Friday, March 31, 2017


Fact check: Medicaid’s Doctor Participation Rates

Fact check: Medicaid’s Doctor Participation Rates

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.

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.”

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.

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.

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).

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).

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.

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).

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




Justice Department joins suit alleging massive Medicare fraud by UnitedHealth | Center for Public Integrity

Justice Department joins suit alleging massive Medicare fraud by UnitedHealth | Center for Public Integrity

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.

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."

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
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 ...
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, 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.
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.

U.S. judge finds that Aetna deceived the public about its reasons for quitting Obamacare - LA Times

U.S. judge finds that Aetna deceived the public about its reasons for quitting Obamacare - LA Times

What Comes Next for Obamacare? The Case for Medicare for All - The New York Times

What Comes Next for Obamacare? The Case for Medicare for All - The New York Times

Republicans for Single-Payer Health Care - The New York Times

Republicans for Single-Payer Health Care - The New York Times

Republicans’ dangerous health-care delusions - The Washington Post

Republicans’ dangerous health-care delusions - The Washington Post

Maine Voices: The problem isn't Obamacare; it's the insurance companies - Portland Press Herald

Maine Voices: The problem isn't Obamacare; it's the insurance companies - Portland Press Herald

Old but worth repeating -- Often

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."

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.

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."

Why Republicans were in such a hurry on health care - The Washington Post

Why Republicans were in such a hurry on health care - The Washington Post

Maine Voices: The problem isn't Obamacare; it's the insurance companies - Portland Press Herald

Maine Voices: The problem isn't Obamacare; it's the insurance companies - Portland Press Herald

With Epic GOP Failure, Dems Urged to Go Bold with Medicare-for-All | Common Dreams

With Epic GOP Failure, Dems Urged to Go Bold with Medicare-for-All | Common Dreams

It's Surprising How Few Countries Have National, Single Payer, Health Care Systems

It's Surprising How Few Countries Have National, Single Payer, Health Care Systems



This needs fact checking.

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..."

With AHCA defeat, some Democrats see chance to push for universal coverage - The Washington Post

With AHCA defeat, some Democrats see chance to push for universal coverage - The Washington Post

What the G.O.P. Doesn’t Get About Who Pays for Health Care - The New Yorker

What the G.O.P. Doesn’t Get About Who Pays for Health Care - The New Yorker

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.

Sunday, March 19, 2017

John Conyers' New Bill Reveals an Obamacare Alternative

John Conyers' New Bill Reveals an Obamacare Alternative

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."

Tuesday, March 14, 2017

Insurance Companies Just Accidentally Made The Case For Medicare For All | The Huffington Post

Insurance Companies Just Accidentally Made The Case For Medicare For All | The Huffington Post
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.

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."

Trump's Backing a Healthcare Plan That Breaks His Promises

Trump's Backing a Healthcare Plan That Breaks His Promises

Sunday, March 12, 2017

Yes, Trump scammed many of his working-class supporters. This new analysis leaves little doubt. - The Washington Post

Yes, Trump scammed many of his working-class supporters. This new analysis leaves little doubt. - The Washington Post

WATCH: This Brilliant AARP Ad Trashes Trumpcare In Just One Minute – Left Wing Nation

WATCH: This Brilliant AARP Ad Trashes Trumpcare In Just One Minute – Left Wing Nation

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."

GOP health care plan shifts benefits toward higher-income people

GOP health care plan shifts benefits toward higher-income people

Your Employer-Provided Health Care Could End With The GOP's Plan | The Huffington Post

Your Employer-Provided Health Care Could End With The GOP's Plan | The Huffington Post

Major health insurer backs GOP's Obamacare repeal bill - POLITICO

Major health insurer backs GOP's Obamacare repeal bill - POLITICO

Paul Ryan needs to answer these questions

Paul Ryan needs to answer these questions

The 3 key provisions in the GOP health care bill that has some experts concerned - ABC News

The 3 key provisions in the GOP health care bill that has some experts concerned - ABC News

Saturday, March 11, 2017

Why Appalachia (and the Whole Nation) Needs a Single Payer Healthcare System | By Katie Lee | Common Dreams

Why Appalachia (and the Whole Nation) Needs a Single Payer Healthcare System | By Katie Lee | Common Dreams

How the GOP's Healthcare Plan Helps Make Case for Medicare-for-All | Common Dreams

How the GOP's Healthcare Plan Helps Make Case for Medicare-for-All | Common Dreams

Charlotte speaker advocates single-payer insurance to reduce complications in health care | The Charlotte Observer

Charlotte speaker advocates single-payer insurance to reduce complications in health care | The Charlotte Observer

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."

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!