics-updates-what-would-single-payer-look-like-in-1490888709-htmlstory.html
Thursday, March 30, 2017
Ryan opposes Trump working with Democrats on healthcare
Ryan opposes Trump working with Democrats on healthcare
I like Medicare. I don't want for profit insurance companies controlling my health care.
I like Medicare. I don't want for profit insurance companies controlling my health care.
Democrats Against Single Payer | Jacobin
Democrats Against Single Payer | Jacobin
"The good news is that the same popular, grassroots pressure that ordinary people successfully put on Republican lawmakers who were preparing to strip Americans of even the meager protections afforded by Obamacare can also be used to push Democrats to support single payer. As much as numerous pundits and politicians mocked Sanders’s concept of getting things done through a “political revolution,” the past few months of widespread activism by ordinary Americans have shown this was far from the out-of-touch fantasy many dismissed it as."
"The good news is that the same popular, grassroots pressure that ordinary people successfully put on Republican lawmakers who were preparing to strip Americans of even the meager protections afforded by Obamacare can also be used to push Democrats to support single payer. As much as numerous pundits and politicians mocked Sanders’s concept of getting things done through a “political revolution,” the past few months of widespread activism by ordinary Americans have shown this was far from the out-of-touch fantasy many dismissed it as."
Wednesday, March 29, 2017
Jerome Christenson: We all need some assurance | Local | winonadailynews.com
Jerome Christenson: We all need some assurance | Local | winonadailynews.com
We all need some assurance
Jerome Christenson
3/29/17
3/29/17
Winona Daily News
The Minnesota Vikings have to be feeling just a bit of gratitude toward the House Republicans this week.
When it comes to choking on the big one, finally, they’re not alone.
Yup, after more than 60 times successfully landing a bill to put an end to Obamacare on
President Obama’s desk, when it came to the vote that would actually do the deed — they dropped the ball; gave up the ghost; faded in the clutch; missed the tag; wussed out; wimped out; wilted; whiffed ...
President Obama’s desk, when it came to the vote that would actually do the deed — they dropped the ball; gave up the ghost; faded in the clutch; missed the tag; wussed out; wimped out; wilted; whiffed ...
Good for them.
In spite of their worst intentions, they did a kindness to millions of their fellow citizens. More of a kindness than most of them will likely ever know. Yeah, anybody who’s been following this serialized debacle knows that when they screwed the pooch on the president’s proposal they kept better than 20 million Americans insured against bankrupting medical bills — but they really did quite a bit more than that. For a few minutes at least, they put a couple hundred million minds at ease.
After all, isn’t that what insurance is really for?
Interesting enough, our friends to the north, down-under and across the pond refer to health insurance as life assurance — a contract that assures a degree of financial security to the beneficiary. It’s assurance we’re after when we pay those premiums ... assurance that when worse comes to worst the bottom won’t fall out of our lives. Assurance that somewhere, someone or something has our back.
It’s one of those things none of us wants to be without. And when it comes to matters of sickness and health, in this country there is precious little assurance for folks who don’t have jobs that schedule open-enrollment every November ... but who get sick, get hurt anyway, and who have kids who get sick. Kids who get hurt.
Been there. Lived that.
It’s been longer than I really care to think, but forget it — that’ll never happen.
We were both working — more hours than I ever have since — but if we wanted insurance,
well get on the phone, hunt down an agent, pay for a policy.
well get on the phone, hunt down an agent, pay for a policy.
Well, my daddy raised me up right. Taught me that the wise, responsible thing to do is buy insurance against the bad things that just might happen. Trouble is, when we went out to buy that insurance, even though we were young, healthy and solvent, after paying rent, buying food and having a car to drive, the coverage we could afford offered less protection than popcorn farts in a hurricane. But we paid the premiums, and we paid the bills that our coverage didn’t cover until the economy went south and took those jobs with it. We got to choose between paying for groceries or paying for medical coverage that covered less than a string bikini. Well, the kids were hungry ...
And that was the worst part. Enough Sudafed, Benedryl, Ibuprofen and cheap 100-proof would get me through a raging sinus infection, and Gayle had her own roster of home remedies for adult ailments that would surely have benefited from a physician’s attention. But we were afflicted with
more pride than good sense and chose to tough it out, rather than run
up bills we realistically had no way to pay.
more pride than good sense and chose to tough it out, rather than run
up bills we realistically had no way to pay.
But toddlers don’t know about that stuff. When an ear hurts, they cry ... and keep on crying no matter what the balance reads at the bottom of the family checkbook. And all you want, as a mom or a dad, is to make the hurt go away, make the crying stop. See a smile again.
But ...
I guess there are folks in Congress, folks in the White House who would call that freedom.
... guess they’ve never had a sick kid.
Tuesday, March 28, 2017
Trump finally gets a good sense of what governing is like - The Washington Post
Trump finally gets a good sense of what governing is like - The Washington Post
Great comment at the end: "The most sensible solution was to fix what was already in place until
the inevitable day, coming soon, when we become a dual health-care
system: Single-payer for the majority of Americans and concierge health
care for the wealthy. It’s just a matter of time."
Great comment at the end: "The most sensible solution was to fix what was already in place until
the inevitable day, coming soon, when we become a dual health-care
system: Single-payer for the majority of Americans and concierge health
care for the wealthy. It’s just a matter of time."
Single-Payer or Bust: The Democrats Need to Give Us Something to Vote For :: Politics :: Features :: Health Care :: Paste
Single-Payer or Bust: The Democrats Need to Give Us Something to Vote For :: Politics :: Features :: Health Care :: Paste
Some examples of how "politics" gets in the way of our elected officials being good representatives of what is best for the people instead of feeding the big money corporations. And, yes we need a way to ensure health care access to all and we can't do that by pretending that a bill giving a big tax cut to the rich and the corporations would do that. The ACA and the Medicare Part D efforts started with good intentions and ended with complicated piecemeal messes that went a little in the right direction but at the expense of feeding the corporation's profit motive. Money did not buy this last election. Gut level passion did. Let's build on that and tell the big money entities to go......themselves.
Some examples of how "politics" gets in the way of our elected officials being good representatives of what is best for the people instead of feeding the big money corporations. And, yes we need a way to ensure health care access to all and we can't do that by pretending that a bill giving a big tax cut to the rich and the corporations would do that. The ACA and the Medicare Part D efforts started with good intentions and ended with complicated piecemeal messes that went a little in the right direction but at the expense of feeding the corporation's profit motive. Money did not buy this last election. Gut level passion did. Let's build on that and tell the big money entities to go......themselves.
Monday, March 27, 2017
Obamacare: The Republican Waterloo - The Atlantic
Obamacare: The Republican Waterloo - The Atlantic
"Conservatives once warned that Obamacare would produce the Democratic Waterloo. Their inability to accept the principle of universal coverage has, instead, led to their own defeat."
"Conservatives once warned that Obamacare would produce the Democratic Waterloo. Their inability to accept the principle of universal coverage has, instead, led to their own defeat."
Obamacare Is Here To Stay For A Long Time, And That's Good News For Big Insurers
Obamacare Is Here To Stay For A Long Time, And That's Good News For Big Insurers
"...a bonanza for the insurance companies. They’re the middlemen that have the upper hand over doctors and patients in the third party payer system..."
"...a bonanza for the insurance companies. They’re the middlemen that have the upper hand over doctors and patients in the third party payer system..."
Saturday, March 25, 2017
ACA and AHCA fall short, but so does the Commonwealth Fund solution
Harvard Business Review
March 21, 2017
Where Both the ACA and AHCA Fall Short, and What the Health Insurance Market Really Needs
By David Blumenthal and Sara Collins
To
understand the ongoing battles about the individual, or non-group,
markets and their reform, three points should be kept in mind.
First,
these insurance markets were distressed before the enactment of the
Affordable Care Act. Second, the ACA improved their functioning but was
not sufficient as passed and implemented to stabilize all of them.
Neither, however, is the American Health Care Act (AHCA), the repeal and
replacement legislation proposed by House Republicans and embraced by
President Trump. Third, the reforms that will improve individual
markets, which we discuss below, are known. They include greater balance
between premium subsidies and penalties for not taking up coverage,
using proven mechanisms for stabilizing risks such as reinsurance, and
accelerating efforts to control the costs of health care services. To
date, the United States has just lacked the political will to adopt
them.
What to do
There is no great mystery about how to shore up private insurance markets.
First,
we need to create balanced risk pools that include both healthy and
less healthy persons in individual insurance markets. This will require
two types of actions. Subsidies for young healthy consumers must be
increased without decreasing those for older Americans so that so-called
young invincibles find the prices of insurance less off-putting but the
neediest customers in individual markets can still afford to
participate.
However, reducing financial
barriers for good risks will not suffice. Unlike many other purchases in
our lives, buying insurance is difficult, confusing, and provides
little short-term gratification; so healthy young people will always
tend to avoid it. That is why creating healthy risk pools for individual
markets will require something like the individual mandate that has
been so unpopular with conservatives. Unless consumers are required to
purchase insurance — or face a meaningful penalty — individual markets
may not function effectively over the long term. By meaningful, we mean a
financial penalty that equals or exceeds the cost of buying insurance
in the first place.
Second, we need to extend
subsidies higher up the income scale than the ACA’s limit of 400% of the
federal poverty level. This will enable more non-poor individuals — who
tend to have lesser disease burdens — to purchase insurance.
Unfortunately, health insurance has become so expensive in the United
States that even many middle-income families cannot afford to purchase
it without the kind of assistance that employers routinely offer their
employees.
Third, if we want private insurers
to participate in ensuring that Americans have access to affordable
insurance, the business of selling this product must be viable. This
means managing the inherent uncertainties associated with selling
insurance in comparatively unpredictable individual markets. The most
effective approaches — used in the Medicare private drug-insurance
market without controversy — are reinsurance and risk corridors. The
first of these means assuring that reinsurance is available and
affordable for plans selling individual and small group products. Risk
corridors protect plans that accumulate unexpectedly high risks by
giving them access to funds collected from insurers that experience
unexpectedly low risks.
Fourth, and perhaps
most important, public and private stakeholders must accelerate efforts
to control the costs of health care services, which are the primary
determinants of the cost of health insurance in all markets, including
employer-sponsored, individual, and public. One reason that other
countries find it easier to insure their entire populations is that
their costs of care are half or less what ours are.
The
key to controlling health care costs in the United States is to
implement aggressively the payment and delivery-system reforms that were
included in the Affordable Care Act but rarely discussed in current
debates.
The facts are clear. We can revive
individual markets that were failing even before the ACA was enacted and
are vital to making affordable care available to Americans. But we will
have to pay for that revival — politically and fiscally.
David
Blumenthal, MD, is president of the Commonwealth Fund. Sara Collins is
the Commonwealth Fund’s vice president for health care coverage and
access.
===
Comment by Don McCanne
It
is quite appropriate that this article was published in the Harvard
Business Review since it finds solutions to the deficiencies of both the
Affordable Care Act (ACA) and the proposed American Health Care Act
(AHCA) in the private health care insurance marketplace. The authors’
proposals are to use government regulations and funds to create a robust
market for private insurance plans - an approach that Harvard MBAs
understand and support.
They would make the
individual mandate more effective by penalizing nonparticipants with a
penalty equal to or larger than the insurance premiums. Forcing
individuals to buy plans with excessive deductibles and inadequate
provider networks is a cruel policy.
They would
increase subsidies for middle-income individuals but that would still
push individuals into low-actuarial value plans, not solving the
problems of impaired access due to narrow networks and unaffordable
out-of-pocket costs.
They would relieve
insurers of bearing risk through the use of reinsurance and risk
corridors. Insurers would be reduced to providing a profusion of
expensive administrative functions, while being protected against the
usual insurance function of bearing risk, allowing their actuaries to
concentrate on profits instead of risk.
They
would more aggressively control health care costs but do so through the
payment and delivery-system reforms of ACA which have already proven to
be quite ineffective. They acknowledge that other countries insure
everyone at costs of care that are “half or less what ours are.”
Well
how do those other nations include everyone and pay an average of half
of what we do? Certainly not by embellishing the private insurance
markets and throwing a bunch of government money at them. Yes, some
countries do use private insurance but they are so heavily regulated
that they qualify as social insurance programs. The governments require
that the financing system serves first the needs of patients whereas we
structure ours to serve first the needs of insurers while leaving
patients exposed to financial hardship and impaired access.
Today
we are at a decision point between ACA and AHCA. Absent any last minute
back-door deals, the likely outcome will be the defeat of AHCA, and
president Trump will walk, leaving ACA in place with little hope for
even the very modest changes suggested by Commonwealth’s Blumenthal and
Collins. And if it should pass in both the House and the Senate, an
unlikely outcome, we will be even worse off than we are.
Instead
of a debate between ACA and AHCA, the debate should have been between
ACA/AHCA and an improved Medicare for all. We can still have that debate
by continuing to educate the public on the deficiencies of ACA and the
virtues of single payer Medicare for all, but we will have to make our
presence felt lest we get lost in the next agenda item that the
Republicans really want - altering the tax system to shift more income
and wealth from the workers to the wealthy. That will really be bad for
the physical and fiscal health of our nation and its people.
Friday, March 24, 2017
Thursday, March 23, 2017
Wednesday, March 22, 2017
Tuesday, March 21, 2017
Monday, March 20, 2017
Sunday, March 19, 2017
Value-Based Purchasing and “Free Lunch Syndrome” | THCB
Value-Based Purchasing and “Free Lunch Syndrome” | THCB
Kip Sullivan again shows how managed care variations do not, in fact, save money. This is an example of regulations from government (and from insurance companies) raising cost in dollars and in health care results/outcomes.
Kip goes into excruciating detail when he researches this topic but it is important.
He summarizes: "Most analysts who publish in health policy journals, especially ACO proponents, are obsessed with incentives, especially financial incentives. They routinely accuse doctors and hospitals of caving in to financial incentives at the expense of payers and patients. But managed care proponents show utterly no interest in looking in the mirror and asking what incentives influence their profession and whether those incentives might be warping their judgment. The prevalence of the free lunch syndrome is circumstantial evidence that health policy entrepreneurs and analysts are influenced by a common incentive or set of incentives. I believe money, tenure, and status are among those incentives. Research on my hypothesis is at least as important as research on the incentives that influence physicians and hospitals."
Kip Sullivan again shows how managed care variations do not, in fact, save money. This is an example of regulations from government (and from insurance companies) raising cost in dollars and in health care results/outcomes.
Kip goes into excruciating detail when he researches this topic but it is important.
He summarizes: "Most analysts who publish in health policy journals, especially ACO proponents, are obsessed with incentives, especially financial incentives. They routinely accuse doctors and hospitals of caving in to financial incentives at the expense of payers and patients. But managed care proponents show utterly no interest in looking in the mirror and asking what incentives influence their profession and whether those incentives might be warping their judgment. The prevalence of the free lunch syndrome is circumstantial evidence that health policy entrepreneurs and analysts are influenced by a common incentive or set of incentives. I believe money, tenure, and status are among those incentives. Research on my hypothesis is at least as important as research on the incentives that influence physicians and hospitals."
Saturday, March 18, 2017
Thursday, March 16, 2017
Wednesday, March 15, 2017
Tuesday, March 14, 2017
Medicare for all and single payer are not “socialized medicine. Our politicians try to use “evil” words like “socialism” to scare misinformed conservatives about what's best for them. An example of socialized medicine is the care delivered through the Department of Veterans Affairs, where medical professionals are government employees and the facilities are paid for by we the people. In contrast, single payer and Medicare for all are universal health insurance, not socialism.
Nobody is talking about government taking control of doctors and hospitals and nurses and everyone else. It’s about we the people creating our own insurance pool with no profit seekers skimming off the top and trying to deny healthcare. Our 250 million-strong pool of people contributing to this program would lower costs for everyone and give more money to actual medical professionals.
Nobody is talking about government taking control of doctors and hospitals and nurses and everyone else. It’s about we the people creating our own insurance pool with no profit seekers skimming off the top and trying to deny healthcare. Our 250 million-strong pool of people contributing to this program would lower costs for everyone and give more money to actual medical professionals.
Single-payer system the answer | Opinion | Eugene, Oregon
Single-payer system the answer | Opinion | Eugene, Oregon
"Health care cannot successfully be treated as a market commodity."
"Health care cannot successfully be treated as a market commodity."
Monday, March 13, 2017
Sunday, March 12, 2017
American Medical Association calls Republican health care plan 'critically flawed'
American Medical Association calls Republican health care plan 'critically flawed'
"...our basic principles. And those are that people who have insurance shouldn’t lose it and people who don’t have it should get it."
"...our basic principles. And those are that people who have insurance shouldn’t lose it and people who don’t have it should get it."
Saturday, March 11, 2017
Paul Ryan's Wonk Shtick Is Getting Old | The Huffington Post
Paul Ryan's Wonk Shtick Is Getting Old | The Huffington Post
"All of which sounds pretty good until you remember that (a) the money pooled to cover the sick is now less than what you started with, and (b) with Ryan’s watered-down version of the mandate, the young and healthy are more likely to simply stay out of the insurance market entirely, whether the premium costs are lower than ever before or not."
"All of which sounds pretty good until you remember that (a) the money pooled to cover the sick is now less than what you started with, and (b) with Ryan’s watered-down version of the mandate, the young and healthy are more likely to simply stay out of the insurance market entirely, whether the premium costs are lower than ever before or not."
COLUMN: Why not repeal and replace? | Opinion | lacrossetribune.com
COLUMN: Why not repeal and replace? | Opinion | lacrossetribune.com
A new name for Single Payer - Americare -- I wouldn't care if they call it TrumpCare - JUST DO IT!
A new name for Single Payer - Americare -- I wouldn't care if they call it TrumpCare - JUST DO IT!
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