Friday, June 30, 2017
Medicare for All
The Economist/YouGov
Poll
April 2-4, 2017
81. Do you favor or
oppose expanding Medicare to provide health insurance to every
American?
60% Favor strongly
or favor somewhat
23% Oppose strongly
or oppose somewhat
https://d25d2506sfb94s.cloudfront.net/cumulus_uploads/document/divhts7l9t/econTabReport.pdf
==
The Economist/YouGov
Poll
June 25-27, 2017
61. Do you favor or
oppose creating a single-payer health care system, in which all
Americans would get their health insurance from one government plan
that is financed by taxes?
44% Favor strongly
or favor somewhat
31% Oppose strongly
or oppose somewhat
https://d25d2506sfb94s.cloudfront.net/cumulus_uploads/document/p97ezf7wcq/econTabReport.pdf
===
Comment by Don
McCanne
During a time when
there is a crescendo of support for single payer/Medicare for All,
the Economist/YouGov polls suggest that support declined during the
past couple of months. There is a lesson here, but it is not that
single payer support is fading.
The single payer
policy community would recognize these two questions as being
essentially the same from a policy perspective. But the layman hears
the first question as being the expansion of Medicare to cover
everyone (Medicare for All), whereas the second question is about
single payer, government, and taxes (single payer). The first is
about a popular insurance program which we have all earned and
eventually participate in, and would it be that everyone could be
included. The second is about government taking over health care and
us being taxed for it when the insurance benefit at work seems to be
working just fine, and the boss is already paying for most of it
anyway. At least that’s often the perception.
We already knew
this. “Medicare for all” polls better than does “single payer.”
What is reassuring is that people are beginning to understand the
single payer concept well enough such that there is more support than
opposition, even if it is a government program for which we will be
taxed. The term “single payer” is out there and will be used by
friend and foe alike, so people have to understand that it refers to
an improved version of Medicare in which everyone gets to
participate.
The lesson? We
should not only continue with but we should expand our education and
advocacy activities through coalitions and grassroots efforts. The
people are getting the word. Support is burgeoning. Soon the public
will be immunized against the soundbites of the opponents.
Thursday, June 29, 2017
Why Canadians Are Increasingly Seeking Medical Treatment Abroad | HuffPost
Why Canadians Are Increasingly Seeking Medical Treatment Abroad | HuffPost
We need to know and admit our weaknesses that need to be worked on.
We need to know and admit our weaknesses that need to be worked on.
Wednesday, June 28, 2017
Medicare Advantage: “The Average Person Is Probably Appalled by This”
Drugs, Crime, Medicare, Nixon - Nygaard Notes
"Young people may not know that there is a “private option” for seniors to choose when they become old enough to qualify for Medicare. If a senior does not want to participate in the traditional fee-for-service Medicare program, they can choose “Medicare Advantage.” I’ll let the Center for Medicare Advocacy explain what we’re talking about: “Traditional Medicare is administered and run by the federal government. Traditional Medicare includes both Part A which covers hospital care and Part B which covers medical insurance. Part C is an alternative to traditional Medicare that allows private health insurance companies to provide Medicare benefits. The private health plans are known as Medicare Advantage plans.”
"Young people may not know that there is a “private option” for seniors to choose when they become old enough to qualify for Medicare. If a senior does not want to participate in the traditional fee-for-service Medicare program, they can choose “Medicare Advantage.” I’ll let the Center for Medicare Advocacy explain what we’re talking about: “Traditional Medicare is administered and run by the federal government. Traditional Medicare includes both Part A which covers hospital care and Part B which covers medical insurance. Part C is an alternative to traditional Medicare that allows private health insurance companies to provide Medicare benefits. The private health plans are known as Medicare Advantage plans.”
The Medicare
Advantage program—that is, the partial privatization of
Medicare—was sold to the public with the traditional pitch that
“increased competition” in the “marketplace” would result in
better care for less money. This doesn’t appear to be the case,
and just this month reports are coming out that offer details about a
fairly huge scam that’s been going on for a very long time. In
fact, the original complaint about the scam was filed in 2011, but
the record was just unsealed in February of this year, and the
details are now coming to light as the Justice Department has decided
to sue UnitedHealth on the basis of the recently-revealed claims.
The New York Timesreports in its May 16th edition that “now a whistle-blower, a
former well-placed official at UnitedHealth Group, asserts that the
big insurance companies have been systematically bilking Medicare
Advantage for years, reaping billions of taxpayer dollars from the
program by gaming the payment system.”
Adds the Times, “The
amounts in question industrywide are mind-boggling: Some analysts
estimate improper Medicare Advantage payments at $10 billion a year
or more.”
“In the first
interview since his allegations were made public, the whistle-blower,
Benjamin Poehling of Bloomington, Minn. [just minutes from Nygaard
Notes HQ!], described in detail how his company and others like it—in
his view—gamed the system: Finance directors like him monitored
projects that UnitedHealth had designed to make patients look sicker
than they were, by scouring patients’ health records electronically
and finding ways to goose the diagnosis codes. The sicker the
patient, the more UnitedHealth was paid by Medicare Advantage—and
the bigger the bonuses people earned, including Mr. Poehling.”
“There were
bonuses when Mr. Poehling and his team hit their revenue targets, Mr.
Poehling said, but no bonuses for better health outcomes or for more
accurate patients’ charts. ‘You or I or the average person is
probably appalled by this,’ Mr. Poehling said. ‘But the scheme
here was not about delivering better care to members—the thing you
would expect from a health care company. It was about increasing the
bottom line.’”
I have no doubt that
“the average person” believes that the primary concern of a
private health care company is to provide better care. That’s the
basis upon which Medicare Advantage—in fact, the entire private
health care sector in the United States—is sold to the public. The
sales pitch goes like this: “Public” programs are rife with
waste, fraud, and abuse, while “private” corporations that follow
the laws of the market are run like well-oiled machines.
That second part is
correct: There is a well-oiled machine at work. The Times quotes
Poehling as saying “They’ve set up a perfect scheme here. It was
rigged so there was no way they could lose.” But UnitedHealth, and
the others, are profit-generating machines, not health-generating
machines. And, well-oiled though they are, whistle-blowers like
Benjamin Poehling are throwing sand into the gears.
Buried deep in the
article, the Times succinctly sums it up the meaning of all of this:
“Mr. Poehling’s allegations, if true, could help explain why
insurers are staying in the Medicare Advantage program even as they
pull out of the Affordable Care Act exchanges in some states:
Medicare Advantage offers a way to get extra money from the federal
government.”
Almost all of the
reporting about Medicare—about health care policy in
general—appears in the Business pages. That’s a powerful message
in itself (telling us as it does that health care is a “business”),
but it also means that most citizens remain ignorant about these
developments, as most people do not regularly read the business
press. Despite the long-standing advice from Nygaard Notes to do so.
Who knows where the
President stands on the issue, but privatizing Medicare is certainly
a high priority for House Speaker Paul Ryan and also for Tom Price,
the new head of the Department of Health and Human Services. And the
sales pitch, as always, will be the promise that a privatized system
will deliver better health care for less money. The Benjamin
Poehling whistle-blower suit tells a different story, and it’s up
to us to talk about this story and to help make the real goal of
privatization—increased profits for Wall Street, not better health
care—clear for all to see."
Tuesday, June 27, 2017
Monday, June 26, 2017
Sunday, June 25, 2017
RECOMMENDATION: HMO exemption in state single-payer legislation must be specific and narrow | Physicians for a National Health Program
RECOMMENDATION: HMO exemption in state single-payer legislation must be specific and narrow | Physicians for a National Health Program
From Kip Sullivan:
From Kip Sullivan:
SB 562, the so-called "single payer" bill introduced in the CA
legislature earlier this year, has been tabled for now, and will
apparently not be heard again in 2017. This may or may not be good
news.
legislature earlier this year, has been tabled for now, and will
apparently not be heard again in 2017. This may or may not be good
news.
As you know, I think the bill in its current form is a multiple-HMO bill because it
contains a huge loophole for Kaiser Permanente, a loophole so large
any insurance company calling itself an "integrated delivery
system" will walk through. SB 562 in its current form will at
best mislead the public about what a single-payer is and do a
relatively ineffective job of keeping costs under control, and at
worst will recreate the ACA mess -- costs won't be contained,
coverage will be stingy or much less than promised, taxes will go up
by more than they need to, and single-payer and universal coverage
and "government" will all get a bad name. Or maybe it will
recreate the Vermont-Governor-Shumlin mess: The researchers and
agencies that have to estimate the cost of SB 562 will see through
the "single payer" charade and score it for what it is -- a
multiple-HMO bill -- and Democrats will be forced to abandon it
because it costs too much.
contains a huge loophole for Kaiser Permanente, a loophole so large
any insurance company calling itself an "integrated delivery
system" will walk through. SB 562 in its current form will at
best mislead the public about what a single-payer is and do a
relatively ineffective job of keeping costs under control, and at
worst will recreate the ACA mess -- costs won't be contained,
coverage will be stingy or much less than promised, taxes will go up
by more than they need to, and single-payer and universal coverage
and "government" will all get a bad name. Or maybe it will
recreate the Vermont-Governor-Shumlin mess: The researchers and
agencies that have to estimate the cost of SB 562 will see through
the "single payer" charade and score it for what it is -- a
multiple-HMO bill -- and Democrats will be forced to abandon it
because it costs too much.
But messages I have gotten from several people in CA suggest that real single-payer
advocates were working on amendments to SB 562 to shrink the Kaiser
loophole. Why these amendments weren't offered in the Senate I don't
know. From everything I've read, SB 562 was introduced in a hurry and
many issues, ranging from funding to the Kaiser loophole, hadn't been
resolved. I suspect SB 562 was written and introduced in a hurry
because the authors didn't anticipate Trump's election and, after his
election, realized Obamacare was in trouble and now was a good time
to push a solution that goes beyond the ACA.
advocates were working on amendments to SB 562 to shrink the Kaiser
loophole. Why these amendments weren't offered in the Senate I don't
know. From everything I've read, SB 562 was introduced in a hurry and
many issues, ranging from funding to the Kaiser loophole, hadn't been
resolved. I suspect SB 562 was written and introduced in a hurry
because the authors didn't anticipate Trump's election and, after his
election, realized Obamacare was in trouble and now was a good time
to push a solution that goes beyond the ACA.
I have also heard that the opportunity to amend in the Assembly wouldn't have arrived
till late July. If that's the case, then there was still time for
real single-payer advocates to prepare and lobby for an amendment
that would shrink the Kaiser loophole. Now that SB 562 is tabled, it
isn't clear (to me at least) what's going to happen to the loophole
language.
till late July. If that's the case, then there was still time for
real single-payer advocates to prepare and lobby for an amendment
that would shrink the Kaiser loophole. Now that SB 562 is tabled, it
isn't clear (to me at least) what's going to happen to the loophole
language.
If in fact what I just told you is true, that would explain why some PNHP docs are
referring to SB 562 as a single-payer. They didn't have a chance to
influence the writing of the original SB 562 because it was written
so quickly, but they anticipated shrinking the Kaiser loophole later
in the process and didn't want to stir up a fuss saying it's not a
single-payer. If the Kaiser loophole was going to be shrunk to the
size of the HMO loophole in HR 676, then the indefinite tabling of SB
562 is not good news.
referring to SB 562 as a single-payer. They didn't have a chance to
influence the writing of the original SB 562 because it was written
so quickly, but they anticipated shrinking the Kaiser loophole later
in the process and didn't want to stir up a fuss saying it's not a
single-payer. If the Kaiser loophole was going to be shrunk to the
size of the HMO loophole in HR 676, then the indefinite tabling of SB
562 is not good news.
Here is a description of the HMO loophole in HR 676 taken from a 2010 article
http://www.pnhp.org/news/2010/july/recommendation-hmo-exemption-in-state-single-payer-legislation-must-be-specific-and-n
I wrote with David Himmelstein and Steffie Woolhandler, the
founders of PNHP, in 2010:
http://www.pnhp.org/news/2010/july/recommendation-hmo-exemption-in-state-single-payer-legislation-must-be-specific-and-n
I wrote with David Himmelstein and Steffie Woolhandler, the
founders of PNHP, in 2010:
==
Specifically,
participating plans must:
participating plans must:
(1) be nonprofit;
(2) "actually deliver care in their own facilities" through salaried physicians who are
employees (not contractors) of the HMO;
(3) not use their capitation or budget payments to cover hospital services (hospital
services would be paid for through a global budget paid directly to the hospital); and
services would be paid for through a global budget paid directly to the hospital); and
(4) not offer financial incentives based on utilization.
Very few HMOs will qualify under this definition.
==
Not one of those four criteria are mentioned by the Kaiser-loophole provisions
currently in SB 562.
Kip
Saturday, June 24, 2017
Friday, June 23, 2017
Wednesday, June 21, 2017
Monday, June 19, 2017
Letter: Single-payer is way to go for health care - Opinion - recordonline.com - Middletown, NY
Letter: Single-payer is way to go for health care - Opinion - recordonline.com - Middletown, NY
Love the simplicity of this LTE:
Love the simplicity of this LTE:
Letter: Single-payer
is way to go for health care
is way to go for health care
Posted Jun 18, 2017
Since WWII we Americans have been trying to pound a square peg into a round hole. I
am referring to the health care vs. health insurance dilemma we struggle with. Health care is the round hole; free-market health insurance is the square peg.
am referring to the health care vs. health insurance dilemma we struggle with. Health care is the round hole; free-market health insurance is the square peg.
Health care is patient-driven and includes preventative measures to help people
remain healthy and supplies a standard of care when needed. People
are treated before small problems accelerate into huge ones that can
send them to the emergency room, the most expensive health care
“system.“Free-market health insurance, the square peg, is a
fee-for-service system that offers various and often very limited
services. We all know the loopholes: no pre-existing conditions
coverage; very limited availability or affordability; and surprises
when you find that this test or that procedure are not covered.
Premiums are up to 30 percent higher because doctors are motivated to
overly prescribe and test, and need additional staff to deal with
insurance companies.
remain healthy and supplies a standard of care when needed. People
are treated before small problems accelerate into huge ones that can
send them to the emergency room, the most expensive health care
“system.“Free-market health insurance, the square peg, is a
fee-for-service system that offers various and often very limited
services. We all know the loopholes: no pre-existing conditions
coverage; very limited availability or affordability; and surprises
when you find that this test or that procedure are not covered.
Premiums are up to 30 percent higher because doctors are motivated to
overly prescribe and test, and need additional staff to deal with
insurance companies.
No wonder we find ourselves at a road block; as the president exclaimed a few days into
office, “who knew health care was so complicated?” I suggest that
we eliminate “complicated” and slip a round peg into the round
hole by switching to a single-payer, universal health-care system.
Throw away the insurance square peg. We could join all other
developed democracies in the world. Everyone wins except the
insurance companies and the politicians who accept their money.
office, “who knew health care was so complicated?” I suggest that
we eliminate “complicated” and slip a round peg into the round
hole by switching to a single-payer, universal health-care system.
Throw away the insurance square peg. We could join all other
developed democracies in the world. Everyone wins except the
insurance companies and the politicians who accept their money.
Sunday, June 18, 2017
Saturday, June 17, 2017
Friday, June 16, 2017
Thursday, June 15, 2017
Wednesday, June 14, 2017
The Solution Is Single-Payer
The Solution Is Single-Payer
The Solution Is Single-Payer
In the face of the monstrosity that is Trumpcare, we must demand Medicare for All
Tuesday, June 13, 2017
Monday, June 12, 2017
Sunday, June 11, 2017
5 reasons all advisers should pay attention to the single-payer debate | Employee Benefit Adviser
5 reasons all advisers should pay attention to the single-payer debate | Employee Benefit Adviser
See comment. Re-training is needed for these poor insurance company workers. But, not for the CEOs.
See comment. Re-training is needed for these poor insurance company workers. But, not for the CEOs.
Is a single-payer system the solution? Universal health care | NWADG
Is a single-payer system the solution? Universal health care | NWADG
This NY Times piece is in a NW Arkansas paper! The country IS changing.
This uses the term "government health care". This is an example of language shaping the issue. There are many, including elected officials, who actually believe single payer universal health care is only the original British model where providers of health care would be employees of the government. The government needs to guarantee access to health care for all. Private insurance (the whole concept of insurance) was installed here between me and my doctor/provider of health care. I don't have private insurance for my local police protection, my local fire department, my local street repair & plowing, my local public school, our military, etc. etc. I don't want all our providers of service to become government employees (BTW - most who are do a great job). I do want private insurance as a part of our health care system to become a failed experiment of the past. It has done nothing to improve my access to health care and it has only succeeded in lining the pockets of very rich CEOs and shareholders. The US has the most expensive health care in the world with the worst outcomes. It is time to turn that around.
This NY Times piece is in a NW Arkansas paper! The country IS changing.
This uses the term "government health care". This is an example of language shaping the issue. There are many, including elected officials, who actually believe single payer universal health care is only the original British model where providers of health care would be employees of the government. The government needs to guarantee access to health care for all. Private insurance (the whole concept of insurance) was installed here between me and my doctor/provider of health care. I don't have private insurance for my local police protection, my local fire department, my local street repair & plowing, my local public school, our military, etc. etc. I don't want all our providers of service to become government employees (BTW - most who are do a great job). I do want private insurance as a part of our health care system to become a failed experiment of the past. It has done nothing to improve my access to health care and it has only succeeded in lining the pockets of very rich CEOs and shareholders. The US has the most expensive health care in the world with the worst outcomes. It is time to turn that around.
Saturday, June 10, 2017
Friday, June 9, 2017
Thursday, June 8, 2017
Wednesday, June 7, 2017
Tuesday, June 6, 2017
Sunday, June 4, 2017
Friday, June 2, 2017
Fixing healthcare: Which single-payer system would be best for California? - LA Times
Fixing healthcare: Which single-payer system would be best for California? - LA Times
Comment by Kip Sullivan:
"This article in the Los Angeles Times http://www.latimes.com/business/lazarus/la-fi-lazarus-single-payer-california-choices-20170307-story.html uses "single payer" to describe the German health care system and Medicare Advantage (the privatized portion of Medicare). It's easy to see why a reporter without much knowledge of health policy would make that mistake, especially now that "single payer" advocates in CA are calling SB 562, a German-style and Medicare Advantage-style bill, a "single payer" bill.
Comment by Kip Sullivan:
"This article in the Los Angeles Times http://www.latimes.com/business/lazarus/la-fi-lazarus-single-payer-california-choices-20170307-story.html uses "single payer" to describe the German health care system and Medicare Advantage (the privatized portion of Medicare). It's easy to see why a reporter without much knowledge of health policy would make that mistake, especially now that "single payer" advocates in CA are calling SB 562, a German-style and Medicare Advantage-style bill, a "single payer" bill.
The reporter, David
Lazurus, interviews several experts and concludes the German system
is the best one for CA because it would allow Kaiser Permanente and
other private insurers to continue to function. One expert tells
Lazurus the "German-style approach ...would make it easier to
incorporate Kaiser." That's accurate. The German system would
leave the insurance industry in place; SB 562 leaves some of the
existing CA insurance industry in place and will create new insurance
companies by shifting total insurance risk onto them.
As I have noted here
before, SB 562 contains an enormous loophole for Kaiser. The loophole
doesn't refer to Kaiser, but instead to "integrated delivery
systems" that would bear all insurance risk just as Kaiser does
now -- in other words, Kaiser is still the same old gigantic HMO
under 562 it's always been. SB 562 proponents, however, have long
made it clear Kaiser is what the authors of SB 562 have in mind when
they wrote the words "integrated delivery system."
Under a single-payer
system, all insurance risk stays with the government (as it does, for
example, in the fee-for-service Medicare program and in Canada).
Under single-payer systems, insurance risk is NOT palmed off onto
private-sector entities like Kaiser and some of the enormous
hospital-clinic chains calling themselves "integrated delivery
systems." When private-sector entities bear insurance risk, they
incur all the costs insurance companies incur (with one or two
exceptions, notably the cost of collecting premiums), and they have
all the incentives to screw patients that insurance companies have
now.
That doesn't mean
that a German system in CA can't cost less than the crazy system CA
and the rest of the country suffers now. (This is especially true of
the German system prior to about 1995.) Multiple-payer systems like
Germany's cut costs as single-payers do with one obvious exception --
the savings in administrative costs that come with one payer paying
doctors and hospitals directly.
A recently released
study of SB 562
http://www.healthycaliforniaact.org/wp-content/uploads/Pollin-Economic-Analysis-SB-562.pdf
concludes it would insure all Californians and yet reduce CA's total
spending by 8 percent. I have only scanned the summary of this study.
I get the impression the study treats CA as if it were a German
system even while calling it a single-payer system. Since I haven't
read the study, I can't say how the study arrives at its conclusion
that total spending will fall by 8 percent. I do think a German-style
system could easily cut spending in an American state by 8 percent.
But a huge caveat is
in order. The system that SB 562 will create will be unlike any seen
anywhere on the planet. The distinguishing feature of the CA system
under 562 will be enormous aggregations of hospitals, clinics,
pharmacies, nursing homes, ambulance services, equipment suppliers,
and God knows what else, with an insurance department on top of all
that to manage risk. No other nation -- not Germany, Holland,
Switzerland -- with multiple-payer systems has allowed or encouraged
the formation of such gigantic fiefdoms. SB 562 not only allows
horizontal and vertical merging of all players, it encourages it.
So as we contemplate
whether a German-style system could work in CA or MN, we have to ask
whether we're talking about the German system or the SB 562 version
of the German system. If we mean the latter, then we have to think
about more than a projected 8 percent cut in total spending. We have
to ask whether it's politically possible to control the merger
madness SB 562 will encourage, and whether it's politically feasible
to audit and otherwise hold accountable corporations as big as Kaiser
as well as the monster corporations that will gobble up every thing
in sight in order to compete with Kaiser."
Thursday, June 1, 2017
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